Heidi Rossetti
University of Texas Southwestern Medical School, Psychiatry, Faculty Member
Background: The concept of mild cognitive impairment (MCI) has evolved since its original conception. So, too, have MCI diagnostic methods, all of which have varying degrees of success in identifying individuals at risk of conversion to... more
Background: The concept of mild cognitive impairment (MCI) has evolved since its original conception. So, too, have MCI diagnostic methods, all of which have varying degrees of success in identifying individuals at risk of conversion to dementia. The neuropsychological actuarial method is a straightforward diagnostic approach that has shown promise in large datasets in identifying individuals with MCI who are likely to have progressive courses. This method has been increasingly applied in various iterations and samples, raising questions of how best to apply this method and when caution should be used. Objective: Our objective was to review the literature investigating use of the neuropsychological actuarial method to diagnose MCI to identify strengths and weaknesses of this approach, as well as highlight areas for further research. Methods: Databases PubMed and PsychInfo were systematically searched for studies that compared the neuropsychological actuarial method to some other dia...
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OBJECTIVE A variety of factors affect list learning performance and relatively few studies have examined the impact of word selection on these tests. This study examines the effect of both language and memory processing of individual... more
OBJECTIVE A variety of factors affect list learning performance and relatively few studies have examined the impact of word selection on these tests. This study examines the effect of both language and memory processing of individual words on list learning. METHOD Item-response data from 1,219 participants, Mage = 74.41 (SD = 7.13), Medu = 13.30 (SD = 2.72), in the Harmonized Cognitive Assessment Protocol were used. A Bayesian generalized (non)linear multilevel modeling framework was used to specify the measurement and explanatory item-response theory models. Explanatory effects on items due to learning over trials, serial position of words, and six word properties obtained through the English Lexicon Project were modeled. RESULTS A two parameter logistic (2PL) model with trial-specific learning effects produced the best measurement fit. Evidence of the serial position effect on word learning was observed. Robust positive effects on word learning were observed for body-object integr...
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Objective: The Jak/Bondi actuarial method has been found to be superior to consensus diagnosis in identifying MCI in some but not all populations and may not perform as well in diverse samples. In this study, diagnostic agreement between... more
Objective: The Jak/Bondi actuarial method has been found to be superior to consensus diagnosis in identifying MCI in some but not all populations and may not perform as well in diverse samples. In this study, diagnostic agreement between actuarial and clinical consensus methods was examined by ethnic group in the heavily Hispanic/Latinx Texas Alzheimer’s Research and Care Consortium (TARCC) cohort. Method: TARCC participants with consensus diagnoses of NC and MCI at baseline (n = 1011; 66.47% female; 49.75% Hispanic; Mage = 67.28; Medu = 13.21) were reclassified via actuarial criteria of two failed tests (>1 SD below normative [MOANS in TARCC] mean) in one cognitive domain OR one failed test in 3+ cognitive domains. Chi square analyses investigated diagnostic agreement and test fail rates by ethnicity. Results: Diagnostic agreement significantly differed between ethnic groups (Cramer’s V = 0.42). 57% of the Hispanic consensus-NC group were relabeled as actuarial-MCI while just 12...
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Objective: Estimating when full time care will be needed in Alzheimer’s Clinical Syndrome (ACS) is difficult. This is due to limited research identifying the factors associated with loss of independent living (LOI), which may differ... more
Objective: Estimating when full time care will be needed in Alzheimer’s Clinical Syndrome (ACS) is difficult. This is due to limited research identifying the factors associated with loss of independent living (LOI), which may differ across dementia stages. Thus, we examined which clinical and neuropsychological factors predict LOI in the early-to-middle and late stages of ACS. Method: Using the National Alzheimer’s Coordinating Center dataset, individuals with ACS aged ≥50 years with no prior stroke were studied. LOI was based on self/informant report of progressing from requiring some assistance with complex activities at ACS diagnosis to needing assistance with basic activities. Four survival analyses were conducted to predict LOI (M time to LOI = 3.6 visits), for the early-to-middle (MMSE at diagnosis ≥20; N = 3128) and late stages of ACS (MMSE≤19; N = 737). Fifteen clinical predictors at time of ACS diagnosis were examined, followed by neuropsychological test scores added to the...
