bluuebunny/crossref_metadata_2025_split huggingface dataset:
Value Assessment in Healthcare Decision-Making of Ethnically and Cognitively Diverse Older Adults
Authors: Mejia A , Smith G D , Curiel R E , Barker W , Behar R , Armstrong M J 
Published: August 2019

Abstract

Objective
Little is known regarding the values that patients with mild cognitive impairment (MCI) incorporate into healthcare decision-making or how culture may affect such values. Even if values overlap across cultures, cultural groups may emphasize the importance of specific values differently since values emanate, at least in part, from cultural and life-long learning. The aim of this study was to explore and compare values that older adults of different ethnicities and cognitive statuses incorporate in their medical decisions.

Participants and Method
Four focus groups were established by identifying older adults as, a) Hispanic or non-Hispanic, and with b) normal cognition or MCI. Participants were recruited from the 1Florida Alzheimer’s Disease Research Center. Focus groups were audio-recorded and transcribed using a professional transcription service.

Results
There were a total of 23 participants (Age: M = 70.9, SD = 6.4). MCI groups had briefer discussions (Time M = 44 minutes) than the normal cognition groups (Time M = 62 minutes). Qualitative analysis of discussions was used to explore the values identified across the focus groups. The MCI groups valued spirituality, doctor recommendations, and family involvement when facing medical decisions. Normal cognition groups valued the necessity of proactive involvement as healthcare consumers and the relationship between the quality of patient-clinician interaction and their health care related decisions. Cultural themes involving perceptions of gender and generational differences emerged from the Hispanic normal cognition group.

Conclusions
This study identified many determinants influencing the medical decision-making process of diverse older adults: including past experiences, family involvement, healthcare barriers, and cultural background. These results have the potential to impact patient-clinician discussions, decisions made by surrogates, and the development of decision aids with a broader range of relevant patient values.
Perceived Racial/Ethnic Discrimination Predicts Worse Global Cognition in a Diverse Sample
Authors: Morris E , Guzman V , Tell E , Summers A C , Clark U S , Byrd D A , Rivera Mindt M , Arce Rentería M 
Published: August 2019

Abstract

Objective
While perceived racial/ethnic discrimination (PD) and HIV can be independently detrimental to cognitive function, it is unclear whether persons living with HIV (PLWH) who experience PD may be at risk for greater cognitive dysfunction than HIV- persons. In a diverse sample, we hypothesized that PD would be related to worse cognition and that this effect would be moderated by HIV status.

Participants and Method
This cross-sectional study included 53 participants (57% PLWH; 77% African American and 23% Latinx; 45% male; M Age = 54.5 ± 6.1 years; M Education = 12.4 ± 2.2 years) who completed the Perceived Ethnic Discrimination Questionnaire (PEDQ) and a neurocognitive (NC) battery. Variables included education (years); HIV status; PEDQ Total Score and global NC T-score (averaged, demographically-corrected T-scores for all tests). A general linear model examined main and interaction effects of HIV status and PD on global cognitive function. Covariates included depression and urine toxicology status for cocaine and marijuana.

Results
Greater PD was associated with higher education and greater depression. The model showed that greater PD (β = -.48, p &lt; .05) and lower education (β = -19.0, p &lt; .01) were related to worse global cognitive function. This relationship was moderated by education (β = .59, p &lt; .01), such that the relationship between PD and global cognitive function was stronger in those with higher education. There was no main effect of HIV or HIV*PD interaction on global cognitive function.

Conclusions
This study demonstrated that greater PD is related to worse global cognitive function and this relationship is stronger in those with more education. While no causal factors can be attributed, racial/ethnic minorities with higher education may be granted greater access to areas with greater structural racism and/or microagressions (i.e., predominantly white workplaces). Future studies should evaluate the role of socioeconomic and workplace diversity when considering discrimination.
The Role of Quality of Education in Neurocognitive Functioning in a Diverse Sample with Chronic Opioid Use Disorder
Authors: Olsen J , Arnsten J , Scott T , Arias F , Zhang C , Rivera Mindt M 
Published: August 2019

Abstract

Objective
Literacy is a proxy for quality of education (QoE) and mediates ethnicity-related differences in neurocognitive (NC) performance in some populations (Manly et al., 2002; Rivera Mindt et al., 2008). However, it is unknown whether this relationship exists in the context of chronic opioid use disorder (OUD). This study examined the role of ethnicity, QoE, opioid use severity, and depression in predicting NC performance in a diverse sample of persons with OUD.

