Multigroup Confirmatory Factor Analysis of the Cognitive Dysfunction Questionnaire: Instrument refinement and measurement invariance across age and sex

Vestergren, P., Rönnlund, M., Nyberg, L. & Nilsson, L.‐G. (2012). Multigroup confirmatory factor analysis of the Cognitive Dysfunction Questionnaire: Instrument refinement and measurement invariance across age and sex. Scandinavian Journal of Psychology 53, 390–400. The study adopted Confirmatory Factor Analysis (CFA) to investigate the factorial structure and reduce the number of items of the Cognitive Dysfunction Questionnaire (CDQ). The analyses were based on data for a total of 1,115 participants from population based samples (mean age: 63.0 ± 14.5 years, range: 25–95) randomly split into a refinement (N = 569) and a cross‐validation (N = 546) sample. Equivalence of the measurement and structural portions of the refined model was demonstrated across the refinement and cross‐validation samples. Among competing models the best fitting and parsimonious model had a hierarchical factor structure with five first‐order and one second‐order general factor. For the final version of the CDQ, 20 items within five domains were selected (Procedural actions, Semantic word knowledge, Face recognition, Temporal orientation, and Spatial navigation). Internal consistency reliabilities were adequate for the total scale and for the subscales. Multigroup CFAs indicated measurement invariance across age and sex up to the scalar level. Finally, higher levels of cognitive dysfunction as reflected by CDQ scores were predicted by advancing age, fewer years of education, and with deficits in general cognitive functioning as reflected by scores on the Mini‐Mental State Examination. In conclusion, the CDQ appears to be psychometrically sound and shows the expected relationships with variables known to be associated with cognitive dysfunction and dementia. Future studies should apply it among clinical groups to further test its usefulness.     

Gender differences in episodic memory

The relationship between gender and memory has been largely neglected by research, despite occasional studies reporting gender differences in episodic memory performance. The present study examined potential gender differences in episodic memory, semantic memory, primary memory, and priming. Five hundred thirty women and 470 men, randomly sampled from the city of Umeå, Sweden, 35–80 years of age, participated in the study. There were no differences between men and women with regard to age or education, or on a measure of global intellectual functioning. As has been demonstrated previously, men outperformed women on a visuospatial task and women outperformed men on tests of verbal fluency. In addition, the results demonstrated that women consistently performed at a higher level than did men on the episodic memory tasks, although there were no differences between men and women on the tasks assessing semantic memory, primary memory, or priming. The women’s higher level of performance on the episodic memory tasks could not be fully explained by their higher verbal ability.     

Prediction of outcome in the behavioural treatment of panic disorder with agoraphobia

Outcome was predicted from pre-treatment characteristics for 62 patients with a primary diagnosis of panic disorder with agoraphobia of moderate to severe magnitude who were treated with 16 sessions of behavioural therapy. Two approaches to the task of prediction was compared: (i) predicting class membership as clinically significantly improved at post-test and at 1-year follow-up on a composite score; and (ii) predicting individual change from the same variable. Agoraphobic severity was found to be a significant predictor of clinically significant improvement at both post-treatment and follow-up. It was also found to be a significant predictor of change at post-treatment, but not at follow-up. Instead the duration of the disorder was found to be a significant predictor of change at follow-up. Perceived treatment credibility, motivation, anxious cluster personality disorder or trait anxiety were not identified as significant predictors of outcome.     

The role of integration in recognition failure and action memory

In three experiments, we studied memory for action events with respect to exceptions from the Tulving-Wiseman function demonstrated in experiments on recognition failure of recallable words. In Experiment 1, we examined exceptions of poor integration in a regular recognition failure condition (i.e., recognition of targets without contextual cues, followed by recall of targets in the presence of contextual cues). In Experiment 2, we examined exceptions of cue overlap in which subjects also had access to the information of contextual cues at recognition test. In Experiment 3, we attempted to equate the levels of recognition across the action and verbal encoding. In addition, the cue overlap and no-cue overlap conditions were studied in a within-subjects design. Results from the three experiments indicated that encoding enactment (episodic integration) and conceptual integration (semantic integration) are related to each other. As a consequence of this relationship, there is a larger independence between recognition and recall of well-integrated items with encoding enactment. On the other hand, for the poorly integrated items without encoding enactment, there is a larger dependence between recognition and recall. Even in the cue overlap condition, where there is a case of large dependence between recognition and recall, the same pattern of data was observed. The results are discussed in terms of an episodic integration view of encoding enactment.     

The effects of marital status on episodic and semantic memory in healthy middle-aged and old individuals

The present study examined the influences of marital status on different episodic and semantic memory tasks. A total of 1882 adult men and women participated in a longitudinal project (Betula) on memory, health and aging. The participants were grouped into two age cohorts, 35-60 and 65-85, and studied over a period of 5 years. Episodic memory tasks concerned recognition and recall, whereas semantic memory tasks concerned knowledge and fluency. The results showed, after controlling for education, some diseases, chronological age and leisure activity as covariates, that there were significant differences between married and single individuals in episodic memory, but not in semantic memory. Married people showed significantly better memory performances than singles in both subsystems of episodic memory, that is, recall and recognition. Also, the rate of decline in episodic memory was significantly larger for singles and widowed than other groups over the 5-year time period in both age groups. The findings demonstrate that the positive relation found between marriage and health can be extended to the relation between marriage and cognitive performance. This effect might be explained by the role played by cognitive stimulation in memory and cognition.     