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Background: Life expectancy (LE) following Alzheimer’s disease (AD) is highly variable. The literature to date is limited by smaller sample sizes and clinical diagnoses. Objective: No study to date has evaluated predictors of AD LE in a... more
Background: Life expectancy (LE) following Alzheimer’s disease (AD) is highly variable. The literature to date is limited by smaller sample sizes and clinical diagnoses. Objective: No study to date has evaluated predictors of AD LE in a retrospective large autopsy-confirmed sample, which was the primary objective of this study. Methods: Participants (≥50 years old) clinically and neuropathologically diagnosed with AD were evaluated using National Alzheimer’s Coordinating Center (N = 1,401) data. Analyses focused on 21 demographic, medical, neuropsychiatric, neurological, functional, and global cognitive predictors of LE at AD dementia diagnosis. These 21 predictors were evaluated in univariate analyses. Variables found to be significant were then entered into a forward multiple regression. LE was defined as months between AD diagnosis and death. Results: Fourteen predictors were significant in univariate analyses and entered into the regression. Seven predictors explained 27% of LE ...
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In healthy adults, neural oscillatory activity within a predominantly left‐lateralized network of brain regions underlies verbal working memory (VWM) performance, but how mild cognitive impairment (MCI) impacts these oscillatory dynamics... more
In healthy adults, neural oscillatory activity within a predominantly left‐lateralized network of brain regions underlies verbal working memory (VWM) performance, but how mild cognitive impairment (MCI) impacts these oscillatory dynamics is not well characterized. The present study utilized the spatiotemporal precision of magnetoencephalographic (MEG) brain imaging to investigate the effects of MCI on the neural oscillations serving specific phases (i.e., encoding, maintenance) of VWM. In congruence with the compensation‐related utilization of neural circuits hypothesis (CRUNCH), we hypothesized that MCI patients would recruit greater neural resources during VWM.
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Previous magnetoencephalography (MEG) studies have shown that individuals with mild cognitive impairment and Alzheimer’s disease (AD) demonstrate increases in δ and θ, decreases in α and β, and lower ratios of relative power between high... more
Previous magnetoencephalography (MEG) studies have shown that individuals with mild cognitive impairment and Alzheimer’s disease (AD) demonstrate increases in δ and θ, decreases in α and β, and lower ratios of relative power between high and low frequency bands compared to controls. This analysis investigates the association between global cortical atrophy, a measure of neurodegeneration, and MEG resting‐state oscillations in cortical regions that show early AD neuropathology.
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The purpose of this review is to critically examine studies that have examined investigated the Montreal Cognitive Assessment (MoCA) and functional or medical outcomes and other health variables in patients with non-neurologic medical... more
The purpose of this review is to critically examine studies that have examined investigated the Montreal Cognitive Assessment (MoCA) and functional or medical outcomes and other health variables in patients with non-neurologic medical conditions. Databases OVID Medline and Embase were systematically searched through April 2020, yielding 281 articles that were separately screened for inclusion. Study characteristics extracted from retained articles are presented in Table S1 (online supplemental materials). Thirty-six articles were retained. Cognitive impairment as assessed by the MoCA was associated with adverse health variables including increased morbidity/mortality, poorer functional abilities, increased length of hospital stay, and increased hospital readmissions in 34 of 36 articles. Cognitive impairment as detected by the MoCA was shown in 34 of 36 studies to be associated with worse functional or medical status compared to those with better cognitive functioning across a variety of medical populations. Further research is needed to better understand how to best use the MoCA to potentially inform treatment planning in medical populations, including referral for more detailed neuropsychological evaluation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Neuropsychiatric symptoms (NPS) are common in neurodegenerative disease, but longitudinal studies using large autopsy-confirmed samples are lacking. Our primary aim was to investigate progression of NPS over time in autopsy-confirmed... more
Neuropsychiatric symptoms (NPS) are common in neurodegenerative disease, but longitudinal studies using large autopsy-confirmed samples are lacking. Our primary aim was to investigate progression of NPS over time in autopsy-confirmed Alzheimer’s disease (ad), Lewy body disease (LBD), and mixed (ad+LBD) cohorts. Data on individuals (age > =50) with autopsy-confirmed ad (N = 1568), ad+LBD (N = 349), and LBD (N = 142) was obtained from the National Alzheimer’s Coordinating Center (Mean visits = 2.61). Neuropsychiatric Inventory Questionnaire (NPI-Q) and 15-item Geriatric Depression Scale (GDS) scores were used to measure NPS. Multilevel zero-inflated binomial regression models were used to assess if NPI-Q and GDS scores differed among ad, ad+LBD, and LBD groups over time. Covariates included: years from baseline to final visit, cognitive status at baseline (i.e., normal, MCI, or dementia), demographic characteristics, MMSE, Functional Activities Questionnaire, and psychotropic treat...