Participants and Method
This cross-sectional study included 74 adults with OUD (Age M = 40.3 [SD = 10.5]; Education M = 11.3 [2.5]; 24% female; 68% Latinx and 32% Non-Latinx White [NLW]). All participants completed comprehensive NC testing and psychiatric/substance use questionnaires. Variables included ethnicity (Latinx vs. Non-Latinx White), years of education, QoE (Wide Range Achievement Test, Third Edition; WRAT-3 Reading Standard Scores), opioid use severity (high vs. low OAT dose), current depression (Beck Depression Inventory, Second Edition; BDI-II Total Score), and demographically-corrected NC T-scores were computed and used for average domain T-scores (e.g., learning, memory, verbal fluency, executive function). Bivariate and ANCOVA analyses were used to compare ethnic groups.

Results
There were no significant group differences on opioid use severity or current depression (p’s &gt; .05). However, compared to the NLW group, the Latinx group had lower years of education (M = 10.9 [SD = 1.7] vs. M = 12.2 [SD = 3.5]; t[72)] = 2.1, p &lt; .05), QoE (M = 83.1 [SD = 13.6] vs. M = 94.8 [SD = 9.4]; t[72] = 3.8, p &lt; .001), executive functioning (M = 42.0 [SD = 6.5] vs. M = 45.8 [SD = 8.5]; t[72) = 2.1, p &lt; .05), and learning (M = 32.2 [SD = 8.2] vs. M = 37.8 [SD = 8.7]; t[72)] = 2.7, p &lt; .05), with medium to large effect sizes (Cohen’s d &gt; .50). The overall effect of ethnicity became non-significant for executive functioning after accounting for QoE (F[2,70] = 10.0, p = .002) and years of education (F[2,70)] = 16.8, p &lt; .001).

Conclusions
The current study found that accounting for years of education and QoE attenuates some differences in NC performance between Latinx and Non-Latinx participants.

References
Manly, J. J., Jacobs, D. M., Touradji, P., Small, S. A., & Stern, Y. (2002). Reading level attenuates differences in neuropsychological test performance between African American and White elders. Journal of the International Neuropsychological Society, 8(3), 341-348. Mindt, M. R., Arentoft, A., Germano, K. K., D’Aquila, E., Scheiner, D., Pizzirusso, M., ... & Gollan, T. H. (2008). Neuropsychological, cognitive, and theoretical considerations for evaluation of bilingual individuals. Neuropsychology review, 18(3), 255-268.
Does Decision-Making Ability Predict HIV-Associated Neurocognitive Disorder?
Authors: Summers A C , Morris A , Savin M J , Aghvinian M , Crook C , Byrd D , Rivera Mindt M 
Published: August 2019

Abstract

Background
Executive dysfunction (EF) in people living with HIV (PLWH) is well-established. However, decision-making, a key aspect of EF, is often overlooked in neurocognitive (NC) evaluations of PLWH. Poor decision-making can detrimentally impact PLWH by increasing risk of poor health outcomes. This study aimed to determine if including a decision-making task in NC evaluations might improve diagnostic formulations.

Participants and Method
This cross-sectional study included 90 PLWH (63 Latinx; 27 non-Latinx white) who were evaluated for HIV-Associated Neurocognitive Disorder (HAND) using established criteria, with the Wisconsin Card Sorting Test (WCST) and Trail Making Test Part B (TMTB) comprising the “traditional” EF domain. The Iowa Gambling Task (IGT) assessed decision-making. Demographically corrected T-scores were calculated for each test. The “traditional” EF tests were averaged into an EF domain T-score. The WCST, TMTB, and IGT were also averaged into a “new” EF+IGT domain T-score.

