Cognitive Assessment Screening Instrument Research Articles

Historic Cognitive Function Trajectories as Predictors of Sedentary Behavior and Physical Activity in Older Adults.

We examined whether trajectories of cognitive function over 10 years predict later life physical activity (PA), sedentary time (ST), and sleep. Participants were from the Adult Changes in Thought (ACT) cohort study. We included 611 ACT participants who wore accelerometers and had 3+ measures of cognition in the 10 years prior to accelerometer wear. The Cognitive Assessment Screening Instrument (CASI) measured cognition and was scored using item-response theory (IRT). activPAL and ActiGraph accelerometers worn over 7 days measured ST and PA outcomes. Self-reported time in bed and sleep quality measured sleep outcomes. Analyses used growth mixture modeling to classify CASI-IRT scores into latent groups and examine associations with PA, ST, and sleep including demographic and health covariates. Results: Participants (Mean age = 80.3 (6.5) years, 90.3% White, 57.1% female, 29.3% had less than 16 years of education) fell into 3 latent trajectory groups: average stable CASI (56.1%), high stable CASI (34.0%), and declining CASI (9.8%). The declining group had 16min less stepping time (95% CI 0.6, 31.4), 1517 fewer steps/day (95% CI 138, 2896), and 16.3min/day less moderate-to-vigorous PA (95% CI (1.3, 31.3) compared to the average stable group. There were no associations between CASI trajectory and sedentary or sleep outcomes. Declining cognition predicted lower PA providing some evidence of a reverse relationship between PA and cognition in older adults. However, this conclusion is limited by having outcomes at only one time point, a non-representative sample, self-reported sleep outcomes, and using a global cognition measure.

Effectiveness of Early Multimodal Non-pharmacological Interventions in Cognitive Preservation in the Elderly.

Multimodal non-pharmacological interventions (MNPI) have been determined as effective in delaying cognitive deterioration. The effectiveness of timing of such interventions in elderly is less discussed. We compared the different effectiveness of MNPI in cognitive preservation in elderly subjects with and without dementia. We enrolled volunteer the elderly subjects. Subjects were classified as dementia group and non-dementia group by instrument of ascertainment of dementia 8. All were assigned to attend 3 hours of MNPI (physical fitness training, Chinese capillary, and Chinese drawings and paintings) twice a week over a 16-week period. Neuropsychiatric tests, including Mini-Mental State Examination (MMSE), Cognitive Assessment Screening Instrument (CASI), clinical dementia rating (CDR), and neuropsychiatric inventory (NPI), were administered before and 1 year after MNPI. We demonstrated the changes of cognition and behavioral and psychological symptoms of dementia (BPSD) before and after MNPI. We compared the different effectiveness of cognition preservation between two groups. In total, there were 43 participants in our study, including 18 with non-dementia and 25 with dementia. The non-dementia group had a significantly higher proportion of cognitive preservation in remote memory (100.0% vs 68.0%, P = .007), orientation (94.4% vs 48.0%, P = .001), drawing (94.4% vs 64.0%, P = .021) and language (77.8% vs 48.0%, P = .049) than the dementia group. The highest proportion of preserved cognition after MNPI was remote memory (100%), followed by orientation (94.4%) and drawing (94.4%) in the non-dementia group. The highest proportion of preserved cognition after MNPI was attention (72%) followed by remote memory (68%), recent memory (64%) and drawing (64%) in the dementia group. Overall, their improved rate in behavioral and psychological symptoms was 55.6%. Our study concluded the benefits of early MNPI in cognition preservation in the elderly, especially in the field of remote memory, orientation, drawing and language.