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OBJECTIVE To elucidate specific symptoms that may differ between adolescent female and male athletes after a sports-related concussion (SRC) and identify symptoms that may require greater clinical attention by medical and athletic staff.... more
OBJECTIVE To elucidate specific symptoms that may differ between adolescent female and male athletes after a sports-related concussion (SRC) and identify symptoms that may require greater clinical attention by medical and athletic staff. DESIGN Prospective. SETTING This study is part of a larger research project conducted at clinics in the North Texas Concussion Network (ConTex) Registry. PARTICIPANTS Subjects (N = 491) aged 12 to 18 years who sustained a diagnosed SRC within 30 days of clinic visit. INDEPENDENT VARIABLES Sex (female vs male). Covariates included age, race, current mood (anxiety and depression), learning disability/ADHD, and time to clinic. MAIN OUTCOME MEASURES Twenty-two individual postconcussion symptoms as measured by the Post-Concussion Symptom Scale from the Sport Concussion Assessment Tool-5 (SCAT-5). RESULTS Girls endorsed higher levels of anxiety and depression symptoms at initial clinic visit. analysis of covariance results revealed that girls had significantly greater symptom severity of headache, dizziness, sensitivity to light, sensitivity to noise, pressure in the head, feeling slowed down, fatigue, and drowsiness than boys. Ordinal logistic regression results also revealed that girls had significantly greater predicted odds of higher symptom severity on these 8 symptoms and in trouble concentrating than boys. CONCLUSIONS Closer examination of specific symptoms with attention to patients' current levels of anxiety and depression symptoms may better inform medical and athletic staff to anticipate and address symptoms that may present greater challenges for adolescent girls than boys.
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Objective Various methods are used to derive normative data for neuropsychological assessment measures. The National Alzheimer’s Coordinating Center (NACC) regression norms (2011) are frequently used within Alzheimer’s Disease Research... more
Objective Various methods are used to derive normative data for neuropsychological assessment measures. The National Alzheimer’s Coordinating Center (NACC) regression norms (2011) are frequently used within Alzheimer’s Disease Research Centers, yet little research exists comparing these norms to similar regression/non-regression-based norms. Normative data for the widely-used Trail Making Test (TMTA&B) was compared between two regression-based normative data methods (Mitrushina and NACC) and traditional normative methods (i.e., Mayo’s Older Americans Normative Studies [MOANS]). Method TMTA&B data were obtained from 14,873 cognitively normal NACC participants (ages: 50–89; education: M = 15.81, SD = 2.90). T-scores for TMTA&B scores based on Mitrushina, NACC, and MOANS norms were computed. T-scores for regression norms were bounded from 20 to 80. Cohen’s d effect sizes were used to compare differences in scores. Results MOANS and Mitrushina norms produced similar normative scores in ...
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Traumatic encephalopathy syndrome (TES) is proposed to represent the long-term impact of repetitive head-injury exposure and the clinical manifestation of chronic traumatic encephalopathy (CTE). This study aimed to evaluate the frequency... more
Traumatic encephalopathy syndrome (TES) is proposed to represent the long-term impact of repetitive head-injury exposure and the clinical manifestation of chronic traumatic encephalopathy (CTE). This study aimed to evaluate the frequency of TES in a cohort of retired professional contact sport athletes, compare the frequency of TES to clinical consensus diagnoses, and identify predictors that increase the likelihood of TES diagnosis. Participants were 85 retired professional contact sport athletes from a prospective cohort at the University of Texas Southwestern Medical Center and the University of Texas at Dallas. Participants ranged in age from 23 to 79 (M = 55.95, SD = 13.82) and obtained 7 to 19 years of education (M = 16.08, SD = 1.03). Retirees were either non-Hispanic white (n = 62) or African-American (n = 23). Retired athletes underwent a standard clinical evaluation, which included a clinical interview, neurological exam, neuroimaging, neuropsychological testing, and conse...
