Individual Subtests Research Articles

Caregiver word reading literacy and health outcomes among children treated in a pediatric nephrology practice.

BackgroundCaregivers play a major role in the healthcare of pediatric patients, particularly during childhood and adolescence. This study examined the impact of caregivers' functional literacy on the health outcomes of adolescents with chronic kidney disease (CKD) or end-stage kidney disease (ESKD).MethodsCaregiver–child dyads in a Southeastern US pediatric nephrology clinic participated in this cross-sectional study. We collected demographic information, data on caregivers' functional literacy skills (Wechsler Individual Achievement Test Word Reading Subtest) and child health outcomes (healthcare utilization and adherence). Negative binomial regression analyses were used to test the relationships.ResultsA total of 98 pediatric patients and their caregivers participated. Caregivers' word reading literacy was associated with their children's healthcare utilization. Patients whose caregivers had lower word reading literacy skills (<7th grade) had greater incidence of emergency room (ER) visits (adjusted incidence rate ratio = 2.05, 95% confidence interval: 1.007, 4.177, P < 0.05) after adjusting for major demographic factors. Patients' hospitalization rates and adherence to medication/diet/appointments were comparable in the two groups.ConclusionsLow caregiver functional word reading literacy was negatively related to health outcomes of adolescents with CKD/ESKD as reflected by greater ER visits. Educational materials and teaching strategies (dialysis training protocols, patient education materials) adjusted for low literacy levels may contribute to better outcomes.

Do individual differences in test preparation compromise the measurement fairness of admission tests?

The existence of individual differences in the use of test preparation has raised concerns regarding the fair and valid use of admission tests. Measurement specialists argued that the extent to which individual differences in test preparation affects the measurement fairness and construct validity of admission tests depends on the processes that lead to an increase in admission tests score due to test preparation. Four theoretical models have been advanced in the literature to account for the effect of test preparation on admission test scores. The four theoretical models make competing predictions with regard to the processes that lead to an increase in admission test scores and the extent to which measurement fairness can be assumed across test-takers differing in test preparation at the time-point of the actual admission exam. In the present article, latent class analysis was used to model individual differences in the use of test preparation methods used by applicants to a medical university (N=1768). Four latent classes of test-takers were identified that differed qualitatively and quantitatively in terms of test preparation. Item response theory analyses and multi-group means and covariance structure analyses indicated strict measurement invariance across the four latent classes at the level of the individual subtests. However, group differences in test-takers admission test scores were not related to differences in either psychometric g, or general natural science knowledge (Gk-ns), respectively. The findings were consistent with theoretical models that attribute the effect of test preparation on test-takers' admission test scores to an increase in test-specific cognitive abilities and/or domain-specific knowledge.

Interpreting Reading Assessment Data

This article is designed to help teachers interpret reading assessment data from DIBELS beyond individual subtests to better support their students’ needs. While it is important to understand the individual subtest measures, it is more vital to understand how each fits into the larger picture of reading development. The underlying construct of each DIBELS subtest is unpacked, followed by a demonstration of how teachers can (a) interpret results and (b) design high-quality interventions around the reading constructs, rather than teaching to individual subtests. Two classroom examples are presented that were designed to illustrate realigned interpretation of assessment results.

Transcranial direct current stimulation to the parietal cortex in hemispatial neglect: A feasibility study

ObjectivesPrior research suggests that dampening neural activity of the intact, presumably overactive hemisphere, combined with increasing neural activity in the damaged hemisphere, might restore cortical interhemispheric balance and reduce neglect. In the present study we repeatedly applied a relatively new technique, transcranial direct current stimulation (tDCS), to the posterior parietal cortex to modulate spontaneous neural activity levels in a polarity dependent fashion to find evidence for improvements in severe hemispatial neglect in chronic patients. MethodsEighty-nine patients were initially identified from our databases as having neglect, after thoroughly screening databases, consulting medical practitioners and baseline testing, only five met our inclusion criteria and agreed to participate. Sixty-five patients were excluded as they did not meet safety criteria for tDCS (epilepsy, metal implants), suffered from other medical conditions (i.e., heart disease, epilepsy, current psychiatric disorder) or displayed only mild neglect at baseline testing. Five patients with severe chronic hemispatial neglect were enrolled in a double-blind, placebo-controlled treatment program. TDCS or placebo was applied for 20minutes over the left (cathodal) and right (anodal) posterior parietal cortex at an intensity of 2mA on five consecutive days. Treatment conditions were separated by a four week wash-out period. Baseline corrected change in performance on the conventional subtests of the Behavioral Inattention Test (BIT) was our primary endpoint. ResultsNo treatment-related effects were observed for the BIT change scores and performance on individual subtests. Moreover, patients' performance somewhat improved only during the stimulation period (day one vs day five, irrespective of whether it was placebo or tDCS), but not thirty days later, indicating a practice effect. DiscussionThe present study does not provide evidence that tDCS to the posterior parietal cortex improves chronic hemispatial neglect. As a result of in- and exclusion health and safety criteria the majority of patients were excluded, which indicates that performing large randomized controlled trials is not feasible in chronic neglect patients.