Results
The new EF+IGT domain T-score significantly predicted HAND diagnosis (R^2 = .14, p &lt; .001). However, using hierarchical regression, the “traditional” EF domain (WCST and TMTB) also significantly predicted HAND (R^2 = .18, p &lt; .001) and adding the IGT Total T-score did not contribute unique variance to the model (R^2 = .18, p &lt; .001; R^2Δ &lt; .001, pΔ = .92).

Conclusions
A new combined EF domain T-score that included decision-making was a significant predictor of HAND diagnosis. However, adding IGT Total Score did not enhance HAND diagnosis compared to “traditional” EF measurement, indicating that the “traditional” EF domain adequately informs HAND diagnosis. A limitation of this study was the small sample size. Given the important health implications of decision-making in PLWH, future research, with a larger sample size is warranted to better conceptualize how decision-making can be incorporated into diagnostic formulations for PLWH.
Community Engagement and Cognition in a Sample of Older Adults Residing in Costa Rica
Authors: Valdivieso Mora E , Ivanisevic M , Johnson D 
Published: August 2019

Abstract

Objective
Costa Rica has the highest percentage of older adults (65+) of the Central American and Latin American region. In fact, Costa Rica has the highest life expectancy within an advanced healthcare system and socioeconomic infrastructure that differentiates it from neighboring countries in Central America. Previous research has shown that older adults who engage in higher social engagement show overall better cognitive functioning (Chen et al., 2018); however, limited research has examined the impact of socialization on cognition across rural and urban regions and furthermore no research to date has examined these factors in Costa Rican older adults. This study examined the effects of community engagement on cognition in urban and rural older adults residing in Costa Rica.

Participants and Method
Participants were neurotypical older adults residing in San Jose (urban region, n = 156) and Guanacaste (rural region, n = 69). Those with a history of neurological conditions and major psychiatric disorders were excluded.

Results
Older adults residing in an urban area (M = 55.43, SD = 23.26) participate more in social engagement within the community compared to those residing in the rural region (M = 46.30, SD = 28.50), p = 0.019. Furthermore, in the urban sample, those with higher social engagement showed better performance on learning and encoding (r = 30), verbal memory (r = 0.26), and executive functioning (r = .20). In older adults residing in the rural region, higher social engagement was only associated with better visuospatial abilities (r = 0.27).

Conclusions
Findings suggest that social engagement in the community for older adults in Costa Rica may serve as a protective factor for their cognitive health. However, there are significant differences on what cognitive processes serve as a protective factor as a function of location (rural versus urban). This study highlights the importance of examining the quality of social engagement when evaluating the cognition of Costa Rican older adults.

References
Chen, Ya-Mei, Tu, Yu-Kang, Yu, Hsiao-Wei, Chiu, Tzu-Ying, Chiang, Tung-Liang, Chen, Duan-Rung, & Chang, Ray-E. (2018). Leisure time activities as mediating variables in functional disability progression: An application of parallel latent growth curve modeling. PLoS ONE, 13(10).
Cognitive Test Differences Between our Bronx English and Spanish Speaking Patients: Lessons Learned Through the Expansion of Neuropsychological Services
Authors: Weiss E , Facchini R , Zwerling J 
Published: August 2019

Abstract

Objective
To demonstrate the differences between the English-speaking and Spanish-speaking patients evaluated at a Memory Disorders Clinic.

Participants and Method
Through a foundation grant to reduce barriers to appropriate neurological care, we established a bilingual/bicultural neuropsychology post-doctoral fellowship. In the initial 2 years, 405 new patients were seen at our multidisciplinary memory disorders clinics for neuropsychological and neurological evaluations. These patients were 63% female (n = 256), and had a mean age of 73.09 (SD = 10.63, range 52-98). Fifty-eight percent of our population identified as Hispanic/Latino (primarily Puerto Rican and Dominican) and 42% were evaluated in Spanish.

Results
Patients evaluated in Spanish had less education (p &lt; .001) and were younger (p = .03) than those evaluated in English (including our Hispanic/Latino English speaking patients). Individuals evaluated in Spanish performed worse on a mental status exam (Blessed) than those evaluated in English (p = .001) even after controlling for age and education (p = .048). However, those evaluated in Spanish were more likely to do better on memory tasks than those evaluated in English, compared to their respective normative peers. Higher levels of anxiety and depression were evident in Hispanics/Latinos compared to non-Hispanics with highest levels in Hispanics evaluated in English.

