Heather R. Romero

Challenges in the Neuropsychological Assessment of Ethnic Minorities: Summit Proceedings

Challenges in the Neuropsychological Assessment of Ethnic Minorities: Summit Proceedings Heather R. Romero a , Sarah K. Lageman b , Vidya (Vidyulata) Kamath c , Farzin Irani d , Anita Sim e , Paola Suarez f , Jennifer J. Manly g , Deborah K. Attix a & the Summit participants a Duke University Medical Center , Durham, NC b Emory University , Atlanta, GA c University of Central Florida , Orlando, FL d University of Pennsylvania , Philadelphia, PA e Minneapolis VA Medical Center , Columbia University Medical Center , Minneapolis, MN f HIV Neurobehavioral Research Center , Columbia University Medical Center , San Diego, CA g G. H. Sergievsky Center and Taub Institute for Research on Alzheimers Disease and the Aging Brain , Columbia University Medical Center , New York, USA Published online: 15 Jun 2009.

Effects of Education and Race on Cognitive Decline: An Integrative Study of Generalizability Versus Study-Specific Results

The objective of the study was to examine variability across multiple prospective cohort studies in level and rate of cognitive decline by race/ethnicity and years of education. We compare data across studies, we harmonized estimates of common latent factors representing overall or general cognitive performance, memory, and executive function derived from the: (a) Washington Heights, Hamilton Heights, Inwood Columbia Aging Project (N = 4,115), (b) Spanish and English Neuropsychological Assessment Scales (N = 525), (c) Duke Memory, Health, and Aging study (N = 578), and (d) Neurocognitive Outcomes of Depression in the Elderly (N = 585). We modeled cognitive change over age for cognitive outcomes by race, education, and study. We adjusted models for sex, dementia status, and study-specific characteristics. The results found that for baseline levels of overall cognitive performance, memory, and executive function, differences in race and education tended to be larger than between-study differences and consistent across studies. This pattern did not hold for rate of cognitive decline: effects of education and race/ethnicity on cognitive change were not consistently observed across studies, and when present were small, with racial/ethnic minorities and those with lower education declining at faster rates. In this diverse set of datasets, non-Hispanic Whites and those with higher education had substantially higher baseline cognitive test scores. However, differences in the rate of cognitive decline by race/ethnicity and education did not follow this pattern. This study suggests that baseline test scores and longitudinal change have different determinants, and future studies to examine similarities and differences of causes of cognitive decline in racially/ethnically and educationally diverse older groups is needed.

A comparison of neuropsychological performance between US and Russia: Preparing for a global clinical trial

Understanding regional differences in cognitive performance is important for interpretation of data from large multinational clinical trials.

Community engagement in diverse populations for Alzheimer disease prevention trials.

The recruitment of asymptomatic volunteers has been identified as a critical factor that is delaying the development and validation of preventive therapies for Alzheimer disease (AD). Typical recruitment strategies involve the use of convenience samples or soliciting participation of older adults with a family history of AD from clinics and outreach efforts. However, high-risk groups, such as ethnic/racial minorities, are traditionally less likely to be recruited for AD prevention studies, thus limiting the ability to generalize findings for a significant proportion of the aging population. A community-engagement approach was used to create a registry of 2311 research-ready, healthy adult volunteers who reflect the ethnically diverse local community. Furthermore, the registry’s actual commitment to research was examined, through demonstrated participation rates in a clinical study. The approach had varying levels of success in establishing a large, diverse pool of individuals who are interested in participating in pharmacological prevention trials and meet the criteria for primary prevention research trials designed to delay the onset of AD. Our efforts suggest that entry criteria for the clinical trials need to be carefully considered to be inclusive of African Americans, and that sustained effort is needed to engage African Americans in pharmacological prevention approaches.

Deconstructing Racial Differences: The Effects of Quality of Education and Cerebrovascular Risk Factors

OBJECTIVES To evaluate the effects of vascular conditions and education quality on cognition over time in White and African American (AA) older adults. METHOD We investigated cross-sectional and longitudinal racial differences in executive functioning (EF) and memory composites among Whites (n = 461) and AAs (n = 118) enrolled in a cohort study. We examined whether cerebrovascular risk factors and Shipley Vocabulary scores (a proxy for education quality) accounted for racial differences. RESULTS On average, AAs had lower quality of education and more cerebrovascular risk factors including hypertension, diabetes, and obesity. AAs had lower mean EF and memory at baseline, but there were no group differences in rates of decline. Cross-sectional racial differences in EF and memory persisted after controlling for vascular disease, but disappeared when controlling for Shipley Vocabulary. DISCUSSION Quality of education appears to be more important than cerebrovascular risk factors in explaining cross-sectional differences in memory and EF performance between White and AA older adults. Further investigation is needed regarding the relative contribution of education quality and cerebrovascular risk factors to cognitive decline among ethnically/racially diverse older adults.

