Population-specific Norms Research Articles

Trabecular bone score norms in Asian-Indians and associations with serum 25(OH)D and parathyroid hormone.

There is limited information on population-specific norms of trabecular-bone-score (TBS) and its associated factors. Here, we provide norms of TBS in Asian-Indians and its relationship with serum 25-hydroxyvitamin D [25(OH)D] and intact-parathyroid hormone (iPTH). TBS, bone-mineral-density (BMD), and vertebral-fractures (VFs) were assessed using dual-energy X-ray absorptiometry in 923 healthy Asian-Indians (aged 20-60 years). Serum 25(OH)D, iPTH, T4/TSH,, glycosylated-haemoglobin (HbA1c) were measured and associations with TBS assessed using multivariable linear regression. Subjects with BMD Z-score ≤ -2.0 or ≥2.0 at any sites, VFs, TSH > 10.0 or <0.05 µIU/ml, blood-glucose >11.1 mmol/L or HbA1c > 8.0% were excluded for generating Asian-Indian norms. TBS norms were generated in 744 healthy Asian-Indians (M:F,389:385). The cut-offs generated for 'normal', 'partially-degraded', and 'degraded' TBS were >1.305, 1.204-1.305 and <1.204, respectively. Mean TBS was lower in females than males (p < .001). There was 75% congruency in TBS categories between Asian-Indian and existing norms. Specificity (97.8 vs. 77.9%, p < .001) and diagnostic-accuracy (97.8% vs. 78.4%, p < .001) of TBS to detect osteoporosis were higher with Asian-Indian norms. The sensitivity of 'partially-degraded' TBS to diagnose osteopenia was also higher with Asian-Indian norms. In multivariable regression, gender, body-mass-index (BMI), BMD-L1-L4, serum PTH, daily dietary-calorie intake and calcium intake were associated with TBS. Though 25(OH)D inversely correlated with PTH, 25(OH)D was not associated with TBS. This study provides norms for TBS in Asian-Indians with gender-specific differences. Increasing age and higher BMI were associated with lower TBS. Associations of TBS with circulating PTH and/or 25(OH)D need confirmation in further studies.

Assessment of normal renal size in healthy individuals in Pakistan and its influencing factors: A cross-sectional study

Background and objectives. In order to address the need to establish normative benchmark of kidney size in healthy population of Pakistan, this study aimed to assess and quantify the renal sizes in healthy individuals within the Pakistani population using ultrasound imaging. Secondary objectives included examining age-related variations, gender-specific differences, and the correlation between Body Mass Index (BMI) and kidney measurements. Materials and methods. A five-year retrospective investigation of 509 patients undergoing non-renal abdominal ultrasounds at NIKUD Research Hospital employed strict participant criteria, excluding those with diabetes, hypertension, abnormal eGFR, or urinalysis. Ultrasound data was collected from medical record of patients aged 18-80 years without a history or ongoing renal disease, excluding any conditions impacting renal size. Results. In 480 participants meeting stringent health criteria, the right kidney measured 10.45 ± 0.97 cm, and the left kidney measured 10.64 ± 0.95 cm. Age-related variations included increasing renal length until the fifth decade, followed by decline. Gender-specific differences, though statistically non-significant, suggested slightly larger renal sizes in females. A positive BMI and renal length relationship indicated increased sizes in obese individuals. Conclusions. This study establishes renal size benchmarks in a healthy Pakistani population, highlighting demographic factors' role in assessments. Variations across age, gender, and BMI underscore the need for population-specific norms in clinical evaluations.

