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Background: Recent evidence suggests that increasing dietary intake of minerals reduces the risk of dementia. This study aimed to examine the relationship between potassium and diagnosis of mild cognitive impairment (MCI) in a sample of older Mexican-Americans from rural and urban populations. Methods: The sample was formed of a total of 139 participants with MCI and 371 normal controls from two independent cohorts: a rural cohort (Facing Rural Obstacles to Healthcare Now through Intervention, Education and Research [Project FRONTIER]) and an urban cohort (the Health and Aging Brain among Latino Elders [HABLE] study). Serum electrolytes examined were sodium and potassium. Age and education were entered in the model as covariates. Results: Across both cohorts, the Project FRONTIER (OR = 3.1; p = 0.01) and the HABLE Project (OR = 2.0; p = 0.04), the results indicated that serum potassium levels significantly increased the risk of diagnosis of MCI. Conclusion: Our finding suggested a link between serum potassium levels and a diagnosis of MCI in Mexican-Americans. The results of this study support a previous research which has suggested that the risk factors for MCI may vary by ethnicity.

IntroductionThe present study sought to investigate the measurement invariance of commonly used neuropsychological tests in an ethnically (Hispanic vs. non-Hispanic) and linguistically (Spanish vs. English) diverse sample.MethodsParticipants were 736 middle-aged and older adults (M Age=62.1, SD=9.1) assessed at baseline. Measurement invariance testing was performed using multiple-group confirmatory factor analysis.ResultsA five-factor model (memory, attention/executive functioning/processing speed, language, visuospatial, and motor) fit the data well (CFI=0.979, RMSEA=0.047) and the composite reliability of the factors ranged from .76 (visuospatial) to .97 (motor). The five-factor model was found to possess strict measurement invariance for ethnicity and language without a decrement in fit compared to a strong (scalar) invariance model (ΔCFI=.000, ΔRMSEA=.002).DiscussionThese results indicate that a five-factor model is suitable for estimating cognitive functioning in Mexican Americans and non-Hispanic whites without bias by ethnicity or language.

BACKGROUND Adults with Down syndrome (DS) are at very high risk for Alzheimer's disease (AD). Neurofilament light (NF-L) has emerged as a potential blood-based biomarker of neurodegeneration due to AD. OBJECTIVE To understand the relationship between plasma NF-L with age, brain amyloid, and tau pathology, neurodegeneration as well as cognitive and functional performance. METHODS We analyzed imaging data as well as cognitive measures in relation to plasma NF-L in adults with DS, ages 30 to 60 who were enrolled in the Down Syndrome Biomarker Initiative. RESULTS We found significant correlations between NF-L plasma concentrations and amyloid pathology (r = 0.73, p = 0.007, pa = 0.041) and significant inverse correlations with regional glucose metabolism in 5 of 6 regions examined, which were Anterior cingulate (r = -0.55, p = 0.067, pa = 0.067), Posterior cingulate r = -0.90, p

BACKGROUND Late life depression is a prodromal feature and a risk factor for Alzheimer's disease (AD) and mild cognitive impairment (MCI). We identified five items in the Geriatric Depression scale (DepE) that are important as a risk for MCI and AD: memory problems, feeling blue, crying, feeling worthless, and trouble concentrating. OBJECTIVE Our goal was to examine the relationship between DepE and cognition in a cohort of Mexican Americans. METHODS Data from 317 Mexican Americans from the HABLE study were analyzed. DepE scores were dichotomized into two groups: endorsement of 1 item or less, and endorsement of 2 or more items. Cognition was assessed via neuropsychological tests, and diagnosis was based on consensus review. We utilized linear regression to examine the association between DepE and cognitive performance, and logistic regression to examine the utility of DepE in predicting MCI. To examine the impact of DepE on memory over 12 months, we performed ANOVA analysis. RESULTS Elevated DepE scores were associated with poorer performance on various measures of memory and cognition, but not executive or visual spatial skills. Over 12 months, we found a decline in immediate memory among women but not men. Those with high scores were 4 times more likely to have MCI. ANOVA of total scores revealed differences between groups on immediate memory (p

