1. Friday Harbor Psychometrics 2012 Scientific Summary UC Davis / SENAS (Spanish and English Neuropsychological Assessment Scales)

2. Friday Harbor Psychometrics Workshop 2011 Acknowledgements Funded in part by Grant R13AG030995-01A1 from the National Institute on Aging The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention by trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

3. Overview SENAS Overview Demographic variables and longitudinal change Ethnicity, clinical diagnosis, and cognitive change Age, education, and relationship to brain Decomposing demographic and brain effects Intracranial volume and cognition Factorial invariance Final thoughts Friday Harbor Psychometrics 2012

4. SENAS Overview Friday Harbor Psychometrics 2012

5. Purpose of SENAS Project (circa 1992) Create matched English and Spanish language neuropsychological tests for ages 60+  New scales based upon neuropsychological model of cognitive functioning  Scales psychometrically matched Within English and Spanish language versions Between English and Spanish language versions  Distribution of item difficulty appropriate to elderly population

6. Friday Harbor Psychometrics 2012 Approach Concept of item and test bias central to project Development and validation based on modern psychometric methods  Item response theory (IRT)  Latent variable modeling Empirically based  Data based approach to making decisions about item selection and scale construction  Empirical evaluation of reliability and validity

7. Friday Harbor Psychometrics 2012 Guiding Principles Initial Scale Development Scales targeted to assess neuropsychologically relevant cognitive domains Verbal and non-verbal measures Non-timed New scales, not translations of existing scales Examiner administered Item generation New items Broad range of difficulty

8. Friday Harbor Psychometrics 2012 SENAS Scales and Abilities Measured

9. Friday Harbor Psychometrics 2012 Model for Item Selection

10. Friday Harbor Psychometrics 2012 Test Information for 3MS and SENAS Object Naming Mungas et al., 2004

11. Scientific Applications Friday Harbor Psychometrics 2012

12. Summary Conclusions / Challenge for Conference Demographic variables have robust effects on baseline test scores  Especially ethnicity and education Demographic variables have minimal effects on longitudinal change  Brain and disease variables account for change Friday Harbor Psychometrics 2012

13. African American N ≈ 425 Hispanic English N ≈ 450 Hispanic Spanish N ≈ 900 Caucasian N ≈ 700 English Hispanic Community African American N ≈ 140 Hispanic N ≈ 130 Caucasian N ≈ 235 Longitudinal Clinic N ≈ 350 N ≈ 175 Cognition Clinical MRI Life Experience Morphometric Measures

14. Ethnicity, education, and cognitive change Friday Harbor Psychometrics 2012

15. Purpose of this study Understand how demographic variables relate to cognitive change Demographic variables of interest  Race/Ethnicity  Education  Language of test administration Friday Harbor Psychometrics 2012

16. Independent Variables Model 1  Verbal Memory Form  Previous Evaluation  Spanish Administration  Prev Eval by Spanish Interaction Model 3  Age & Education  Gender Model 2  Race/Ethnicity Model 4  Recruitment Source  Clinical Diagnosis  APOE Genotype Friday Harbor Psychometrics 2012

17. Language, Ethnicity, Education Effects Episodic Memory Friday Harbor Psychometrics 2012 BaselineChange EffectEstimateSEEstimateSE Intercept.62.08 Time -.04.02 Previous Eval -.06.04 Language (Spanish) -.30.13-.04.04 Span x PrevEval.33.12 Hispanic-.29.11.04.03 African American -.06.08.01.02 Education.03.01-.00.00

18. Language, Ethnicity, Education Effects Executive Function Friday Harbor Psychometrics 2012 BaselineChange EffectEstimateSEEstimateSE Intercept.32.07 Time -.03.02 Previous Eval.01.03 Language (Spanish) -.08.11-.01.03 Span x PrevEval.08.07 Hispanic-.32.09.02.03 African American -.30.07.04.02 Education.05.01-.00.00