Conclusions
Through a grant to expand services to the previously underserved Spanish-only speaking population of the Bronx, we were able to validate the need for appropriate language and cultural resources in our robust medical community. We demonstrated that our Spanish speaking population is diverse and requires different resources from their English-speaking counterparts. Our data supports the establishment of additional studies (including improved cultural and language specific normative data) and further education of providers working with our diverse populations.
Normative Data for Wisconsin Card Sorting Test-64 Item in a Spanish Speaking Adult Population Living in the US/Mexico Border Region
Authors: Yassai-Gonzalez D , Marquine M J , Perez-Tejada A , Umlauf A , Kamalyan L , Morlett Paredes A , Suarez P , Rivera Mindt M , Artiola i Fortuny L , Franklin D R , Cherner M , Heaton R K 
Published: August 2019

Abstract

Objective
The Wisconsin Card Sorting Test (WCST) is a commonly used test of executive functioning. We aimed to generate norms on the WCST-64 item version for Spanish-speakers living in the US.

Participants and Method
Healthy Spanish-speakers (N=189) were recruited (Age M = 38.2, SD = 10.3, range 19-60; Education M = 10.9, SD = 4.5, range 0-20; 59.3% female) from the US-Mexico border region. Participants completed the WCST-64 as part of a larger neuropsychological battery. Spearman correlations and Wilcoxon Rank-sum tests were used to assess associations between demographic variables and raw scores. T-scores enabling demographic corrections for various WCST-64 measures (Total Errors, Perseverative Responses, Perseverative Errors, and Number of Categories Completed) were obtained using fractional polynomial equations with corrections for age, education, and gender. Uncorrected percentile scores were reported for Failures to Maintain Set. Rates of neurocognitive impairment (NCI; T &lt; 40) were calculated by applying the newly developed norms along with published norms for non-Hispanic (NH) White and African American English-speakers.

Results
Older age was significantly associated with worse performance, and higher education was linked to better performance on most WCST-64 raw scores. Current norms resulted in expected rates of NCI (14-16% across measures). Applying norms for NH-Whites overestimated NCI (38-52% across measures). Applying norms for African Americans yielded NCI rates closer to what would be expected, with milder misclassifications (NCI: Total Errors = 14%, Perseverative Responses = 19%, Perseverative Errors = 10%).

Conclusions
Regional normative data will improve interpretation of test performance on the WCST-64 for Spanish-speakers of Mexican origin living in the US and will facilitate a more valid analysis of neuropsychological profile patterns in this population. Future research will need to explore the generalizability of these norms to other groups.
Factorial Validity of the Emotional Verbal Learning Test-Spanish (EVLT-S)
Authors: Zink D N , Reyes E , Kuwabara H , Strauss G P , Allen D N 
Published: August 2019

Abstract

Objective
The EVLT-S is the Spanish translation of a novel measure of emotional verbal learning and memory. The current study aimed to preliminarily examine the factorial validity of the EVLT-S to determine if its latent structure was similar to that identified for the EVLT by Strauss and Allen (2013) in a sample of 329 English speakers.

Participants and Method
Two principal component analyses (PCAs) were conducted to examine the latent structure of the EVLT-S. The first PCA examined EVLT/EVLT-S performance in a combined sample of English language-dominant participants (n = 52; Age M = 23.1 years; Education M = 13.4 years; 32.7% White non-Hispanic, 36.5% Hispanic, and 30.8 % other; 55.8% female) and Spanish language-dominant participants (n = 50; Age M = 20.3 years; Education M = 12.8 years; 98% Hispanic and 2% other; 72% female). The second PCA was conducted with the Spanish dominant sample alone (n = 50). PCAs were conducted using comparable scores and procedures reported by Strauss and Allen (2013), including scores for the four emotion categories (happiness, sadness, anger, anxiety), varimax rotation, and Kaiser-Guttman criteria to determine the number of components, allowing for direct comparisons between the current results and those previously reported.

Results
Both PCA’s identified five components that accounted for 68.6 – 70.4 percent of the variance and attained simple structure. Based on factor loadings, these components were labeled Anger, Sadness, Happiness, Anxiety, and Short-Term Memory (STM).

