Neuropsychological Evaluation Among School‐Aged Children in the Context of HIV in an Urban Kenyan Setting

In Lower-and-Middle-Income Countries (LMICs) there is a clear need for neurocognitive tools to evaluate children predisposed to cognitive impairment due to conditions such as HIV (Human Immunodeficiency Virus) and stunting (slow growth of height-for-age compared to the general population). Evaluating cognitive impairment, especially in children with HIV and stunting, may help in early diagnosis and treatment to reduce the risk of underperforming in school, dropping out, and the long-term risk effects of reduced income and increased poverty. Cultural aspects play a role in cognitive performance and may contribute to biased performance if the measurement tools are utilized in settings where they were not developed and /or validated. The general goals of this research were to review the tools used to evaluate the mental abilities/cognition of lower school students and to adapt and validate the Computerized Battery for Neuropsychological Evaluation of Children (BENCI) in a cohort of Kenyan children living with HIV and those living without HIV. Moreover, we used the BENCI to evaluate the role of stunting in neuropsychological outcomes such as thinking, attention, reasoning and remembering among 6 – 12-year-olds living with HIV. In our review of the tools, we found evidence of shortcomings in outcomes measured, psychometric properties evaluated and evidence of development and adaptation. Studies were confined to certain geographical settings, mostly high-income countries and there was a scarcity of adequately adapted, validated, and standardized tools for Sub-Saharan Africa. We concluded that there was a need to conduct subsequent studies to enable valid neuropsychological assessments that monitor development and inform future interventions. We, therefore, adapted and validated the BENCI; a preferred tool because it covers the main relevant outcomes of cognition. Successful translation, piloting and testing of psychometric properties resulted in a tool with good reliability or consistent results for most subtests. BENCI also showed that it could measure the same abilities as the few available tools for memory, reasoning, and inhibition. An analytic procedure that shows us how well the outcomes fit constructs such as reasoning, flexibility, verbal memory, and fluency showed that the outcomes fit well and we can reliably compare the constructs outcomes between HIV-positive and HIV-negative groups and also the mean difference for most of the BENCI subtests between the two HIV groups with caution for the language comprehension and short memory subtests. In summary, even though some subtests could be improved in future work, we found the adapted English version of the BENCI to be a valid and reliable neurocognitive tool for use among Kenyan children. Moreover, further research on the potential impact of HIV and stunting on cognitive performance on the BENCI showed that HIV directly impacted stunting and all cognitive outcomes, while stunting was found to (partially) mediate the effects of HIV on reasoning, verbal memory, and fluency. We observed that children with a double burden of HIV and stunting have poorer cognitive performance compared to those with either HIV only or stunting only. In settings with a shortage of adequately standardized and robustly validated tools that measure cognitive ability, we can objectively measure disparities in cognition by aligning and validating tools to cultural context. This enables us to know the true burden of impairment and the associated risk factors.-In de lagere en middeninkomenslanden (LMICs) is er een duidelijke behoefte aan neurocognitieve tests om kinderen te evalueren die vatbaar zijn voor cognitieve stoornissen als gevolg van aandoeningen zoals HIV (Human Immunodeficiency Virus) en groeiachterstand (langzame groei van de lengte naar leeftijd in vergelijking met voor de algemene bevolking). Het evalueren van cognitieve stoornissen, vooral bij kinderen met HIV en groeiachterstand, kan helpen bij een vroege diagnose en behandeling om het risico op onderpresteren op school, uitval en de langetermijnrisico-effecten van een lager inkomen en een grotere armoede te verminderen. Culturele aspecten spelen een rol bij cognitieve testprestaties en kunnen bijdragen aan vertekende prestaties als de meetinstrumenten worden gebruikt in omgevingen waar ze niet zijn ontwikkeld en/of gevalideerd. De algemene doelstellingen van dit onderzoek waren het beoordelen van de literatuur over tests die worden gebruikt om de mentale vermogens/cognitie van basisschoolleerlingen te evalueren en het aanpassen en valideren van de Computerized Battery for Neuropsychological Evaluation of Children (BENCI) in een cohort van Keniaanse kinderen die leven met HIV en die leven zonder HIV. Daarnaast hebben we de BENCI gebruikt om de rol van groeiachterstand in neuropsychologische uitkomsten zoals denken, aandacht, redeneren en herinneren te evalueren bij 6-12-jarigen met HIV.In de literatuurstudie over bestaande tests vonden we vaak tekortkomingen in de gemeten uitkomsten, de geëvalueerde psychometrische eigenschappen, en in de aanpassingen naar nieuwe culturele contexten. Psychometrische onderzoeken werden voornamelijk gedaan in landen met een hoog inkomen, en er is duidelijke behoefte aan adequaat aangepaste, gevalideerde en gestandaardiseerde tests voor Sub-Sahara-Afrika om valide neuropsychologische beoordelingen te doen om de neurocognitieve ontwikkeling te monitoren en sturing te geven aan werkzame interventies.Daarom hebben we de BENCI aangepast en gevalideerd; een test die de voorkeur verdient omdat het de belangrijkste relevante uitkomsten van cognitie bestrijkt. Het succesvol vertalen, testen en testen van psychometrische eigenschappen resulteerde in een testbatterij met goede betrouwbaarheid voor de meeste subtests. BENCI toonde ook aan dat het dezelfde vaardigheden kon meten als de weinige beschikbare tests voor geheugen, redeneren en inhibitie. Een factoranalyse liet dat de BENCI goed past bij een theoretisch model van de neurocognitieve vaardigheden en dat die constructen op equivalente wijze worden gemeten bij zowel HIV-positieve en HIV-negatieve groepen . Samenvattend: hoewel sommige subtests in toekomstig werk verbeterd zouden kunnen worden, vonden we dat de aangepaste Engelse versie van de BENCI een valide en betrouwbaar neurocognitieve testbatterij is voor gebruik bij Keniaanse kinderen. Verder onderzoek liet zien naar de potentiële impact van HIV en groeiachterstand op de cognitieve prestaties op de BENCI liet zien dat van HIV en groeiachterstand een effect hebben op redeneren, verbaal geheugen en vloeiendheid van redeneren. In omgevingen met een tekort aan voldoende gestandaardiseerde en robuust gevalideerde tests die cognitieve vaardigheden meten, kunnen we verschillen in cognitieve vaardigheden objectief meten door instrumenten af te stemmen op de culturele context en deze te valideren. Dit stelt ons in staat de last van de ziektes zoals HIV en groeiachterstanden te onderzoeken en er interventies voor te ontwikkelen