Methods used in 'ALDH2*2 association with longevity and reduced risk of cognitive decline in Japanese-American men'

ALDH2*2 is a loss of function mutation common in East Asian populations associated with facial flushing on exposure to alcohol and increased risk of certain cancers. Conversely, absence of the ALDH2*2 mutation is associated with increased risk of hypertension and cerebral microbleeds, and two recent studies report a higher frequency of ALDH2*2 alleles in nonagenarians compared to population control samples. We used survival analysis to investigate the association between ALDH2*2 and risk of cognitive impairment and death after controlling for midlife alcohol consumption and other covariates. Participants are 621 Japanese-American men (72 to 92) enrolled in the Honolulu Asia Aging Study (HAAS) and assessed for cognitive impairment for up to 20 years. Impairment was defined as crossing below a threshold score of 74 on the Cognitive Assessment Screening Instrument (CASI). Age at death was determined by Hawaii state death certificate. Ounces of ethyl alcohol consumed per month was assessed by structured interview (number, frequency, and type of beverage) conducted 25 years prior to baseline cognitive assessment. Persons heterozygous for the ALDH2*2 variant have reduced risk of cognitive impairment and reduced risk of death, compared to homozygote non-carriers. Covarying by alcohol exposure had no effect on observed associations. This study replicates previous findings associating ALDH2*2 with longevity, and provides evidence the protective effect extends to cognition. This poster details the statistical analysis carried out to obtain these results.

Effectiveness of the 10 cm2 Rivastigmine Patch in Taiwanese Patients with Mild-to-Moderate Alzheimer's Dementia: A 48-Week Real-World Observational Study.

IntroductionThe current study aimed to provide data on the effectiveness of the 10 cm2 rivastigmine patch in patients with Alzheimer’s disease (AD) in a real-world setting in Taiwan.MethodsThis was a 48-week, single-arm, open-label, observational, and post-marketing study conducted across seven centers in Taiwan between May 5, 2016 and July 10, 2017. Eligible patients (aged 55–95 years) treated with the 10 cm2rivastigmine patch were enrolled based on physicians’ judgment and according to the Taiwan reimbursement criteria of the drug. Data were prospectively collected at Week 0 (baseline), Week 24, and Week 48. The primary endpoint was the change in the cognitive assessment screening instrument (CASI) scores at Week 48 versus baseline. The changes from baseline in clinical dementia rating (CDR), mini-mental state examination (MMSE), and neuropsychiatric inventory (NPI) scores were evaluated, as were treatment persistence and the safety profile.ResultsOf the 285 eligible patients [full analysis set (FAS)], 216 (75.8%) completed the study protocol while 180 (63.2%) persisted on the 10 cm2 rivastigmine patch for the full 48 weeks. At baseline, 89.8% of patients had a CDR score of 0.5 or 1, while the change in CDR score at Week 48 was not significant. In the FAS, both the CASI and MMSE scores had numerical improvement at Week 24 but declined by 2.1 and 0.4 points, respectively, at Week 48 (p = 0.005 and p = 0.022). The increment in NPI scores was not significant. The most common drug-related adverse events (AEs) were pruritus (11.2%), nausea (3.5%), rash (3.2%), and vomiting (2.8%).ConclusionsThe use of the 10 cm2 rivastigmine patch in the mild stage of AD maintained cognitive function at Week 24 and neuropsychiatric function at Week 48. The treatment persistency and safety profile support the clinical tolerability of the rivastigmine patch in the management of mild-to-moderate AD in Taiwan.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-021-01893-6.

Cognitive Impairment after Lacunar Stroke and the Risk of Recurrent Stroke and Death

