Visual Association Test Research Articles

Visual associative learning to detect early episodic memory deficits and distinguish Alzheimer's disease from other types of dementia.

We investigated how well a visual associative learning task discriminates Alzheimer's disease (AD) dementia from other types of dementia and how it relates to AD pathology. 3,599 patients (63.9 ± 8.9 years old, 41% female) from the Amsterdam Dementia Cohort completed two sets of the Visual Association Test (VAT) in a single test session and underwent magnetic resonance imaging. We performed receiver operating curve analysis to investigate the VAT's discriminatory ability between AD dementia and other diagnoses and compared it to that of other episodic memory tests. We tested associations between VAT performance and medial temporal lobe atrophy (MTA), and amyloid status (n = 2,769, 77%). Patients with AD dementia performed worse on the VAT than all other patients. The VAT discriminated well between AD and other types of dementia (area under the curve range 0.70-0.86), better than other episodic memory tests. Six-hundred forty patients (17.8%) learned all associations on VAT-A, but not on VAT-B, and they were more likely to have higher MTA scores (odds ratios range 1.63 (MTA 0.5) through 5.13 for MTA ≥ 3, all p < .001) and to be amyloid positive (odds ratio = 3.38, 95%CI = [2.71, 4.22], p < .001) than patients who learned all associations on both sets. Performance on the VAT, especially on a second set administered immediately after the first, discriminates AD from other types of dementia and is associated with MTA and amyloid positivity. The VAT might be a useful, simple tool to assess early episodic memory deficits in the presence of AD pathology.

Reduced visual associative learning is linked to Alzheimer’s disease pathology

AbstractBackgroundReduced learning is an early sign of memory impairment and relevant in the context of Alzheimer’s disease. The Visual Association Test (VAT) is a brief visual associative memory task comprising two sets (A and B) of six interactive pictures (e.g., a monkey holding an umbrella). We hypothesized that the VAT may be able to elicit learning deficits on set B when administered directly following set A, particularly in patients with Alzheimer’s disease‐related episodic memory deficits. We related learning on the VAT to medial temporal lobe atrophy (MTA) and amyloid‐β positivity.MethodWe selected 3,599 patients (63.9±8.9 years, 41% female) who completed two VAT sets. Patients had subjective cognitive decline (n = 1,369, 38%), mild cognitive impairment (n = 756, 21%), Alzheimer’s disease dementia (n = 856, 24%), or other types of dementia (n = 618, 17%). Average MTA scores of both hemispheres from magnetic resonance imaging were available for all; amyloid‐β status was obtained from cerebrospinal fluid or positron emission tomography for n = 2,769 (77%). We modeled learning curves on both VAT sets using linear mixed models, including an interaction with amyloid‐β status. Using logistic regressions, we analyzed the relationship between learning of associations on both sets (either all associations on both sets, or all associations on the first, but not the second set) and MTA, as well as amyloid‐β status.ResultMost patients learned all associations on both sets (n = 2,442, 68%). Patients who learned all associations on the first, but not the second set (n = 640, 18%) were more likely to have higher MTA scores and to be amyloid‐β positive than those who learned all associations (Table 1). Figure 1 shows learning curves on both sets of the VAT, stratified by amyloid‐β status. Less steep learning curves seem to suggest that amyloid‐β positive patients benefited less from completing a first set than amyloid‐β negative patients.ConclusionWe observed reduced learning on the second set, with those who did not learn all associations on both sets having more medial temporal lobe atrophy and more often being amyloid‐β positive. The VAT may be a useful, simple tool to assess early episodic memory deficits in the presence of Alzheimer’s disease pathology.

