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To compare the sensitivity, specificity, and predictive value of published versus sample-based norms to detect early dementia in the Uniform Data Set (UDS).
The UDS was administered to 526 nondemented participants from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Baseline scores were standardized using published norms and healthy control data from ADNI corrected for age, education, and sex. Subjects obtaining two scores < −1 SD (determined separately using published and sample norms) were labeled “at risk for dementia.” Both methods were compared on sensitivity, specificity, and positive/negative predictive value (PPV/NPV) for dementia at follow-up.
Risk scores derived from published data had 86.1% sensitivity, 62.0% specificity, 68.6% accuracy, 46.1% PPV, and 92.2% NPV. Those from sample norms were more sensitive (91.0%), less specific (52.9%), and less accurate (63.3%), with worse PPV (42.1%) and similar NPV (94.0%). Sample norms were better at identifying incident dementia cases with relatively lower education than those with higher education. Discrepancies between both methods were more common in women.
Sample norms are marginally more sensitive than published norms for predicting dementia, while published norms are slightly more accurate. Accuracy of risk estimates for women and those with lower education may be increased using locally generated norms.
It is crucial to clarify the structure of attention-deficit/hyperactivity disorder (ADHD) symptomatology in all age groups to determine how to best conceptualize this disorder across the lifespan. We tested the ADHD factor structure across adulthood and investigated independent associations with executive functions.
Data from 645 adults aged 18–59 and 233 adults aged 60–85 were drawn from the Nathan Kline Institute Rockland Sample. Participants completed the Conners Adult ADHD Rating Scale and tests of executive functioning. Invariance of the ADHD factor structure was investigated using confirmatory factor analyses. Associations with cognition were explored using multiple linear regression.
Results confirmed a bifactor model with 3 specific factors (inattention, hyperactivity, and impulsivity). Factor loadings and item intercepts were invariant across ages. Levels of hyperactivity and impulsivity were lower in older adults. Inattentive symptoms in young adults were positively related to cognitive flexibility. In older adults, ADHD symptoms predicted poorer working memory.
ADHD symptoms manifest similarly across adulthood. The lack of robust associations between ADHD symptomatology and executive functions raises concerns about the usefulness of neuropsychological measures in diagnosing adult ADHD. These results support the validity of the ADHD concept in older adults but suggest a need for age-appropriate normative criteria.
Studies of amnestic mild cognitive impairment (aMCI) and late-life depression (LLD) have examined the similarities and differences between these syndromes, but few have investigated how the cognitive profile of comorbid aMCI and subclinical depressive symptoms (aMCI/D+) may compare to that of aMCI or LLD. Memory biases for certain types of emotional information may distinguish these groups.
A total of 35 aMCI, 23 aMCI/D+, 13 LLD, and 17 elderly controls (CONT) rated the valence (positive, negative, or neutral) of 30 pictures from the International Affective Picture System. Mean percent positive, negative, and neutral images recalled was compared within groups immediately and 30 minutes later.
Overall memory performance was comparable in aMCI and aMCI/D+, and both recalled fewer items than CONT and LLD. Group differences emerged when valence ratings were considered: at immediate and delayed recall, positive and negative pictures were generally better-remembered than neutral pictures by CONT, aMCI, and LLD, but valence was not associated with recall in aMCI/D+. Follow-up analyses suggested that the perceived intensity of stimuli may explain the emotional enhancement effect in CONT, aMCI, and LLD.
Results support previous research suggesting that the neuropsychological profile of aMCI/D+ is different from that of aMCI and LLD. Although depressed and non-depressed individuals with aMCI recall comparable quantities of information, the quality of the recalled information differs significantly. On theoretical grounds, this suggests the existence of distinct neurobiological or neurofunctional manifestations in both groups. Practically, these differences may guide the development of personalized emotion-focused encoding strategies in cognitive training programs.
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