Introduction: Patients with poststroke cognitive impairment appear to be at higher risk of recurrent stroke and death. However, whether cognitive impairment after lacunar stroke is associated with recurrent stroke and death remains unclear. We assessed whether global or domain-specific cognitive impairment after lacunar stroke is associated with recurrent stroke and death. Methods: We considered patients from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial with a baseline cognitive exam administered in English by certified SPS3 personnel, 14–180 days after qualifying lacunar stroke. We considered a baseline score of ≤86 on the Cognitive Assessment Screening Instrument to indicate global cognitive impairment, <10 on the Clock Drawing on Command test to indicate executive function impairment, and domain-specific summary scores in the lowest quartile to indicate memory and nonmemory impairment. We used Cox proportional hazards models to estimate the association between poststroke cognitive impairment and subsequent risk of recurrent stroke and death. Results: The study included 1,528 participants with a median enrollment time of 62 days after qualifying stroke. During a mean follow-up of 3.9 years, 11.4% of participants had recurrent stroke and 8.2% died. In the fully adjusted models, memory impairment was independently associated with an increased risk of recurrent stroke (hazard ratio, 1.48; 95% confidence interval [95% CI]: 1.04–2.09) and death (hazard ratio, 1.87; 95% CI: 1.25–2.79). Global impairment (hazard ratio, 1.66; 95% CI: 1.06–2.59) and nonmemory impairment (hazard ratio, 1.74; 95% CI: 1.14–2.67) were associated with an increased risk of death. Discussion/Conclusion: After lacunar stroke, memory impairment was an independent predictor of recurrent stroke and death, while global and nonmemory impairment were associated with death. Cognitive screening in lacunar stroke may help identify populations at higher risk of recurrent stroke and death.

The Relationship Between Glucose Control and Cognitive Function in People With Diabetes After a Lacunar Stroke.

Lacunar strokes and diabetes are risk factors for cognitive dysfunction. Elucidating modifiable risk factors for cognitive dysfunction has great public health implications. One factor may be glycemic status, as measured by glycated hemoglobin (A1c). The aim of this study was to assess the relationship between A1c and cognitive function in lacunar stroke patients with diabetes. The effect of baseline and follow-up A1c on the baseline and the change in Cognitive Assessment Screening Instrument (CASI) score over time among participants with a median of 2 cognitive assessments (range, 1-5) was examined in 942 individuals with diabetes and a lacunar stroke who participated in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial (ClinicalTrials.gov No. NCT00059306). Every 1% higher baseline A1c was associated with a 0.06 lower standardized CASI z score (95% CI, -0.101 to -0.018). Higher baseline A1c values were associated with lower CASI z scores over time (P for interaction = .037). A 1% increase in A1c over time corresponded with a CASI score decrease of 0.021 (95% CI, -0.0043 to -0.038) during follow-up. All these remained statistically significant after adjustment for age, sex, education, race, depression, hypertension, hyperlipidemia, body mass index, cardiovascular disease, obstructive sleep apnea, diabetic retinopathy, nephropathy insulin use, and white-matter abnormalities. This analysis of lacunar stroke patients with diabetes demonstrates a relationship between A1c and change in cognitive scores over time. Intervention studies are needed to delineate whether better glucose control could slow the rate of cognitive decline in this high-risk population.

MON-636 The Relationship Between Glucose Control &amp; Cognitive Function in People with Diabetes After a Lacunar Stroke

Background & Objective Both lacunar strokes and diabetes are risk factors for dementia and cognitive dysfunction. Thus, elucidating modifiable risk factors for cognitive dysfunction in people with type 2 diabetes who experienced a lacunar infarct has large public health implications. One such factor may be glycemic status, as measured by glycosylated hemoglobin (A1C). Thus, the aim of this study was to assess the relationship between A1C and cognitive function in people with diabetes after a lacunar stroke. Research Design & Methods The effect of baseline and follow-up A1C on the baseline and the change in Cognitive Assessment Screening Instrument (CASI) score over time among participants with a median of 2 cognitive assessments (range 1-5) was examined in of 942 individuals with diabetes and a lacunar stroke who participated in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial (ClinicalTrials.gov number, NCT00059306). Results Every 1 % higher baseline A1C was associated with a 0.06 lower standardized CASI z-score (95% CI -0.101, -0.018). Higher baseline A1C values were associated with lower CASI z-score over time (p for interaction=0.037). A 1% increase in A1C over time, corresponded with a CASI score decrease of 0.021 (95% CI -0.0043, -0.038) during follow-up. All these remained statistically significant after adjustment for age, sex, education, race, depression, hypertension, hyperlipidemia, BMI, CVD, OSA, diabetic retinopathy, nephropathy insulin use and White Matter Abnormalities. Conclusion This analysis of 942 individuals with diabetes after a lacunar stroke demonstrates a relationship between A1C and change in cognitive scores over time. Intervention studies are needed in order to delineate if better glucose control could slow the rate of cognitive decline in this high risk population.