Adiposity and insulin resistance moderate the links between neuroelectrophysiology and working and episodic memory functions in young adult males but not females

IntroductionObesity and insulin resistance negatively influence neural activity and cognitive function, but electrophysiological mechanisms underlying these interrelationships remain unclear. This study investigated whether adiposity and insulin resistance moderated neural activity and underlying cognitive functions in young adults. MethodsReal-time electroencephalography (EEG) was recorded in 38 lean (n = 12) and obese (n = 26) young adults with (n = 15) and without (n = 23) insulin resistance (18–38 years, 55.3% female) as participants completed three neurocognitive tasks in working memory (Operation Span), inhibitory control (Stroop), and episodic memory (Visual Association Test). Body fat percentage was quantified by a dual-energy X-ray absorptiometry scan (DEXA/DXA). Fasting serum insulin and glucose were quantified to calculate Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) values, for which a higher value indicates more insulin resistance. Hierarchical moderated regression analysis tested these interrelationships. ResultsIn males, greater frontal negative slow wave (fNSW) and positive slow wave (PSW) amplitudes were linked to higher working memory accuracy in participants with low, but not high, body fat percentage and HOMA-IR levels. In contrast, body fat percentage and HOMA-IR did not moderate these associations in females. Furthermore, body fat percentage and HOMA-IR values moderated the relationship between greater fNSW amplitudes and better episodic memory accuracy in males, but not females. Finally, body fat percentage and insulin resistance did not moderate the link between neural activity and inhibitory control for either sex. ConclusionYoung adult males, but not females, with higher body adiposity and insulin resistance showed reduced neural activity and worse underlying working and episodic memory functions.

FC 104: Apathy Associates with Cognitive Dysfunction and Mortality in Older Ckd Patients

Abstract BACKGROUND AND AIMS The growing population of older patients with chronic kidney disease (CKD) often faces unidentified cognitive impairments and high prevalence of depressive symptoms. Apathy is a clinical syndrome associated with both depression and cognitive decline in community-dwelling older people. Furthermore, apathy has been more often linked to vascular impairments, which are also highly prevalent in the CKD population. However, so far, prevalence and consequences of apathy in older CKD patients have not been studied. We aimed (1) to investigate the prevalence of apathy symptoms in an older population with CKD stage G4/G5 (eGFR &amp;lt; 20 mL/min/1.73 m2), and (2) to assess if apathy is associated with, frailty, cognitive and functional impairments and mood. In addition, we (3) investigated the relation between apathy at baseline and mortality during four years of follow-up. METHOD Data was used from the prospective multicenter COPE (Cognitive Decline in Older Patients with ESKD) cohort, which included CKD patients aged ≥65 years with an eGFR of ≤20 mL/min/1.73 m2. Symptoms of apathy were assessed with the 3-item subscale of the 15-item Geriatric Depression (GDS-3A score ≥2) and depressive symptoms with the remaining items of this scale (GDS-12D ≥2). Frailty, (Fried Frailty Index ≥3), functional dependence (GARS score), handgrip strength and walking speed were measured. Cognitive functioning was assessed by means of global cognition (Mini Mental State Examination), visuoconstruction (Clock drawing), memory (15-Word Verbal Learning Test and Visual Association Test), executive function (Trail Making Test-B) and psychomotor speed (Letter Digit Substitution Test, Trail Making Test -A). Cross-sectional correlations between groups were tested with t-tests, Mann–Whitney and Chi-squared tests. Hazard ratio for mortality was analysed with Cox regression adjusting for age, gender and primary vascular kidney disease. RESULTS In total n = 180 patients, 67% male, were included with a median age of 75.5 years (IQR 71.0–80.9) and mean eGFR of 16.5 (SD 4.6). Symptoms of apathy and isolated apathy (i.e. with no symptoms of depression) were seen in respectively 36% (n = 64) and 17% (n = 30) of the study population. Presence of apathy symptoms at baseline was associated with primary vascular kidney disease (P = 0.031), depression (P &amp;lt; 0.001), frailty (P &amp;lt; 0.001) and decreased physical functioning (i.e. functional dependence; P &amp;lt; 0.001, handgrip strength; P = 0.026 and walking speed; P &amp;lt; 0.001). Presence of apathy symptoms was also associated with reduced executive function (P = 0.045) and psychomotor speed (P = 0.022). Furthermore, patients with apathy symptoms had a 1.9 times higher mortality risk (P = 0.022, adjusted for age, gender and primary vascular renal disease). CONCLUSION Symptoms of apathy occurred in one third of this cohort of older advanced CKD patients. Although apathy was associated with presence of depressive symptoms, half of the cases were not. Apathy is associated with multiple functional and cognitive measures and two-fold increased mortality. Future investigations should focus on cause of apathy and its value in predicting cognitive decline in older CKD patients. Because of the relation of apathy with future outcomes, assessment of apathy might be of value in shared decision making on renal replacement therapy in older CKD patients.

