Matthew Calamia

Association between olfaction and higher cortical functions in Alzheimer's disease, mild cognitive impairment, and healthy older adults.

ABSTRACT Introduction: Neural regions important for smell are proximal and closely connected to cortical areas that have been strongly implicated in higher order functions of value-based decision making and emotional memory. The integrity of these neural regions are affected in aging and neurodegenerative conditions. Two specific predictions follow from these neuroanatomical arrangements—namely, that olfaction would be associated with value-based decision making and with emotional memory. Method: To test these predictions, we measured these different capacities in participants with presumed varying degrees of integrity of the relevant brain structures: specifically, 13 patients with Alzheimer’s disease, 8 patients with mild cognitive impairment, and 20 healthy older adults. The participants completed detailed tests of olfaction, value-based decision making, emotional memory, and general cognitive ability. Results: Olfactory functioning was significantly associated with emotional and nonemotional memory. The association was especially strong and consistent for memory recall with olfaction, explaining as much as 10% additional variance over and above general cognition. Olfactory functioning was not strongly or consistently associated with decision making over and above general cognition. Conclusion: Olfaction is a strong predictor of memory recall. These findings may contribute to a better understanding of olfaction and specific cognitive domains known to be affected by aging and implicated in neurodegenerative disease.

Characteristics of a Mild Traumatic Brain Injury Sample Recruited Using Amazon’s Mechanical Turk

Several barriers exist in the recruitment of individuals with a history of mild traumatic brain injury (mTBI). The current study is the first to examine whether crowdsourcing, which has been used in other clinical populations, is useful in the recruitment of those with mTBI.

I'd Do Anything for Research, But I Won't Do That: Interest in Pharmacological Interventions in Older Adults Enrolled in a Longitudinal Aging Study

Alzheimer’s disease (AD) ranks as the 6th leading cause of death in the United States, yet unlike other diseases in this category, there are no disease-modifying medications for AD. Currently there is significant interest in exploring the benefits of pharmacological treatment before the onset of dementia (e.g., in those with mild cognitive impairment); however, recruitment for such studies is challenging. The current study examined interest in pharmacological intervention trials relative to other types of clinical interventions. A total of 67 non-demented older adults enrolled in a longitudinal cognitive aging study completed a questionnaire assessing interest in participating in a variety of hypothetical research study designs. Consistent with past research, results showed that the opportunities for participants to advance science, receive feedback about their current health, and help themselves or others, were associated with increased interest in clinical trial participation. Some factors were not associated with change in interest (e.g., a doctor not recommending participation) while others were associated with decreased interest (e.g., having to come in for multiple visits each week). Relative to other types of interventions, pharmacological intervention trials were associated with the least interest in participation, despite pharmacological interventions being rated as more likely to result in AD treatment. Decreased interest was not predicted by subjective memory concerns, number of current medications, cardiovascular risk, or beliefs about the likely success of pharmacological treatments. These results highlight the challenges faced by researchers investigating pharmacological treatments in non-demented older individuals, and suggest future research could contribute to more effective ways of recruiting participants in AD-related clinical trials.

Comparison of self-reported and informant-reported depressive symptoms in an outpatient neuropsychology clinic sample

ABSTRACT Introduction: Depressive symptoms are common in patients assessed by neuropsychologists, and these symptoms can have an effect on cognitive functioning. Discrepancies between patient- and informant-reported depressive symptoms have been found in some diagnostic groups, raising concerns as to the value of assessing depressive symptoms via self-report alone. This study aimed to examine the relationship between these discrepancies and cognitive functioning in a heterogeneous outpatient neuropsychological sample. Method: Sixty-two patients with a variety of diagnoses (e.g., stroke, mild cognitive impairment) completed a measure of depressive symptoms and a battery of neuropsychological tests. Informants also rated the patients’ depressive symptoms and completed a measure of the patients’ functional abilities. Results: Patient and informant reports of depressive symptoms were moderately correlated; larger differences between patient- and informant-reported symptoms were associated with poorer verbal learning and memory and greater functional impairments. Conclusions: The moderate level of agreement found for depressive symptoms is consistent with past studies using specific neuropsychological patient groups and other studies in both clinical and non-clinical populations. These results highlight the utility of collecting informant reports of depressive symptoms in neuropsychological evaluations.

Understanding heterogeneity in older adults: Latent growth curve modeling of cognitive functioning

ABSTRACT Background: Clarifying relationships between specific neurocognitive functions in cognitively intact older adults can improve our understanding of mechanisms involved in cognitive decline, which may allow identification of new opportunities for intervention and earlier detection of those at increased risk of dementia. Method: The present study employed latent growth curve modeling to longitudinally examine the relationship between executive attention/processing speed, episodic memory, language, and working memory functioning utilizing the neuropsychological test battery from the National Alzheimer’s Disease Coordinating Center. A total of 691 relatively healthy older adults (Mage = 69.07, SD = 6.49) were assessed at baseline, and 553 individuals completed three visits spanning a two-year period. Results: Better cognitive performance was concomitantly associated with better functioning across domains. Subtle declines in executive attention/processing speed processes were found, while, on average, memory and language performance improved with repeated testing. Lower executive attention/processing speed performance at baseline predicted less incremental growth rate in memory. In turn, higher initial memory functioning was associated with incremental improvements in language performance. Conclusions: These results are consistent with the notion that intact executive function and attention processes are important to preserving memory functioning with advanced age, but are also the functions most susceptible to decline with age. These findings also provide further insight into the critical role of practice effects in clinical assessment practice and have implications for pharmaceutical trials. Practice effects should be routinely considered as they may give the appearance of retention of function within the cognitive domains considered to be a hallmark of Alzheimer’s disease pathology.