Differential item functioning due to cognitive status does not impact depressive symptom measures in four heterogeneous samples of older adults

The objective of this study is to determine whether differential item functioning (DIF) due to cognitive status impacted three depressive symptoms measures commonly used with older adults.

Challenges in international clinical trials to delay early symptomatic Alzheimer's disease

odds ranging from 2.4 to 4.99. The pooled adjusted risk ratio was 2.91 (95% confidence interval: 1.51 5.61). Risk estimates were presented in the context of a key confounder-cerebral infarcts-which are more common in those with T2DM and might contribute to the manifestation of clinical AD. We provide evidence from clinico-neuropathologic studies that demonstrates the following: First, those with dementia at postmortem are more likely to have both AD-type and cerebrovascular pathologies. Second, cerebral infarcts are more common than AD-type pathology in those with T2DM and dementia. Finally, cerebral infarcts reduce the number of AD lesions required for the manifestation of clinical dementia, but they do not appear to interact synergistically with AD-type pathology. Conclusions: Therefore, the increased risk of clinically diagnosed AD seems to be mediated through cerebrovascular pathology.

Demographic characteristics do not decrease the utility of depressive symptoms assessments: examining the practical impact of item bias in four heterogeneous samples of older adults

Previous studies have identified differential item function (DIF) in depressive symptoms measures, but the impact of DIF has been rarely reported. Given the critical importance of depressive symptoms assessment among older adults, we examined whether DIF due to demographic characteristics resulted in salient score changes in commonly used measures.

DERIVING AN INFORMED NEUROCOGNITIVE COMPOSITE MEASURE FOR DELAY-OF-ONSET TRIALS IN MILD COGNITIVE IMPAIRMENT DUE TO ALZHEIMER'S DISEASE (MCI-AD)

P3-398 DERIVING AN INFORMED NEUROCOGNITIVE COMPOSITE MEASURE FOR DELAY-OF-ONSET TRIALS IN MILD COGNITIVE IMPAIRMENT DUE TO ALZHEIMER’S DISEASE (MCI-AD) Mark A. Espeland, Leslie Vaughan, Heather Romero, Kathleen M. Hayden, Brenda L. Plassman, Kathleen A. Welsh-Bohmer, Wake Forest School of Medicine, Winston Salem, North Carolina, United States; Wake Forest University, Winston-Salem, North Carolina, United States; Duke University Medical Center, Bryan ADRC, Durham, North Carolina, United States; Bryan ADRC, Duke University Medical Center, Durham, North Carolina, United States; Duke University, Durham, North Carolina, United States; Duke University-Bryan ADRC, Durham, North Carolina, United States. Contact e-mail: mespelan@wakehealth.edu

Preclinical cognitive phenotypes for Alzheimer's disease: A latent profile approach

linear regression models were used to evaluate associations between MoCA domains and normalized WLM, Trails B, and ADCScog scores, each in separate models adjusted for age, sex, and education. Results: The sample was mostly female (74%), Caucasian (80% Caucasian; 18% AfrAmer), and highly educated (mean 16.4, standard deviation (SD) 2.3). The average MoCA score was 26.6 (SD 2.9). The MoCA memory score was the strongest predictor of WLM (0.34, 95% CI 0.026-0.43) with a one-third standard unit increase on WLM score for every unit increase in memory score. Memory was also the strongest predictor of ADCScog score (higher scores indicate impairment) (0.18, CI 0.270.08). MoCA executive function was the strongest predictor of Trails-B, with each unit increase in executive function corresponding to almost a one third standard unit decrease on Trails B (0.29, CI 0.400.19). Conclusions: Simple MoCA subscales correspond with well-established cognitive tests (WLM, Trails-B, and ADCScog). This study helps establish the construct validity of the MoCA as a cognitive screening instrument capable of detecting key cognitive domains affected in MCI and early AD in a community sample.