Association of Endogenous Erythropoietin Levels and Iron Status With Cognitive Functioning in the General Population.

BackgroundEmerging data suggest that erythropoietin (EPO) promotes neural plasticity and that iron homeostasis is needed to maintain normal physiological brain function. Cognitive functioning could therefore be influenced by endogenous EPO levels and disturbances in iron status.ObjectiveTo determine whether endogenous EPO levels and disturbances in iron status are associated with alterations in cognitive functioning in the general population.Materials and MethodsCommunity-dwelling individuals from the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study, a general population-based cohort in Groningen, Netherlands, were surveyed between 2003 and 2006. Additionally, endogenous EPO levels and iron status, consisting of serum iron, transferrin, ferritin, and transferrin saturation were analyzed. Cognitive function was assessed by scores on the Ruff Figural Fluency Test (RFFT), as a reflection of executive function, and the Visual Association Test (VAT), as a reflection of associative memory.ResultsAmong 851 participants (57% males; mean age 60 ± 13 years), higher endogenous EPO levels were independently associated with an improved cognitive function, reflected by RFFT scores (ß = 0.09, P = 0.008). In multivariable backward linear regression analysis, EPO levels were among the most important modifiable determinants of RFFT scores (ß = 0.09, P = 0.002), but not of VAT scores. Of the iron status parameters, only serum ferritin levels were inversely associated with cognitive function, reflected by VAT scores, in multivariable logistic regression analysis (odds ratio, 0.77; 95% confidence interval 0.63–0.95; P = 0.02 for high performance on VAT, i.e., ≥11 points). No association between iron status parameters and RFFT scores was identified.ConclusionThe findings suggest that endogenous EPO levels and serum ferritin levels are associated with specific cognitive functioning tests in the general population. Higher EPO levels are associated with better RFFT scores, implying better executive function. Serum ferritin levels, but not other iron status parameters, were inversely associated with high performance on the VAT score, implying a reduced ability to create new memories and recall recent past. Further research is warranted to unravel underlying mechanisms and possible benefits of therapeutic interventions.

Amyloid‐β deposition in cognitively normal oldest‐old is associated with cortical thinning and faster memory decline