Physician norms for the Automated Neuropsychological Assessment Metrics (ANAM)

Introduction The development of population specific norms for the Automated Neuropsychological Assessment Metrics (ANAM) is to help expand the utility for use with other population groups. Currently, normative data are available for general military, special operations, athletic, and community populations. The current study provides normative reference values for use in assessing physicians. Materials and methods Retrospective data from a sample of 2,288 physicians who completed the ANAM were examined. The data were gathered from practicing civilian physicians serving in the National Guard or Reserves who completed the assessment as part of the mandated Department of Defense clinical testing policy. The effects of age and sex on performance were examined for all subtests. Normative tables were stratified by age (23–29, 30–34, 35–39, 40–44, 45–49, 50–54, 55–59, 60–64, 65–79) and sex. Base rates of low scores among the physician population were also examined. Results Older age was associated with lower performance on all subtests with small-to-medium effect sizes. A mixed pattern of performance was observed as a factor of sex with females scoring better on one subtest and males scoring better on three subtests. However, effects sizes associated with sex were small and likely of minimal clinical significance. A total of 11.3% of the physician sample scored below average on two or more tests in the battery. Conclusions This study provides normative data for practicing physicians that can be used to help inform clinical decision-making.

Normative data for three physical frailty parameters in an aging, rural Indian population.

IntroductionPhysical frailty is associated with multiple adverse health outcomes. Since physical characteristics markedly vary with different populations, population‐specific norms for physical frailty parameters are necessary. Such norms are lacking for the Indian population, especially for older, rural Indians. We aimed to develop normative values for three quantitative, frailty parameters—handgrip strength, “Timed Up‐and‐Go” (TUG) test time, and physical activity in an aging, rural Indian population.MethodsThe study sample is from an ongoing, prospective, cohort (Srinivaspura NeuoSenescence and COGnition, SANSCOG) comprised of rural, community‐dwelling, cognitively healthy, aging Indians. Subjects are recruited through area sampling strategy, from villages of Srinivaspura, Kolar district, Karnataka state, India. Three physical frailty parameters of Fried's phenotype—handgrip strength (n = 1787), TUG time (n = 1863), and physical activity (n = 1640) were assessed using digital hand dynamometry, TUG test, and General Physical Activity Questionnaire (GPAQ), respectively.ResultsThe 10th, 25th, 50th, 75th, 90th percentiles for the three frailty parameters were: right‐hand grip strength (kg): males—13.9, 18.6, 23.8, 28.7, 33.7 and females—7.8, 10.6, 14.2, 17.9, 21.3; left‐hand grip strength (kg): males—13.3, 18.3, 23.6, 28.9, 32.9 and females—7.9, 10.5, 14.3, 17.8, 21.2; TUG time (s): males—9.1, 10.1, 11.4, 13.4, 15.5 and females—9.5, 10.7, 12.4, 14.5, 16.6; physical activity (MET‐minutes/week): males—1680; 4320; 8880; 15,840; 23,352 and females—1680; 4320; 9240; 15,120; 20,160.DiscussionOur findings show that from 45 years onwards, overall grip strength decreases and TUG time increases, with women performing significantly poorer than men across all age groups, except >75 years, where no differences were seen. Physical activity did not show any consistent trend according to age or gender. Reference values for this aging, rural Indian population were substantially lower for grip strength and higher for TUG time than aging populations in several Western and other Asian countries.

Updated demographically adjusted norms for the Brief Visuospatial Memory Test-revised and Hopkins Verbal Learning Test-revised in Spanish-speakers from the U.S.-Mexico border region: The NP-NUMBRS project

Objective We generated demographically adjusted norms for the Brief Visuospatial Memory Test-revised (BVMT-R) and the Hopkins Verbal Learning Test-revised (HVLT-R) for Spanish-speakers from the U.S.-Mexico border region as part of a larger normative project. Methods: Healthy native Spanish-speakers (n = 203; Age: 19–60 years; Education: 0–20 years, 59% women) living in Arizona (n = 63) and California (n = 140) completed the BVMT-R and the HVLT-R as part of the larger Neuropsychological Norms for the U.S.-Mexico Border Region in Spanish (NP-NUMBRS) project. Raw scores were converted to T-scores utilizing fractional polynomial equations, which considered linear and non-linear effects of demographic variables (age, education, sex). To demonstrate the benefit of employing our population-specific norms, we computed the proportion of our participants whose test performance fell below one standard deviation (T-score < 40) when applying published norms from non-Hispanic English-speakers, compared to the base rate derived from the new normative sample. Results: The resulting demographically adjusted T-scores showed the expected psychometric properties and corrected the misclassification in rates of impairment that were obtained when applying norms based on the English-speaking sample. Unexpectedly, participants in Arizona obtained slightly lower HVLT-R T-scores than those in California. This site effect was not explained by available sociodemographic or language factors. Supplementary formulas were computed adjusting for site in addition to demographics. Conclusions: These updated norms improve accuracy in identification of learning and memory impairment among Spanish-speaking adults living in the U.S.-Mexico border region. It will be important to generate additional data for elders, as the present norms are only applicable to adults age 60 and younger.