Objectives To analyze the association between chronic kidney disease (CKD) and mild cognitive impairment (MCI) in Mexican Americans and to determine whether there is a blood-based proteomic profile linking CKD to MCI. Design Retrospective analysis of cohort study. Setting Health and Aging Brain among Latino Elders study. Participants Mexican Americans (N = 437, 105 men, 332 women). Measurements Data were analyzed to examine the link between estimated glomerular filtration rate (eGFR) and detailed neuropsychological functioning. Serum proteomic markers were also examined. Results Lower eGFR levels were associated with significantly poorer neuropsychological functioning across multiple domains. After adjusting for age, sex, education, and diabetes mellitus, participants with an eGFR less than 45 mL/min per 1.73 m2 performed significantly worse than those with an eGFR from 45 to 59 mL/min per 1.73 m2 or 60 mL/min per 1.73 m2 and higher in processing speed (F = 14.1, P < .001), executive functioning (F = 4.5, P = .01), visuospatial skills (F = 4.8, P = .009), and global cognitive functioning (F = 6.2, P = .002). Participants with an eGFR less than 45 mL/min per 1.73 m2 also performed significantly worse than those with an eGFR of 60 mL/min per 1.73 m2 or greater on delayed memory (F = 3.8, P = .02). There was a trend toward lower eGFR levels being associated with greater risk of MCI (odds ratio (OR) = 2.4, 95% confidence interval (CI) = 0.91–6.1, P = .07), which was stronger for men (OR = 9.6, 95% CI = 1.3–74.3, P = .03). A serum proteomic profile consisting of Factor VII, interleukin-10, C-reactive protein, and fatty acid binding protein was 93% accurate in detecting CKD-related MCI. Conclusion Lower eGFR was associated with significantly poorer neuropsychological functioning in Mexican Americans. A blood-based profile was generated that was highly accurate in detecting CKD-related MCI. A blood profile capable of predicting CKD-related cognitive impairment would be of benefit for the design of clinical interventions.

Blood-based biomarkers related to Alzheimer's disease (AD) have significant potential to advance both the diagnostic and therapeutic processes and procedures related to this devastating disease. In light of this potential, a significant amount of work has been conducted in recent years. In fact a PubMed search (6/2016) using the terms “blood based biomarkers AND Alzheimer's disease” yielded 474 hits with an overwhelming 48% of these articles being published from 2013–2016. This special issue of Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring on Advances in blood-based biomarkers of Alzheimer's disease is intended to provide a broad-based snapshot regarding several aspects of the space. This special issue contains advancements in the space spanning newer technologies (e.g., exosome biomarkers) as well as progression in markers that have been more extensively studied (e.g., autoantibodies, apoJ). The special issue is broken down by categories that broadly correspond to a specific putative context of use (COU). Blood-based biomarkers offer an excellent complementary information to well-established cerebrospinal fluid (CSF), imaging (MRI, PET, other) biomarkers for the establishment of multistage processes for diagnostic and therapeutic strategies, such as what has been of tremendous utility in other areas of medicine (e.g., cancer [1]). The intention of these blood-based biomarkers is to increase access to CSF, imaging, and other biomarker modalities as well as to provide novel information to enhance the scientific understanding of the complete biological dysfunction associated with AD and other neurological diseases. This special issue has been conceptually divided into broadly defined categories beginning with methodological considerations, to a set of possible context of uses (COUs) and ends with a study highlighting ethnic considerations in this space of scientific investigation.

Research on the link between APOEε4 and neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) has been inconsistent. Previous work has shown a relationship between serum biomarkers of vascular risk and inflammation and NPS in AD. The current study investigated the impact of APOEε4 status on the relationship between biomarkers of cardiovascular risk, systemic inflammation, and NPS. The sample was drawn from the TARCC Longitudinal Research Cohort; the final sample of 190 consisted of 124 females and 66 males meeting the diagnostic criteria for mild to moderate AD. 115 individuals were APOEε4 carriers and 75 were non-carriers. Serum-based clinical biomarkers of vascular risk and biomarkers of inflammation related to AD were analyzed. NPS data was gathered from caretakers/family members using the Neuropsychiatric Inventory. The significant biomarkers differed for carriers and non-carriers with IL15 being a negative biomarker of total NPS accounting for 12% of the variance for carriers and IL18 and TNFα negative predictors for non-carriers (18% of variance). Patterns related to specific symptoms were similar. Stratification by gender revealed significant biomarkers of total NPS for female carriers were negative IL15 and IL1ra (18% of variance) and for female non-carriers were negative IL18 and positive homocysteine. Total cholesterol was a positive biomarker of total NPS for both male carriers (36% of variance) and non-carriers (negative TNFα and total cholesterol, 32% of variance). These findings suggest that dysregulation of inflammatory activity is related to NPS, that cholesterol is a significant factor in the occurrence of NPS, and that gender and APOE status need to be considered.

To examine the link between disturbed sleep and depression scores in Mexican Americans and non-Hispanic Whites.Data were analyzed for 566 participants (45% Mexican Americans) who were part of a rural healthcare study, Project FRONTIER. Mean age was 55.5 years for Mexican Americans (70% female) and 65.6 years for non-Hispanic Whites (69% female). Self-reported sleep disturbance was entered as the predictor, GDS-30 total and factor scores as the outcome variables, and age, sex, education, BMI, and medical diagnoses (hyperlipidemia, diabetes mellitus, and hypertension) entered as covariates.Mexican Americans reported higher rates of sleep disturbances (25%) than non-Hispanic whites (17%). Sleep disturbances were significantly associated with GDS-30 total scores and the factors Dysphoria and Cognitive Impairment in both Mexican Americans and non-Hispanic whites.In this study, Mexican Americans reported higher rates of sleep disturbances than non-Hispanic whites. Disturbed sleep was positively associated with depression and the factor scores for Dysphoria and Cognitive Impairment in both groups. Given the paucity of research on sleep disorders in Mexican Americans, identifying what sleep disorders are present and the impact treating these sleep disorders have on depression warrant further investigation.