AbstractBackgroundThe Alzheimer’s disease (AD) pathological cascade is hypothesized to start with the accumulation of amyloid‐β (Aβ). However, the precise effect of Aβ deposition on cognitive decline in the oldest‐old remains controversial, since very old individuals can have intact cognition despite abnormal AD biomarkers. Here we studied, in cognitively normal individuals of 90 years and older, the impact of Aβ on structural brain integrity and the association of Aβ and structural brain integrity on decline over time in memory functioning.MethodFifty‐seven cognitively normal individuals (age mean ± sd = 92.7 ± 2.9) were selected from the EMIF‐AD 90+ study. Aβ status was determined by visual reads on [18F]‐flutemetamol PET (normal = Aβ‐, abnormal = Aβ+); cortical thickness and hippocampal volume were quantified on structural MRI with FreeSurfer and FSL, respectively. Cortical thickness was computed according to the Desikan‐Killany atlas and averaged across hemispheres. Hippocampal volume was normalized for intracranial volume. Memory performance was evaluated using a composite score of the CERAD (delayed recall), Logical Memory (delayed recall), Rey Complex Figure (delayed copy), and the Visual Association Test, that were repeated after 20 months (n = 43). Effects of Aβ status, regional cortical thickness, hippocampal volume, time, and their interactions on memory function were assessed with linear mixed models, adjusted for age and sex.ResultRoughly one out of three (n = 19; 33%) individuals had an abnormal amyloid PET (Table 1). Compared to Aβ‐, those with Aβ+ showed at baseline a thinner parahippocampal and medial orbitofrontal cortex (p&lt;.05; Figure 1), while hippocampal volume did not differ. Over time, Aβ+ individuals showed a steeper decline (β ± SE = ‐.27 ± .09; p&lt;.01;) on memory performance than Aβ‐ (Figure 1). Faster memory decline was also predicted by cortical thinning in predominantly temporal regions in the whole group (Figure 1).ConclusionIn the oldest‐old with initially intact cognition, Aβ pathology was associated with a thinner cortex and faster decline in memory performance. These results suggest that Aβ abnormality, even in the oldest old with apparent high reserve and maintenance mechanisms, is indicative of active neurodegeneration. Other pathologies may also contribute to decline in the oldest old as a thinner temporal lobe predicted decline in memory irrespective of Aβ pathology.

Amyloid‐β deposition in cognitively normal oldest‐old is associated with cortical thinning and faster memory decline

AbstractBackgroundThe Alzheimer’s disease (AD) pathological cascade is hypothesized to start with the accumulation of amyloid‐β (Aβ). However, the precise effect of Aβ deposition on cognitive decline in the oldest‐old remains controversial, since very old individuals can have intact cognition despite abnormal AD biomarkers. Here we studied, in cognitively normal individuals of 90 years and older, the impact of Aβ on structural brain integrity and the association of Aβ and structural brain integrity on decline over time in memory functioning.MethodFifty‐seven cognitively normal individuals (age mean±sd = 92.7±2.9) were selected from the EMIF‐AD 90+ study. Aβ status was determined by visual reads on [18F]‐flutemetamol PET (normal=Aβ‐, abnormal=Aβ+); cortical thickness and hippocampal volume were quantified on structural MRI with FreeSurfer and FSL, respectively. Cortical thickness was computed according to the Desikan‐Killany atlas and averaged across hemispheres. Hippocampal volume was normalized for intracranial volume. Memory performance was evaluated using a composite score of the CERAD (delayed recall), Logical Memory (delayed recall), Rey Complex Figure (delayed copy), and the Visual Association Test, that were repeated after 20 months (n=43). Effects of Aβ status, regional cortical thickness, hippocampal volume, time, and their interactions on memory function were assessed with linear mixed models, adjusted for age and sex.ResultRoughly one out of three (n=19; 33%) individuals had an abnormal amyloid PET (Table1). Compared to Aβ‐, those with Aβ+ showed at baseline a thinner parahippocampal and medial orbitofrontal cortex (p&lt;.05; Fig.1), while hippocampal volume did not differ. Over time, Aβ+ individuals showed a steeper decline (β±SE=‐.27±.09; p&lt;.01;) on memory performance than Aβ‐ (Fig.1). Faster memory decline was also predicted by cortical thinning in predominantly temporal regions in the whole group (Fig.1).ConclusionIn the oldest‐old with initially intact cognition, Aβ pathology was associated with a thinner cortex and faster decline in memory performance. These results suggest that Aβ abnormality, even in the oldest old with apparent high reserve and maintenance mechanisms, is indicative of active neurodegeneration. Other pathologies may also contribute to decline in the oldest old as a thinner temporal lobe predicted decline in memory irrespective of Aβ pathology.