Using Regression Discontinuity to Test the Impact of a Tier 2 Reading Intervention in First Grade

Multitiered systems of reading instruction and intervention, including response to intervention, are widely used in early reading by schools to provide more intense services to students who need them. Research using randomized controlled trials has compared innovative Tier 2 interventions to business-as-usual Tier 2 approaches and established a number of important components that compose effective Tier 2 interventions in early reading. The purpose of this study was to test the impact of a Tier 2 intervention with Tier 2 compared to Tier 1 instruction alone using regression discontinuity. A cut score was used to assign first-grade students at risk for reading difficulties to Tier 2 intervention plus Tier 1 instruction. Students who missed the cut score in the control group received Tier 1 instruction only. Students in the treatment group, just below the cut score, made greater gains on the SAT10 total score and the individual subtests than students just above the cut score. Outcomes were not significant on oral reading fluency.

Clinical utility of the Wechsler Memory Scale—Fourth Edition (WMS-IV) in predicting laterality of temporal lobe epilepsy among surgical candidates

This study evaluated the accuracy of the Wechsler Memory Scale—Fourth Edition (WMS-IV) in identifying functional cognitive deficits associated with seizure laterality in localization-related temporal lobe epilepsy (TLE) relative to a previously established measure, the Rey Auditory Verbal Learning Test (RAVLT). Emerging WMS-IV studies have highlighted psychometric improvements that may enhance its ability to identify lateralized memory deficits. Data from 57 patients with video-EEG-confirmed unilateral TLE who were administered the WMS-IV and RAVLT as part of a comprehensive presurgical neuropsychological evaluation for temporal resection were retrospectively reviewed. We examined the predictive accuracy of the WMS-IV not only in terms of verbal versus visual composite scores but also using individual subtests. A series of hierarchal logistic regression models were developed, including the RAVLT, WMS-IV delayed subtests (Logical Memory, Verbal Paired Associates, Designs, Visual Reproduction), and a WMS-IV verbal–visual memory difference score. Analyses showed that the RAVLT significantly predicted laterality with overall classification rates of 69.6% to 70.2%, whereas neither the individual WMS-IV subtests nor the verbal–visual memory difference score accounted for additional significant variance. Similar to previous versions of the WMS, findings cast doubt as to whether the WMS-IV offers significant incremental validity in discriminating seizure laterality in TLE beyond what can be obtained from the RAVLT.

Social perception in adults with Parkinson's disease.

Our study assessed how nondemented patients with Parkinson's disease (PD) interpret the affective and mental states of others from spoken language (adopt a "theory of mind") in ecologically valid social contexts. A secondary goal was to examine the relationship between emotion processing, mentalizing, and executive functions in PD during interpersonal communication. Fifteen adults with PD and 16 healthy adults completed The Awareness of Social Inference Test, a standardized tool comprised of videotaped vignettes of everyday social interactions (McDonald, Flanagan, Rollins, & Kinch, 2003). Individual subtests assessed participants' ability to recognize basic emotions and to infer speaker intentions (sincerity, lies, sarcasm) from verbal and nonverbal cues, and to judge speaker knowledge, beliefs, and feelings. A comprehensive neuropsychological evaluation was also conducted. Patients with mild-moderate PD were impaired in the ability to infer "enriched" social intentions, such as sarcasm or lies, from nonliteral remarks; in contrast, adults with and without PD showed a similar capacity to recognize emotions and social intentions meant to be literal. In the PD group, difficulties using theory of mind to draw complex social inferences were significantly correlated with limitations in working memory and executive functioning. In early PD, functional compromise of the frontal-striatal-dorsal system yields impairments in social perception and understanding nonliteral speaker intentions that draw upon cognitive theory of mind. Deficits in social perception in PD are exacerbated by a decline in executive resources, which could hamper the strategic deployment of attention to multiple information sources necessary to infer social intentions.