What types of recommendations are we giving patients? A survey of clinical neuropsychologists

Abstract Objective: To identify types of recommendations that neuropsychologists most frequently give to patients, and determine which specific recommendations are most and least consistently given to patients across and within different diagnostic populations. Method: A total of 309 clinical neuropsychologists completed a survey evaluating the frequency with which they made particular types of recommendations (e.g. driving, employment and education, health and rehabilitation referrals) to patients with various disorders (e.g. traumatic brain injury, dementia). Results: Recommendations in some categories were common across diagnoses (e.g. recommendations related to health). Neuropsychologists reported being more likely to give patients with dementia (relative to other clinical populations) recommendations related to educational resources, supervision and independence, and driving. Patients with a TBI diagnosis were more likely to be given recommendations related to employment and education, health and rehabilitation referrals, and mental health and substance use. Patients with a psychiatric diagnosis were more likely to be given recommendations related to mental health and substance use. Irrespective of diagnosis, neuropsychologists reported being most likely to give recommendations that could be implemented by the patient or caregiver without assistance from outside sources. Neuropsychologists varied in their use of recommendations to seek evaluations and treatment from health and rehabilitation referrals and in providing recommendations related to driving. Conclusions: Recommendations provided within diagnostic groups are consistent with the etiology and prognosis of those conditions. Recommendations for the use of compensatory strategies to address cognitive deficits and recommendations to improve health were endorsed by the vast majority of neuropsychologists across diagnoses.

Factor structure and clinical correlates of the 61-item Wender Utah Rating Scale (WURS)

The objective of this study was to assess the factor structure and clinical correlates of a 61-item version of the Wender Utah Rating Scale (WURS), a self-report retrospective measure of childhood problems, experiences, and behavior used in ADHD assessment. Given the currently mostly widely used form of the WURS was derived via a criterion-keyed approach, the study aimed to use latent variable modeling of the 61-item WURS to potentially identify more and more homogeneous set of items reflecting current conceptualizations of ADHD symptoms. Exploratory structural equation modeling was used to generate factor scores which were then correlated with neuropsychological measures of intelligence and executive attention as well as a broad measure of personality and emotional functioning. Support for a modified five-factor model was found: ADHD, disruptive mood and behavior, negative affectivity, social confidence, and academic problems. The ADHD factor differed somewhat from the traditional 25-item WURS short form largely through weaker associations with several measures of personality and psychopathology. This study identified a factor more aligned with DSM-5 conceptualization of ADHD as well as measures of other types of childhood characteristics and symptoms which may prove useful for both research and clinical practice.

The association of anxiety, depression, and worry symptoms on cognitive performance in older adults

ABSTRACT Emerging research suggests that a relationship exists between the cognitive aspects of anxiety (e.g. worry) and cognitive decline in older adults. The current study examined the association between anxiety, depressive, and worry symptoms on cognitive performance. Participants were 156 older adults enrolled in the Nathan Kline Institute-Rockland Sample Study (NKI-RS). Hierarchical linear regression analysis was used to determine the unique associations of anxiety, depressive, and worry symptoms on cognitive performance as measured by the Penn Computerized Neurocognitive Battery (Penn CNB), the Delis-Kaplan Executive Function System (D-KEFS), and the Rey Auditory Verbal Learning Test (RAVLT). Worry symptoms were a significant predictor of Penn CNB social cognition, complex cognition, executive function, and episodic memory performance as well as RAVLT immediate and short-delay recall, but not of D-KEFS performance or RAVLT long-delay recall. In contrast, anxiety and depressive symptoms had few unique associations with cognitive performance. Given that worry symptoms have a negative impact on many aspects of neurocognitive performance, they may have utility in predicting and preventing cognitive decline in older adults.

Response to Shapiro and Chandler Letter to the Editor

pay close attention to discriminant validity more generally. In sum, we agree that identifying and characterizing a sample of individuals with mTBI on MTurk is an important objective because access to this group has the potential to greatly accelerate the pace of discovery in nonclinical research. Bernstein and Calamia do many things right, but it is easy for readers unfamiliar with conducting online studies to overlook details that may impact data quality. Furthermore, the rarity of mTBI leaves a narrow margin for error. It is important for researchers using MTurk to understand its limitations and to ensure that they are taking all necessary steps to address them.

Assessing the Longer-Term Effects of Mild Traumatic Brain Injury on Self-Reported Driving Ability

Mild traumatic brain injury (mTBI) can have long‐term cognitive and functional consequences, and recent mTBI has been associated with impaired performance on measures related to driving ability. However, it remains unclear whether mTBI history is associated with poorer driving performance.