Pharmacological treatment of increased vascular risk and cognitive performance in middle-aged and old persons: six-year observational longitudinal study

BackgroundLowering vascular risk is associated with a decrease in the prevalence of cardiovascular disease and dementia. However, it is still unknown whether lowering of vascular risk with pharmacological treatment preserves cognitive performance in general. Therefore, we compared the change in cognitive performance in persons with and without treatment of vascular risk factors.MethodsIn this longitudinal observational study, 256 persons (mean age, 58 years) were treated for increased vascular risk during a mean follow-up period of 5.5 years (treatment group), whereas 1678 persons (mean age, 50 years) did not receive treatment (control group). Cognitive performance was three times measured during follow-up using the Ruff Figural Fluency Test (RFFT) and Visual Association Test (VAT), and calculated as the average of standardized RFFT and VAT score per participant. Because treatment allocation was nonrandomized, additional analyses were performed in demographic and vascular risk-matched samples and adjusted for propensity scores.ResultsIn the treatment group, mean (SD) cognitive performance changed from − 0.30 (0.80) to − 0.23 (0.80) to 0.02 (0.87), and in control group, from 0.08 (0.77) to 0.24 (0.79) to 0.49 (0.74) at the first, second and third measurement, respectively (ptrend < 0.001). After adjustment for demographics and vascular risk, the change in cognitive performance during follow-up was not statistically significantly different between the treatment and control group: mean estimated difference, − 0.10 (95%CI − 0.21 to 0.01; p = 0.08). Similar results were found in matched samples and after adjustment for propensity score.ConclusionChange in cognitive performance during follow-up was similar in treated and untreated persons. This suggests that lowering vascular risk preserves cognitive performance.

Associations of Subjective Memory Complaints and Simple Memory Task Scores With Future Dementia in the Primary Care Setting.

Family physicians need simple yet comprehensive algorithms to discriminate between community-dwelling older persons who are at increased risk of dementia and those who are not. We aimed to investigate associations between incident dementia and responses to a single question regarding subjective memory complaints (SMC) combined with scores on 2 simple memory tests that are easy to use in the primary care setting. Analyses were based on data from 3,454 community-dwelling older persons who participated in the 6- to 8-year Prevention of Dementia by Intensive Vascular Care (preDIVA) trial, yielding 21,341 person-years of observation. Participants were considered a single cohort. We used Cox models to assess separate and combined associations of SMC, an imperfect score on the Mini-Mental State Examination delayed recall item (MMSE-5), and an imperfect score on the Visual Association Test (VAT) with future dementia. Subjective memory complaints alone were associated with future dementia (hazard ratio [HR] = 3.01; 95% CI, 2.31-3.94; P <.001), as were the MMSE-5 (HR = 2.14; 95% CI, 1.59-2.87; P <.001) and VAT (HR = 3.19; 95% CI, 2.46-4.13; P <.001) scores. After a median follow-up of 6.7 years, the occurrence of dementia ranged from 4% to 30% among persons with SMC, depending on the MMSE-5 and VAT scores. These test scores did not substantially alter the association with future dementia for persons without SMC. In persons with SMC, the strength of the association between future dementia and an imperfect MMSE-5 score depends substantially on the VAT score.

Assessment of Visual Association Memory in Low-Educated, Non-Western Immigrants with the Modified Visual Association Test

Background: Neuropsychological tests are influenced by culture, language, level of education, and literacy, but there are few cognitive tests of which the applicability in ethnic minority populations has been studied. Objectives: The aim of this study was to assess the reliability and validity of the Visual Association Test (VAT), a test of visual association memory, in a non-Western, low-educated memory clinic population. Additionally, a modified version of the VAT using colored photographs instead of line drawings was studied (mVAT). Method: Both the original VAT and the mVAT were administered to non-Western immigrants (n = 73) from 2 multicultural memory clinics in Rotterdam, The Netherlands, and a control sample of non-demented Turkish elderly (n = 14) with low education levels (32 and 29% illiterate, respectively). Results: Both the VAT and the mVAT were able to discriminate persons with and without dementia (area under the curve: VAT, 0.77–0.88; mVAT, 0.85–0.95). The mVAT had more homogeneous item difficulty levels than the VAT. Administration of parallel versions of the VAT and the mVAT within the same person revealed higher scores on the mVAT (Z = –3.35, p = 0.001). Conclusions: The mVAT is a reliable and valid measure of memory in non-Western immigrants. Clinicians and researchers should be aware that the memory performance of immigrants may be systematically underestimated when using tests with black-and-white line drawings, such as the original VAT.