Exposure to arsenic causes many diseases. Most Americans in rural areas use groundwater for drinking, which may contain arsenic above the currently allowable level, 10µg/L. It is cost-effective to estimate groundwater arsenic levels based on data from wells with known arsenic concentrations. We compared the accuracy of several commonly used interpolation methods in estimating arsenic concentrations in >8000 wells in Texas by the leave-one-out-cross-validation technique. Correlation coefficient between measured and estimated arsenic levels was greater with inverse distance weighted (IDW) than kriging Gaussian, kriging spherical or cokriging interpolations when analyzing data from wells in the entire Texas (p

The purpose of the study was to examine the link between geographic information system (GIS)-estimated regional specific groundwater levels and neuropsychological functioning in a sample of individuals with and without cognitive impairment.This cross-sectional study design analyzed data from 1390 participants (733 Alzheimer's disease, 127 Mild Cognitive Impairment, and 530 with normal cognition) enrolled in the Texas Alzheimer's Research and Care Consortium. GISs analyses were used to estimate regional specific groundwater arsenic concentrations using the Environmental Systems Research Institute and arsenic concentrations from the Texas Water Development Board.In the full cohort, regional specific arsenic concentrations were positively associated with language abilities (p = 0.008), but associated with poorer verbal memory, immediate (p = 0.008), and delayed (p 0.001), as well as poorer visual memory, immediate (p = 0.02), and delayed (p 0.001). The findings varied by diagnostic category with arsenic being related with cognition most prominently among mild cognitive impairment cases.Overall, estimated regional specific groundwater arsenic levels were negatively associated with neuropsychological performance.

The Brief Smell Identification Test (BSIT) is a commonly used measure of olfactory functioning in elderly populations. Few studies have provided normative data for this measure, and minimal data are available regarding the impact of sociodemographic factors on test scores. This study presents normative data for the BSIT in a sample of English- and Spanish-speaking Hispanic and non-Hispanic Whites. A Rasch analysis was also conducted to identify the items that best discriminated between varying levels of olfactory functioning, as measured by the BSIT. The total sample included 302 older adults seen as part of an ongoing study of rural cognitive aging, Project FRONTIER. Hierarchical regression analyses revealed that BSIT scores require adjustment by age and gender, but years of education, ethnicity, and language did not significantly influence BSIT performance. Four items best discriminated between varying levels of smell identification, accounting for 59.44% of total information provided by the measure. However, items did not represent a continuum of difficulty on the BSIT. The results of this study indicate that the BSIT appears to be well-suited for assessing odor identification deficits in older adults of diverse backgrounds, but that fine-tuning of this instrument may be recommended in light of its items' difficulty and discrimination parameters. Clinical and empirical implications are discussed.

The purpose of the study was to provide characterization of Mexican Americans who meet criteria for Alzheimer's disease (AD) and mild cognitive impairment (MCI). For the study, 1,069 participants ages 40 and above who self-identified as either non-Hispanic white (n = 633) or Mexican American (n = 436) were recruited using a community-based participatory research approach. Global cognition was assessed via the Mini-Mental State Examination (MMSE), dementia severity by the Clinical Dementia Rating Scale, and depression via the Geriatric Depression Scale 30-item version. Age, gender, education, ApoE e4 allele frequency, and diabetic diagnoses were also analyzed. The findings showed that Mexican Americans (normal controls, MCI, and AD) were younger, less highly educated, performed more poorly on the MMSE, endorsed more symptoms of depression, were more likely to be diagnosed with diabetes, and possessed the ApoE e4 allele less frequently. Age was the only significant risk factor for cognitive dysfunction (AD/MCI) among Mexican Americans (OR = 1.06, 95% CI = 1.03-1.09). Age (B = 0.07, std = 0.02, p < 0.001) and ApoE e4 presence (B = 0.9, std = 0.4, p = 0.02) were significantly related to increased disease severity. Given the rapidly growing and aging Mexican American population, there is a substantial need for research into cognitive aging, MCI, and AD among this ethnic group. The current findings hold important implications for both clinic and research settings and point to additional research needs.

The CLOX test is a neuropsychological measure intended to aid in the assessment and detection of dementia in elderly populations. Few studies have provided normative data for this measure, with even less research available regarding the impact of socio-demographic factors on test scores. This study presents normative data for the CLOX in a sample of English- and Spanish-speaking Hispanic and non-Hispanic Whites. The total sample included 445 cognitively healthy older adults seen as part of an ongoing study of rural cognitive aging, Project FRONTIER. Unlike previous studies, criteria for “normality” (i.e., unimpaired) for CLOX1 and CLOX2 were based not merely on global impairment, but also on domain-specific impairment of executive functioning on the EXIT25 and/or Trail Making Test B (Trails B), or visuospatial/constructional impairment on the Line Orientation and Figure Copy subtests of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), respectively. Hierarchical regression analyses revealed that CLOX1 scores require adjustment by Age across ethnicities, while Education and Gender are necessary stratification markers for CLOX1 performance only in non-Hispanic Whites. None of the demographic variables were valid predictors of CLOX2 performance, negating the need for such adjustments. In addition to being the first study to provide separate normative data for CLOX performance in Hispanic and non-Hispanic White samples, the current study offers a novel approach to defining “normal” by cognitive domain. We also highlight the need to directly examine the impact of socio-demographic factors before applying normative corrections based on factors that have negligible impact on test scores.