A Preliminary Analysis of Tympanometric Parameters in a Local Multiethnic Population.

Background: Tympanometry is a routine clinical test ordered at the Department of Otolaryngology, Ear, Nose and Throat (ENT) at Changi General Hospital (CGH). In combination with the pure tone audiogram, tympanograms aid in the diagnostic value of various middle ear disorders. However, its diagnostic value depends on the physician and audiologist’s accuracy of classifying and interpreting the tympanograms. Presently, Caucasian normative values are used in the classification of tympanograms, which could be inaccurate without population specific norms. Therefore, there is a need to understand ethnic differences in tympanometry parameters in order to usefully interpret the tympanogram. Thus far, there are no local studies on the differences in tympanometric parameters among multiethnic groups. Previous studies also had conflicting results on the effects of ethnicity with direct or indirect comparison only between two ethnic groups. To our knowledge, this is the first preliminary investigation on the effects of demographic and anthropometric measurements on tympanometric parameters. Materials and Methods: 90 patients’ medical charts were randomly selected and reviewed to extract demographic, anthropometric and clinical information. Tympanogram characteristics among ethnic groups were investigated using univariate and multivariate analyses. The mean ages of males and females in the study were 41.9 years ± 17.4 and 46.1 ± 19.2, respectively. Results: Gender significantly influenced ear canal volume (ECV). Chinese had marginally significant lower static admittance (SA) as compared to non-Chinese. There were, however, no effects of age or anthropometric measurements on tympanometric results. Conclusion: Further prospective large cohort analyses are warranted to expand this investigation to better elucidate differences observed in tympanometric parameters and establish population specific norms for appropriate and accurate tympanogram classifications.

Developing and evaluating the validity of the behavioural assessment of dysexecutive functioning – intellectual disabilities adaptation (BADS-ID)

PurposeAssessment of executive functioning is an important element of a comprehensive assessment of intellectual abilities. Few assessments available are accessible for individuals with intellectual disabilities (ID) and none have population-specific norms. This paper aims to describe the adaptation of the behavioural assessment of dysexecutive syndrome (BADS).Design/methodology/approachAdaptations were made to the BADS tests to create the BADS – intellectual disabilities (BADS-ID). Data from three doctoral dissertations were combined to explore the utility, reliability, validity and component structure of the BADS-ID. Properties of the BADS-ID were compared with the Cambridge Executive Functioning Assessment (CEFA).FindingsThe BADS-ID is accessible to IQ range 50–70 and has a two-component structure. It has good inter-rater reliability, but poor internal consistency. It has a good face and content validity but evidence for concurrent and discriminative validity is weak. All properties are comparable to or better than the CEFA.Research limitations/implicationsFurther research is needed to improve reliability and validity. The development of an accessible test battery with known reliability and validity for individuals with ID should facilitate research into executive functioning in this population. There is the potential to develop population-specific norms from the data.Practical implicationsAn accessible test battery for individuals with ID is helpful in clinical situations.Originality/valueTo the best of the authors’ knowledge, this is the first study to explore the adaptation of the BADS for use with individuals with ID.