Testing Episodic Memory in Elderly Subjects: Not as Simple as It Looks

Background/Aims: The available episodic memory tests are not specifically constructed to examine older subjects. Their use in outpatient memory clinics may result in aborted test administration. We used a strict adherence to the test protocol in cognitively healthy, amnestic mild cognitive impairment (aMCI), and Alzheimer’s disease dementia subjects to assess the possibility of preventing this. Methods: This is a cross-sectional study in memory outpatient subjects with a mean age of 74.5 years. Primary study outcomes were: number of missing values and test results in the Visual Association Test (VAT) and the 15 Word Test (15WT). Results: A strict adherence to the test protocol resulted in a 10-fold decrease in the number of missing values in the VAT. For the 15WT this could not be realized mostly because the test was deemed too demanding for 1 in 6 patients. Conclusions: This study is one of the few examining the applicability of well-known episodic memory tests in older subjects. A strict adherence to the test protocol reduced the number of missing values. Floor effects were stronger for the 15WT than for the VAT. Results favor the use of the VAT in senior subjects and show the unsuitability of the 15WT in this group.

The visual association test – Extended: detecting non-credible memory performance

Saliency detection is the task of locating informative regions in an image, which is a challenging task in computer vision. In contrast to the existing saliency detection models that focus on either local or global image property, an effective salient object detection method is introduced based on joint modeling global shape and local consistency. To this end, Restricted Boltzmann Machine (RBM) is utilized to model salient object shape as global image property and Conditional Random Field (CRF), on the other hand, is adopted to achieve its local consistency. In order to obtain the final saliency map, a universal framework is introduced to combine the results of RBM and CRF. Experimental results on five benchmark datasets demonstrate that the proposed saliency detection method performs favorably against the existing state-of-the-art algorithms.

Effects of Korsakoff Amnesia on performance and symptom validity testing

Performance validity tests (PVTs) and Symptom validity tests (SVTs) are developed to identify people that present false or exaggerated symptoms. Although a key factor of both types of tests includes relative insensitivity to cognitive disorders, the direct effects of amnesia have been poorly studied. Therefore, a sample of 20 patients diagnosed with Korsakoff Amnesia (KA) through neuropsychological assessment and 20 healthy comparisons (HC) were administered the Test of Memory Malingering (TOMM), the Structured Inventory of Malingered Symptomatology (SIMS), and the newly developed Visual Association Test – Extended (VAT-E). Our results show that KA patients scored systematically lower on the TOMM and VAT-E, while performance on the SIMS was comparable with healthy comparisons. Some KA patients were regarded as underperformers based on the TOMM and VAT-E, suggesting limitations in applying these instruments in severe amnesia. There was a strong interdependence of PVTs in logistic regression. We conclude that the TOMM and VAT-E are not fully robust against severe memory disorders and show a serious risk of false positives. Complete neuropsychological profile analysis is needed, and PVTs should be interpreted with caution in patients with suspected amnesia.

Improving Prediction of Dementia in Primary Care.

