Neuropsychological test norms controlled for physical health: Does it matter?

The objective of the present study was to investigate the effects of physical health on neuropsychological test norms. Medical and neuropsychological data from 118 healthy volunteer controls, aged 26–91 years, were collected during five recruitment occasions. The examinations included a clinical investigation, brain neuroimaging, and a comprehensive neuropsychological test battery. Test‐specific statistical regression‐weights for age, education and gender were calculated to establish preliminary test norms. Hierarchical regression analyses demonstrated that control in addition for physical health moved best performance from age 60 to 65 for abstraction; replaced a plateau above age 70 for verbal fluency, with a continued rise in performance; eliminated significant negative influences of age on auditory learning, spatial reasoning and complex copying; reduced them on wordlist recall, psychomotor speed, visual scanning and mental shifting; and slightly reduced negative influences of low education on most verbal tests, several memory tests, and psychomotor speed, indicating rises in normative scores of up to 0.8 SD at age 80 and 0.4 SD at age 60. No differences were found at age 40. Although the sample size is not adequate to be used for normative data, the findings indicate that norms uncontrolled for health overestimate the negative influence of advanced age and low education, implying a risk of drawing false diagnostic conclusions.     

Normative data on a battery of neuropsychological tests in the Han Chinese population

In order to develop normative data of a battery of neuropsychological tests in the mainland Chinese population, we examined the performance of 15 neuropsychological tests in 465 healthy subjects (231 males and 234 females) in a population‐based cohort study. The years of education were ranged between 1 and 23 years, and ages were ranged between 16 and 75 years old. The 15 neuropsychological tests cover five domains of neurocognitive functions including attention and speed of information processing, memory and learning, verbal function, visual constructive abilities, and executive function. We also assessed the effects of gender, age, educational attainment on the performance of these neuropsychological tests. The results showed that, as expected, educational attainment and age are the two main factors affecting performance in these tests. Educational attainment has the strongest predictive effect on all tests, while the majority of tests selected in this study are also affected by age at examination to varying degrees. The presented normative data will be useful for future studies in related clinical research, and be of value in transcultural neuropsychological studies.     

Level of performance accuracy for core Halstead-Reitan measures by pooling normal controls from published studies: comparison with existing norms in a clinical sample

The Halstead-Reitan Neuropsychological Test Battery offers a multifaceted, empirically supported interpretive framework for neuropsychological assessment founded upon raw scores referenced to a brain-damaged sample. Complementary approaches have used T scores from normal samples often composed of community volunteers or medical patients, augmented by regression. By pooling normal controls of all types from published studies, a sample large enough for stratification of core Halstead-Reitan measures by age and education was obtained (206 studies, N1 = 17,980). Comparisons based on T scores with two published normative systems in an outpatient sample produced a continuum: liberal norms for medical patients, intermediate pooled values from many types of subjects, and stringent norms for community volunteers. Features recommending clinical application of pooled norms include enhanced accuracy in clinical situations precluding a full battery, few empty cells or inversions for nonelderly subjects, and a screening application based upon a very large Trail Making Test sample (Trails B: n > 14,000).     

The cognitive functioning of older adult instrumental musicians and non-musicians

This study examined similarities and differences in the cognitive profiles of older adult instrumental musicians and non-musicians. We compared neuropsychological test scores among older adult non-musicians, low-activity musicians (<10 years of lessons), and high-activity musicians (≥10 years of lessons), controlling for self-reported physical and social activity, years of education, and overall health. Significant differences among groups were found on tasks of visual spatial ability, naming, and executive functioning. No significant differences were found on tests of attention/processing speed, or episodic memory. The current study supports late life cognitive benefits of early musical training, but only in select cognitive domains, including language, executive functioning, and visual spatial ability. The results are discussed in the context of cognitive reserve and aging.     

Psychometric properties and reference data for Danish versions of Free and Cued Selective Reminding Test,Category Cued Memory Test and Logical Memory

Memory assessment is a key element in neuropsychological testing. Gold standard evaluation is based on updated normative data, but in many small countries (e.g. in Scandinavia) such data are sparse. In Denmark, reference data exist for non‐verbal memory tests and list‐learning tests but there is no normative data for memory tests which capture narrative recall and cued recall. In a nation‐wide study, Free and Cued Selective Reminding Test (FCSRT ), WMS ‐III Logical Memory (LM ) and a newly developed test Category Cued Memory Test (CCMT ‐48) were applied in 131 cognitively intact persons (aged 60–96 years). Regression‐based reference data for Danish versions of FCSRT , CCMT ‐48 and LM adjusted for age, education and gender are provided. Gender and age‐group had a significant impact on the expected scores, whereas the effect of education had a limited effect on expected scores. Test performances were significantly correlated in the range 0.21–0.51. Based on these findings and previous results it may be relevant to assess both free recall, cued recall and recognition to tap the earliest changes associated with neurodegeneration, and this study therefore provides an important supplement to existing Danish normative data. Future studies should investigate the discriminative validity of the tests and the clinical utility of the presented reference data.     