M2b macrophage subset decrement as an indicator of cognitive function in Alzheimer's disease

Alzheimer's disease (AD) is a chronic neurodegenerative disease. Various inflammatory processes account for the pathology of AD, and macrophages in particular have a distinct polarization phenotype related to M1/M2 classification. We aimed to investigate macrophage polarization patterns as an indicator of cognitive function in AD. We recruited 54 non-demented individuals as control and 105 AD patients as experimental groups respectively. Percentages of macrophage (PM2K+ CD14+ and PM2K+ CD14- ) and macrophage polarization subsets (M1, M2a, M2b, and M2c) were assessed using flow cytometry. All AD patients were classified by dementia severity using clinical Dementia Rating scale (CDR) as CDR 0.5, 1 and ≧2. AD patients had cognitive function evaluation using Mini-Mental State Examination (MMSE) and Cognitive Assessment Screening Instrument (CASI). We compared the macrophage polarization patterns between control and patient groups. Cognitive function was evaluated in association with macrophage polarization patterns in AD patients. The percentages of PM2K+ CD14+ and PM2K+ CD14- macrophages were higher in AD patients than in controls. M2b macrophage subset decrement and M1 macrophage subset increment of PM2K+ CD14+ and PM2K+ CD14- macrophages were observed in AD patients compared with controls. Although percentages of macrophage subsets were not consistent with CDR staging, PM2K+ CD14+ M2b macrophage subset decrement was correlated with worse cognitive functioning by MMSE and CASI in AD patients. M2b macrophage subset decrement and M1 macrophage subset increment were noted in AD patients, while PM2K+ CD14+ M2b macrophage subset decrement indicated worse cognitive function in such patients.

THE EFFECT OF COGNITIVE TRAINING AND PHYSICAL ACTIVITY PROGRAM IN COGNITIVE FUNCTION OF ELDERLY FACILITY RESIDENTS

This study evaluated the effectiveness of a combined cognitive training (CT) and physical activity (PA) intervention in improving cognitive function for institutionalized older residents with cognitive impairment. An experimental design with pre/post-test evaluations in a double-blind assessments at three points (baseline, T0; post-treatment, T1; 8-weeks-follow-up, T2), conducted an 8-week-CTPA intervention. Participants (N=134) were recruited from 12 institutions. Centers were randomly assigned into wait-list control, treatment I or treatment II groups. Treatment I group (low frequency) underwent combined 30-minutes sessions of individual-non-computer-based multi-domain CT (twice a week) with 30-minutes-group-chair-based PA (3 times a week). Treatment II group underwent the same protocol as Treatment I group, but with high frequency, 5 days per week for both CT and PA. The primary outcome, Cognitive Assessment Screening Instrument(CASI) total scores showed significant improvement in the treatment I and treatment II groups at T1-T0 and T2-T0, compared to the wait-list control group(10.55±9.60, 12.75±11.64, -8.01±6.61, p=0.000; 8.32±7.81, 11.75±10.19, -7.11±5.78, p=0.000), however there were no significant differences between two treatment groups. In CASI’s nine sub-domains, all the mean difference between groups were also significant at T1-T0 and T2-T0 (all p<0.05). The two treatment groups only significantly differ on CASI-ORIENT domain at T2-T0 (p=0.02). The findings revealed that a combined CT-and-PA intervention have positive immediate (T1-T0) and delayed (T2-T0) effects in cognitive function for older institutional residents with cognition-impairment. The two treatment groups did not show dose-response relationship. Even more, the low frequency intervention was more effective on several domains than high frequency intervention did.

Effect of Advanced Glycation End Products on the Progression of Alzheimer's Disease.