The purpose of this study was to explore the sensitivity and specificity of the Clock Drawing Test by using a widely employed four-point scoring system to discriminate between patients with Alzheimer's disease or vascular dementia. Receiver operating characteristic analysis indicated that the Clock Drawing Test was able to distinguish between normal elders and those with a dementia diagnosis. The cutoff score for differentiating patients with Alzheimer's disease from normal participants was = 3. The cutoff score for differentiating those with vascular disease from normal participants was = 3. Overall, the four-point scoring system demonstrated good sensitivity and specificity for identifying cognitive dysfunction associated with dementia; however, the current findings do not support the utility of the four-point scoring system in discriminating Alzheimer's disease and vascular dementia.

Patients from two neuropsychology clinics (n = 283) were divided into model development (n = 189) and validation samples (n = 94) with proportional representation from each clinic. Three regression based models of four WAIS-III subtests were developed and cross-validated to evaluate their FSIQ estimation accuracy: (1) an optimized stepwise regression model derived from the development sample (Comprehension, Matrix Reasoning, Similarities, and Picture Arrangement), (2) an a priori WASI based model (Similarities, Matrix Reasoning, Vocabulary, and Block Design), and (3) an a priori model with relatively rapidly administered subtests from each Index Score factor of the WAIS-III (Information, Picture Completion, Arithmetic, and Digit Symbol-Coding). The models produced good (92 to 97%) FSIQ estimation accuracy within 10 points of FSIQ with none of these models performing significantly better than another. The utility of clinical use of short form FSIQ estimation is a function of accuracy needed versus administration time reduction and ease for the patient.

Assessing effort level during neuropsychological evaluations is critical to support the accuracy of cognitive test scores. Many instruments are designed to measure effort, yet they are not routinely administered in neuropsychological assessments. The Test of Memory Malingering (TOMM) and the Word Memory Test (WMT) are commonly administered symptom validity tests with sound psychometric properties. This study examines the use of the TOMM Trial 1 and the WMT Immediate Recognition (IR) trial scores as brief screening tools for insufficient effort through an archival analysis of a combined sample of mild head-injury litigants ( N = 105) who were assessed in forensic private practices. Results show that both demonstrate impressive diagnostic accuracy and calculations of positive and negative predictive power are presented for a range of base rates. These results support the utility of Trial 1 of the TOMM and the WMT IR trial as screening methods for the assessment of insufficient effort in neuropsychological assessments.

Despite the rapidly growing nature of the Mexican American population in the United States, relatively little is known regarding cognitive aging among this minority group compared to non-Hispanic, white individuals. The current study was conducted to describe the nature of cognitive and affective characteristics of Mexican American patients with dementia or other cognitive disorders on initial presentation to a Memory Disorder Clinic. Archival data were reviewed from this specialty clinic for 219 patients who were evaluated for the first time over a 2-year period. Twenty-two Mexican American patients were identified, and a sample of 22 matched non-Hispanic white patients was derived for comparison. When compared to non-Hispanic white patients, Mexican Americans were found in fewer numbers, reported higher levels of anxiety and depression, and produced lower scores on neurocognitive assessments. Results support the notion that Mexican American patients present for cognitive assessment and treatment at a greater stage of impairment severity as compared to non-Hispanic whites.

The original factor structure of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has received little empirical support, but at least eight alternative factor structures have been identified in the literature. The current study used confirmatory factor analysis to compare the original RBANS model with eight alternatives, which were adjusted to include a general factor. Participant data were obtained from Project FRONTIER, an epidemiological study of rural health, and comprised 341 adults (229 women, 112 men) with mean age of 61.2 years (SD = 12.1) and mean education of 12.4 years (SD = 3.3). A bifactor version of the model proposed by Duff and colleagues provided the best fit to the data (CFI = 0.98; root-mean-squared error of approximation = 0.07), but required further modification to produce appropriate factor loadings. The results support the inclusion of a general factor and provide partial replication of the Duff and colleagues RBANS model.

Diabetes in Mexican Americans is a major cause of morbidity and mortality. Older Mexican Americans experience higher rates of depression than other groups and are especially susceptible to comorbid...

The Test of Memory Malingering (TOMM) is the most frequently used symptom validity test (SVT) by neuropsychologists and appears to be robust in the context of a number of neurological and psychiatric conditions. The current study cross-validated and extended prior research by examining the relation between scores on self-report measures of depression and anxiety, independently and combined, and scores on the TOMM in an outpatient neuropsychology clinic. A total of 262 files were reviewed, 67 of which contained complete data on the TOMM, Beck Depression Inventory-II, and the State-Trait Anxiety Inventory. Results show that scores on self-report inventories of depression and anxiety are not significantly related to scores on the TOMM, cross-validating previous research. Extending prior research, current analyses demonstrate that TOMM scores are not significantly influenced by the combined relation of self-reported symptoms of depression and anxiety. Findings support the utility of the TOMM with patients reporting affective disturbances.

