Psychology (Functional Area: Clinical Psychology)

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Open Access
Accuracy of the Montreal Cognitive Assessment in Detecting Cognitive Impairment Following Stroke
(2018-11-21) Zaidi, Syeda Khush-Bakht; Rich, Jill Bee
Vascular cognitive impairment (VCI) post stroke is frequent, but may go undetected, which highlights the need to better screen cognitive functioning post stroke. We sought to examine the diagnostic accuracy of the Montreal Cognitive Assessment (MoCA), a cognitive screening measure recommended for use with stroke populations. We assessed cognitive status in 161 individuals who were at least 3 months post stroke with a comprehensive battery of neuropsychological measures. We compared diagnostic accuracy using a single cut point compared to two cut points and determined that sensitivity and specificity were optimal when two cut points were applied. This resulted in three groups, where 27% of participants scored 23 and were classified as high likelihood of cognitive impairment, and 25% of participants scored 28 and were classified as low likelihood of cognitive impairment. The remaining 47% of participants scored from 24 to 27 and were classified as indeterminate likelihood of cognitive impairment. The addition of a processing speed measure improved classification for this group by correctly classifying 71% of the individuals in this category. We provide a three-category diagnostic approach to better identify individuals as certain and uncertain likelihood of cognitive impairment. The addition of a processing speed measure provides a practical and efficient method to increase confidence in the determined outcome, while also expanding the utility of the MoCA.
Open Access
Cognitive Mechanisms of Wise Reasoning Across the Adult Lifespan
(2018-11-21) Darboh, Bri Susanna; Turner, Gary
Investigations have begun to unpack the cognitive architecture of wisdom, yet, controversies remain, including disparate notions of the role of memory. There is no agreed upon definition of wisdom; however, there is consensus that wisdom involves expert knowledge grounded in life experience, suggesting memory is integral to wisdom. We predicted that though wisdom remains stable, the cognitive mechanisms may differ with agewisdom and memory would be positively associated, with episodic memory contributing more in young. We administered measures of general and personal wisdom to young and old, and measures of episodic and semantic memory. Three crucial findings emerged. First, the importance of making a priori distinctions between personal and general wisdom is highlighted. Second, while general wisdom remains stable, personal wisdom is augmented with increasing age. Finally, episodic and semantic memory were positive predictors of personal wisdom, and the effect of episodic memory was more robust in young adults.
Open Access
Development and Validation of the Memory Impact Questionnaire
(2016-11-25) Shaikh, Komal Tariq; Rich, Jill Bee
Many healthy older adults experience age-related memory changes that can impact complex activities of everyday living. Whereas qualitative interviews have been useful in gaining insight into the experience of older adults who are facing memory difficulties, there is a need for measures that quantify the impact of normal memory changes in daily living. The objective of this study was to develop and validate a new instrument, the Memory Impact Questionnaire (MIQ). Exploratory factor analysis revealed three themes: (a) Negative Emotion, (b) Lifestyle, and (c) Coping. Among a group of 100 older adults, analyses revealed adequate internal consistency among subscale items as well as construct validity of the three scales in relation to other questionnaires. With an aging population, it is increasingly important to develop tools that can help capture the experience of older adults in order to improve support programs for this population.
Open Access
Everyday Impact of Memory Changes Among Older Adults
(2021-11-15) Shaikh, Komal Tariq; Rich, Jill Bee
Many older adults report subjective memory complaints that can impact their everyday living. The extent to which such complaints impact daily functioning are important criteria to consider when diagnosing memory conditions. In addition, as most of the research identifying the impact of memory changes is qualitative in nature, there is a need for quantitative studies that examine the impact of memory changes across the cognitive aging spectrum and how this impact is related to subjective and objective cognition. Moreover, addressing the everyday impact of memory changes is a crucial goal of memory interventions due to its implications for later disease development, and as such there is a need for instruments with strong measurement properties that assess the everyday impact of memory changes. The goal of the present research was to address these issues. In Study 1, I examine neuropsychologists practices in assessing functional abilities within the context of diagnosing memory conditions. A survey of 280 neuropsychologists revealed that neuropsychologists consider a variety of components that comprise everyday life and utilize several different instruments when assessing functioning. There was a lack of consensus among respondents when asked to diagnose individuals with different levels of impairment in daily functioning, underscoring the need for more measures that assess everyday functioning. In Study 2, I quantify the impact of memory changes across a cognitive aging spectrum ranging from normal cognition to mild cognitive impairment and describe associations between memory impact and both subjective and objective cognition. Results indicated that older adults with lower self-reported memory ability and poorer objective memory performance reported a greater burden of memory change on everyday living. In Study 3, I describe the responsiveness to intervention of a recently developed instrument that quantifies the impact of memory changes on everyday life. Results provided support for the clinical utility of this instrument in evaluating changes in memory impact. Collectively, these studies explore the impact of memory changes on everyday functioning among older adults, particularly how functioning is assessed by clinicians, the cognitive correlates of everyday functioning, and tools that can be used to assess functioning within the context of memory interventions.
