The Mini-Cog, Clock Drawing Test, and Three-Item Recall Test: Rapid Cognitive Screening Tools with Comparable Performance in Detecting Mild NCD in Older Patients

Background: Early mild neurocognitive disorder (mild NCD) detection can allow for appropriate planning and delay disease progression. There have been few studies examining validated mild NCD detection tools. One such tool that may be of use is the Mini-Cog, which consists of the clock drawing test (CDT) and three-item recall. Methods: This study aimed to compare the diagnostic properties of the Mini-Cog, the CDT alone, and the three-item recall test alone in mild NCD detection according to DSM-5 criteria. The participants were older patients attending the medicine outpatient clinic. Area under receiver operating characteristic (ROC) curve (AUC) analysis was used to compare the tools’ accuracy. Results: A total of 150 patients were enrolled, 42 of whom were diagnosed as having mild NCD. The AUCs of ROC curves of the three-item recall, CDT, Mini-Cog1, and Mini-Cog2 were 0.71, 0.67, 0.73, and 0.71, respectively (p = 0.36). The sensitivity of the tools was 85.7%, 66.7%, 57.4%, and 69% respectively. The tests performed similarly in participants with ≤6 years of education (p = 0.27) and those with >6 years of education (p = 0.49). Conclusions: All tools exhibited similar acceptable performance in detecting mild NCD and were not affected by education. These convenient tools might be suitable for use in clinical practice.

Comprehension of Morse Code Predicted by Item Recall From Short-Term Memory

Purpose Morse code as a form of communication became widely used for telegraphy, radio and maritime communication, and military operations, and remains popular with ham radio operators. Some skilled users of Morse code are able to comprehend a full sentence as they listen to it, while others must first transcribe the sentence into its written letter sequence. Morse thus provides an interesting opportunity to examine comprehension differences in the context of skilled acoustic perception. Measures of comprehension and short-term memory show a strong correlation across multiple forms of communication. This study tests whether this relationship holds for Morse and investigates its underlying basis. Our analyses examine Morse and speech immediate serial recall, focusing on established markers of echoic storage, phonological-articulatory coding, and lexical-semantic support. We show a relationship between Morse short-term memory and Morse comprehension that is not explained by Morse perceptual fluency. In addition, we find that poorer serial recall for Morse compared to speech is primarily due to poorer item memory for Morse, indicating differences in lexical-semantic support. Interestingly, individual differences in speech item memory are also predictive of individual differences in Morse comprehension. Conclusions We point to a psycholinguistic framework to account for these results, concluding that Morse functions like “reading for the ears” ( Maier et al., 2004 ) and that underlying differences in the integration of phonological and lexical-semantic knowledge impact both short-term memory and comprehension. The results provide insight into individual differences in the comprehension of degraded speech and strategies that build comprehension through listening experience. Supplemental Material https://doi.org/10.23641/asha.16451868

A-105 Perceived Workload and Depression on the Rey 15-Item Recall and Recognition Test: The Impact of Ethnicity and Brain Injury

Introduction We examined the impact of perceived workload and depressive symptoms on Rey-15 plus recognition (RMT) in ethnic minority participants with traumatic brain injury (TBI). Methods The sample consisted of 63 healthy comparison [HC: 38 with ethnic minority status (EM) & 25 non-ethnic minority Caucasian (NEM)] participants and 40 persons with TBI (18 EM; 22 NEM). The Hospital Anxiety and Depression Scale to measure depressive symptoms (HADS-D) and the NASA-Task Load Index (NASA TLX) to measure perceived workload. Results ANCOVAs revealed that NEM outperformed EM on the RMT, p = 0.000, ηp2 = 0.37. TBI survivors reported higher levels of HADS-D compared to HC participants, p = 0.018, ηp2 = 0.06. Additionally, the EM group reported higher levels of frustration on the RMT compared to NEMs, p = 0.033, ηp2 = 0.05. Interactions emerged for physical demand where NEM participant’s with TBI had higher ratings than EM participants with TBI. For HCs, the EM participants provided higher physical demand ratings than their NEM counterparts, p = 0.029, ηp2 = 0.05. Additionally, a significant relationship between HADS-D and RMT was observed in the healthy NEM participants (r = −0.558, p = 0.004) and NEM participants with TBI (r = −0.288, p = 0.080). Finally, significant relationships between HADS-D and mental demand, physical demand, temporal demand, frustration, and overall subjective workload were observed in healthy EM participants, r = 0.342–0.431, p < 0.05. Conclusion Consistent with previous research, TBI survivors reported higher levels of depressive symptoms, which were associated with RMT performances. Overall, our data suggest the relationship between perceived workload, depression, and performance is complex and that investigators should interpret performance validity scores in person with TBI, depression, and/or EM status with great care.