Neurocognitive impairment in Spanish-speaking Latinos living with HIV in the US: Application of the neuropsychological norms for the US–Mexico border region in Spanish (NP-NUMBRS)

Objective Latinos in the US are at increased risk for HIV-associated neurocognitive impairment (NCI). Most studies of US Latinos living with HIV have included primarily English-speakers only. We investigated the rate, pattern, and correlates of HIV-associated NCI in native Spanish-speaking Latinos living in the US near the Mexican border. Methods Participants included 407 native Spanish-speaking Latinos (Age: M = 37.65, SD = 10.0; Education: M = 10.75, SD = 4.1; 53% male): 153 persons living with HIV (PLWH; 56% AIDS) and 254 healthy controls. All participants completed comprehensive neuropsychological assessments in Spanish. Raw neuropsychological test scores from seven domains were converted to demographically-adjusted T-scores using norms developed with healthy controls. Global and domain NCI were defined per established criteria. Among PLWH we applied norms developed for non-Hispanic (NH) Whites and Blacks, and investigated correlates of global NCI, including HIV disease characteristics and psychiatric comorbidities. Results Utilizing population specific norms, rates of global NCI were significantly higher among PLWH (39%) than healthy controls (17%), comparable to previously published rates. In contrast, rates of global NCI in the same group of PLWH were significantly different when NH White norms (63%, p < 0.0001) and NH Black norms were used (18%, p < 0.0001). Among PLWH without a history of lifetime substance use disorder, more years of antiretroviral exposure were significantly associated with decreased rates of global NCI. Conclusions Present findings lend support to the validity of newly developed norms for native Spanish-speakers living near the US-Mexico border, and underscore the importance of utilizing appropriate norms to accurately identify HIV-associated NCI.

An evaluation of the Movement ABC-2 Test for use in Italy: A comparison of data from Italy and the UK

BackgroundThe standardized test within the Movement Assessment Battery for Children-2nd edition (MABC-2) is used worldwide to assess motor problems in children. Ideally, any country using a test developed in another country should produce national norms to ensure that it functions effectively in the new context. AimThe first objective of this study was to explore the differences in motor performance between Italian and British children. The second was to examine the structural validity of the test for the Italian sample. MethodA total of 718 Italian (IT) and 765 British (UK) children, aged 3–10 years, were individually tested on the age-appropriate items of the MABC-2 Test. ResultsDevelopmental trends emerged on every task and differences between IT and UK children were obtained on 11 of 27 task comparisons. Interactions between age and country indicated that differences were not consistently in favor of one culture. Confirmatory factor analysis generally supported the proposed structure of the MABC-2 Test. ConclusionAlthough the differences between the IT and the UK children were relatively few, those that did emerge emphasize the need for population specific norms and suggest that cultural diversity in motor experiences should be considered when evaluating motor abilities in children.

Intelligence, Functioning, and Related Factors in Children with Cerebral Palsy.

Cerebral palsy (CP) is the most common significant motor impairment in childhood. CP is defined as a primary disorder of posture and movement; however, intellectual impairment is prevalent in children with CP. The purpose of this study was to examine the intelligence level associated with gross motor function and hand function, type of CP, the presence of comorbid disorders such as epilepsy, and other factors. In total, 107 children with CP were included. Age, gender, prenatal/natal/postnatal risk factors, type of CP, and presence of other neurodevelopmental disorders were recorded as demographic findings. Intellectual functions of the patients were determined by clinical assessment, adaptive function of daily life, and individualized, standardized intelligence testing. The gross motor function and hand function of the patients were classified using the "Gross Motor Function Classification System" and "Bimanual Fine Motor Function" measurements, respectively. The mean age of the patients was 8.10±3.43 years (2-16 years). The study included 63 (58.9%) male patients and 44 (41.1%) female patients. During clinical typing, 80.4% of the patients were spastic, 11.2% were mixed, 4.7% were dyskinetic, and 3.7% were ataxic. Intellectual functioning tests found 26.2% of the children within the intellectual norm and that 10% of the children had a borderline intellectual disability, 16% of them had a mild intellectual disability, 17% of them had a moderate intellectual disability, and 30.8% of them had a severe intellectual disability. No significant relationship was determined between the CP type and intellectual functioning (p>0.05). Intellectual functioning was found to be significantly correlated with hand functions and motor levels (p<0.001). Factors related with intellectual functioning were neonatal convulsion, epilepsy, and speech disorders. Intelligence assessment should be an essential part of CP evaluation and research. There is not enough reliable knowledge, unanimity regarding validity data, and population-specific norms in the intelligence assessments of children with CP. Research is required to assess properly intelligence for children with CP.