Long-term musical training may improve different forms of visual attention ability

Many studies have suggested that structural and functional cerebral neuroplastic processes result from long-term musical training, which in turn may produce cognitive differences between musicians and non-musicians. We aimed to investigate whether intensive, long-term musical practice is associated with improvements in three different forms of visual attention ability: selective, divided and sustained attention. Musicians from symphony orchestras (n = 38) and non-musicians (n = 38), who were comparable in age, gender and education, were submitted to three neuropsychological tests, measuring reaction time and accuracy. Musicians showed better performance relative to non-musicians on four variables of the three visual attention tests, and such an advantage could not solely be explained by better sensorimotor integration. Moreover, in the group of musicians, significant correlations were observed between the age at the commencement of musical studies and reaction time in all visual attention tests. The results suggest that musicians present augmented ability in different forms of visual attention, thus illustrating the possible cognitive benefits of long-term musical training.     

Predictors of driving outcomes in advancing age

This study aimed to develop predictive models for real-life driving outcomes in older drivers. Demographics, driving history, on-road driving errors, and performance on visual, motor, and neuropsychological test scores at baseline were assessed in 100 older drivers (ages 65-89 years [72.7]). These variables were used to predict time to driving cessation, first moving violation, or crash. Using Cox proportional hazards regression models, significant individual predictors for driving cessation were greater age and poorer scores on Near Visual Acuity, Contrast Sensitivity, Useful Field of View, Judgment of Line Orientation, Trail Making Test-Part A, Benton Visual Retention Test, Grooved Pegboard, and a composite index of overall cognitive ability. Greater weekly mileage, higher education, and "serious" on-road errors predicted moving violations. Poorer scores from Trail Making Test-Part B or Trail Making Test (B-A) and serious on-road errors predicted crashes. Multivariate models using "off-road" predictors revealed (a) age and Contrast Sensitivity as best predictors for driving cessation; (b) education, weekly mileage, and Auditory Verbal Learning Task-Recall for moving violations; and (c) education, number of crashes over the past year, Auditory Verbal Learning Task-Recall, and Trail Making Test (B-A) for crashes. Diminished visual, motor, and cognitive abilities in older drivers can be easily and noninvasively monitored with standardized off-road tests, and performances on these measures predict involvement in motor vehicle crashes and driving cessation, even in the absence of a neurological disorder. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Time of day affects episodic memory in older adults

The neuropsychological test scores of 2030 cognitively normal older adults were examined to evaluate performance patterns as they related to time of day (TOD) at which testing was initiated. Multiple regression analyses were used to examine the association of TOD with scores on seven neuropsychological tests used in the clinical evaluation of dementia. Episodic memory performance was significantly related to TOD, while memory span and verbal fluency were not. Best performance occurred during early morning hours and late afternoon; worst performance occurred mid-day (i.e., noon). These findings may have implications for clinical assessment, the design of research on dementia, and the daily functioning of older adults.     

Time of Day Affects Episodic Memory in Older Adults*

ABSTRACT

The neuropsychological test scores of 2,030 cognitively normal older adults were examined to evaluate performance patterns as they related to time of day (TOD) at which testing was initiated. Multiple regression analyses were used to examine the association of TOD with scores on seven neuropsychological tests used in the clinical evaluation of dementia. Episodic memory performance was significantly related to TOD, while memory span and verbal fluency were not. Best performance occurred during early morning hours and late afternoon; worst performance occurred mid-day (i.e., noon). These findings may have implications for clinical assessment, the design of research on dementia, and the daily functioning of older adults.     

Measuring attention in very old adults using the Test of Everyday Attention

There is a need for validated measures of attention for use in longitudinal studies of older populations. We studied 249 participants aged 80 to 101 years using the population-based MOBILIZE Boston Study. Four subscales of the Test of Everyday Attention (TEA) were included, measuring attention switching, selective, sustained and divided attention and a neuropsychological battery including validated measures of multiple cognitive domains measuring attention, executive function and memory. The TEA previously has not been validated in persons aged 80 and older. Among participants who completed the TEA, scores on other attentional measures strongly with TEA domains (R=.60-.70). Proportions of participants with incomplete TEA subscales ranged from 8% (selective attention) to 19% (attentional switching). Reasons for not completing TEA tests included failure to comprehend test instructions despite repetition and practice. These results demonstrate the challenges and potential value of the Test of Everyday Attention in studies of very old populations.     