Association of the ASCO Classification with the Executive Function Subscores of the Montreal Cognitive Assessment in Patients with Postischemic Stroke

The ASCO classification can evaluate the etiology and mechanisms of ischemic stroke more comprehensively and systematically than conventional stroke classification systems such as Trial of Org 10172 in Acute Stroke Treatment (TOAST). Simultaneously, risk factors for cognitive impairment such as arterial sclerosis, leukoaraiosis, and atrial fibrillation can also be gathered and graded using the ASCO classification. Sixty patients with postischemic stroke underwent cognitive testing, including testing by the Japanese version of the Montreal cognitive assessment (MoCA-J) and the mini-mental state examination (MMSE). Ischemic strokes were categorized and graded by the ASCO classification. In this phenotype-based classification, every patient is characterized by the A-S-C-O system (A for Atherosclerosis, S for Small vessel disease, C for Cardiac source, and O for Other cause). Each of the 4 phenotypes is graded 0, 1, 2, or 3, according to severity. The conventional TOAST classification was also applied. Correlations between individual MoCA-J/MMSE scores and the ASCO scores were assessed. The total score of the ASCO classification significantly correlated with the total scores of MoCA-J and MMSE. This correlation was more apparent in MoCA-J than in MMSE, because MoCA-J scores were normally distributed, whereas MMSE scores were skewed toward the higher end of the range (ceiling effect). Results for individual subtests of MoCA-J and MMSE indicated that cognitive function for visuoexecutive, calculation, abstraction, and remote recall significantly correlated with ASCO score. These results suggest that the ASCO phenotypic classification of stroke is useful not only for assessing the etiology of ischemic stroke but also for predicting cognitive decline after ischemic stroke.

Critical Thinking Exercises in the Classroom are Helpful but not Sufficient for Improving Critical Thinking Test Scores

A Review of:&#x0D; Wallace, E. D., &amp; Jefferson, R. N. (2013). Developing Critical Thinking Skills For Information Seeking Success. New Review of Academic Librarianship, 19(3): 246-255.&#x0D; &#x0D; Objective – To determine whether a series of workbook exercises contributed to improved critical thinking test scores.&#x0D; &#x0D; Design – Post-test design with a quasi-experimental control group.&#x0D; &#x0D; Setting – Military college in the United States of America.&#x0D; &#x0D; Subjects – 76 undergraduates enrolled in a required freshman orientation seminar.&#x0D; &#x0D; Methods – Approximately one third of the enrolled participants (n=26) were provided with a copy of the book Critical Thinking: Building the Basics. A subset of exercises was completed independently over three to four class sessions during the first three weeks of the semester. The control group (n=50) did not receive any critical skills thinking instruction. The iCritical Thinking Skills Test, an online exam provided by Educational Testing Service (ETS), was administered to both groups during a class session. The exam consists of 7 types of tasks: define, access, evaluate, manage, integrate, create, communicate, evaluated using 14 tasks based on real-world scenarios.&#x0D; &#x0D; Main Results – Approximately 20% (15) of all students passed the test, 9 from the intervention group and 6 from the control group. Significant differences were detected between the groups on the Integrate and Manage subtests. The range for individual subtests and total scores was wide. Scores for two of the seven subtests, Create and Evaluate, showed the greatest amount of variability; the Communicate subtest scores had the least. &#x0D; &#x0D; Conclusion – Limitations of the study include potential motivational differences between the groups. Students who completed workbook exercises appeared to be motivated to do well on the test, while those who did not seemed less motivated. The effectiveness of exercises in developing critical thinking skills in this study will persuade administrators to consider using such exercises in the classroom.