Shared links between type 2 diabetes mellitus (T2DM) and Alzheimer's disease (AD) have been well-known. A high concentration of advanced glycation end products (AGEs) has been reported to contribute to impaired mobility in patients with AD, but there is limited understanding regarding the longitudinal impact of AGEs on cognitive performance. This study aims to explore whether the concentrations of AGEs mediate the clinical progression of cognitive performance in patients with AD and T2DM. Twenty-five patients aged 79.0±5.8 years who were diagnosed with probable AD with a Clinical Dementia Rating (CDR) of 0.5 or 1 and T2DM were enrolled in this study. When patients participated in the study, the concentration of plasma AGEs was tested. A series of neuropsychological tests, namely the Mini-Mental Status Examination (MMSE), Cognitive Assessment Screening Instrument (CASI), and CDR, were performed annually during follow-up. The association between the concentration of AGEs and changes in overall cognition and cognition related daily living performance was analyzed. After the mean 48.6±2.1 months of follow-up, AGEs were found to be significantly associated with a change in CDR. A total of 12 (48%) patients experienced a decline in CDR; they had a significantly higher concentration of AGEs than did those whose CDR did not deteriorate (100.5 ± 14.2 versus 81.5 ± 17.7; p = 0.007). This difference in CDR remained significant after adjustment for age, sex, education level, and apolipoprotein E4 status (adjusted p = 0.023). In conclusion, this study indicates that a high concentration of AGEs may be a predictor of a long-term decline in cognition related daily living performance in patients with AD and T2DM.

Galantamine plasma concentration and cognitive response in Alzheimer's disease.

BackgroundGalantamine has been approved for the treatment of Alzheimer’s disease (AD). However, there are few studies which have reported the association between cognitive responses and galantamine plasma concentration. The aim of this study was to determine the correlation between galantamine plasma concentration and the subsequent cognitive response following treatment in AD patients.MethodsAD sufferers who continuously took 8 mg/d galantamine for at least 6 months without previous exposure to other kinds of AChEI such as donepezil, rivastigmine, or memantine were included in this cohort study. The assessments included the Mini Mental Status Examination (MMSE), Clinical Dementia Rating Scale (CDR) and the Cognitive Assessment Screening Instrument (CASI). Each subdomain of the CASI assessment was conducted at baseline and after 6 months of galantamine. The plasma concentrations of galantamine were measured by capillary electrophoresis after 6 months of the treatment. Logistic regression was performed to adjust for age, gender, apolipoprotein E ε4 genotype status, and baseline score to investigate the association between galantamine plasma concentrations and the cognitive response.ResultsThe total sample consisted of 33 clinically diagnosed AD patients taking galantamine 8 mg/d for 6 months. There was no linear correlation between galantamine concentration and cognitive response in patients. However, 22 patients were responsive to the treatment in the long-term memory domain. In CASI subset domain, concentration improved during the 6 months follow up.ConclusionsIn the limited samples study, galantamine mostly benefitted the cognitive domain of long-term memory. The benefits were not related to the galantamine plasma concentration. Objective intra-individual evaluation of therapeutic response should be encouraged.

Predictive Models for Evaluating Cognitive Ability in Dementia Diagnosis Applications Based on Inertia- and Gait-Related Parameters

An impaired cognitive ability is an important indicator of dementia-related disease. Accordingly, this paper utilizes 12 inertia-related features, 19 gait-related features, and 2 balance-related features to analyze the gait performance of subjects while performing single-task and dual-task walking tests and balance tests. The features most closely correlated with the cognitive ability of the subjects are extracted via a correlation analysis method and a sequential forward floating selection (SFFS) algorithm, respectively. The extracted features are then used to predict the cognitive assessment screening instrument (CASI) and mini mental state examination (MMSE) scores of the subjects using three different prediction models, namely a linear regression model, a nonlinear regression model, and a feedforward neural network (FNN) model. It is shown that the optimal prediction performance (i.e., prediction error = 7.89±5.86 for the CASI score and prediction error = 3.21±2.86 for the MMSE score) is obtained using the SFFS feature selection method and the FNN model. Overall, the results show that the feature selection and modeling methods proposed in this paper provide an accurate and objective means of evaluating the cognitive ability of individuals for dementia diagnosis purposes.