The increased role of neuropsychologists in the courtroom has led to an increased effort in the detection of possible symptom exaggeration/malingering. Whereas domain specific measures of malingering have traditionally been used in this detection process, the identification of performance profiles and cut-off scores on standard neuropsychological assessment instruments may provide an alternate strategy. The present study evaluated the effectiveness of performance profiles and cut-off scores in discriminating traumatic brain injury (TBI) litigants suspected of malingering from those not suspected of malingering on the Memory Assessment Scales (MAS). Results suggest that TBI litigants suspected of poor effort will perform globally at a lower level than TBI litigants not suspected of poor effort on nearly all MAS indices, however, the performance profiles of each group was similar. Cut-off scores, especially when used in combination, were also effective in correctly classifying individuals in the two groups. The present findings warrant further research examining the utility of the proposed cut-off scores separately and concomitantly. Such research will aid the clinical neuropsychological practitioner in interpreting aberrant performance profiles on the MAS in forensic situations.

The importance of the detection of possible symptom exaggeration/malingering has gained increased attention among neuropsychologists, and as a result, a number of techniques have been developed for the identification of suspected malingering. The goal of this study was to examine the extent towhich several of these commonly used techniques correlate with one another in a clinical sample. Archival data on 97 litigants were analyzed, and scores on the Test of Memory Malingering (TOMM), Rey 15-Item Test (Rey-15), and MMPI-2 validity scales were compared. The MMPI-2 validity scales did not positively correlate with any trial on the TOMM or with the Rey-15, with the exception of the Fb scale which significantly negatively correlated with TOMM trial 1. The results of the present study suggest that the MMPI-2 validity scales are measuring a different construct than tests of malingered memory deficits, and therefore should be interpreted cautiously in forensic evaluations.

The possibility of racial bias in neuropsychological test materials has received increasing attention in recent years. The purpose of the present study was to investigate whether an own-race recognition bias would provide an advantage for Caucasian participants over African American participants on the Faces subtest of the Recognition Memory Test (RMT). Thirty Caucasian and 30 African American undergraduates completed the RMT, Shipley Institute of Living Scale (SILS), and Symbol Digit Modalities Test (SDMT). No significant group difference was found on RMT Faces. However, mean RMT Faces scores for both groups were below the 10th percentile in spite of average scores on the SDMT and SILS. A second study was conducted to further examine the validity of the RMT norms for this age range (i.e., 18-24) and to provide 2-week test-retest reliabilities. The mean RMT Faces subtest score was 39.78 (10th percentile), and 28% of the sample scored at or below the fifth percentile. Test-retest reliabilities were.63 and.64 for RMT Words and Faces, respectively. Results of these studies suggest that re-examination of the current norms for RMT Faces is warranted for adults aged.

The Trail Making Test (TMT) is one of the most commonly administered tests in neuropsychological assessments. It has been shown to be a valid indicator of brain damage due to traumatic brain injury (TBI), as well as a number of other neuropathological conditions. TMT error and ratio scores have been suggested as possible markers of malingering. The present study examined the utility of various TMT scores as malingering measures in 94 TBI litigants. Litigants were divided into those suspected of (n = 27) and those not suspected of malingering (n = 67) based on scores obtained on the Test of Memory Malingering and/or the Rey 15-Item Test. TMT errors did not discriminate between suspected and nonsuspected malingerers; however, the overall level of performance on the TMT was suppressed in suspected malingerers. The TMT ratio score was significantly lower in litigants suspected of malingering, although the clinical utility of this ratio is minimal. Results of the present study suggest using caution when interpreting TMT scores as markers of malingering in TBI litigants.

Background: Neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) are a major factor in nursing home placement and a primary cause of stress for caregivers. Elevated cholesterol has been linked to psychiatric disorders and has been shown to be a risk factor for AD and to impact disease progression. The present study investigated the relationship between cholesterol and NPS in AD. Methods: Data on cholesterol and NPS from 220 individuals (144 females, 76 males) with mild-to-moderate AD from the Texas Alzheimer's Research and Care Consortium (TARCC) cohort were analyzed. The total number of NPS and symptoms of hyperactivity, psychosis, affect and apathy were evaluated. Groups based on total cholesterol (TC; ≥200 vs. Results: Individuals with high TC had lower MMSE scores as well as significantly more NPS and more symptoms of psychosis. When stratified by gender, males with high TC had significantly more NPS than females with high TC or than males or females with low TC. Conclusion: The role of elevated cholesterol in the occurrence of NPS in AD appears to be gender and symptom specific. A cross-validation of these findings will have implications for possible treatment interventions, especially for males with high TC.