DEVELOPMENT OF PHONOLOGICAL AWARENESS OF STUTTERING CHILDREN AND CHILDREN WITH FLUENT SPEECH

The aim of this study was to determine characteristics of phonological awareness of stuttering children and children with fluent speech. The sample consisted of 64 children, between 56 and 83 months old (4 years and 8 months to 6 years and 11 months). Examinees were divided in two groups. The first group consisted of 32 stuttering children, 19 males, and 13 females. The control group consisted of 32 children with fluent speech, whose age and sex were equal to the age and sex of the children in the experimental group. The research was conducted in preschools and primary schools in Tuzla and Una-Sana Canton in Bosnia and Herzegovina. The subjects were examined with 7 subtests (syllable and phoneme blending abilities, ability to rhyme, phoneme segmentation, phoneme deletion, phoneme transposition and spoonerisms). Each of the subtest scores, which index a variety of phonological awareness abilities, was examined separately. Phonological awareness score is the total score which relates to a common result that the subjects achieved on these 7 individual subtests. The results showed that there were no statistically significant differences between stuttering children and their peers with fluent speech in relation to Phonological awareness score. The examination of differences between stuttering and non-stuttering children in individual variables, which describe phonological awareness, showed that there was statistically significant difference in the ability to rhyme between these two subjects groups. T-test was used for examination of the differences between the male stuttering children and their fluent peers, and also female stuttering children and their fluent peers for the phonological awareness variables. The results exhibited statistically significant differences in the variable Rhyme between the male stuttering children and their fluent peers. In addition, we examined the ability of phonemic analysis of children who stutter and children with fluent speech. The results showed that there were not statistically significant differences between stuttering and nonstuttering children related to phonemic analysis abilities.

A Cluster Analytic Study of the Wechsler Intelligence Test for Children-IV in Children Referred for Psychoeducational Assessment Due to Persistent Academic Difficulties

Wechsler Intelligence Test for Children-IV core subtest scores of 472 children were cluster analyzed to determine if reliable and valid subgroups would emerge. Three subgroups were identified. Clusters were reliable across different stages of the analysis as well as across algorithms and samples. With respect to external validity, the Globally Low cluster differed from the other two clusters on Wechsler Individual Achievement Test-II Word Reading, Numerical Operations, and Spelling subtests, whereas the latter two clusters did not differ from one another. The clusters derived have been identified in studies using previous WISC editions. Clusters characterized by poor performance on subtests historically associated with the VIQ (i.e., VCI + WMI) and PIQ (i.e., POI + PSI) did not emerge, nor did a cluster characterized by low scores on PRI subtests. Picture Concepts represented the highest subtest score in every cluster, failing to vary in a predictable manner with the other PRI subtests.

Modeling individual subtests of the WAIS IV with multiple latent factors.

Performance on a cognitive test can be viewed either as measuring a unitary function or as reflecting the operation of multiple factors. Individual subtests in batteries designed to measure human abilities are commonly modeled as a single latent factor. Several latent factors are then used to model groups of subtests. However these latent factors are not independent as they are related through hierarchical or oblique structures. As a result, the simple structure of subtest performance results in complex latent factors. The present study used structural equation modeling to evaluate several multidimensional models of the Wechsler Adult Intelligence Scales- fourth edition (WAIS-IV) subtests. Multidimensional models of subtest performance provided better model fit as compared to several previously proposed one dimensional models. These multidimensional models also generalized well to new samples of populations differing in age from that used to estimate the model parameters. Overall these results show that models that describe subtests as multidimensional functions of uncorrelated factors provided a better fit to the WAIS-IV correlations than models that describe subtests as one dimensional functions of correlated factors. There appears to be a trade-off in modeling subtests as one dimensional and modeling with homogeneous latent traits. More consideration should be given to models that include multiple uncorrelated latent factors as determinants of the performance on a given subtest. These results support the view that performance on any given cognitive test is potentially the result of multiple factors. Simple structure may be too simple.