Angiotensin-converting enzyme insertion/deletion polymorphism and the longitudinal progression of Alzheimer's disease.

The angiotensin-converting enzyme gene (ACE) insertion (I)/deletion (D) polymorphism is considered a biologically plausible gene for Alzheimer's disease (AD) in cross-sectional studies. The present study aimed to investigate the longitudinal effect of ACE I/D polymorphism on AD progression. This 3-year observational study investigated the longitudinal effect of ACE I/D polymorphism on AD progression. Clinically diagnosed AD patients with a clinical dementia rating (CDR) of 0.5 or 1 were enrolled in the study. The Mini-Mental State Examination (MMSE), Cognitive Assessment Screening Instrument (CASI) and the CDR scale were carried out for all patients on the date of the initial interview and 36±6months after the initial evaluation. A total of 177 patients with sporadic AD were enrolled in this study. Among all patients, those with the I/I genotype showed a higher risk of CDR deterioration (I/I versus I/D+D/D: adjusted OR 2.103, 95% CI 1.113-3.972; adjusted P=0.022). Among 74 AD patients without hypertension, those with the I/I genotype showed significantly greater differences in the MMSE, CASI and the CDR-sum of box scores, and a higher risk of CDR deterioration (I/I versus I/D+D/D: adjusted OR 3.255, 95% CI 1.099-9.639; adjusted P=0.033) after adjustment for possible confounders during the 3-year follow up. Patients with AD who were homozygous for the I allele presented with a more rapid AD deterioration than did those who had other ACE genotypes, particularly those patients without hypertension. Geriatr Gerontol Int 2017; 17: 1544-1550.

Effects of multiple training modalities in patients with Alzheimer's disease: a pilot study.

ObjectiveThis pilot study investigated the effects of multiple training modalities on cognition, neuropsychiatric symptoms, caregivers’ burden, and quality of life in patients with Alzheimer’s disease (AD).Patients and methodsThis intervention study was conducted in 24 patients with AD aged ≥65 years with a Clinical Dementia Rating (CDR) score of 0.5–1. The patients were assigned to receive multiple training modalities (1 hour for each training: Tai Chi, calligraphy, and drawing) over a 6-week period in either the experimental group (n=14) or the comparison group (n=10). A series of neuropsychological tests – namely the Traditional Chinese version Mini-Mental Status Examination, Cognitive Assessment Screening Instrument (CASI), Neuropsychiatric Inventory and the Neuropsychiatric Inventory Caregiver Distress Scale, and the Clinical Dementia Rating Sum of Boxes scale – were conducted at the baseline and after the intervention. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) and Zarit Caregiver Burden Scale were used to assess the quality of life and caregivers’ burden, respectively. Independent sample t-test and paired sample t-test were used to analyze the data.ResultsAfter the intervention, the experimental group reported higher scores in the orientation domain of CASI (P=0.007) and in the psychiatry domain of WHOQOL-BREF (P=0.042) compared with the comparison group. Caregivers’ distress was significantly decreased in the experimental group (P=0.035) but not in the comparison group (P=0.430).ConclusionThe multiple training modalities improved scores in the orientation domain of CASI and psychiatry domain of WHOQOL-BREF in patients with AD. Moreover, the intervention reduced caregivers’ distress.

A correlativity study of plasma APL1β28 and clusterin levels with MMSE/MoCA/CASI in aMCI patients

