Using multivariate base rates of low scores to understand early cognitive declines on the uniform data set 3.0 Neuropsychological Battery.

Abstract

Objective: Low neuropsychological test scores are commonly observed even in cognitively healthy older adults. For batteries designed to assess for and track cognitive decline in older adults, documenting the multivariate base rates (MBRs) of low scores is important to differentiate expected from abnormal low score patterns. Additionally, it is important for our understanding of mild cognitive impairment and preclinical declines to and determine how such score patterns predict future clinical states. Method: The current study utilized Uniform Data Set Neuropsychological Battery 3.0 (UDS3NB) data for 5,870 English-speaking, older adult participants from the National Alzheimer's Coordinating Center from 39 Alzheimer's disease Research Centers from March 2015 to December 2018. MBRs of low scores were identified for 2,608 cognitively healthy participants that had completed all cognitive measures. The association of abnormal MBR patterns with subsequent conversion to mild cognitive impairment and dementia were explored. Results: Depending on the operationalization of "low" score, the MBR of demographically adjusted scores ranged from 1.40 to 79.2%. Posttest probabilities using MBR methods to predict dementia status at 2-year follow up ranged from .06 to .33, while posttest probabilities for conversion to mild cognitive impairment (MCI) ranged from .12-.32. Conclusions: The data confirm that abnormal cognitive test scores are common among cognitively normal older adults. Using MBR criteria may improve our understanding of MCI. They may also be used to enrich clinical trial selection processes through recruitment of at-risk individuals.

How impaired is too impaired? Exploring futile neuropsychological test patterns as a function of dementia severity and cognitive screening scores

“…However, recall measures require intact consolidation abilities, such that those who are densely amnestic will not be able to give a single scorable answer even when they can participate (Heilman & Valenstein, 2010). That being said, producing extremely low normed scores on individuals tests is relatively common (4.30–22.80%, depending on the task), conforming with a wealth of prior research on the base rates of low scores (Binder, Iverson, & Brooks, 2009; Brooks & Iverson, 2010; Brooks, Iverson, & Holdnack, 2013; Brooks, Iverson, Holdnack, & Feldman, 2008; Brooks, Iverson, & White, 2007; Holdnack et al., 2017; Kiselica, Kaser, et al., 2020; Kiselica Webber et al., 2020a).…”

“…First, the UDS3NB was designed specifically for clinical research with older adults and is relatively brief (approximately 20–40 minutes in our experience). While there are a growing number of tools to support its application in clinical samples (Devora, Beevers, Kiselica, & Benge, 2020; Kiselica, Kaser, et al., 2020; Kiselica Webber et al., 2020a; Kiselica, Kaser, et al., 2020; Kiselica Webber, & Benge, 2020b; Kiselica, Kaser, et al., 2020; Sachs et al., 2020; Weintraub et al., 2018), it is not as lengthy or extensive as other more commonly utilized batteries that can last several hours (Rabin, Paolillo, & Barr, 2016). Thus, our findings may not generalize to other batteries commonly employed in clinical practice, and they highlight the importance of tailoring testing strategies to the population of interest.…”

“…Cognitive tests utilized in the UDS3NB are described in detail in other publications (Besser et al., 2018; Weintraub et al., 2018). Our analyses utilized 12 core scores from this battery (Kiselica, Kaser, Webber, Small, & Benge, 2020; Kiselica, Kaser, et al., 2020; Kiselica Webber, & Benge, 2020a, 2020b). They included 1) three indices of language abilities – The Multilingual Naming Test (Gollan, Weissberger, Runnqvist, Montoya, & Cera, 2012; Ivanova, Salmon, & Gollan, 2013) and the two semantic fluency trials (animals and vegetables); 2) visual test scores – Benson Figure copy and recall trials (Possin, Laluz, Alcantar, Miller, & Kramer, 2011); 3) scores on measures of attention – Number Span Forwards and backwards; 4) indices assessing executive functions – Trail Making Parts A and B (Partington & Leiter, 1949) and a letter fluency test (F‐ and L‐words); and 5) memory test scores – Craft Story immediate and delayed verbatim recall scores (Craft et al., 1996).…”

Empirically defining the preclinical stages of the Alzheimer's continuum in the Alzheimer's Disease Neuroimaging Initiative

“…In clinical trials and medical settings, however, an established testing history in participants is often lacking. In such situations, researchers have taken to applying demographically adjusted normative data to ascertain whether an individual demonstrates subtly lowered scores, compared to what might be expected, given the individual's background 10–13 . Thus, although there are several available methods to index TCD with preliminary validation, further research is necessary for a consensus to be reached on how best to operationalize TCD.…”

Neuropsychological Equivalence of the Clinical Diagnosis of Mild Cognitive Impairment in the National Alzheimer’s Coordinating Center Uniform Data Set and Alzheimer’s Disease Neuroimaging Initiative

“…To better understand important clinical outcomes, such as the actual risk of conversion for those with MCI, clinical predictors of conversion, and to correct the issue of nonequivalence, researchers may need to rely on an empirical approach to diagnosing MCI that can be applied across both cohorts and ensure similarity of diagnostic groups. For example, we have previously put forth a multivariate base rate approach to diagnosing MCI in NACC that could be replicated in ADNI [26]. Alternatively, the Jak/Bondi empirical approach to diagnosing MCI in ADNI could be replicated in NACC [7,27].…”