What We Know About Creativity

<b>Objective:</b> We sought to establish the reliability and validity of a novel composite cognitive endpoint for monitoring improvement in memory and processing speed in future drug trials. <b>Background</b> Approximately 50% of all patients with Multiple Sclerosis have clinically significant symptoms of cognitive impairment that impact their ability to work and interfere with the quality of their home life and leisure activities. FDA officials have approved composite cognitive endpoints for the study of drug interventions for Alzheimer9s (ADAS-COG) and Schizophrenia (MATRICS), but not MS. <b>Design/Methods:</b> We administered the Selective Reminding Test (SRT), Brief Visuospatial Memory Test, Revised, PASAT, and SDMT to 60 MS patients at 4 centers twice over a 45 day timespan. These measures were chosen based on their known sensitivity to MS cognitive symptoms, the availability of alternate forms and known cross-cultural utility. Norm-referenced data was used to study the test-retest reliability of each measure. A composite measure for use as an endpoint in a drug trial was constructed based on factor structure. <b>Results:</b> Test-retest reliability for individual subtests ranged from r = .62 for the SRT delayed recall trial to .88 for the SDMT. A general composite representative of performance across measures had reliability of .91. Processing Speed and Memory composite indices were r =.89 and r =.86, respectively with modest practice effects. Secondary Progressive patients performed approximately .8 standard deviations below Relapsing-Remitting patients, with the two populations demonstrating cognitive impairment with frequencies 77% and 39%, respectively. Cognitive impairment correlated reasonably well (r = .40) with Informant reports on the Multiple Sclerosis Neuropsychological Questionnaire. <b>Conclusions:</b> The novel composite endpoint is a reliable, repeatable measure of general cognitive functioning that is sensitive to cognitive impairment in both Secondary Progressive and Relapsing –Remitting MS patients. Supported by: Biogen-Idec. <b>Disclosure:</b> Dr. DeLuca has received personal compensation for activities with Kessler Foundation Research Center and Biogen Idec.Dr. DeLuca has received research support from Biogen Idec. Dr. Foley has received personal compensation for activities with Biogen Idec. Dr. Foley has received research support from Bayer Pharmaceuticals. Dr. Benedict has received personal compensation for activities with Bayer Pharmaceuticals Corporation, Biogen Idec, Serono, Inc., Novartis, Merck &amp; Co., Inc. and Pfizer Inc as speaker, consultant and/or member on advisory panel. Dr. Benedict has received research support from Memen Pharmaceuticals, Shire Pharmaceuticals and Biogen Idec. Dr. Caruso has received personal compensation for activities with Biogen Idec as a consultant. Dr. Caruso has received research support from Biogen Idec. Dr. Erlanger has received personal compensation for activities with Biogen Idec as a consultant. Dr. Erlanger has received research support from Biogen Idec. Dr. Kaushik has received personal compensation for activities with Panmedix as a research coordinator. Dr. Kaushik has received research support from Biogen-Idec.

Ceiling and floor effects on the Rivermead Behavioural Memory Test in patients with alcohol-related memory disorders and healthy participants

Objective. The Rivermead Behavioural Memory Test (RBMT) is a widely used measure of everyday memory performance. In the most recent revision of this test (RBMT-3) some important changes have been made compared with the RBMT. This study examines whether this revision has improved the quality of the clinical classifications using this test, as well as the frequency of floor and ceiling performances that were prominent on some subtests of the RBMT, using a heterogeneous study sample. Methods. Twenty-five healthy adults and 25 patients with alcohol-related memory impairment (including 15 Korsakoff patients) were examined using both the RBMT and the RBMT-3. The number of perfect scores and floor performances, as well as the percentage of individuals classified as impaired (< 5th percentile), were scored and compared. Results. Administration of the RBMT-3 results in less participants performing at or near individual subtest's ceiling, and resulted in less floor performances. Moreover, the RBMT-3 misclassifies less healthy participants as impaired than the RBMT. Conclusions. The RBMT-3 is a substantial improvement over the original RBMT, as it reduces the problem of ceiling and floor performances and the number of misclassifications. However, more research is needed on the ecological validity of the RBMT-3.

Limitations for Interpreting Failure on Individual Subtests of the Montreal Cognitive Assessment

The Montreal Cognitive Assessment (MoCA) is sensitive to mild forms of cognitive impairment in geriatric populations and asks questions under the subheadings visuospatial/executive, naming, attention, language, abstraction, delayed recall, and orientation. This study examined the extent to which these subsets of MoCA items evaluate their intended cognitive domains. Clinical data from 185 geriatric memory clinic outpatients who underwent cognitive screening and subsequent neuropsychological assessment were analyzed. Factor analysis of their neuropsychological test scores identified 5 cognitive domains memory, language, visuospatial ability, attention/processing speed, and cognitive control. Scores on MoCA subtests were examined for their correlations with individual factor scores and for their sensitivity and specificity in predicting impairment within each domain. The MoCA subtest scores correlated significantly but modestly with neuropsychological test factor scores in their corresponding domains, for example, the correlation between 5-word recall and the memory factor was 0.46. However, subtest scores were poor predictors of impaired performance on the tests contributing to each cognitive domain. The best predictive accuracy was seen for the visuospatial/executive subtest that showed fair accuracy at predicting impairment on tests in the visuospatial domain. Other subtests showed unacceptably poor levels of accuracy when predicting impaired scores in their respective domains (60%-67%). In a sample of geriatric outpatients referred for cognitive assessment, performance on individual items and subtests of the MoCA yields insufficient information to draw conclusions about impairment in specific cognitive domains as determined by neuropsychological testing.

