Brian P. Yochim

D-KEFS Trail Making Test performance in patients with lateral prefrontal cortex lesions

This study evaluated cognitive set-shifting in 12 patients with focal lesions in the lateral prefrontal cortex (LPC) by examining their performance on the Trail Making Test from the Delis-Kaplan Executive Function System (D-KEFS). Patients with LPC lesions performed significantly worse than controls on the D-KEFS Trail Making Test on the Letter Sequencing, Number-Letter Switching (set-shifting), and Motor Speed conditions. Patients with LPC lesions performed significantly more slowly on the Number-Letter Switching condition even after controlling for performance on the four baseline conditions of the test. In addition, patients with LPC lesions exhibited significantly elevated error rates on the Number-Letter Switching condition. Results suggest that LPC lesions can lead to impaired cognitive set-shifting on a visual-motor sequencing task.

Prevalence of cognitive impairment, depression, and anxiety symptoms among older adults with glaucoma.

PurposeTwo factors which may disrupt the ability to adhere to the treatment for glaucoma are cognitive impairment and mental health complications. Poor adherence to treatment may lead to preventable vision loss. Past research in this area has been limited by little focus on older patients with glaucoma, and the use of brief measures of cognition that may not detect subtle deficits related to Alzheimer disease. Patients and MethodsThis study examined the prevalence of cognitive impairment, depression, and anxiety in a sample of 41 glaucoma patients at a tertiary care glaucoma clinic. They had a mean age of 70.0 years (SD=9.2 y; range: 51 to 86 y) and 70% (n=30) were female. Two cognitive measures commonly used in detecting dementia were used to measure cognitive functioning. ResultsControlling for age, memory impairment was found in approximately 20% of the sample, and impaired executive functioning was found in approximately 22% of the sample. Forty-four percent of the sample scored in the impaired range on one or more measures. Mild-to-moderate depressive symptoms were found in 12.2% of participants, and 1 person reported clinically significant anxiety. ConclusionsThe results from this study indicate that cognitive impairment may be common in older patients with glaucoma. This has implications for treatment adherence, as difficulties in remembering information may significantly impede the ability to follow instructions from a physician. It is imperative that physicians and caregivers are aware of the prevalence of such conditions, as they are among the first to interact with such individuals. Given the high prevalence of cognitive impairment and depressive symptoms, future research should examine the impact of such factors on glaucoma treatment adherence.

Late life anxiety is associated with decreased memory and executive functioning in community dwelling older adults.

This study assessed the degree to which anxiety and depression symptoms are associated with memory and executive functioning among community-dwelling older adults (N=120; M age=74.9 years, SD=7.2 years; 62% women). Participants completed the Geriatric Anxiety Scale, Geriatric Depression Scale, Comorbidity Index, California Verbal Learning Test, Second Edition (CVLT-II), and the Trail Making, Verbal Fluency, and 20 Questions subtests of the Delis-Kaplan Executive Function System (D-KEFS). Multiple regression analyses indicated that anxiety and depression predicted poorer ability to learn new information (CVLT-II, Trials 1-5). Both anxiety and depression predicted performance on the D-KEFS Trail Making test, Number-Letter Switching condition. Anxiety, but not depression, predicted decreased categorization as measured by the D-KEFS 20 Questions, Initial Abstraction Score. Depression but not anxiety, predicted performance on D-KEFS Letter Fluency and Category Fluency. Findings suggest that anxiety and depression have unique relationships with cognitive functioning in community-dwelling older adults.

Development and initial validation of a self-report assessment tool for anxiety among older adults: The Geriatric Anxiety Scale

Anxiety is a common experience among older adults and can be a cause for major clinical concern. Brief and psychometrically sound screening instruments are needed to detect anxiety in later life. The purposes of this study were to develop a brief, self-report measure of anxiety for use with older adults (called the Geriatric Anxiety Scale [GAS]) and to report on its preliminary psychometrics. The GAS includes 30 self-report items of which 25 items represent three common domains of anxiety symptoms among older adults (cognitive, somatic, and affective) and 5 items represent common content areas of worry. The GAS total score and subscale scores demonstrated good internal reliability in community dwelling and in clinical samples. In addition, correlation analyses provided solid evidence of convergent and construct validity for the GAS in both samples. Present results support the preliminary validity of the GAS for clinical and research purposes. We conclude with a discussion of limitations and future research topics.