Amnestic mild cognitive impairment (aMCI) is a sub-clinical condition characterized by memory deficits that are not severe enough to affect daily functioning. Here we investigated two potential biomarkers found in the cerebrospinal fluid of AD patients, APLP1-derived Aβ-like peptides 28 (APL1β28) and clusterin plasma levels, in terms of their relationship to cognitive function, as reflected in the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA) and the Cognitive Assessment Screening Instrument (CASI) in aMCI patients. Forty-seven aMCI patients and thirty-five age- and gender-matched healthy adult controls were recruited for this study. Using the ELISA method, we found that the mean concentrations of both APL1β28 and clusterin were not significantly different between the control and aMCI groups. The APL1β28 levels were positively correlated with clusterin and that both were negatively correlated with the MMSE scores of the aMCI patients. Clusterin levels were negatively correlated with the MoCA and CASI scores of the aMCI patients. Using multivariate analysis, the correlation between clusterin and MMSE/MoCA/CASI was independent of other AD risk factors including age, education, sex, body mass index and ApoE genotype. The data presented here demonstrate that plasma clusterin levels reflect cognitive function in aMCI patients.

Abstract 140: Long-term disability after lacunar stroke: Secondary Prevention of Small Subcortical Stroke Study

Background: Long-term disability after lacunar stroke is under-studied. We hypothesized that vascular and demographic risk factors predict worsening disability after recovery from lacunar stroke, even in the absence of recurrent stroke. Methods: The Secondary Prevention of Small Subcortical Stroke Study is a clinical trial in lacunar stroke patients with annual assessments of disability with the Older Americans Resources and Survey Instrumental Activities of Daily Living (IADL) scale (range 0-14), measuring 7 IADLs. Generalized estimating equations were used to model the likelihood of disability (IADL score &lt;14) over time, adjusting for demographics, medical risk factors, cognitive and mood factors, and region in univariate and multivariable models. IADL assessments after recurrent stroke were censored. We stratified by study region and age quartile (&lt;55, 55-63, 63-72, ≥72 years), and the final model excluded non-significant terms. Results: Among 2820 participants, mean age was 63.4 years (SD 10.8), 63% were male, 51% White, 32% Hispanic, 36% had some college education, 36% had diabetes, 90% had hypertension, and 10% had prior stroke. Mean follow-up was 3.5 years. Mean IADL score at 3 months was 12.5 (SD 2.5), and 43% were disabled. In multivariable models, female sex (OR 1.5, 95% CI 1.3-1.8), diabetes (1.52, 1.30-1.75), current smoking (1.28, 1.06-1.54), non-regular alcohol use (1.6, 1.4-1.9), prior stroke (1.61, 1.28-2.00), cognitive assessment screening instrument score (0.98 per point, 0.97-0.98), and depression (1.79, 1.49-2.17) were associated with disability. The youngest age quartile had decreased odds of disability over time (OR 0.56 per year, 95% CI 0.36-0.91), whereas the oldest age quartile had increased odds (1.33, 0.83-2.22). There was heterogeneity by region (p&lt;0.0001): Americans and Latin Americans had 2.5-fold greater odds of disability per year compared to Spaniards. Conclusion: In lacunar stroke patients, older age predicted worsening long-term disability, even without recurrent stroke. Worse long-term function was associated with vascular risk factors and prior stroke, and regional differences may have been due to geographic variations in health care delivery or scale interpretation.

Test bias in a cognitive test: differential item functioning in the CASI.

Assessment of test bias is important to establish the construct validity of tests. Assessment of differential item functioning (DIF) is an important first step in this process. DIF is present when examinees from different groups have differing probabilities of success on an item, after controlling for overall ability level. Here, we present analysis of DIF in the Cognitive Assessment Screening Instrument (CASI) using data from a large cohort study of elderly adults. We developed an ordinal logistic regression modelling technique to assess test items for DIF. Estimates of cognitive ability were obtained in two ways based on responses to CASI items: using traditional CASI scoring according to the original test instructions as well as using item response theory (IRT) scoring. Several demographic characteristics were examined for potential DIF, including ethnicity and gender (entered into the model as dichotomous variables), and years of education and age (entered as continuous variables). We found that a disappointingly large number of items had DIF with respect to at least one of these demographic variables. More items were found to have DIF with traditional CASI scoring than with IRT scoring. This study demonstrates a powerful technique for the evaluation of DIF in psychometric tests. The finding that so many CASI items had DIF suggests that previous findings of differences between groups in cognitive functioning as measured by the CASI may be due to biased test items rather than true differences between groups. The finding that IRT scoring diminished the impact of DIF is discussed. Some preliminary suggestions for how to deal with items found to have DIF in cognitive tests are made. The advantages of the DIF detection techniques we developed are discussed in relation to other techniques for the evaluation of DIF.

