Development and Preliminary Validation of Standardized Regression-Based Change Scores as Measures of Transitional Cognitive Decline

Abstract

Objective An increasing focus in Alzheimer’s disease and aging research is to identify transitional cognitive decline. One means of indexing change over time in serial cognitive evaluations is to calculate standardized regression-based (SRB) change indices. This paper includes the development and preliminary validation of SRB indices for the Uniform Data Set 3.0 Neuropsychological Battery, as well as base rate data to aid in their interpretation. Method The sample included 1,341 cognitively intact older adults with serial assessments over 0.5–2 years in the National Alzheimer’s Coordinating Center Database. SRB change scores were calculated in half of the sample and then validated in the other half of the sample. Base rates of SRB decline were evaluated at z-score cut-points, corresponding to two-tailed p-values of .20 (z = −1.282), .10 (z = −1.645), and .05 (z = −1.96). We examined convergent associations of SRB indices for each cognitive measure with each other as well as concurrent associations of SRB indices with clinical dementia rating sum of box scores (CDR-SB). Results SRB equations were able to significantly predict the selected cognitive variables. The base rate of at least one significant SRB decline across the entire battery ranged from 26.70% to 58.10%. SRB indices for cognitive measures demonstrated theoretically expected significant positive associations with each other. Additionally, CDR-SB impairment was associated with an increasing number of significantly declined test scores. Conclusions This paper provides preliminary validation of SRB indices in a large sample, and we present a user-friendly tool for calculating SRB values.

How impaired is too impaired? Exploring futile neuropsychological test patterns as a function of dementia severity and cognitive screening scores

“…However, recall measures require intact consolidation abilities, such that those who are densely amnestic will not be able to give a single scorable answer even when they can participate (Heilman & Valenstein, 2010). That being said, producing extremely low normed scores on individuals tests is relatively common (4.30–22.80%, depending on the task), conforming with a wealth of prior research on the base rates of low scores (Binder, Iverson, & Brooks, 2009; Brooks & Iverson, 2010; Brooks, Iverson, & Holdnack, 2013; Brooks, Iverson, Holdnack, & Feldman, 2008; Brooks, Iverson, & White, 2007; Holdnack et al., 2017; Kiselica, Kaser, et al., 2020; Kiselica Webber et al., 2020a).…”

“…First, the UDS3NB was designed specifically for clinical research with older adults and is relatively brief (approximately 20–40 minutes in our experience). While there are a growing number of tools to support its application in clinical samples (Devora, Beevers, Kiselica, & Benge, 2020; Kiselica, Kaser, et al., 2020; Kiselica Webber et al., 2020a; Kiselica, Kaser, et al., 2020; Kiselica Webber, & Benge, 2020b; Kiselica, Kaser, et al., 2020; Sachs et al., 2020; Weintraub et al., 2018), it is not as lengthy or extensive as other more commonly utilized batteries that can last several hours (Rabin, Paolillo, & Barr, 2016). Thus, our findings may not generalize to other batteries commonly employed in clinical practice, and they highlight the importance of tailoring testing strategies to the population of interest.…”

“…Cognitive tests utilized in the UDS3NB are described in detail in other publications (Besser et al., 2018; Weintraub et al., 2018). Our analyses utilized 12 core scores from this battery (Kiselica, Kaser, Webber, Small, & Benge, 2020; Kiselica, Kaser, et al., 2020; Kiselica Webber, & Benge, 2020a, 2020b). They included 1) three indices of language abilities – The Multilingual Naming Test (Gollan, Weissberger, Runnqvist, Montoya, & Cera, 2012; Ivanova, Salmon, & Gollan, 2013) and the two semantic fluency trials (animals and vegetables); 2) visual test scores – Benson Figure copy and recall trials (Possin, Laluz, Alcantar, Miller, & Kramer, 2011); 3) scores on measures of attention – Number Span Forwards and backwards; 4) indices assessing executive functions – Trail Making Parts A and B (Partington & Leiter, 1949) and a letter fluency test (F‐ and L‐words); and 5) memory test scores – Craft Story immediate and delayed verbatim recall scores (Craft et al., 1996).…”

Empirically defining the preclinical stages of the Alzheimer's continuum in the Alzheimer's Disease Neuroimaging Initiative

“…approach worth noting, including its heavy reliance on process scores from the Auditory Verbal Learning task and its failure to index other cognitive domains, such as visuospatial skills and higher‐level reasoning and problem‐solving abilities. Furthermore, this method uses baseline data, and TCD could alternatively be defined by subtle declines across serial evaluations 9,14 …”

“…Currently, there are several promising methods for operationalizing TCD. For example, methods using data from serial assessments revealed that some individuals demonstrate small but statistically significant and clinically meaningful decreases in cognitive performance over time 7–9 . Importantly, those who demonstrate such preclinical cognitive changes are at risk for future mild cognitive impairment or dementia diagnoses.…”