The Interrelationship of Common Clinical Movement Screens: Establishing Population-Specific Norms in a Large Cohort of Military Applicants.

Musculoskeletal injuries (MSK-Is) are a leading cause of missed duty time and morbidity in the military. Modifiable risk factors for MSK-Is, such as inadequate core stability, poor movement patterns, and dynamic balance deficits, have not been identified in military applicants on entering service. To establish normative functional movement data using a series of screens in military applicants entering basic training and explore relationships among several movement tests. Cross-sectional study. Military Entrance Processing Station. A total of 1714 (1434 male, 280 female) military applicants entering the US Army (n = 546), Navy (n = 414), Air Force (n = 229), or Marine Corps (n = 525). We conducted the Functional Movement Screen (FMS), Y-Balance Test (YBT), overhead squat (OHS), and Landing Error Scoring System (LESS). Movements were assessed using the scoring convention for each screen. The FMS, YBT, OHS, and LESS scores and associations among the movement screens as well as clinical meaningfulness. A total of 1037 of the 1714 enrolled applicants were screened on the day they left for basic training. Normative means for this population were established: FMS = 14.7 ± 1.8, YBT anterior-reach difference = 3.1 ± 3.0 cm, mean YBT composite differences = 8.0 ± 6.8 cm, mean YBT composite percentage = 90.9% ± 8.3%, OHS errors = 5.0 ± 2.8, and LESS score = 5.7 ± 2.1. Backward regression results revealed that the YBT composite percentage was related to the FMS and OHS scores in males and to the FMS and LESS results in females. However, clinically meaningful relationships between the tests varied for both males and females. Sex-normative values for the FMS, YBT, OHS, and LESS screens were established for US military applicants, and some of the assessments overlapped. Overall, males performed better on the OHS and LESS and achieved a greater YBT composite percentage than females. The regression results revealed movement screen performance relationships that varied by sex and clinical meaningfulness. In future studies, we will determine if performance on any of the screens is associated with MSK-Is in basic trainees.

Performance of Dutch children on the Bayley III: a comparison study of US and Dutch norms.

BackgroundThe Bayley Scales of Infant and Toddler Development-third edition (Bayley-III) are frequently used to assess early child development worldwide. However, the original standardization only included US children, and it is still unclear whether or not these norms are adequate for use in other populations. Recently, norms for the Dutch version of the Bayley-III (The Bayley-III-NL) were made. Scores based on Dutch and US norms were compared to study the need for population-specific norms.MethodsScaled scores based on Dutch and US norms were compared for 1912 children between 14 days and 42 months 14 days. Next, the proportions of children scoring < 1-SD and < -2 SD based on the two norms were compared, to identify over- or under-referral for developmental delay resulting from non-population-based norms.ResultsScaled scores based on Dutch norms fluctuated around values based on US norms on all subtests. The extent of the deviations differed across ages and subtests. Differences in means were significant across all five subtests (p < .01) with small to large effect sizes (η p 2) ranging from .03 to .26). Using the US instead of Dutch norms resulted in over-referral regarding gross motor skills, and under-referral regarding cognitive, receptive communication, expressive communication, and fine motor skills.ConclusionsThe Dutch norms differ from the US norms for all subtests and these differences are clinically relevant. Population specific norms are needed to identify children with low scores for referral and intervention, and to facilitate international comparisons of population data.

Hispanic Youth With Excess Weight Display Psychological Distress

Adolescent overweight/obesity (OW/O) has reached epidemic proportions. The Youth Self-Report (YSR) was administered to 514 primarily Hispanic urban high school students to examine the relationship between weight and psychological distress. YSR and study population-specific norms were used to assess risk on Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, and Social Problems scales. OW/O status increased Social Problems regardless of norms. OW/O students endorsed greater Withdrawn/Depressed symptoms with YSR norms; greater Anxious/Depressed and Somatic Complaints were endorsed with population-specific norms. Females drive results. Findings suggest norms need to incorporate minority and economically disadvantaged groups.