The Boston Naming Test is a neuropsychological measure of confrontation naming, short forms of which can be advantageous with various populations. The purpose of this study was to establish a Spanish–English equivalent version of the BNT using item response theory. Data were analyzed from 380 Project FRONTIER participants; 27 items differed between groups and were removed from the measure. Additionally, 18 items did not differ between groups but were poor items. The current 15-item Spanish–English equivalent version of the BNT offers significant advantages. Future work is required to validate the diagnostic utility of the instrument in various settings and populations.

Women are at a 2-fold risk of developing late-onset Alzheimer's disease (AD) (onset at 65 years of age or older) compared with men. During perimenopausal years, women undergo hormonal changes that are accompanied by metabolic, cardiovascular, and inflammatory changes. These all together have been suggested as risk factors for late-onset AD. However, not all perimenopausal women develop AD; we hypothesize that certain genetic factors might underlie the increased susceptibility for developing AD in postmenopausal women. We investigated the Androgen Receptor gene (AR) in a clinical cohort of male and female AD patients and normal control subjects by sequencing all coding exons and evaluating the length and distribution of the CAG repeat in exon 1. We could not establish a correlation between the repeat length, sex, and the disease status, nor did we identify possible pathogenic variants. AR is located on the X chromosome; to assess its role in AD, X-inactivation patterns will need to be studied to directly correlate the actual expressed repeat length to a possible sex-specific phenotypic effect.

Background Mexican Americans are the fastest aging segment of the U.S. population, yet little scientific literature exists regarding the Alzheimer's disease (AD) among this segment of the population. The extant literature suggests that biomarkers of AD will vary according to race/ethnicity though no prior work has explicitly studied this possibility. The aim of this study was to create a serum-based biomarker profile of AD among Mexican American. Methods Data were analyzed from 363 Mexican American participants (49 AD and 314 normal controls) enrolled in the Texas Alzheimer's Research & Care Consortium (TARCC). Non-fasting serum samples were analyzed using a luminex-based multi-plex platform. A biomarker profile was generated using random forest analyses. Results The biomarker profile of AD among Mexican Americans was different from prior work from non-Hispanic populations with regards to the variable importance plots. In fact, many of the top markers were related to metabolic factors (e.g., FABP, GLP-1, CD40, pancreatic polypeptide, insulin-like-growth factor, and insulin). The biomarker profile was a significant classifier of AD status yielding an area under the receiver operating characteristic curve, sensitivity, and specificity of 0.77, 0.92, and 0.64, respectively. Combining biomarkers with clinical variables yielded a better balance of sensitivity and specificity. Conclusion The biomarker profile for AD among Mexican American cases is significantly different from that previously identified among non-Hispanic cases from many large-scale studies. This is the first study to explicitly examine and provide support for blood-based biomarkers of AD among Mexican Americans. Areas for future research are highlighted.

The cognitive correlates of functional status are essential to dementia case-finding. Nevertheless, cognitive performance is a generally weak predictor of functional outcomes. We have employed structural equation models to explicitly distinguish functional status, and therefore "dementia-relevant" variance in cognitive task performance (i.e., δ) from the variance that is unrelated to a dementing process (i.e., g'). Together, g' + δ encompass Spearman's g. Although δ represents only a small fraction of the total variance in cognitive task performance, it is more strongly associated with dementia status than is g'. In this study, we validate δ in a well characterized Alzheimer's disease cohort, the Texas Alzheimer's Research and Care Consortium. Our approach results in "error free" continuous variables. This suggests that δ can serve as a dementia specific endophenotype. As a result, future studies may be able to associate δ with inflammatory and genetic biomarkers.

Conclusions: These initial data suggest that serum protein-based biomarkers can be combined with clinical information to accurately classify AD. A disproportionate number of inflammatory and vascular markers were weighted most heavily in the analyses. Additionally, these markers consistently distinguished cases from controls in significant analysis of microarray, logistic regression, and Wilcoxon analyses, suggesting the existence of an inflammatory-related endophenotype of AD that may provide targeted therapeutic opportunities for this subset of patients.

Objectives. To investigate the link between neurocognitive measures and various aspects of daily living (ADL and IADL) in women and men with mild Alzheimer's disease (AD).Methods. Participants were 202 AD patients (91 male, 111 female) with CDR global scores of ≤1. ADLs and IADLs ratings were obtained from caregivers. Cognitive domains were assessed with neuropsychological testing.Results. Memory and executive functioning were related to IADL scores. Executive functioning was linked to total ADL. Comparisons stratified on gender found attention predicted total ADL score in both men and women. Attention predicted bathing and eating ability in women only. Language predicted IADL functions in men (food preparation) and women (driving).Conclusions. Associations between ADLs/IADLs and memory, learning, executive functioning, and language suggest that even in patients with mild AD, basic ADLs require complex cognitive processes. Gender differences in the domains of learning and memory area were found.