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Objective Examine prediction of functional ability with neuropsychological tests using latent item response theory. Method The sample included 3155 individuals (Mage = 69.72, SD = 9.41; Median education =13.15, SD = 4.40; white = 92.81%;... more
Objective Examine prediction of functional ability with neuropsychological tests using latent item response theory. Method The sample included 3155 individuals (Mage = 69.72, SD = 9.41; Median education =13.15, SD = 4.40; white = 92.81%; female = 62.03%; MCI = 25.13%; Dementia = 28.87%) from the Texas Alzheimer’s Research and Care Consortium who completed functional and cognitive assessments [Mini Mental State Examination (MMSE), Logical Memory (LM), Visual Reproduction (VR), Controlled Oral Word Association Test (COWAT), Trail Making Test (TMT), Boston Naming Test, and Digit Span]. Functional measures [Clinical Dementia Rating Scale, Physical Self Maintenance Scale, and Instrumental Activities of Daily Living)] were combined into a single outcome variable using confirmatory factor analysis. Item response theory (IRT) was used to fit the data, and latent regression to predict the latent trait score using neuropsychological data. Results All three functional scales loaded onto a sing...
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Objective Characterize three functional living scales under item response theory and examine these scales for evidence of differential item functioning (DIF) by participant and/or informant ethnicity and education. Method Baseline data... more
Objective Characterize three functional living scales under item response theory and examine these scales for evidence of differential item functioning (DIF) by participant and/or informant ethnicity and education. Method Baseline data from 3155 participants [Mage = 70.59(9.55); Medu = 13.3(4.26); 61.72%female] enrolled in the Texas Alzheimer’s Research and Care Consortium with data from the Clinical Dementia Rating Scale (CDR; functional items), Physical Self-Maintenance Scale (PSMS), and Instrumental Activities of Daily Living Scale (IADL) were used. The sample was predominately white (93.94%) and 35.97% identified as Hispanic. Graded response models fit all three tests best. DIF was examined by iteratively dropping item-by-item constraints and then testing model fit. Results The CDR demonstrated overall good item functioning with clear separation between all of the rating categories for each item, while the PSMS and IADL did not, suggesting the item ratings should be reconsidered...
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Medical). MABP was calculated using the equation 1/3(SBP) + 2/ 3(DBP) (Sesso et al., 2000). SWkM was assessed using the SWkM task of the SUCCAB (Pipingas et al., 2010). Diffusion MRI data was collected using a Siemans Trio 3T scanner and... more
Medical). MABP was calculated using the equation 1/3(SBP) + 2/ 3(DBP) (Sesso et al., 2000). SWkM was assessed using the SWkM task of the SUCCAB (Pipingas et al., 2010). Diffusion MRI data was collected using a Siemans Trio 3T scanner and analysed using the NUNDA advanced diffusion pipeline (Alpert et al., 2016). Six white matter regions of interest were selected based upon previously identified associations with blood pressure as well as working memory. Multiple regression and mediation analysis was performed using SPSS (results considered significant if p<0.05). Results: After controlling for age, gender, education, BMI, and use of blood pressure medications, brachial and central MABP’s negatively predicted microstructural integrity within the fornix (brachial b1⁄4 -0.002, p1⁄40.017; central b1⁄4 -0.002, p1⁄40.020). Fornix microstructure predicted SWkM accuracy (b1⁄4 3.017, p1⁄40.005), but not response time (p1⁄40.431). While MABP’s did not directly predict SWkM accuracy (brachial p1⁄40.541; central p1⁄4 0.648), an indirect association via fornix microstructure was identified (brachial effect 1⁄4 -0.0063, 95% CI: -0.0139 -0.002; central effect 1⁄4 -0.0064; 95% CI: -0.0141 -0.002). Conclusions: Elevated MABP appears to predict poorer fornix microstructure. There also appears to be an indirect effect of elevated MABP on SWkM performance via a detrimental effect upon fornix integrity. Subsequently, modifying MABP, through medication or lifestyle interventions may support neurocognitive health in older adults at risk of advanced cognitive decline.