Exploring interhemispheric collaboration in older compared to younger adults

Physical and Name Identity letter-matching tasks were used to explore differences in interhemispheric collaboration in younger and older adults. To determine whether other factors might also be related to across/within-hemisphere processing or visual field asymmetries, neuropsychological tests measuring frontal/executive functioning were administered, and comparisons were made for participants split into low and high efficiency groups based on performance on the letter-matching tasks. A Task by Across/Within interaction was found for both groups, but with a stronger within-hemisphere advantage for the Physical Task and a weaker across-hemisphere advantage for the Name Task for older participants. More efficient groups and better performers on several neuropsychological tasks showed a reduced across-hemisphere advantage for the Name Identity task. Findings suggest that computational complexity, specific task demands, and perhaps trade-offs between age-related changes in gray and white matter all contribute to whether processing loads are distributed across or within hemispheres as we age.     

Visual and auditory selective attention and reflection-impulsivity in normal and learning-disabled boys at two age levels

Selective attention to visual and auditory stimuli and reflection-impulsivity were studied in normal and learning-disabled 8- and 12-year-old boys. Multivariate analyses, followed by univariate and paired-comparison tests, indicated that the normal children increased in selective attention efficiency with age to both visual and auditory stimuli. Learning-disabled children increased in selective attention efficiency with age to auditory, but not to visual, stimuli. Both groups increased with age in reflection as measured by Kagan's Matching Familiar Figures Test (MFF). The 8-year-old learning-disabled children were more impulsive than the 8-year-old normals on MFF error scores, but not on MFF latency scores. No difference occurred between the 12-year-old learning-disabled and normal children on either MFF error or MFF latency scores. Correlations between the selective attention scores and MFF error and latency scores were not significant.This research was supported in part by BEH grant G007507227. The authors are indebted to Eleanor McCandless for her assistance in securing the learning-disabled subjects and to James McLeskey and Michael Popkin for their assistance in collecting and analyzing data.     

Driving manoeuvre during lane maintenance in older adults: Associations with neuropsychological scores

Older drivers experience difficulties in lane maintenance under challenging driving sections due to age-related cognitive declines, yet there is little comprehensive evidence on associations between cognitive functions and the lane maintenance in this population. In this study, fifty older drivers completed an on-road driving assessment and a battery of standard neuropsychological tests. Mean Lane Position (MLP), Standard Deviation of Lane Position (SDLP) and manoeuvre time calculated from precise vehicle movement trajectories were used as the lane maintenance parameters. The GNSS tracking vehicle movement presents comprehensive and reliable vehicle position data, which is more sensitive for detecting subtle variations of lane maintenance in older drivers. Statistical analysis results showed that lower visual attention (selective and divided attention) was associated with higher MLP and SDLP; MLP was also correlated to spatial abilities, executive function, and motor speed; manoeuvre time was negatively correlated with drivers’ risk-taking personality (all p < .01). Selective attention was found to be the best predictor of MLP in lane maintenance. A combined eight variables from three neuropsychological tests, UFOV 2 and 3, BD and BJLO, D-KEFS TMT 1, 2, 3, and 4, correctly classified 80.4% of participants with good versus low-performing lane maintenance.     

Fitness to drive following cerebral pathology: The Rookwood Driving Battery as a tool for predicting on‐road driving performance

The use of neuropsychological testing to determine fitness to drive in people with neuropathology is likely to be an increasingly attractive alternative to on‐road testing for many candidates for assessment. The Rookwood Driving Battery has been shown to have good predictive value for determining some who are likely to fail an on‐road test in early studies. This study replicated earlier research by examining the predictive value and theoretical validity of the battery on a larger sample of 391 participants, as well as extending earlier analysis by examining the effect of older age (over 70 years) and the interaction between age and pathology on battery and on‐road performance. The battery demonstrated good positive and negative predictive values for predicting on‐road performance. There were significant effects of older age on both the Rookwood Battery performance and the on‐road test, with older adults performing significantly poorer on both. There was no interaction between age and pathology on the Rookwood Battery but on‐road age interacted with some pathologies to produce significantly poorer performances. Furthermore, correlation and regression analysis indicate that the battery is a powerful instrument that encompasses tests of core neuropsychological functions needed for driving.     