Performance of School Age Reading Disabled Students on the Phonological Awareness Subtests of the Comprehensive Test of Phonological Processing (CTOPP)

This study examined the performance of reading disabled children on the two Phonological Awareness Subtests of the Comprehensive Test of Phonological Processing (CTOPP). Participants performed significantly different on these two subtests with a poorer performance on the Elision subtest than Blending Words. In addition, the two subtests were not correlated for this group. Results suggest that, for reading disabled children, interpretation of the composite score may not be as useful as considering the individual subtests scores.

Assessing musical abilities objectively: construction and validation of the profile of music perception skills.

A common approach for determining musical competence is to rely on information about individuals’ extent of musical training, but relying on musicianship status fails to identify musically untrained individuals with musical skill, as well as those who, despite extensive musical training, may not be as skilled. To counteract this limitation, we developed a new test battery (Profile of Music Perception Skills; PROMS) that measures perceptual musical skills across multiple domains: tonal (melody, pitch), qualitative (timbre, tuning), temporal (rhythm, rhythm-to-melody, accent, tempo), and dynamic (loudness). The PROMS has satisfactory psychometric properties for the composite score (internal consistency and test-retest r>.85) and fair to good coefficients for the individual subtests (.56 to.85). Convergent validity was established with the relevant dimensions of Gordon’s Advanced Measures of Music Audiation and Musical Aptitude Profile (melody, rhythm, tempo), the Musical Ear Test (rhythm), and sample instrumental sounds (timbre). Criterion validity was evidenced by consistently sizeable and significant relationships between test performance and external musical proficiency indicators in all three studies (.38 to.62, p<.05 to p<.01). An absence of correlations between test scores and a nonmusical auditory discrimination task supports the battery’s discriminant validity (−.05, ns). The interrelationships among the various subtests could be accounted for by two higher order factors, sequential and sensory music processing. A brief version of the full PROMS is introduced as a time-efficient approximation of the full version of the battery.

Calcium and vitamin D supplementation and cognitive impairment in the women's health initiative.

To examine the effects of vitamin D and calcium on cognitive outcomes in elderly women. Post hoc analysis of a randomized double-blind placebo-controlled trial. Forty Women's Health Initiative (WHI) clinical centers across the United States. Four thousand one hundred forty-three women aged 65 and older without probable dementia at baseline who participated in the WHI Calcium and Vitamin D Trial and the WHI Memory Study. Two thousand thirty-four women were randomized to receive 1,000 mg of calcium carbonate combined with 400 IU of vitamin D(3) (treatment) and 2,109 to placebo. Primary: classifications of probable dementia or mild cognitive impairment (MCI) based on a four-phase protocol that included central adjudication. Secondary: global cognitive function and individual cognitive subtests. Mean age of participants was 71. During a mean follow-up of 7.8 years, 39 participants in the treatment group and 37 in the placebo group developed incident dementia (hazard ratio (HR) = 1.11, 95% confidence interval (CI) = 0.71-1.74, P = .64). Likewise, 98 treatment participants and 108 placebo participants developed incident MCI (HR = 0.95, 95% CI = 0.72-1.25, P = .72). There were no significant differences in incident dementia or MCI or in global or domain-specific cognitive function between groups. There was no association between treatment assignment and incident cognitive impairment. Further studies are needed to investigate the effects of vitamin D and calcium separately, on men, in other age and ethnic groups, and with other doses.