The effects of cognitive behavior therapy delivered by students in a psychologist training program: an effectiveness study

Relatively little is known about the efficacy of clinically inexperienced student therapists carrying out cognitive behavior therapy (CBT) under supervision during a professional, psychologist training program. The current study evaluated this by collecting pre- and posttreatment data on 591 consecutive patients receiving treatment at the Psychotherapy Clinic of the Department of Psychology, Stockholm University, Sweden, over an 8-year period. The patients had mainly anxiety disorders or depression with a mean duration of 15 years, and received individual CBT for a mean of 18 sessions. They improved significantly on both general measures (Beck Anxiety Inventory [BAI], Beck Depression Inventory [BDI], and Quality of Life Inventory [QOLI]) and disorder-specific self-report scales. The proportions of recovered patients on the BAI (63%) and the BDI (60%) were higher than those of a comparison effectiveness study. On the specific self-report scales the current sample improved as much as the samples in extant efficacy trials. We conclude that clinically inexperienced student therapists who receive supervision from experienced supervisors can achieve treatment effects that are on a par with those of experienced licensed psychotherapists.     

Musculoskeletal pain complaints and performance on cognitive tasks over the adult life span

The present study aimed at comparing participants with and without self reported musculoskeletal pain in a normal population with regard to performance on a range of tests for episodic memory, semantic memory, and other cognitive functions and to see if expected differences interacted with age. The results showed that participants with pain performed worse on a range of tasks as compared to participants without pain, and that these differences occurred regardless of age. The most robust effects of pain were displayed on tests for vocabulary and construction ability as these were the only effects that remained significant after controlling for years of education and reported depression in separate analyses. When depression and education were controlled for in the same analysis, even these effects were eliminated, suggesting interplay between pain, depressive status, and educational level in the negative effects on cognitive functioning.     

New evidence on the nature of the encoding of action events

Differences in recall patterns between subject-performed tasks (SPTs) and verbal materials have been interpreted in terms of SPTs being nonstrategic or automatically encoded. In a series of three experiments, we tested this notion by comparing free recall of SPTs and sentences in conditions of'(1) nondivided versus divided attention for organizable items, (2) organizable versus nonorganizable items, and (3) nondivided versus divided attention for nonorganizable items. It was found that recall of both SPTs and sentences decreased in conditions of divided attention. A decrease in recall was also observed for both types of material when nonorganizable as compared to organizable materials were used. In addition, the degree of clustering was higher for SPTs than for sentences. These data suggest that there is a strategic component involved in the encoding of SPTs. We propose that the action elements of SPTs (e.g., motor features, shape, texture) are automatically encoded, whereas the verbal component is strategically encoded. It is emphasized that organization is an encoding strategy critical to SPT recall.     

Fading—A new technique in the treatment of phobias

Phobias have been subject to more research by behavior therapists than any other psychiatric disorder. In 1975 Marks described more than 20 different techniques that have been developed for or used in the treatment of phobias.The technique to be described in this paper—fading—was first used by Barlow and Agras (1973) as an alternative to aversive techniques for homosexuals. Originally the technique was designed to change the stimulus control of sexual responsiveness by introducing or “fading in” heterosexual stimuli during periods of sexual arousal elicted by homosexual stimuli.One purpose of the single-case studies presented here was to explore the possibility of achieving a similar result with phobic clients. In other words, the aim was to create a state of calmness and positive sensations in the client and then to gradually “fade in” phobic stimuli. The hypothesis was that the stimulus control of anxiety exerted by the phobic stimuli would decrease and finally be extinguished due to the antagonistic effects of observing and imagining positive scenes.A second purpose of this application of fading was to develop a technique for reducing phobic anxiety which could give more control to the client than is the case in, for example, systematic desensitization.     

Natural teeth and cognitive function in humans

A number of neurobiological, psychological and social factors may account for cognitive impairment. In animal studies a relation between dental status and cognitive performance has been found. It is unclear whether such a relation exists for humans. In a first step we compared the performance of 1,351 participants (53% women, 47% men; age M = 54.0) with natural teeth to 487 edentulous participants (59% women, 41% men; age M = 71.3) on 12 cognitive tests. The natural teeth group had a lower mean age, fewer women, more years of education, higher mini-mental state (MMSE), and performed significantly higher on several cognitive tests. In a subsequent analysis, the cognitive performance of a subset of the participants (50-85 years) was examined. In this analysis, 211 had natural dentition and 188 were edentulous. The groups were matched for gender, age, social variables, diseases, stress and MMSE. The cognitive disadvantage of the edentulous group was still apparent. The results suggest that functional natural teeth relate to relatively preserved cognitive functioning in older age.