D-KEFS Tower Test performance in patients with lateral prefrontal cortex lesions: The importance of error monitoring

This study investigated performance on the Delis–Kaplan Executive Function System (D-KEFS) Tower Test in a sample of 12 patients with focal lesions in the lateral prefrontal cortex (PFC) and 12 control participants. PFC patients performed worse overall, spent more time on each move, and committed significantly more rule violations. The rule violation measure demonstrated 83% sensitivity and 100% specificity in the detection of lesions. Findings highlight the importance of error monitoring in the assessment of executive functioning. These preliminary results suggest that the lateral PFC may be critical for self-monitoring/inhibition and speed of processing in planning tasks.

Measuring anxiety in late life: A psychometric examination of the Geriatric Anxiety Inventory and Geriatric Anxiety Scale

We examined the psychometric properties, internal scale reliability and validity, of two geriatric anxiety measures: the Geriatric Anxiety Inventory (GAI) and Geriatric Anxiety Scale (GAS). We also determined the extent to which memory ability influenced the psychometric properties of these measures. Older adult participants (N=110; M age=75 years) completed self-report, clinician-rated and diagnostic psychiatric measures and a neuropsychiatric battery. GAI and GAS scores had good internal consistency, adequate reliability, and strong convergent validity. GAI scores had better discriminant validity than GAS scores relative to a health rating. Both measures had strong associations with depression scores. Psychometric properties were decreased in participants with average delayed memory recall compared with those with superior recall. Both measures had good psychometric support, particularly in those with strong memory abilities. Psychometric performance characteristics indicate that the GAI and GAS may be good alternatives to anxiety measures not designed specifically for older adults.

Psychometric Properties of the Geriatric Anxiety Scale: Comparison to the Beck Anxiety Inventory and Geriatric Anxiety Inventory

This study explored the convergent and discriminant validity of the Geriatric Anxiety Scale (GAS), a new measure of anxiety symptoms for older adults. The GAS, Beck Anxiety Inventory (BAI), Geriatric Anxiety Inventory (GAI), Beck Depression Inventory, Second Edition (BDI-II), and Geriatric Depression Scale (GDS) were administered to 117 community-dwelling, predominantly White, older adults (62% female; M age = 74.75 years, range = 60 − 89 years; M years of education = 14.97). Scores on the GAS were strongly associated with scores on measures of anxiety and depression, but not associated with scores on measures of reading ability or processing speed. The GAS possesses strong convergent and discriminant validity and shows promise as a measure of anxiety in older adults.

“Vascular Depression” Predicts Verbal Fluency in Older Adults

Past research has found links among cerebrovascular risk factors (CVRFs), depression, and cognition in older adults. This study investigated how well baseline cerebrovascular burden and depression predicted verbal fluency three and six months later. Participants were 139 medical rehabilitation patients, age 60 and above. The Geriatric Depression Scale, Charlson Co-Morbidity Index, and Dementia Rating Scale were administered at baseline, and verbal fluency was measured three and six months later. Structural equation modeling found that depression significantly predicted verbal fluency at both time points, independently of demographic variables, baseline cognition, or medical burden. CVRFs correlated with depressive symptoms but did not independently predict verbal fluency. Findings suggest that vascular depression may be a possible signal of impaired brain integrity, consistent with Alexopoulos and colleagues (2000) conceptual framework.

Depressive Symptoms and Cognitive Impairment Predict All-Cause Mortality in Long-Term Care Residents

This study investigated whether symptoms of depression and cognitive dysfunction predicted all-cause mortality in long-term care (LTC) residents at 12 months after admission. Participants were 171 adults with a mean age of 77 in an urban LTC setting (51% African American and 49% European American). The Geriatric Depression Scale and the Dementia Rating Scale, Second Edition (DRS-2), were administered upon admission, and demographic variables and the Charlson Comorbidity Index were also recorded. Cox regression analyses found that increased depressive symptoms, lower performance on the DRS-2, and European American ethnicity were significant predictors of all-cause mortality. The overall results suggest that the combination of cognitive dysfunction and depressive symptoms can increase the chances of 12-month, all-cause mortality in LTC settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Naming Test of the Neuropsychological Assessment Battery: Convergent and Discriminant Validity

This study investigated the convergent and discriminant validity of the naming subtest of the Neuropsychological Assessment Battery (NAB), a measure of word-finding. Seventy community-dwelling adults age 60 and above completed the NAB naming test (Forms 1 and 2), the Boston Naming Test (BNT), and other measures of verbal and visual memory, visuoperceptual skills, processing speed, and abstraction. The NAB naming test correlated highly with the BNT and with established measures of memory. The BNT correlated more strongly with education and with sex. The BNT correlated more strongly with a measure of visuoperceptual skills than the NAB naming test did, suggesting that visuoperception is more involved in the BNT. Divergent validity of the NAB naming was demonstrated by a lack of correlations with less-related measures. Findings suggest that the NAB naming test possesses convergent and divergent validity as a measure of word-finding.