19. Executive Function Trajectories by Education Friday Harbor Psychometrics 2012

20. Average Ethnic Group Performance by Model – Episodic Memory Friday Harbor Psychometrics 2012

21. Ethnicity, clinical diagnosis, and cognitive change Friday Harbor Psychometrics 2012

22. Episodic Memory by Diagnosis Change Friday Harbor Psychometrics 2012 Mungas et al., 2010

23. Episodic Memory by Diagnosis Change African American Friday Harbor Psychometrics 2012

24. Episodic Memory by Diagnosis Change Hispanic Friday Harbor Psychometrics 2012

25. Episodic Memory by Diagnosis Change Caucasian Friday Harbor Psychometrics 2012

26. Age, education, and relationship to brain Friday Harbor Psychometrics 2012

27. MRI Effect Sizes and Age and Education Adjustment - Episodic Memory Mungas et al., 2009

28. Friday Harbor Psychometrics 2012 Executive Function, MRI, Age & Education African Americans Executive Function Age BM Education -.55.00 -.03.32.36.39-.26 -.24 Mungas et al., 2009

29. Friday Harbor Psychometrics 2012 Executive Function, MRI, Age & Education Hispanics Executive Function Age BM Education -.60.00 -.17.46.30.44-.40.01 Mungas et al., 2009

30. Friday Harbor Psychometrics 2012 Executive Function, MRI, Age & Education Caucasians Executive Function Age BM Education -.53.00 -.10.29.28-.36 -.07 Mungas et al., 2009

31. Friday Harbor Psychometrics 2012 Age and Education Influences on MRI - Cognition Relationships It is possible to separate disease effects from extraneous influences MRI effects on cognition can obscured by demographic effects on test performance, especially when Demographic relationship with test score is larger than relationship with disease Substantial heterogeneity of demographic variable in population of interest

32. Decomposing demographic and brain effects Friday Harbor Psychometrics 2012 Reed et al., 2010

33. Friday Harbor Psychometrics 2012

34. Data 288 subjects. 158 normal, 92 MCI, 38 demented 96 African Americans, 74 Hispanics (32 tested in English, 42 tested in Spanish), and 118 Caucasians. Education M = 12.7 yrs (range 0-25) Age M = 74.7 yrs (range 60-93) Mean evaluations = 3.5; 74% had 3 or more evaluations. N of evaluations truncated at 5. Reed et al., 2010

35. Friday Harbor Psychometrics 2012 Mem-D ~ 20% of episodic memory variance Mem-B ~ 20% of episodic memory variance Mem-R ~ 50% of episodic memory variance Reed et al., 2010

36. Friday Harbor Psychometrics 2012 Relationships of memory components with global cognitive function (CDR sum of boxes) DVMemory Component Standardized Coefficient p CDR SumMem-D-0.09ns Mem-B-0.430.001 Mem-R-0.440.001 Reed et al., 2010

37. Friday Harbor Psychometrics 2012 Relationships of memory components with clinical progression (conversion to MCI or dementia) Memory Component Relative Risk Ratio (confidence interval) Mem-D1.58 (0.92 - 2.71) Mem-B0.19 (0.11 - 0.33) Mem-R0.27 (0.18 - 0.40) Reed et al., 2010

38. Friday Harbor Psychometrics 2012 Relationships of memory components with longitudinal change in cognition (executive function) Memory Component Random Effect ParameterStandard Error p Mem-Dbaseline0.3640.0430.001 Mem-Bbaseline0.1800.0310.001 Mem-Rbaseline0.3290.0340.001 Mem-Dchange-0.0110.010ns Mem-Bchange0.0500.0100.001 Mem-Rchange0.0470.0110.001 Reed et al., 2010

39. Friday Harbor Psychometrics 2012 Effects of Mem-D? Substantial variance in Episodic Memory was uniquely related to demographic variables (ethnicity and education especially)  Greater amount for other cognitive domains Mem-D was minimally related to clinical outcomes  Especially longitudinal decline and conversion Challenge in clinical neuropsychological assessment is to separate demographic from brain influences on test scores Reed et al., 2010

40. Intracranial volume and cognition Friday Harbor Psychometrics 2012 Farias et al., 2012

41. Model of joint effects of intracranial volume and brain structure Friday Harbor Psychometrics 2012 Farias et al., 2012

42. Semantic Memory by ICV Friday Harbor Psychometrics 2012 Farias et al., 2012

43. Cognition and ICV ICV related to Semantic Memory and Executive Function ICV not related to Episodic Memory Early development might have impact on cortical development Friday Harbor Psychometrics 2012 Farias et al., 2012