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Objective Research examining the course of Alzheimer’s disease (AD) in Hispanics is lacking. This study examined demographic, psychiatric, cognitive, and genetic predictors of longitudinal functional change in Hispanics and non-Hispanics... more
Objective Research examining the course of Alzheimer’s disease (AD) in Hispanics is lacking. This study examined demographic, psychiatric, cognitive, and genetic predictors of longitudinal functional change in Hispanics and non-Hispanics with AD. Method Longitudinal change in instrumental activities of daily living (IADL) was examined over 10 years (M = 4.15 years) in 292 subjects (Hispanic = 67, non-Hispanic = 225). All were part of the Texas Alzheimer’s Research & Care Consortium and included those with AD (n = 217) and those with mild cognitive impairment at baseline who progressed to AD at follow-up (n = 75). Baseline comparisons were conducted between ethnic groups for demographics, Geriatric Depression Scale (GDS-30) score, Mini Mental State Examination (MMSE) score, presence of apolipoprotein ɛ4 alleles (APOE4), and annualized IADL change scores and then entered into a multiple linear regression model as predictors of annualized IADL change. Results The Hispanic group had sig...
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Research Interests: Health Behavior, Dementia, Cognition, Magnetic Resonance Imaging, Life Style, and 15 moreExercise therapy, Brain, Humans, Internal Medicine, Blood Glucose, Hypertension, Blood Pressure, Cholesterol, Female, Body Mass Index, Aged, Atrophy, Brain Structure, Alzheimer Disease, and Antihypertensive agents
Considerably less attention has been paid to psychological and social sequelae of concussion in youth athletes compared with neurocognitive outcomes. This narrative review consolidates the literature on postconcussive emotional and... more
Considerably less attention has been paid to psychological and social sequelae of concussion in youth athletes compared with neurocognitive outcomes. This narrative review consolidates the literature on postconcussive emotional and psychosocial functioning in school-aged children and adolescents, highlighting athlete-specific findings. MEDLINE and PsycINFO databases were queried for pediatric concussion studies examining psychological and/or social outcomes, and 604 studies met search criteria (11 of those specific to sport). Results were organized into domains: emotional and social dysfunction, behavioral problems, academic difficulties, sleep disturbance, headache, and quality of life. The small body of literature regarding psychological and social issues following pediatric concussion suggests behavioral disturbances at least temporarily disrupt daily life. Extrapolation from samples of athletes and nonathletes indicates postconcussive anxiety and depressive symptoms appear, alth...
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To examine whether history of traumatic brain injury (TBI) is associated with more rapid progression from mild cognitive impairment (MCI) to Alzheimer's disease (AD). Data from 2,719 subjects with MCI were obtained from the National... more
To examine whether history of traumatic brain injury (TBI) is associated with more rapid progression from mild cognitive impairment (MCI) to Alzheimer's disease (AD). Data from 2,719 subjects with MCI were obtained from the National Alzheimer's Coordinating Center. TBI was categorized based on presence (TBI+) or absence (TBI-) of reported TBI with loss of consciousness (LOC) without chronic deficit occurring >1 year prior to diagnosis of MCI. Survival analyses were used to determine if a history of TBI predicted progression from MCI to AD up to 8 years. Random regression models were used to examine whether TBI history also predicted rate of decline on the Clinical Dementia Rating scale Sum of Boxes score (CDR-SB) among subjects who progress to AD. Across 8 years, TBI history was not significantly associated with progression from MCI to a diagnosis of AD in unadjusted (HR = 0.80; 95% CI [0.63, 1.01]; p = .06) and adjusted (p = .15) models. Similarly, a history of TBI was a...