Intelligence assessments for children with cerebral palsy: a systematic review

Cerebral palsy (CP) is defined as a primary disorder of posture and movement; however, approximately 45% of children with CP also have an intellectual impairment. Prevalence estimates are limited by a lack of guidelines for intelligence testing. This systematic review aims to identify and examine intelligence assessments for children with CP. Electronic databases (PubMed, PsycINFO, Web of Science, CINAHL, EMBASE, and ERIC) were searched to identify assessments that (1) measured intellectual function, (2) in children aged 4 to 18 years, (3) with CP, and (4) with psychometrics available. Searches yielded 48 assessments, of which nine provided psychometric data for children with CP. The included tests were the Columbia Mental Maturity Scale, the Leiter International Performance Scale, the Peabody Picture Vocabulary Test, the Pictorial Test of Intelligence, the Raven's Coloured Progressive Matrices, the Stanford-Binet Intelligence Scales, the Wechsler Adult Intelligence Scale, the Wechsler Intelligence Scale for Children, and the Wechsler Preschool and Primary Scale of Intelligence. Intelligence assessments in children with CP lack reliability data, consensus regarding validity data, and population-specific norms. Research is required to establish psychometrics for children with CP. For children with higher motor involvement and/or communication and/or visual impairments, multiple options are required to assess intelligence appropriately.

International Epidemiology of Child and Adolescent Psychopathology I: Diagnoses, Dimensions, and Conceptual Issues

To review international findings on the prevalence of diagnosed disorders, generalizability of dimensional scales, and distributions of dimensional scores for school-age children and to address the conceptual and clinical issues raised by the findings. A review of findings for interviews (Development and Well-Being Assessment, Diagnostic Interview Schedule for Children) and dimensional rating instruments (Conners Rating Scales, Strengths and Difficulties Questionnaire [SDQ]) that have been used to assess general population samples of at least 300 children in at least five societies. Prevalence estimates for diagnosed disorders varied greatly, owing at least in part to methodologic variations. A Goodman five-dimension model for the SDQ received some support, whereas a three-dimension internalizing-externalizing-prosocial model for the SDQ was supported for epidemiologic studies. The SDQ total difficulties scores varied less than the prevalence estimates for diagnoses, but population-specific norms may be needed. Numerous studies have shown the feasibility of assessing children in diverse societies with diagnostic interviews and dimensional ratings. However, the findings disclose challenges to be met to help clinicians take account of the similarities and differences found for psychopathology in different societies.

Stereophotogrammetric Analysis of Nasolabial Morphology among Asian Malays: Influence of Age and Sex

It is clear that population-specific norms should be used when planning plastic and reconstructive surgery for selected patients. In this study, we aimed to generate nasal and labial reference values by applying a stereophotogrammetric technique. A further aim was to investigate the effect of sexual dimorphism, age-related changes, and the interrelation between nasal and labial morphology. Cross-sectional study. The data were collected from different locations on the Malaysian peninsula. A total of 276 Asian Malays (138 males and 138 females) were included in this study, and a three-dimensional system was used for capturing data. The sample was divided into three age groups: 13 to 14, 15 to 17, and 18 to 36 years. Twenty-five dimensions of the nose and lips were measured and analyzed separately in males and females. Significant differences between males and females were identified in 11 distances, and significant effects of age were found in most of the dimensions (p < .05). Significant correlations between the nasal and labial dimensions were recorded, particularly between lateral lip height and width of the ala insertion. A principal component analysis showed interrelationships between the nasal width distances and upper lip height. This study has provided a new three-dimensional database for nose and lip morphology in Malays and demonstrated patterns of variation that can be used by surgeons to make comparisons within and between different human populations and also to develop treatment plans for their patients.