The Effort Index (EI) of the RBANS was developed to assist clinicians in discriminating patients who demonstrate good effort from those with poor effort. However, there are concerns that older adults might be unfairly penalized by this index, which uses uncorrected raw scores. Using five independent samples of geriatric patients with a broad range of cognitive functioning (e.g., cognitively intact, nursing home residents, probable Alzheimer's disease), base rates of failure on the EI were calculated. In cognitively intact and mildly impaired samples, few older individuals were classified as demonstrating poor effort (e.g., 3% in cognitively intact). However, in the more severely impaired geriatric patients, over one third had EI scores that fell above suggested cutoff scores (e.g., 37% in nursing home residents, 33% in probable Alzheimer's disease). In the cognitively intact sample, older and less educated patients were more likely to have scores suggestive of poor effort. Education effects were observed in three of the four clinical samples. Overall cognitive functioning was significantly correlated with EI scores, with poorer cognition being associated with greater suspicion of low effort. The current results suggest that age, education, and level of cognitive functioning should be taken into consideration when interpreting EI results and that significant caution is warranted when examining EI scores in elders suspected of having dementia.

Background: The purpose of this study was to examine the mediating impact of executive functioning on the link between other neuropsychological domain scores and informant-based rating of functional status.Methods: Data on 181 participants were analyzed from an ongoing epidemiological study of rural health, Project FRONTIER (mean age = 64.6 ± 13.8 years, 69% women, 42% Mexican American). Executive functioning was assessed by the EXIT25 and other neuropsychological domains were assessed via the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Informant-based rating of functional status was assessed via the Clinical Dementia Rating Scale sum of boxes scores (CDR SB).Results: RBANS Index scores were each significantly (p < 0.05) related to CDR SB scores and EXIT25 scores. EXIT25 score was a significant partial mediator of the link between four RBANS indices (Immediate Memory, Attention, Visuospatial/Construction, Delayed Memory) and CDR SB scores, and a complete mediator of the fifth index (Language).Conclusion: Executive functioning is a mediator of the link between other neuropsychological domains and daily functioning. Neuropsychological assessments that do not measure executive functioning will provide only a partial clinical picture with adults and elders.

Background It was recently demonstrated that the Clinical Dementia Rating scale Sum of Boxes (CDR-SB) score can be used to accurately stage severity of Alzheimer dementia and mild cognitive impairment (MCI). However, to our knowledge, the utility of those interpretive guidelines has not been cross-validated or applied to a heterogeneous sample of dementia cases. Objective To cross-validate the staging guidelines proposed in a previous study using the National Alzheimer's Coordinating Center (NACC) database. Design The previously published cut scores were applied to the NACC sample and diagnostic accuracy estimates obtained. Next, analyses were restricted to NACC participants with a CDR global score (CDR-GS) of 0.5 and receiver operating characteristic curves generated to determine optimal CDR-SB cut scores for distinguishing MCI from very early dementia. Setting The 2008 NACC uniform data set. Participants There were 12 462 participants (5115 controls; 2551 patients with MCI; 4796 patients with dementia, all etiologies) in the NACC data set used for the current analysis. Main Outcome Measure Accurate prediction of diagnoses (MCI or dementia) using the CDR-SB score. Results The previously proposed CDR-SB ranges successfully classified the vast majority of patients across all impairment ranges with a κ of 0.91 and 94% overall correct classification rate. Additionally, the CDR-SB score discriminated between patients diagnosed with MCI and dementia when CDR-GS was restricted to 0.5 (overall area under the curve = 0.83). Conclusions These findings cross-validate the previously published CDR-SB interpretative guidelines for staging dementia severity and extend those findings to a large heterogeneous sample of patients with dementia. Additionally, the CDR-SB scores distinguished MCI from dementia in patients with reasonable accuracy when CDR-GS was restricted to 0.5.

Purpose To determine the trend and disparities in infant mortality rate (IMR) from 1990 to 2004 in Texas, which is one of the few states with severe physician shortage in the United States. Methods Trend analysis and Poisson regression were performed with data from Texas Department of State for Health Services and other Web sites. Results IMR decreased from 1990 to 2000 followed by a trend of increase from 2000 to 2004 in Texas. The recent trend of increase in IMR was observed in all ethnic groups. IMR was associated with ethnicity, area of residence in Texas (rural vs urban areas in east vs south vs west), median income index, and primary care physician supply (primary care physician to population ratio). IMR in blacks was more than 2 times that of other ethnic groups, and the gap had been increasing since 1997. The recent increasing trend in IMR coincided with a decreasing trend in primary care physician supply and a decrease or a slower increase in median income index. Conclusions IMR increased in recent years, particularly in African Americans in Texas. Measures should be taken to reverse the worsening trend in IMR and to reduce regional and racial disparities.

Neuropsychologists routinely assess patients from racially, ethnically, and culturally diverse populations. Despite this fact, there remains a paucity of research investigating the influence of these variables on neuropsychological test performance. The Symbol Digit Modalities Test (SDMT) is a widely used measure of attention, visual scanning and tracking, and psychomotor speed. The purpose of the present study was to assess the relation between ethnicity and SDMT performance in ethnically diverse cognitively normal and cognitively impaired samples. Participants were 168 college students (81 Caucasian, 49 African American, 20 Asian American, and 18 Hispanic) and 24 patients (12 Caucasian and 12 Hispanic) chronically infected with hepatitis C. Results revealed no significant group differences in SDMT performance in either the student or patient sample. Furthermore ethnicity accounted for only 2 and 3 percent of the variance in SDMT scores for the patient and student samples, respectively. These findings provide preliminary support for the use of the SDMT across ethnically diverse populations in both clinical and normal samples though further analysis is warranted.