The Mini-Mental State Examination (MMSE) is one of the most widely used instruments to screen for cognitive deficits; however, this instrument alone is not sensitive enough to detect early symptoms of dementia. We aimed to investigate whether additionally using the Visual Association Test (VAT) improves the predictive value of the MMSE score for development of dementia. Analyses were based on data from 2,690 primary care patients aged 70 to 78 years who participated in the Prevention of Dementia by Intensive Vascular Care (preDIVA) trial. We assessed change in the 30-point MMSE score over 2 years and the VAT score at 2 years-dichotomized as perfect (6 points) or imperfect (≤5 points)-and evaluated the predictive values of these tests for a diagnosis of dementia in the subsequent 4 to 6 years. Data were analyzed with logistic regression analysis. Patients having a decline of 2 points or more in total MMSE score over 2 years had an odds ratio of 3.55 (95% CI, 2.51-5.00) for developing dementia. Patients having the same decline in MMSE score plus an imperfect VAT score had an odds ratio of 9.55 (95% CI, 5.89-15.41) for developing dementia. A 1-point decline in MMSE score increased odds of dementia only when the VAT score was imperfect. Dementia risk for patients with a 2- or 3-point decrease in MMSE score and a perfect VAT score did not differ significantly from the average risk of the cohort as a whole. Administering the VAT in patients with a small decline on the MMSE over a 2-year period has substantial incremental value for identifying those at elevated risk for developing dementia. This simple test may help distinguish older adults who need further cognitive examination from those in whom a watchful waiting policy is justified.

Visual Association Test: A brief cognitive tool and low cost alternative to biomarkers in predicting progression of amnestic mild cognitive impairment to Alzheimer’s disease (P5.185)

Visual Association Test: A brief cognitive tool and low cost alternative to biomarkers in predicting progression of amnestic mild cognitive impairment to Alzheimer’s disease (P5.185)

Treatable Vascular Risk and Cognitive Performance in Persons Aged 35 Years or Older: Longitudinal Study of Six Years

BackgroundPoor cognitive performance is associated with high vascular risk. However, this association is only investigated in elderly. As neuropathological changes precede clinical symptoms of cognitive impairment by several decades, it is likely that cognitive performance is already associated with vascular risk at middle-age.ObjectivesTo investigate the association of cognitive performance with treatable vascular risk in middle-aged and old persons.DesignLongitudinal study with three measurements during follow-up period of 5.5 years.SettingCity of Groningen, the Netherlands.ParticipantsCohort of 3,572 participants (age range, 35–82 years; mean age, 54 years; men, 52%).ExposureTreatable vascular risk as defined by treatable components of the Framingham Risk Score for Cardiovascular Disease at the first measurement (diabetes mellitus, smoking, hypercholesterolemia and hypertension).MeasurementsChange in cognitive performance during follow-up. Cognitive performance was measured with Ruff Figural Fluency Test (RFFT) and Visual Association Test (VAT), and calculated as the average of the standardized RFFT and VAT score per participant.ResultsThe mean (SD) cognitive performance changed from 0.00 (0.79) at the first measurement to 0.15 (0.83) at second measurement and to 0.39 (0.82) at the third measurement (Ptrend<0.001). This change was negatively associated with treatable vascular risk: the change in cognitive performance between two measurements decreased with 0.004 per one-point increment of treatable vascular risk (95%CI, -0.008 to 0.000; P=0.05) and with 0.006 per one-year increment of age (95%CI, -0.008 to -0.004; P<0.001).ConclusionsChange in cognitive performance was associated with treatable vascular risk in persons aged 35 years or older.

Affective components of electoral behavior: design and validity of visual association test of attitude

A key trend in the modern social sciences is a deeper understanding of high level of structural complexity of the factors influencing human — ‘economic man’: all possible motives of human behavior are limited to maximization of utility of available resources. Interestingly, electoral behavior is still considered as a special case of ‘economic behavior’ as the only voters’ motive behind the act of voting is conscious pursuit of self-interest.On closer examination, it turns out that the assumption has no transparent grounds and it is still used mechanically despite numerous ‘inconvenient’ empirical facts. The paper explores theoretical restrictions of the applications of the economic behavior model to electoral choices. Rich empirical evidence used in the article show that there are wide areas where human behavior cannot be explained in terms of reasonably motivated search of ‘the best outcome’. The author has designed a special test to gather empirical evidence its description, mechanism and the approach used to interpret the results are published for the first time.