S36-04 - Culturally sensitive assessment of depression from a psychometric perspective

A significant challenge in the culturally sensitive use of psychological and psychiatric instruments for depression is “bias”. Bias means that there is a lack of equivalence: Variation in the score is a result not of variation in the disorder or presence of the symptom in question but rather is due to “cultural factors”. Construct bias is perhaps the most complex of all, and is related to the very manner in which depression is understood. Psychological and psychiatric diagnostic and screening instruments delimit the very “nature” of depression, and fall prey to both false positives and false negatives when assessing individuals from cultures in which the experience and expression of depression is distinct from that found in the West. Equally complex are both method and item bias. In the former, the very method used—for example, a horizontal Likert-like scale—is responded to differentially across cultures, thus resulting in variance that is due not to variations in the presence of symptom but rather the manner of response. Item bias occurs when the item in question is understood in different ways in different cultures. Finally, there is concern about basic issues surround norms, cut-off scores and the like, in as much as the lack of equivalence indicates that results must be interpreted in accordance with population specific norms. Depression diagnostic and screening instruments and their items will be selectively reviewed to demonstrate the presence of bias, and concrete suggestions will be presented to achieve a more culturally sensitive assessment process.

Neuropsychological testing of culturally and linguistically diverse individuals: the case of Greek-speaking individuals

The aim of this review is to update clinicians and researchers regarding neuropsychological tools that have been normed in Greece, thereby assisting them to improve diagnostic accuracy when undertaking neuropsychological assessment of Greek-speaking individuals. A growing number of neuropsychological tests of cognition have been normed in the healthy Greek adult population and the findings reported in the English-language literature. Neuropsychological Greek normative studies have revealed performance differences in Greek speakers. In general, research findings indicate that population-specific norms are required for accurate neuropsychological assessment of the Greek adult population. Validating neuropsychological tests of cognition in healthy Greek adults improves clinicians' and researchers' ability to accurately assess, diagnose and manage Greek individuals with cognitive disorders. Normative studies in Greek-speaking clinical populations and studies examining performance differences between native Greek speakers and the Greek diaspora are directions for future research.

Abstract 6214: Comparison of Adiponectin Levels in Healthy Americans and Japanese: Results from Framingham and Fukuoka

Background and Objectives: Adiponectin is an adipocytokine with insulin-sensitizing and anti-atherosclerotic effects. Serum adiponectin levels have been reported to be negatively correlated with body weight and waist circumference (WC). Low plasma adiponectin levels are known to predispose to the development of insulin resistance and type 2 diabetes mellitus. Adiponectin levels may vary according to ethnic group. The aim of this study was to investigate potential differences in plasma adiponectin levels between Japanese and Americans. Methods: Subjects consisted of 2,060 healthy American male and female participants in exam 6 of the Framingham Offspring Study (mean age 57.0 ± 9.0 years, 57.4 ± 10.5 years, respectively), and 1131 healthy Japanese male and female participants in the Fukuoka Study (mean age 56.3 ± 5.5 years, 55.6 ± 5.4 years, respectively). Frozen plasma samples (at −80 degree C) from both studies were shipped to Tufts University, Boston. Plasma concentrations of direct LDL-C, fasting plasma glucose and adiponectin were measured using the same assay kits on the same machine (Hitachi 911) by the same staff. Anthropometric measurements including weight, height, body mass index (BMI) and WC, were also used in the analysis. Results: Plasma adiponectin levels were significantly and inversely correlated with BMI, WC, glucose, insulin, triglycerides, and systolic and diastolic blood pressure. Moreover adiponectin levels were significantly and positively correlated with HDL-C in both populations. Mean BMI and WC of Japanese men and women were significantly lower (23.8 kg/m 2 and 22.1 kg/m 2 , 86.0 cm and 78.7 cm, respectively) than in US men and women (28.2 kg/m 2 and 27.0 kg/m 2 , 100.4 cm and 92.8 cm, respectively) (all p&lt;0.05). However, mean adiponectin levels (± SD) in Japanese men and women were significantly lower (9.3 ± 4.5 micro g/mL and 14.7 ± 7.3 micro g/mL, respectively) than in US men and women (10.3 ± 5.2 micro g/mL and 16.3 ± 7.7 micro g/mL, respectively)(p&lt;0.05). Conclusion: Our data indicate a substantially lower prevalence of adiposity, but not higher adiponectin levels, in a healthy Japanese population as compared to an American population. The data indicate that population specific norms may have to be used for different ethnic groups.

Performance on the Mini-Mental State Examination and Mattis Dementia Rating Scale Among Older American Indians

Performance on the Mini-Mental State Examination and Mattis Dementia Rating Scale Among Older American Indians