Norms for the Beck Depression Inventory (BDI-II) in a Large Dutch Community Sample

The Beck Depression Inventory (BDI-II) is a widely used instrument that provides information about the presence and severity of depressive symptoms. Although the BDI-II is a psychometrically sound instrument, relatively little is known about norm scores. This study aimed to develop reliable norms for the BDI-II in a Dutch community sample. Gender, age, and education were hypothesized to predict BDI-II scores. A total of 7,500 respondents from a community sample in The Netherlands completed the BDI-II. It was investigated by means of multiple regression analysis whether distinct norms for genders, education levels, and age group are appropriate. BDI-II scores depended on gender and education level, but not on age. BDI-II norms were computed based on the final regression model. These BDI-II norms can be used for diagnostic purposes, clinical decision making, or the evaluation of treatment effects.     

Age- and education-adjusted normative data for the Montreal Cognitive Assessment (MoCA) in older adults age 70–99

The original validation study for the Montreal Cognitive Assessment (MoCA) suggests a cutoff score of 26; however, this may be too stringent for older adults, particularly for those with less education. Given the rapidly increasing number of older adults and associated risk of dementia, this study aims to provide appropriate age- and education-adjusted norms for the MoCA. Data from 205 participants in an ongoing longevity study were used to derive normative data. Individuals were grouped based on age (70–79, 80–89, 90–99) and education level (≤12 Years, 13–15, ≥16 Years). There were significant differences between age and education groups with younger and more educated participants outperforming their counterparts. Forty-six percent of our sample scored below the suggested cutoff of 26. These normative data may provide a more accurate representation of MoCA performance in older adults for specific age and education stratifications.     

Diminished effect of age and education on neuropsychological test performances of older children with learning disabilities

Previous research has shown that age and education have a significant effect on neuropsychological test scores among normals, but that these effects are sharply diminished, or perhaps totally obliterated, among adults with brain damage and children with brain damage. These findings would have their major practical clinical significance in limiting the use of age and/or education adjustments of raw scores for subjects with brain damage, especially if the adjustments were based on data derived from the study of normal subjects. The present investigation studied the effects of age and education on the Neuropsychological Deficit Scale (NDS) for Older Children scores of children with learning disabilities, aged 9 through 14 years. No significant effects among age and education variables and NDS scores were found. In fact, younger and older subgroups as well as lower- and higher-educated subgroups earned mean NDS scores that were not significantly different. It appears that the neuropsychological consequences of learning disabilities override the effects of age and education in the 9- through 14-year age range.     

Development of time sensitivity: Duration ratios in time bisection

This study investigated the development of children's abilities to discriminate durations as a function of their ratio and examined whether the ability to discriminate durations that differed by a very difficult ratio is related to the development of attention capacities. Children aged 5 and 8 years, as well as adults, performed a series of temporal bisection tasks with a ratio between the short and the long anchor duration that was changed to control the difficulty of the task (5:6, 2:3, and 1:2) in two duration ranges (<1 s and >3 s). In addition, they completed neuropsychological tests in order to assess their short-term memory, working memory, and visual attention abilities. The results showed that, at ratios of 2:3 and 1:2, most participants were able to discriminate the anchor durations in bisection. However, their sensitivity to time improved, whatever the duration range, both as the distance between the anchor durations increased and with increasing age. For the smallest duration ratio (5:6), few of the children were able to discriminate the anchor durations in the bisection task in comparison to adults. Hierarchical regression analyses performed on the neuropsychological tests revealed that, for the 2:3 ratio between anchor durations, the participants' visual attention scores explained a large part of the variance in time sensitivity. The children's lower temporal sensitivity was probably due to their limited visual attention abilities, thus explaining the difficulty they experienced in discriminating very close durations (5:6).     

Assessment of perception of morphed facial expressions using the Emotion Recognition Task: Normative data from healthy participants aged 8–75

The ability to recognize and label emotional facial expressions is an important aspect of social cognition. However, existing paradigms to examine this ability present only static facial expressions, suffer from ceiling effects or have limited or no norms. A computerized test, the Emotion Recognition Task (ERT), was developed to overcome these difficulties. In this study, we examined the effects of age, sex, and intellectual ability on emotion perception using the ERT. In this test, emotional facial expressions are presented as morphs gradually expressing one of the six basic emotions from neutral to four levels of intensity (40%, 60%, 80%, and 100%). The task was administered in 373 healthy participants aged 8–75. In children aged 8–17, only small developmental effects were found for the emotions anger and happiness, in contrast to adults who showed age‐related decline on anger, fear, happiness, and sadness. Sex differences were present predominantly in the adult participants. IQ only minimally affected the perception of disgust in the children, while years of education were correlated with all emotions but surprise and disgust in the adult participants. A regression‐based approach was adopted to present age‐ and education‐ or IQ‐adjusted normative data for use in clinical practice. Previous studies using the ERT have demonstrated selective impairments on specific emotions in a variety of psychiatric, neurologic, or neurodegenerative patient groups, making the ERT a valuable addition to existing paradigms for the assessment of emotion perception.