Open Access
Functional and Structural Substrates of Neural Modulation in Older Adults After Executive Control Training
(2015-01-26) Adnan, Areeba; Turner, Gary
The fronto-parietal control network (FPCN) and dorsal attention network (DAN) are critical for goal-directed cognition (GDC), which is known to decline with advancing age. Here, we investigated whether a strategy-based executive control training intervention (GOALS) would alter recruitment of the FPCN and DAN in healthy older adults. We also investigated whether functional brain changes would be associated with improvements in GDC and structural integrity of frontal-posterior white matter tracts. Thirteen participants were randomly assigned to the five-week long GOALS training and 12 were randomly assigned to a time and intensity matched control intervention group. Both groups were tested before and after intervention on a goal-directed cognitive task while undergoing fMRI scanning. We observed post-training increases in activation within the FPCN during a selective working memory task requiring GDC in the GOALS training group as compared to the control group, p < .001. These increases were positively correlated with the integrity of white matter pathways connecting frontal and posterior brain regions in the GOALS group, p < .001. In conclusion, this study is the first to our knowledge to report changes in functional neural networks known to subserve GDC in older adults after training and relate these changes to the integrity of underlying white matter tracts.
Open Access
Investigating White Matter Lesion Load, Intrinsic Functional Connectivity, and Cognitive Abilities in Older Adults
(2020-05-11) Kantarovich, Karin; Turner, Gary
Changes to the while matter of the brain disrupt neural communication between spatially distributed brain regions and are associated with cognitive changes in later life. While approximately 95% of older adults experience these brain changes, not everyone who has significant white matter damage displays cognitive impairment. Few studies have investigated the association between white matter changes and cognition in the context of functional brain network integrity. This study used a data-driven, multivariate analytical model to investigate intrinsic functional connectivity patterns associated with individual variability in white matter lesion load as related to fluid and crystallized intelligence in a sample of healthy older adults (n = 84). Several primary findings were noted. First, a reliable pattern emerged associating whole-brain resting-state functional connectivity with individual variability in measures of white matter lesion load, as indexed by total white matter lesion volume and number of lesions. Secondly, white matter lesion load was associated with increased network disintegration and dedifferentiation. Specifically, lower white matter lesion load was associated with greater within- versus between-network connectivity. Higher white matter lesion load was associated with greater between-network connectivity compared to within. These associations between intrinsic functional connectivity and white matter lesion load were not reliably associated with crystallized and fluid intelligence performance. These results suggest that changes to the white matter of the brain in typically aging older adults are characterized by increased functional brain network dedifferentiation. The findings highlight the role of white matter lesion load in altering the functional network architecture of the brain.
Open Access
Mismatch Negativity as a Marker of Auditory Pattern Separation Integrity in Aging
(2023-12-08) Chow, Ricky Ka Lok; Rosenbaum, Shayna
How does auditory perception interact with precision in memory (i.e., mnemonic discrimination) in aging? This study examined how the mismatch negativity (MMN), an electrophysiological marker of change detection and encoding, relates to age differences in mnemonic discrimination. The MMN was recorded from 33 young (18–32 years, 18 females) and 30 older (55–86 years, 14 females) adults in a passive oddball paradigm using tone sequences. Participants then completed an incidental recognition test for old targets against similar lures and dissimilar foils. Older adults showed attenuated MMN amplitudes and poorer performance discriminating targets from lures and foils than young adults. Across participants, smaller MMN amplitude predicted worse recognition performance. Notably, MMN amplitude partially explained age-related declines in target-lure discriminability, but not target-foil discriminability. Findings reinforce the MMN as a marker of pattern separation integrity, and clarify how age-related declines in mnemonic discrimination are explained by age differences at encoding.
Open Access
Subjective and objective spatial memory and navigation abilities in aging and amnesia
(2024-03-16) Pishdadian, Sara; Rosenbaum, R. Shayna
Compared to the extensive research on how older adults evaluate their memory abilities, the evaluation of subjective spatial navigation abilities is understudied. This dissertation was guided by four research objectives: 1) Investigate the psychometric properties of a subjective spatial navigation questionnaire to assess the nature and extent of self-reported changes to spatial navigation in neurotypical aging; 2) Determine the relationship among subjective assessments of spatial navigation and of memory and how they relate to psychological distress and objective memory performance; 3) Understand the impact of hippocampal damage on subjective awareness of areas of spared and impaired episodic and spatial memory; and 4) Identify more precisely the conditions in which spatial memory and navigation depend on hippocampal integrity. In study 1, multidimensional item response theory was used to evaluate the factor structure and item reliability of the novel Changes in Navigation Questionnaire (CNQ) in a community sample of older adults. Results showed that the CNQ has a reliable factor structure, with items falling under typical and atypical changes. In study 2, the relationship between subjective spatial navigation and metamemory in aging was investigated using structural equation modeling. Findings showed that the subjective spatial navigation and metamemory constructs had a positive, weak correlation. Objective episodic memory performance did not load onto metamemory, and allocentric spatial memory performance had a weak loading onto spatial navigation abilities. Psychological distress symptoms had stronger loadings on metamemory than spatial navigation abilities. In study 3, two individuals with hippocampal amnesia completed questionnaires assessing metamemory and spatial navigation abilities and were compared to age-, gender-, and education-matched controls. The individuals with amnesia reported sound awareness of metamemory and spatial navigation difficulties. Lastly, in study 4, these individuals’ performance on a videogame wayfinding measure was compared with that of thousands of well-matched controls. The individuals showed distinct patterns of impairment and preservation on the tasks. These dissertation results show that subjective spatial navigation abilities can be reliably captured with questionnaires, are weakly related to metamemory, and that accurate self-evaluation is not contingent on intact episodic memory. The findings also highlight specific aspects of navigation that are hippocampal dependent.