Reliability and Sensitivity to Cognitive Impairment of a Novel Endpoint for Use in Pharmaceutical Trials in Multiple Sclerosis (P04.114)

Objective: We sought to establish the reliability and validity of a novel composite cognitive endpoint for monitoring improvement in memory and processing speed in future drug trials. Background Approximately 50% of all patients with Multiple Sclerosis have clinically significant symptoms of cognitive impairment that impact their ability to work and interfere with the quality of their home life and leisure activities. FDA officials have approved composite cognitive endpoints for the study of drug interventions for Alzheimer9s (ADAS-COG) and Schizophrenia (MATRICS), but not MS. Design/Methods: We administered the Selective Reminding Test (SRT), Brief Visuospatial Memory Test, Revised, PASAT, and SDMT to 60 MS patients at 4 centers twice over a 45 day timespan. These measures were chosen based on their known sensitivity to MS cognitive symptoms, the availability of alternate forms and known cross-cultural utility. Norm-referenced data was used to study the test-retest reliability of each measure. A composite measure for use as an endpoint in a drug trial was constructed based on factor structure. Results: Test-retest reliability for individual subtests ranged from r = .62 for the SRT delayed recall trial to .88 for the SDMT. A general composite representative of performance across measures had reliability of .91. Processing Speed and Memory composite indices were r =.89 and r =.86, respectively with modest practice effects. Secondary Progressive patients performed approximately .8 standard deviations below Relapsing-Remitting patients, with the two populations demonstrating cognitive impairment with frequencies 77% and 39%, respectively. Cognitive impairment correlated reasonably well (r = .40) with Informant reports on the Multiple Sclerosis Neuropsychological Questionnaire. Conclusions: The novel composite endpoint is a reliable, repeatable measure of general cognitive functioning that is sensitive to cognitive impairment in both Secondary Progressive and Relapsing –Remitting MS patients. Supported by: Biogen-Idec. Disclosure: Dr. DeLuca has received personal compensation for activities with Kessler Foundation Research Center and Biogen Idec.Dr. DeLuca has received research support from Biogen Idec. Dr. Foley has received personal compensation for activities with Biogen Idec. Dr. Foley has received research support from Bayer Pharmaceuticals. Dr. Benedict has received personal compensation for activities with Bayer Pharmaceuticals Corporation, Biogen Idec, Serono, Inc., Novartis, Merck & Co., Inc. and Pfizer Inc as speaker, consultant and/or member on advisory panel. Dr. Benedict has received research support from Memen Pharmaceuticals, Shire Pharmaceuticals and Biogen Idec. Dr. Caruso has received personal compensation for activities with Biogen Idec as a consultant. Dr. Caruso has received research support from Biogen Idec. Dr. Erlanger has received personal compensation for activities with Biogen Idec as a consultant. Dr. Erlanger has received research support from Biogen Idec. Dr. Kaushik has received personal compensation for activities with Panmedix as a research coordinator. Dr. Kaushik has received research support from Biogen-Idec.

Suitability of the Montreal Cognitive Assessment versus the Mini-Mental State Examination in Detecting Vascular Cognitive Impairment

The Mini-Mental State Examination (MMSE) has been criticized as being an insufficient screening test for patients with vascular cognitive impairment because of its insensitivity to visuospatial and executive functional deficits. The Montreal Cognitive Assessment (MoCA) was designed to be more sensitive to such deficits, and thus may be a superior screening instrument for vascular cognitive impairment. Twelve patients with extensive leukoaraiosis detected on magnetic resonance imaging (average age, 76.0 ± 8.7 years) underwent neurologic and cognitive testing, including MMSE and the Japanese version of the MoCA (MoCA-J). Accepted cutoff scores of <27 for the MMSE and <26 for the MoCA-J were taken to indicate cognitive impairment. Z-scores were calculated to evaluate the discriminating ability of individual MMSE and MoCA-J subtest scores. Although there was a strong correlation between the total MMSE and total MoCA-J scores (r = 0.90; P < .0001), MMSE scores were skewed toward the higher end of the range (range, 18-30; median, 28), whereas MoCA-J scores were normally distributed (range, 9-28; median, 21). Of the 7 patients with an unimpaired MMSE score, 6 (86%) had an impaired MoCA-J score. Z-scores were >5 for 4 MMSE subtests (orientation, registration, naming, and language) but for only 1 MoCA-J subtest (naming). The MoCA-J better discriminated cognitive status in subjects with extensive leukoaraiosis. Our findings suggest that the MoCA-J is more sensitive than the MMSE in screening for cognitive impairment in patients with subcortical vascular cognitive impairment.