The Visual Association Test to study episodic memory in clinical geriatric psychology

The Visual Association Test (VAT) is abrief learning task that consists of six line drawings of pairs of interacting objects (association cards). Subjects are asked to name or identify each object and later are presented with one object from the pair (the cue) and asked to name the other (the target). The VAT was administered in aconsecutive sample of 174 psychogeriatric day care participants with mild to major neurocognitive disorder. Comparison of test performance with normative data from non-demented subjects revealed that 69% scored within the range of amajor deficit (0-8 over two recall trials), 14% aminor, and 17% no deficit (9-10, and ≥10 respectively).VAT-scores correlated with another test of memory function, the Cognitive Screening Test (CST), based on the Short Portable Mental Status Questionnaire (r= 0.53). Tests of executive functioning (Expanded Mental Control Test, Category Fluency, Clock Drawing) did not add significantly to the explanation of variance in VAT-scores.Fifty-five participants (31.6%) were faced with initial problems in naming or identifying one or more objects on the cue cards or association cards. If necessary, naming was aided by the investigator. Initial difficulties in identifying cue objects were associated with lower VAT-scores, but this did not hold for difficulties in identifying target objects.A hierarchical multiple regression analysis was used to examine whether linear or quadratic trends best fitted VAT performance across the range of CST scores. The regression model revealed alinear but not aquadratic trend. The best fitting linear model implied that VAT scores differentiated between CST scores in the lower, as well as in the upper range, indicating the absence of floor and ceiling effects, respectively. Moreover, the VAT compares favourably to word list-learning tasks being more attractive in its presentation of interacting visual objects and cued recall based on incidental learning of the association between cues and targets.For practical purposes and based on documented sensitivity and specificity, Bayesian probability tables give predictive power of age-specific VAT cutoff scores for the presence or absence of amajor neurocognitive disorder across arange of apriori probabilities or base rates.

An Exploratory Study Investigating How Adults with Intellectual Disabilities Perform on the Visual Association Test (VAT).

Neuropsychological tests of memory are believed to offer the greatest sensitivity at identifying people at the risk of developing dementia. There is a paucity ofstandardized and appropriate neuropsychological assessments of memory for adults with an intellectual disability. This study examines how adults with an intellectual disability perform on the Visual Association Test(VAT). Forty participants (18-45years) with intellectual disability, without a diagnosis of dementia, completed the VAT and subtests of the CAMCOG-DS. Correlational analysis of the test variables was carried out. All participants performed well on the VAT irrespective of age, gender or IQ. No significant correlations were found between the VAT and the subtests of the CAMCOG-DS. The VAT was found to be an easy and quick test to use with people with intellectual disability and all participants scored above 'floor' level.

Visual associations cued recall A Paradigm for Measuring Episodic Memory Decline in Alzheimer’s Disease

ABSTRACTRepeated measurements of episodic memory are needed for monitoring amnestic mild cognitive impairment (aMCI) and mild Alzheimer’s disease (AD). Most episodic memory tests may pose a challenge to patients, even when they are in the milder stages of the disease. This cross-sectional study compared floor effects of the Visual Association Test (VAT) and the Rey Auditory Verbal Learning Test (RAVLT) in healthy elderly controls and in patients with aMCI or AD (N = 125). A hierarchical multiple regression analysis was used to examine whether linear or quadratic trends best fitted the data of cognitive test performance across global cognitive impairment. Results showed that VAT total scores decreased linearly across the range of global cognitive impairment, whereas RAVLT total scores showed a quadratic trend, with total scores levelling off for 90% of aMCI patients and 94% of AD patients. We conclude that the VAT shows few if any floor effects in patients with aMCI and mild AD and is therefore a potentially promising cognitive test for monitoring episodic memory impairment.