Open Access
The Effects of Prior Knowledge on Mnemonic Discrimination in Young and Older Adults, and in Hippocampal Amnesia
(2018-11-21) Pishdadian, Sara; Rosenbaum, Shayna
The hippocampus is critical to discriminating between newly learned, highly similar stimuli; less clear is its role in discriminating representations based on prior knowledge. In this study, young adults, older adults divided by performance on a cognitive screening measure, and people with hippocampal amnesia were asked to discriminate between pairs of real-world familiar landmarks and well-known animals using the metrics of geographical distance and size. Results showed all participants had lower accuracy for judgments with more similar item pairs. Low-performing older adults showed selectively worse performance on judgments with more similar item pairs. Amnesic individuals performance appeared to depend on lesion location. Only patient BL, who has selective bilateral dentate gyrus lesions, had difficulty on the landmark task when judging between highly similar distances. These results reinforce the importance of investigating representation similarity, even for well-established representations, and offer insight into mnemonic discrimination across the lifespan and within amnesia.
Open Access
The Ontogenetic Course and Multicomponent Nature of Wise Reasoning Across the Adult Lifespan: Perspectives From Neuropsychology
(2023-12-08) Darboh, Bri Susanna; Turner, Gary
Wisdom has long been revered as a desirable feature of aging in theoretical, folk, and lay discourse. In recent decades, there has been a surge of empirical psychological research on the association between wisdom and age, including the underlying cognitive mechanisms that may contribute to its expression. However, this remains an ongoing area of debate, with diverse and often conflicting views reported in the research literature. Further, less is known about how the cognitive architecture of wisdom may differ in younger and older adults. The current work aimed to empirically examine whether ‘older is wiser’, and the cognitive and neural substrates associated with wise reasoning in younger and older adulthood. We begin with a systematic review and meta-analyses to quantify the current consensus in the literature regarding the relationship between general (insight into life in general) and personal (insight into oneself) wisdom with (i) cognition (Study 1) and (ii) age (Study 2). Study 1 included 22 studies for which outcomes were categorized into six cognitive domains to facilitate domain-specific meta-analyses: i) crystallized intelligence, ii) fluid intelligence, iii) general intellectual functioning, iv) memory, v) attention, and vi) executive function. We observed a significant positive effect of crystallized and fluid intelligence on wisdom, with the most robust effects observed for crystallized intelligence. Aggregate effect sizes in the remaining cognitive domains were null. Study 2 included 52 studies to examine the relationship between wisdom and age. There was a significant positive effect of age on wisdom, with larger effects observed for general versus personal wisdom. Extending from these systematic reviews we next conducted two empirical studies. First, we examined associations among wisdom, age, and specific aspects of cognitive function implicated in wise reasoning (leveraging findings from Studies 1 and 2) in 344 neurologically healthy younger (n = 181) and older (n = 163) adults (Study 3). While older adults scored higher on measures of self-reported personal wisdom, performance-based general wisdom was stable across the adult lifespan. Memory was a stronger predictor of general than personal wisdom in the combined, young, and older adult samples, and this association was more robust in older adults. Finally, in an exploratory analysis (Study 4), we examined relationships among wisdom, memory, and brain function (resting-state functional connectivity) in 286 neurologically healthy younger (n = 157) and older (n = 129) adults. General wisdom was associated with greater integration among frontoparietal (CONT) and default (DN) subnetworks than personal wisdom in the combined age sample. General wisdom in older adulthood was associated with more robust network dedifferentiation than in young, while the opposite pattern was observed for personal wisdom (i.e., greater within-network connectivity of CONT and DN regions in older than younger adulthood). Taken together, these findings illustrate that older may be wiser, and critically depends on the problem-solving context (intra-personal versus extra-personal). Moreover, our findings provide converging evidence that personal and general wisdom are discrete abilities, with distinct age-related trajectories, cognitive determinants, and underlying neural architectures.

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Browsing Psychology (Functional Area: Clinical Psychology) by Subject "Aging"

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