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To report descriptive and normative data for the Montreal Cognitive Assessment (MoCA) in a population-based African American sample. The MoCA was administered to 1,419 African American participants (mean age 49.89 years, range 18-75, 64%... more
To report descriptive and normative data for the Montreal Cognitive Assessment (MoCA) in a population-based African American sample. The MoCA was administered to 1,419 African American participants (mean age 49.89 years, range 18-75, 64% female). After excluding those with subjective cognitive complaints (n = 301), normative data were generated by education and overlapping age ranges (n = 1,118). Pearson correlations and analysis of variance were used to examine the relationship to demographic variables, and frequency of missed items was reviewed. Total MoCA scores (mean 22.3, SD 3.9) were lower than previously published normative data derived from an elderly Caucasian Canadian population with 80% falling below the suggested cutoff (<26) for impairment. Several MoCA items were missed by a large portion of the sample, including cube drawing (72%), delayed free recall (66% <4/5 words), sentence repetition (63%), and abstraction items (45%). This is the first study to examine nor...
Research Interests: Cognitive Science, Gerontology, Cognition, Adolescent, Medicine, and 15 moreIndependent Living, Population, Humans, Female, Male, Normative, African Americans, Aged, Middle Aged, Adult, Educational Status, Montreal Cognitive Assessment, Neurosciences, Cognition disorders, and Neuropsychological Tests
This study explored the utility of the Montreal Cognitive Assessment (MoCA) in the detection of cognitive change over time in a community sample (age ranging from 58 to 77 years). The MoCA was administered twice approximately 3.5 years... more
This study explored the utility of the Montreal Cognitive Assessment (MoCA) in the detection of cognitive change over time in a community sample (age ranging from 58 to 77 years). The MoCA was administered twice approximately 3.5 years apart (n = 139). Participants were classified as mild cognitive impairment (MCI) or cognitively intact at follow-up based on multidisciplinary consensus. We excluded 33 participants who endorsed cognitive complaints at baseline. The MCI group (n = 53) showed a significant decrease in MoCA scores (M = -1.83, p < .001, d = 0.64). When accounting for age and education, the MCI group showed a decline of 1.7 points, while cognitively intact participants remained stable. Using Reliable Change Indices established by cognitively intact group, 42% of MCI participants demonstrated a decline in MoCA scores. Results suggest that the MoCA can detect cognitive change in MCI over a 3.5-year period and preliminarily supports the utility of the MoCA as a repeatable...
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This study examined whether history of traumatic brain injury (TBI) is associated with increased risk and earlier onset of mild cognitive impairment (MCI). Subjects with MCI (n = 3,187) and normal cognition (n = 3,244) were obtained from... more
This study examined whether history of traumatic brain injury (TBI) is associated with increased risk and earlier onset of mild cognitive impairment (MCI). Subjects with MCI (n = 3,187) and normal cognition (n = 3,244) were obtained from the National Alzheimer's Coordinating Center database. TBI was categorized based on lifetime reported TBI with loss of consciousness (LOC) without chronic deficit. Logistic regression was used to examine TBI history as a predictor of MCI, adjusted for demographics, apolipoprotein E-ɛ4 (ApoE4), a composite vascular risk score, and history of psychiatric factors. ANCOVA was used to examine whether age at MCI diagnosis and estimated age of onset differed between those with (TBI+) and without (TBI-) a history of TBI. TBI history was a significant predictor (p < 0.01) and associated with increased odds of MCI diagnosis in unadjusted (OR = 1.25; 95% CI = 1.05-1.49) and adjusted models, accounting for age, education, ApoE4, and a composite vascular...
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We retrospectively examined whether a history of traumatic brain injury (TBI) is associated with an earlier age of symptom onset and diagnosis in a large sample of patients with behavioural variant frontotemporal dementia (bvFTD). Data on... more
We retrospectively examined whether a history of traumatic brain injury (TBI) is associated with an earlier age of symptom onset and diagnosis in a large sample of patients with behavioural variant frontotemporal dementia (bvFTD). Data on patients with bvFTD (n=678) were obtained from the National Alzheimer's Coordinating Center Uniform Data Set. TBI was categorised based on reported lifetime history of TBI with loss of consciousness (LOC) but no chronic deficits occurring more than 1 year prior to diagnosis of bvFTD. Analysis of covariance (ANCOVA) was used to determine if clinician-estimated age of symptom onset and age at diagnosis of bvFTD differed between those who reported a history of TBI with LOC (TBI+) and those who did not (TBI-). Controlling for sex, the TBI+ bvFTD group had an age of symptom onset and age of diagnosis that was on average 2.8 and 3.2 years earlier (p<0.01) than the TBI- bvFTD group. TBI history with LOC occurring more than 1 year prior to diagnosis...