This study examined the relation between ethnicity and results obtained during standard administration of the Cognistat, a screening measure of cognitive functioning, in a sample of male veterans seeking substance use disorder treatment (n = 312). Results indicated that screening items for the Naming, Calculation, and Similarities subtests were missed significantly more frequently by African American compared to Caucasian veterans, although the frequency of identification as impaired on the full metric portion of this scales did not differ based on ethnicity. The mean scores on the metric items for these three scales were very similar between groups. Additionally, African American veterans diverted to the Constructional Ability metric items had significantly lower scores on items from that subtest. Logistic regression analyses of impairment identification on the various subtests indicated that ethnicity was a significant (p < .005) predictor beyond the covariates of age and years of education for the Calculation subtest, but only accounted for 4.8% of the variance. Based on the results of the current study, it is recommended that 1) the entire Cognistat be administered regardless of screening item performance to minimize the risk of potential ethnic or cultural based performance bias and 2) a prospective study of potential demographic bias based on comparing Cognistat screening results to a battery of specific neuropsychological assessments of the same constructs be performed to maximize the potential specificity and sensitivity of this assessment for all demographic groups.

Current standard neuropsychology practice is to examine normative sample performance for systematic influences of demographic variables and then to correct for these influences. The most commonly examined demographic variables are age, gender, and years of education, and current normative databases frequently take these into consideration. However, there is a literature to suggest that self-reported years of educational attainment may not be an accurate reflection of some patients' level of performance and may actually overpredict grade estimates based on reading level. Many of these studies have focused on older samples of individuals who were free of neurological or psychiatric symptoms. In this study, a younger sample (average age = 44.5) of African American (N = 62) and Caucasian (N = 133) patients referred to an outpatient psychiatry unit was examined. Results suggest that the prior findings of a significant discrepancy between self-reported years of education and Wide Range Achievement Test-3rd Edition Reading Recognition performance hold for a younger sample with a broad range of clinical diagnoses. How these findings might influence clinical practice are discussed.

Demographic variables have long been known to exert effects on psychological testing. Variables such as age, education, and gender have been thoroughly researched, and their effects are well documented. Other demographic variables such as race, ethnicity, socioeconomic status, native language, and acculturation are less well researched within the field of neuropsychology. Research that has been produced to date has demonstrated that each of these variables does indeed wield some effect on neuropsychological test performance. Therefore, it is important that these variables be reported in the literature so that neuropsychologists are able to generalize research findings to their everyday practice with patients from diverse backgrounds. With this in mind, the current study was undertaken in order to determine the frequency with which a range of demographic variables are being reported in current neuropsychological research journals. Publications from 1995 to 2000 in five of the most frequently utilized neuropsychology journals were reviewed. Results showed that while age, education, and gender are frequently reported, information on race, ethnicity, native language, and acculturation are rarely, if ever, reported. These results show that even though great strides have been taken in the burgeoning field of cross-cultural neuropsychology, current trends need to be changed in order for progress to continue.

Until recently, the notion of having blood markers of Alzheimer disease (AD) available for clinical use was more likely to be seen in an episode of a TV medical drama or a science fiction movie than in a peer-reviewed scientific journal. The search for biomarkers suffered from serious obstacles, including, but not limited to, inadequate diagnostic accuracy, and an inability to replicate findings across samples between laboratories or even within individual laboratories. However, the serious scientific world took notice when, in 2007, Ray et al.1 published a plasma-based screening tool that utilized advanced proteomic and bioinformatics methods to create a blood profile that was highly accurate in identifying persons with AD as well as those who were most likely to progress from mild cognitive impairment (MCI) to AD dementia. Enthusiasm diminished, …

Background Although a great deal of literature has focused on risk factors for mild cognitive impairment (MCI), little published work examines risk for MCI among Mexican Americans. Methods Data from 1628 participants (non-Hispanic n = 1002; Mexican American n = 626) were analyzed from two ongoing studies of cognitive aging and Alzheimer's disease, Project FRONTIER (Facing Rural Obstacles to health Now Through Intervention, Education & Research) and TARCC (Texas Alzheimer's Research & Care Consortium). Results When looking at the full cohorts (non-Hispanic and Mexican American), age, education, Apolipoprotein E ( APOE ) e4 status and gender were consistently related to MCI diagnosis across the two cohorts. However, when split by ethnicity, advancing age was the only significant risk factor for MCI among Mexican Americans across both cohorts. Conclusions The current data suggest that many of the previously established risk factors for MCI among non-Hispanic cohorts may not be predictive of MCI among Mexican Americans and point to the need for additional work aimed at understanding factors related to cognitive aging among this underserved segment of the population.