Effects of Aerobic Exercise and High-Intensity Interval Training on the Mental Health of Adolescents Living in Poverty: Protocol for a Randomized Controlled Trial

Background: The increasing rate of mental health issues among adolescents has recently been a considerable concern in Hong Kong. In particular, adolescents with low socioeconomic status (SES) are likely to experience poor mental health, including low self-esteem and high levels of anxiety, anger, and depression. Previous research has found that physical activities have a positive impact on improving mental health outcomes among adolescents. However, approximately 96% of adolescents in Hong Kong do not engage in regular exercise, which potentially increases the risk of poor mental health. Objective: In this study, we aim to examine whether changes in the 3 indicators (reduced ill-being, enhanced well-being, and cognitive functions) of mental health among adolescents with low SES are evident before and after exercise. In addition, this study compares the effectiveness of aerobic exercise and high-intensity interval training on these indicators among adolescents with low SES. Methods: A total of 78 participants from low-income families aged between 12 and 15 years from 3 to 4 secondary schools will be recruited for this study. They will be randomly assigned to either an aerobic exercise group (26/78, 33%), a high-intensity interval training group (26/78, 33%), or a control group (26/78, 33%). Participants in the first 2 groups will take part in a 10-week training program period. Participants in the control group will participate in other physical activities during the same intervention period. The training sessions will be conducted 3 times per week on nonconsecutive days. A range of neuropsychological tests and psychometric scales will be used to measure the executive functions and indicators of psychological well-being and ill-being, including enjoyment, self-efficacy, mood, depression, anxiety, and stress at pretest, posttest, and follow-up assessments. Results: The project was funded in 2021 by the Research Matching Grant Scheme, through the University Grants Committee of the Hong Kong Special Administrative Region Government. Ethical approval has been obtained from the author’s institution. Participant recruitment will begin in January 2022 and continue through to April 2022. Data collection and follow-up are expected to be completed by the end of 2022. The results are expected to be submitted for publication in 2023. Conclusions: The findings will help inform policy makers and practitioners in promoting the importance of physical exercise to enhance mental health

Initial assessment of reliability of a self-administered web-based neuropsychological test battery

AbstractIntroductionWeb-based neuropsychological testing can be an important tool in meeting the increasing demands for neuropsychological assessment in the clinic and in large research studies. The primary aim of this study was to investigate practice effects and reliability of self-administered web-based neuropsychological tests in Memoro. Due to lack of consistent analysis and reporting of reliability in the literature, especially intraclass correlation coefficients (ICC), we highlight how using different ICC measures results in different estimates of reliability.Method61 (31 females) participants (mean age 53.3 years) completed the Memoro tests twice with a median of 14 days between testing.ResultsPractice effects were detected for all cognitive measures (d = 0.32–0.61), most pronounced for memory measures. Reliability estimated using two-way random effects single measure absolute agreement ICC(2,1) were between 0.55 and 0.74. Two-way mixed effects average measure consistency ICC(3,2), ranged from 0.79 to 0.89. Reliability was highest for the processing speed task and lower for the memory tasks.ConclusionsMemoro tests had test-retest reliability similar to that of traditional, computerized and web-based test batteries used clinically and in research. It is important to carefully choose and specify the ICC implemented, as ICC(2,1) and ICC(3,2) give different results and reflect reliability of different measures