Research Interests: Psychology, Cognitive Science, Dementia, Traumatic Brain Injury, Medicine, and 14 moreComorbidity, Humans, United States, Female, Male, Aged, Middle Aged, Frontotemporal Dementia, Retrospective Studies, Neurosciences, Age of Onset, Neuropsychological Tests, Psychology and Cognitive Sciences, and Medical and Health Sciences
Purpose To determine in a large multiethnic cohort the cardiovascular and genetic risk factors associated with smaller volume in the hippocampus, precuneus, and posterior cingulate, and their association with preclinical deficits in... more
Purpose To determine in a large multiethnic cohort the cardiovascular and genetic risk factors associated with smaller volume in the hippocampus, precuneus, and posterior cingulate, and their association with preclinical deficits in cognitive performance in patients younger and older than 50 years. Materials and Methods The institutional review board approved the study and all participants provided written informed consent. Eligible for this study were 1629 participants (700 men and 929 women; mean age, 50.0 years ± 10.2 [standard deviation]) drawn from the population-based Dallas Heart Study who underwent laboratory and clinical analysis in an initial baseline visit and approximately 7 years later underwent brain magnetic resonance imaging with automated volumetry and cognitive assessment with the Montreal Cognitive Assessment (MoCA). Regression analysis showed associations between risk factors and segmental volumes, and associations between these volumes with cognitive performance...
Research Interests: Radiology, Magnetic Resonance Imaging, Medicine, Brain, Humans, and 15 moreInternal Medicine, Female, Male, Risk factors, Aged, Middle Aged, Precuneus, Posterior Cingulate, Adult, Cardiovascular Diseases, Risk Factors, Montreal Cognitive Assessment, Cognition disorders, brain size, and Medical and Health Sciences
Subcortical lacunar infarcts and white matter hyperintensities (WMH) are common neuroradiological findings, but few studies associate between these insults and cognition in a community-dwelling population. The Dallas Heart Study is a... more
Subcortical lacunar infarcts and white matter hyperintensities (WMH) are common neuroradiological findings, but few studies associate between these insults and cognition in a community-dwelling population. The Dallas Heart Study is a population-based initiative whose assessments included demographic and clinical findings including brain MRI and the Montreal Cognitive Assessment (MoCA). The presence and number of lacunes in subjects aged over 55 years were assessed by study physicians. The WMH volume was measured by an automated method. The association between the presence and number of lacunar infarcts and of WMH volume with the total MoCA score and subdomains was assessed using linear regression with adjustment for age, gender and self-reported ethnicity. In 609 subjects with valid data, both the presence and the increasing number of lacunes were associated with lower MoCA scores, even after adjusting for demographic variables. The presence of lacunes was also associated with lower...
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The Montreal Cognitive Assessment (MoCA) is a cognitive screening instrument growing in popularity, but few studies have conducted psychometric item analyses or attempted to develop abbreviated forms. We sought to derive and validate a... more
The Montreal Cognitive Assessment (MoCA) is a cognitive screening instrument growing in popularity, but few studies have conducted psychometric item analyses or attempted to develop abbreviated forms. We sought to derive and validate a short-form MoCA (SF-MoCA) and compare its classification accuracy to the standard MoCA and Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI), Alzheimer disease (AD), and normal aging. 408 subjects (MCI n = 169, AD n = 87, and normal n = 152) were randomly divided into derivation and validation samples. Item analysis in the derivation sample identified most sensitive MoCA items. Receiver Operating Characteristic (ROC) analyses were used to develop cut-off scores and evaluate the classification accuracy of the SF-MoCA, standard MoCA, and MMSE. Net Reclassification Improvement (NRI) analyses and comparison of ROC curves were used to compare classification accuracy of the three measures. Serial subtraction (Cramer's V = .408), de...