EXPRESS: The effect of early list manipulations on the DRM illusion

The Deese-Roediger-McDermott (DRM) paradigm is widely used to study false memory in the laboratory. It tests memory for lists of semantically related words (correct list item memories) and their non-presented associates (false lure memories). Evidence suggests that early items in DRM lists could make an especially significant contribution to false memories of lures, as they may critically influence the underlying associative activation and/or gist extraction processes. The present study tested this suggestion by using two manipulations that were intended to affect processing of early DRM list items. The first was interpolation of a semantically unrelated distractor item among the list items (Experiments 1 and 2). The second was arranging for these items to be either the strongest or weakest associates of the lure (Experiment 2). In Experiment 1, a distractor item reduced both list item and lure recall when presented early in a DRM list, but selectively disrupted list item recall when presented late in the list. In Experiment 2, arranging for the early list items to be the weakest associates of the lure reduced false recall of the lure but had no effect on list item recall. The findings are discussed with respect to theories that explain false memory in the DRM protocol, including fuzzy trace theory (FTT) and activation monitoring theory (AMT). They are also discussed with respect to general theories of memory and the potential role of category/context information in generating false memories.

Changing Between Virtual Reality and Real-World Adversely Affects Memory Recall Accuracy

Context-dependency effects on memory exist, whereby people’s context influences their ability to accurately recall items from memory. This effect was not previously studied when considering virtual reality as an environmental context. We show that adverse effects on recall of memorized items exist when changing between virtual and real environments. The effect was not present when memorizing and recall were both done in VR; it appears to be caused by the change of environmental context. This previously unknown effect may impact how we use VR for memorization tasks, particularly when accurate recall of memorized information in a real environment is important. In a memory-recall experiment (n = 51) participants that underwent a context change involving VR after memorizing performed significantly worse on 24-h later item recall than those who did not change context (17% lower accuracy, p < 0.001). In particular memorizing in VR as opposed to a real environment lowers accuracy of recall in a real environment (24% lower, p = 0.001).

End-to-End Tracing and Congestion in a Blockchain

Modern supply chain applications are complex systems that play an important role in many different sectors. Supply chain management systems are implemented to handle increasing complexity and flows of goods. However, most of these systems are also increasing the complexity of providing trust and a global view of transactions in a distributed supply chain system. Blockchain technology introduces a new architectural style to support the traceability and trust of transactions performed by participants in a network. This chapter uses this emerging technology to realize a supply chain use case from JLP Meats in the UK with improved transparency, trust, and end-to-end querying while discussing potential challenges of realizing large-scale enterprise blockchain applications. The process of farm-to-fork is implemented and tested for traceability, item recall, block analysis, congestion enabling food safety, and sustainable agriculture. Potential challenges are highlighted in complex supply chains that need heterogeneous trade compliance and scalability.