Dementia Screening: Can a Second Administration Reduce the Number of False Positives?

<h3>Objective</h3> Early diagnosis of dementia is important for medical treatment and quality-of-life interventions. The authors examine whether administering a second cognitive screening after a poor initial score can improve the accuracy of diagnosis. Of particular interest is reducing false positives that may generate an unnecessary referral for a dementia work-up. <h3>Methods</h3> A group of 389 Japanese men from the Honolulu-Asia Aging Study were administered the Cognitive Assessment Screening Instrument (CASI) twice within a 2-month period. A small sample received a follow-up CASI 3 years later. <h3>Results</h3> Administration of a second CASI reduced the false-positive rate by 16.1% in the total sample and 20.2% in those suspected of having mild dementia. The negative predictive value for the second administration was 80% for the entire sample and 82.6% for those suspected of having mild dementia. <h3>Conclusion</h3> Administration of a second cognitive screening in patients initially scoring in the dementia range can significantly reduce the number of false positives for dementia. This technique may be useful to managed-care companies who aim to reduce unnecessary costs in medical care.

Dementia Screening: Can a Second Administration Reduce the Number of False Positives?

Early diagnosis of dementia is important for medical treatment and quality-of-life interventions. The authors examine whether administering a second cognitive screening after a poor initial score can improve the accuracy of diagnosis. Of particular interest is reducing false positives that may generate an unnecessary referral for a dementia work-up. A group of 389 Japanese men from the Honolulu-Asia Aging Study were administered the Cognitive Assessment Screening Instrument (CASI) twice within a 2-month period. A small sample received a follow-up CASI 3 years later. Administration of a second CASI reduced the false-positive rate by 16.1% in the total sample and 20.2% in those suspected of having mild dementia. The negative predictive value for the second administration was 80% for the entire sample and 82.6% for those suspected of having mild dementia. Administration of a second cognitive screening in patients initially scoring in the dementia range can significantly reduce the number of false positives for dementia. This technique may be useful to managed-care companies who aim to reduce unnecessary costs in medical care.

Longitudinal association of vascular and Alzheimer's dementias, diabetes, and glucose tolerance.

To assess the relationship between impaired glucose tolerance and both vascular dementia and AD. Diabetes and abnormalities of glucose metabolism have been associated with stroke and poor cognitive function. In addition, glycoproteins and glycosylation have been postulated to be associated with the development of neuritic plaques characteristic of AD. A historical prospective cohort study of Japanese-American men (n = 3,774), who were examined at ages 45 to 68 (1965 through 1968) and again at ages 71 to 93 (1991 through 1993). Measurements were obtained by clinical and home examinations: assessment of glucose intolerance (nonfasting 1 hour after glucose load) from 1965 through 1968 and history of diabetes diagnosed by a physician at examinations given from 1965 through 1968 and from 1976 through 1978. At the 1991 through 1993 examinations, the Cognitive Assessment Screening Instrument (CASI)-an instrument designed for use in cross-cultural settings combining features of the Folstein Mini-Mental State Examination, the Modified Mini-Mental State Examination, and the Hasegawa Dementia Screening Scale-was used. Diagnosis and classification of AD and vascular dementia were made by a consensus panel using neuropsychologic assessment data, a neurologist's evaluation, and information from a family informant. Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., revised criteria were used to establish dementia, and subclassification by cause was based on other published criteria. No association between AD and diabetes, present either 25 or 15 years previously, was found after adjustment for age and education in a multiple regression model. A significant association was found between impaired glucose tolerance at baseline and vascular dementia (p < 0.01). These findings confirm expected relationships between impaired glucose tolerance and stroke-related dementia but do not support an association of disordered glucose metabolism with AD.