44. Factorial invariance Friday Harbor Psychometrics 2012

45. Sample Community dwelling recruited using cognitive screening protocol and clinic referrals  Whites - n=678  Blacks - n=352  Hispanics, English Speaking n=434  Hispanics, Spanish Speaking n=877 Broad range of cognitive function  Normal to demented Mungas et al., 2011

46. Friday Harbor Psychometrics 2012 Word List Learning 2 Spatial Config Learning Word List Learning 1 Verbal Comprehension Verbal Expression Verbal Abstraction Picture Association Object Naming Category Fluency Phonemic Fluency Working Memory Verbal Attention Visual Attention NonVerbal Reasoning Pattern Recognition Spatial Localization Best Factor Structure FluencySpatialVerbalMemoryAttention Mungas et al., 2011

47. Friday Harbor Psychometrics 2012 Invariance of Dimensional Structure Across Ethnic and Language Groups Same number of dimensions Invariant Factor Loadings  Observed test scores have same relationship to latent dimensions Some differences in Intercepts for tests  Spanish speaker has to have greater latent attention ability to achieve a given Verbal Attention score Mungas et al., 2011

48. Friday Harbor Psychometrics 2012 Verbal Attention by Attention/Working Memory Mungas et al., 2011

49. Final Thoughts Friday Harbor Psychometrics 2012

50. Longitudinal Trajectories Friday Harbor Psychometrics 2012

51. Longitudinal Trajectories Friday Harbor Psychometrics 2012

52. Conclusions Cross-sectional results can be misleading  Confound lifelong ability and disease effects Longitudinal assessment important to separate these effects  Ideally beginning in mid adulthood  In absence of ideal – evidence that demographic effects on cognitive decline are small and distal Don’t assume a low score is impairment Friday Harbor Psychometrics 2012

53. References Farias, S. T., D. Mungas, et al. (2012). "Maximal brain size remains an important predictor of cognition in old age, independent of current brain pathology." Neurobiol Aging 33(8): 1758-1768. Mungas, D., B. R. Reed, et al. (2004). "Spanish and English Neuropsychological Assessment Scales (SENAS): Further development and psychometric characteristics." Psychological Assessment 16(4): 347-359. Mungas, D., B. R. Reed, et al. (2005). "Spanish and English Neuropsychological Assessment Scales: relationship to demographics, language, cognition, and independent function." Neuropsychology 19(4): 466-475. Friday Harbor Psychometrics 2012

54. References Mungas, D., B. R. Reed, et al. (2009). "Age and education effects on relationships of cognitive test scores with brain structure in demographically diverse older persons." Psychology and Aging 24(1): 116-128. Mungas, D., L. Beckett, et al. (2010). "Heterogeneity of cognitive trajectories in diverse older persons." Psychol Aging 25(3): 606-619. Mungas, D., K. F. Widaman, et al. (2011). "Measurement invariance of neuropsychological tests in diverse older persons." Neuropsychology 25(2): 260-269. Reed, B. R., D. Mungas, et al. (2010). "Measuring cognitive reserve based on the decomposition of episodic memory variance." Brain 133: 2196-2209. Friday Harbor Psychometrics 2012

55. Ethnic Differences and DIF SENAS Picture Association and Verbal Learning English Administration - N = 1113  396 Hispanics, 480 Whites, 237 Blacks Spanish Administration - N = 801 Ability adjusted for all-source DIF  Education, Ethnicity, Age MIMIC approach

56. Friday Harbor Psychometrics 2012 Picture Association Effects of DIF Adjustment

57. Friday Harbor Psychometrics 2012 Word List Learning Effects of DIF Adjustment

58. Friday Harbor Psychometrics 2012 Effect of DIF Adjustment on Individual Scores (95% confidence interval) Picture Association Word List Learning White±.29 s.d.±.10 s.d. Black±.41 s.d.±.02 s.d. Hispanic - English±.23 s.d.±.00 s.d. Hispanic - Spanish±.36 s.d.±.06 s.d.

59. Friday Harbor Psychometrics 2012 SENAS and DIF DIF accounted for a very small amount of ethnic differences in Object Naming, Picture Association, Word List Learning DIF effects differ by domain  Greater for measures of semantic memory  Smaller for episodic memory DIF effects can potentially bias interpretation of individuals scores  Especially in borderzone areas

60. Cross-sectional ethnic differences can be explained by confounding variables Friday Harbor Psychometrics 2012

61. Semantic Memory Mean Ethnic Group Differences