25 The Relationship between Judgment and Cognitive Performance in a Mixed-Clinical Older Adult Veteran Sample
Authors: Brown Katelyn , Kleinman Kayla , Stewart-Willis Jada J. 
Published: December 2023

Objective:

Judgment, defined as the capacity to make decisions carefully after consideration of available information, which may entail a variety of sources, has come to be regularly assessed within neuropsychology, and impairment of judgment has been demonstrated across multiple disorders (Rabin, Borgos, & Saykin, 2008). This study aimed to re-examine the relationship between judgment and performance on measure of cognitive functioning including (memory, attention, language, visuospatial abilities, speed, and aspects of executive functioning) in a mixed-clinical sample of older adult veterans.

Participants and Methods:

Data for this study was collected from the Cognitive Functioning in Older Adult Veteran’s database repository (CFOAV) at a large Veteran Affairs Healthcare System (VAHCS). Participants were veterans seeking treatment in the Neuropsychology Assessment Clinic. Inclusion criteria were that participants must have answered the nine questions from the TOP-J and received a score based on the specific criteria. Participants were excluded if they appeared to lack adequate test engagement or had a serious mental illness. The final sample for the current study consisted of 83 veterans (73% male, n = 76), ranging from 50 to 89 years (m = 72.01, SD = 9.70), with and average of 13 years of education (SD = 3.21). Of the sample, 75% reported that they were White, 7% African American/Black, and 1% Latino/Hispanic, and ICD-10 diagnoses ranged from age-related cognitive decline, mild cognitive impairment, vascular dementia, and dementia in other disease classified.

Results:

Using SPSS (Version 27), Pearson correlations were conducted to examine the relationship between the TOP-J raw score, demographic variables, and measures of cognitive functioning, including the WTAR, the RBANS index scores, WAIS-DS, TMT A, TMT B, COWAT, and ANT. Missing data were excluded pairwise in the analyses. Correlation analyses revealed a significant small-to-medium correlation between the TOP-J and the. There were small to medium correlations between the TOP-J, WTAR (r = .31, p = .01), TMT A (r = .27, p = .02), WAIS DS (r = .30, p = .01), and RBANS Attention index (r = .35, p = .04). There was a significant large relationship between the TOP-J and the RBANS Immediate Memory index (r = .52, p = .002). There were no significant associations between the TOP-J, demographic variables (e.g., biological sex, age, and education), TMT-B, COWAT, or ANT.

Conclusions:

The study supported previous decision making research (Moye, Karel, Gurrera & Asar, 2006) that has found the ability to attend to and immediately retain information to be an important foundational component. While the present study did not fully replicate previous findings that the Top-J was correlated to measures of executive functioning, strong correlations did emerge with verbal memory and a measure of crystalized verbal abilities similar to Rabin et al. (2007). Such research informs the assessment practical judgment. It also indicates that one’s ability to acquire and encoded unstructured and contextual verbal information, as well as pre-morbid verbal abilities, may provide potential targets to improve or compensate from decrements in overall practical judgement. This is certainly an areas for future research.