WLS-ILIAD: New Longitudinal Resource for Cognitive and Dementia Data

One of the distinctive strengths of WLS is the availability of Henmon-Nelson IQ scores on all participants while in high school, followed by prospective collection of data through cognitive batteries of varying size and sophistication. Launched in 1993, the initial longitudinal cognitive testing included 8 abstract reasoning items followed by the administration of larger cognitive batteries in 2004 and 2011 comprised of a 10-item word recall test, digit ordering task, phonemic and category fluency, as well as repeated and new items from the WAIS-R similarities task first administered in the 1993 survey. In 2018, with R01 funding from NIA, the scope of cognitive testing expanded significantly and includes administration of a phone-based cognitive screening measure, and a comprehensive in-person neuropsychological assessment for individuals identified at risk for dementia targeting a range of cognitive domains, including memory, language, attention, visuospatial abilities, and executive functioning.

How Does Cochlear Implantation Lead to Improvements on a Cognitive Screening Measure?

Purpose Cognitive screening tools to identify patients at risk for cognitive deficits are frequently used by clinicians who work with aging populations in hearing health care. Although some studies show improvements in performance on cognitive screening exams when hearing loss intervention is provided in the form of a hearing aid or cochlear implant (CI), it is worth examining whether these improvements are attributable to increased auditory access to test items. This study aimed to examine whether performance and pass rate on a cognitive screening measure, the Montréal Cognitive Assessment (MoCA), improve as a result of CI, whether improved performance on auditory-based test items drives changes in MoCA performance, and whether postoperative MoCA performance relates to post-CI speech perception ability. Method Data were collected in adult CI candidates pre-implantation and 6 months postimplantation to examine the effect of intervention on MoCA performance. Participants were 77 CI users between the ages of 55 and 85 years. Participants completed the MoCA, administered audiovisually, and speech perception testing with monosyllabic (CNC) words at both intervals. Results Compared to 31 participants pre-operatively, 45 participants passed the MoCA postoperatively, which was a significant difference in pass rate. An improvement in MoCA scores could be attributed primarily to improvement in the “Delayed Recall” test domain, which was auditory based. Post-CI MoCA performance was related to post-CI CNC speech perception performance. Conclusions Improved performance and pass rates were demonstrated on the traditional MoCA test of cognitive screening from before to 6 months after CI. Improvements could primarily be attributed to better performance on a delayed recall task dependent on auditory access, and post-CI MoCA scores were related to post-CI speech perception abilities. Further studies are needed to investigate the application of cognitive screening tools in patients receiving hearing loss interventions, and these interventions' impact on patients' real-world functioning.

C-22 Examining the Factor Structure of the Clock-In-the-Box in Older Adults

Objective To investigate the factor structure of the Clock-In-the-Box (CIB), a cognitive screening measure, and compare it to the original CIB subscores (Working Memory and Planning/Organization) that were created based on clinical observations. The new factor structure was used to determine the predictive validity of the CIB subscores, in predicting cognitive diagnosis in an older veteran population. Methods Neuropsychological evaluations conducted at VA Boston Healthcare System were reviewed. Exploratory factor analysis (EFA) and logistic regression were employed to determine the predictive validity of the new CIB subscores compared to the original subscores. Results The cohort had a mean age of 69.77 years (SD = 10.12), 97% male and mainly white (84.9%). EFA revealed a best fit two-factor model, explaining 60% of the variance (Factor 1 - 46% and, Factor 2 - 14% of the variance). Factor 1 reflected conceptual items (i.e., numbers, resembles clock) while Factor 2 reflected planning/organizational items (i.e., hand length, number spacing). Factors were moderately correlated (r = .456). Logistic regression revealed the original and new subscores were equivalent in predicting cognitive impairment when controlling for age and education; correctly classified 82% of the cases. When controlling for age and education, only Factor 2 remained predictive of impairment. Conclusions Analysis of specific task items resulted in subscores that differ from those initially generated based on clinical experience, with both providing clinically useful information. The CIB is a brief instrument with good predictive validity of cognitive impairment and clinically useful as a first line screening to inform the need for further assessment.

Validity and Clinical Utility of Different Clock Drawing Test Scoring Systems in Multiple Forms of Dementia

The Clock Drawing Test (CDT) has a known potential for the detection of cognitive impairment in populations with dementia, especially Alzheimer disease (AD). Our aim was to compare the clinical utility of 3 CDT scoring systems (Rouleau, Cahn, and Babins) in several pathologies with cognitive compromise from a tertiary center memory clinic. We selected patients with a clinical diagnosis of mild stage AD, behavioral variant frontotemporal dementia (FTD), vascular dementia (VaD), dementia with Lewy bodies (DLB), and Parkinson disease with dementia (PDD). The results showed significant differences between the several diagnoses with the following pattern of results: AD, DLB < FTD, VaD, PDD. Qualitative analysis of clock drawing errors confirmed the stimulus-bound response as a hallmark of AD, while conceptual deficit was significantly more prevalent in patients with AD and DLB. Our results supported the CDT potential as a cognitive screening measure for mild dementia, particularly sensitive to AD and DLB, especially when we used the Cahn scoring system and its analysis of qualitative errors.