Motoric Cognitive Risk Syndrome Using Three-Item Recall Test and Its Associations with Fall-Related Outcomes: The Korean Frailty and Aging Cohort Study

Motoric cognitive risk (MCR) syndrome is originally defined as the presence of subjective cognitive complaints (SCCs) and slow gait (SG). MCR is well known to be useful for predicting adverse health outcomes, including falls and dementia. However, around four out of five older Korean adults reported SCCs, thereby, it may not be discriminative to define MCR in Korea. We adopted the three-item recall (3IR) test, instead of SCCs, to define MCR. This cross-sectional analysis included 2133 community-dwelling older adults aged 70–84 years, without dementia or any dependence in activities of daily living from the Korean Frailty and Aging Cohort Study. The newly attempted criteria of MCR using 3IR were met by 105 participants (4.9%). MCR using 3IR showed synergistic effects on fall-related outcomes, whereas the conventional definition of MCR using SCCs was not superior to SG only. MCR using 3IR was associated with falls (odds ratio [OR]: 1.92; 95% confidence interval (CI): 1.16–3.16), recurrent falls (OR: 2.19; 95% CI: 1.12–4.32), falls with injury (OR: 1.98; 95% CI: 1.22–3.22), falls with fracture (OR: 2.51; 95% CI: 1.09–5.79), fear of falling (OR: 3.00; 95% CI: 1.83–4.92), and low activities-specific balance confidence (OR: 3.13; 95% CI: 1.57–6.25). We found that MCR using 3IR could be useful in predicting fall-related outcomes in a cultural background reporting more SCCs, such as Korea.

Qualitative Interviewing: Testing Health Surveys Among Vietnam War Veterans at the Age of 70 Years

The Vietnam Era Health Retrospective Observational Study (VE-HEROeS) is a nationwide study designed to compare the health of U.S. Vietnam era veterans to age- and sex-matched U.S. residents. Two self-administered mail questionnaires, one for veterans and the other for the U.S. nonmilitary population, were developed using already validated and newly developed items. A pretest was conducted to evaluate item recall and comprehension, new-item response validity, and the overall survey experience (usability of survey materials including the screener questionnaire for nonveterans). Subject recruitment was completed using convenience sampling and a $50 incentive. Cognitive interviewing and usability interviewing, two qualitative research methods, were implemented. Interviews were conducted in two stages (Stage 1, cognitive interviewing, n = 12; Stage 2, usability testing, n = 8) by three experienced methodologists. Concurrent probing techniques, unscripted probes, and retroactive probing were used to elicit response from 14 veterans and six nonveterans (mostly male, White, and aged 65-70 years). Information about the overall survey process was also obtained through observation during usability testing. Results signify that qualitative research is an important part of questionnaire development targeting older veterans due to issues involving comprehension, interpretability, and recall.

Wait, There’s a Baby in this Bath Water! Update on Quantitative and Qualitative Cut-Offs for Rey 15-Item Recall and Recognition

Objective Evaluate the effectiveness of Rey 15-item plus recognition data in a large neuropsychological sample. Method Rey 15-item plus recognition scores were compared in credible (n = 138) and noncredible (n = 353) neuropsychology referrals. Results Noncredible patients scored significantly worse than credible patients on all Rey 15-item plus recognition scores. When cut-offs were selected to maintain at least 89.9% specificity, cut-offs could be made more stringent, with the highest sensitivity found for recognition correct (cut-off ≤11; 62.6% sensitivity) and the combination score (recall + recognition – false positives; cut-off ≤22; 60.6% sensitivity), followed by recall correct (cut-off ≤11; 49.3% sensitivity), and recognition false positive errors (≥3; 17.9% sensitivity). A cut-off of ≥4 applied to a summed qualitative error score for the recall trial resulted in 19.4% sensitivity. Approximately 10% of credible subjects failed either recall correct or recognition correct, whereas two-thirds of noncredible patients (67.7%) showed this pattern. Thirteen percent of credible patients failed either recall correct, recognition correct, or the recall qualitative error score, whereas nearly 70% of noncredible patients failed at least one of the three. Some individual qualitative recognition errors had low false positive rates (<2%) indicating that their presence was virtually pathognomonic for noncredible performance. Older age (>50) and IQ < 80 were associated with increased false positive rates in credible patients. Conclusions Data on a larger sample than that available in the 2002 validation study show that Rey 15-item plus recognition cut-offs can be made more stringent, and thereby detect up to 70% of noncredible test takers, but the test should be used cautiously in older individuals and in individuals with lowered IQ.