Research Interests: Psychology, Cognitive Science, Psychometrics, Dementia, Cognition, and 15 moreAging, Mild Cognitive Impairment, Medicine, Humans, Orientation, Female, Male, Aged, Middle Aged, Montreal Cognitive Assessment, Alzheimer Disease, Early Diagnosis, Neurosciences, Neuropsychological Tests, and mass Screening
Research Interests: Cardiology, Cognition, Magnetic Resonance Imaging, Atherosclerosis, Linear models, and 15 moreHumans, Internal Medicine, Female, Apolipoprotein E, Clinical Sciences, Aged, Longitudinal Studies, Genotype, Coronary Angiography, Adult, Age Factors, Coronary Artery Disease, Cognition disorders, Aorta Abdominal, and Cardiovascular medicine and haematology
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Understanding the relationships between age-related changes in brain structure and cognitive function has been limited by inconsistent methods for assessing brain imaging, small sample sizes, and racially/ethnically homogeneous cohorts... more
Understanding the relationships between age-related changes in brain structure and cognitive function has been limited by inconsistent methods for assessing brain imaging, small sample sizes, and racially/ethnically homogeneous cohorts with biased selection based on risk factors. These limitations have prevented the generalizability of results from brain morphology studies. To determine the association of 3.0-T structural brain magnetic resonance (MR) imaging measurements with cognitive function in the multiracial/multiethnic, population-based Dallas Heart Study. Whole-brain, 2-dimensional, fluid-attenuated inversion recovery and 3-dimensional, magnetization-prepared, rapid acquisition with gradient echo MR imaging at 3.0 T was performed in 1645 Dallas Heart Study participants (mean [SD] age, 49.9 [10.5] years; age range, 19-85 years) who received both brain MR imaging and cognitive screening with the Montreal Cognitive Assessment between September 18, 2007, and December 28, 2009. M...
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Background and Purpose— The natural history of white matter hyperintensity (WMH) progression resulting from normal aging versus comorbid vascular insults remains unclear. Therefore we investigated age-related differences in WMH volumes... more
Background and Purpose— The natural history of white matter hyperintensity (WMH) progression resulting from normal aging versus comorbid vascular insults remains unclear. Therefore we investigated age-related differences in WMH volumes among a group with comorbid hypertension, abnormal body mass index, and diabetes mellitus to a normal aging group drawn from the same population lacking any of these comorbidities. Methods— WMH volumes were acquired using 3T MRI for 2011 Dallas Heart Study participants. The slope of the WMH versus age regression was compared between normal and comorbidity groups <50 and ≥50 years of age where a change in slope was demonstrated. Results— Aging was linearly associated with greater log WMH volume for both normal ( P =0.02) and comorbidity ( P <0.0001) groups. Beyond 50 years of age, more rapid increases in WMH volumes for age were seen in the group with comorbidities ( P <0.0001) but not in the normal group ( P =0.173). The between-group differe...
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ABSTRACTBackground: The purpose of this study is to determine if the three-step Luria test is useful for differentiating between cognitive disorders.Methods: A retrospective record review of performance on the three-step Luria test was... more
ABSTRACTBackground: The purpose of this study is to determine if the three-step Luria test is useful for differentiating between cognitive disorders.Methods: A retrospective record review of performance on the three-step Luria test was conducted on 383 participants from a university-based dementia clinic. The participants ranged in their diagnosis from frontotemporal dementia (FTD; n = 43), Alzheimer disease (AD; n = 153), mild cognitive impairment (MCI; n = 56), and normal controls (NC; n = 131). Performance of the Luria test was graded as normal or abnormal.Results: An abnormal test occurred in 2.3% of NC, 21.4% of MCI, 69.8% of FTD, and 54.9% of AD subjects. The frequency of abnormal tests in all diagnostic groups increased with functional impairment as assessed by the Clinical Dementia Rating scale (CDR). When CDR = 3 (severe), 100% of the FTD and 72.2% of the AD subjects had abnormal Luria tests.Conclusions: The three-step Luria test distinguished NC and persons with MCI from F...