Conclusions
The PCA analyses in this study were exploratory in nature but were remarkably consistent with prior results attained in a much larger sample (n = 329) of English speakers. Results provide preliminary support for a stable and generalizable EVLT latent structure in Spanish and English versions. Future studies with larger samples using confirmatory factor analyses are needed to further establish the factorial validity of the EVLT-S.

References
Strauss, G. P., & Allen, D. N. (2013). Emotional Verbal Learning Test: development and psychometric properties. Archives of clinical neuropsychology, 28(5), 435-451.
A Case of a Monolingual Spanish-Speaking Latina with Semantic Variant Primary Progressive Aphasia (svPPA)
Authors: Perez L 
Published: August 2019

Abstract

Objective
Often, individuals with lower educational attainment and limited proficiency in the English language get misdiagnosed and/or undertreated, which can impact their quality of life and other outcomes. The present case study intends to review and discuss the presentation of a monolingual, Spanish-speaking woman with Semantic Variant Primary Progressive Aphasia (svPPA), who was originally referred for a neuropsychological evaluation to determine the severity of her existing Alzheimer’s Disease (AD) diagnosis.

Case Description
Ms. X, is a 64-year-old, right-handed Hispanic woman with 6 years of education. Symptoms included forgetfulness, restlessness, and insomnia. Her family reported that she was repeating her ideas frequently during conversations and failing to recognize previously acquainted people, including her own relatives. A recent MRI of the brain showed anterior temporal lobe atrophy.

Diagnostic Impressions and Outcomes
Overall, she showed naming deficits (anomia), impaired verbal fluency, surface dyslexia, and significant problems with comprehension. Executive functioning, sentence repetition, working memory, and attention were generally intact. Qualitatively, her speech was apparently fluent and automatic, yet clearly empty in meaning. In Ms. X’s case, collateral reports of word-finding difficulties, tendency to repeat her thoughts incessantly, associative agnosia and prosopagnosia, and spared repetition and motor speech are strongly indicative of svPPA.

Discussion
svPPA primarily impacts language production and comprehension, and is characterized by severe anomia, word-finding difficulties, impaired single word comprehension, and in some cases, defective recognition of familiar faces. On testing, impairments can be observed in confrontation naming, with motor speech and repetition, working memory, episodic memory, visuospatial skills, and problem-solving skills relatively intact. Language symptoms are thought to stem from deficits of the semantic system.
Do You Understand Me? An Aphasia Assessment Case Study in a Non-Native English Speaker
Authors: Ruiz A , McLaren M E , Riggall E , Penna S 
Published: August 2019

Abstract

Objective
We report on the assessment of a non-native, English speaking patient who presented for a comprehensive neuropsychological evaluation following an infarct with associated language deficits. Challenges in assessment and interpretation given language and cultural barriers are discussed.

Case Description
The patient presented for an evaluation of cognitive and emotional difficulties following a left internal carotid artery infarct. Brain MRI revealed multiple acute infarcts in the left hemisphere, including the left occipital, medial aspect of the left temporal, left frontal, and left parietal lobes. While the patient had lived in the U.S. for 30 years and spoke English fluently for work, he primarily spoke his native language (Tamil). Given the lack of medically certified interpreters in the region along with a lack of culturally sensitive tests, the patient was evaluated in English using English-based tests and norms.

Diagnostic Impressions and Outcomes
Results were suggestive of a transcortical sensory aphasia. Language comprehension deficits were observed in both oral and written formats, while simple oral expression and repetition remained intact. The lack of normative data that matched the patient’s demographic background in addition to the lack of available samples regarding the patient’s English language functioning prior to the stroke made assessing the severity of deficits challenging. The family’s cultural norms and the patient’s unawareness of his deficits may have resulted in underreporting of the patient’s symptoms to providers. These factors further complicated the selection of appropriate recommendations for short- versus long-term disability.

Discussion
Specific challenges included an inability to assess the patient in his native language while using culturally-sensitive measures; thus, shedding light on the current clinical need for increasing competency in the assessment of non-native English-speaking patients. Further directions and opportunities are discussed.