Assessing Executive Function in Adolescence: A Scoping Review of Existing Measures and Their Psychometric Robustness

Background: There is much research examining adolescents\u27 executive function (EF) but there is little information about tools that measure EF, in particular preference of use, their reliability and validity. This information is important as to help both researchers and practitioners select the most relevant and reliable measure of EF to use with adolescents in their context. Aims: We conducted a scoping review to: (a) identify the measures of EF that have been used in studies conducted among adolescents in the past 15 years; (b) identify the most frequently used measures of EF; and (c) establish the psychometric robustness of existing EF measures used with adolescents. Methods: We searched three bibliographic databases (PsycINFO, Ovid Medline, and Web of Science) using key terms “Adolescents,” “Executive Functions,” and “measures”. The search covered research articles published between 1st January 2002 and 31st July 2017. Results: We identified a total of 338 individual measures of EF from 705 eligible studies. The vast majority of these studies (95%) were conducted in high income countries. Of the identified measures, 10 were the most used frequently, with a cumulative percent frequency accounting for nearly half (44%) the frequency of usage of all reported measures of EF. These are: Digit Span (count = 160), Trail Making Test (count = 158), Behavior Rating Inventory of Executive Function (count = 148), Wisconsin Card Sorting Test (count = 140), Verbal Fluency Tasks (count = 88), Stroop Color-Word Test (count = 78), Classical Stroop Task (count = 63), Color-Word Interference Test from Delis-Kaplan battery (count = 62), Rey-Osterrieth Complex Figure Test (count = 62), and Original Continuous Performance Test (count = 58). In terms of paradigms, tasks from Span (count = 235), Stroop (count = 216), Trails (count = 171), Card sorting (count = 166), Continuous performance (count = 99), and Tower (count = 94) paradigms were frequently used. Only 48 studies out of the included 705 reported the reliability and/or validity of measures of EF used with adolescents, but limited to studies in high income countries. Conclusion: We conclude that there is a wide array of measures for assessing EF among adolescents. Ten of these measures are frequently used. However, the evidence of psychometric robustness of measures of EF used with adolescents remains limited to support the validity of their usage across different contexts

Do informal caregivers of people with dementia mirror the cognitive deficits of their demented patients?:A pilot study

Recent research suggests that informal caregivers of people with dementia (ICs) experience more cognitive deficits than noncaregivers. The reason for this is not yet clear. Objective: to test the hypothesis that ICs ‘mirror' the cognitive deficits of the demented people they care for. Participants and methods: 105 adult ICs were asked to complete three neuropsychological tests: letter fluency, category fluency, and the logical memory test from the WMS-III. The ICs were grouped according to the diagnosis of their demented patients. One-sample ttests were conducted to investigate if the standardized mean scores (t-scores) of the ICs were different from normative data. A Bonferroni correction was used to correct for multiple comparisons. Results: 82 ICs cared for people with Alzheimer's dementia and 23 ICs cared for people with vascular dementia. Mean letter fluency score of the ICs of people with Alzheimer's dementia was significantly lower than the normative mean letter fluency score, p = .002. The other tests yielded no significant results. Conclusion: our data shows that ICs of Alzheimer patients have cognitive deficits on the letter fluency test. This test primarily measures executive functioning and it has been found to be sensitive to mild cognitive impairment in recent research. Our data tentatively suggests that ICs who care for Alzheimer patients also show signs of cognitive impairment but that it is too early to tell if this is cause for concern or not

Recommendations for the use of common outcome measures in pediatric traumatic brain injury research

This article addresses the need for age-relevant outcome measures for traumatic brain injury (TBI) research and summarizes the recommendations by the inter-agency Pediatric TBI Outcomes Workgroup. The Pediatric Workgroup\u27s recommendations address primary clinical research objectives including characterizing course of recovery from TBI, prediction of later outcome, measurement of treatment effects, and comparison of outcomes across studies. Consistent with other Common Data Elements (CDE) Workgroups, the Pediatric TBI Outcomes Workgroup adopted the standard three-tier system in its selection of measures. In the first tier, core measures included valid, robust, and widely applicable outcome measures with proven utility in pediatric TBI from each identified domain including academics, adaptive and daily living skills, family and environment, global outcome, health-related quality of life, infant and toddler measures, language and communication, neuropsychological impairment, physical functioning, psychiatric and psychological functioning, recovery of consciousness, social role participation and social competence, social cognition, and TBI-related symptoms. In the second tier, supplemental measures were recommended for consideration in TBI research focusing on specific topics or populations. In the third tier, emerging measures included important instruments currently under development, in the process of validation, or nearing the point of published findings that have significant potential to be superior to measures in the core and supplemental lists and may eventually replace them as evidence for their utility emerges

Understanding Medication Self-Management Capacity among Older Adults Living in Low-Income Housing Communities

Understanding Medication Self-Management Capacity among Older Adults Living in Low-Income Housing Communities ABSTRACT Background: Medication self-management capacity (MMC) is an individual’s cognitive and functional ability to self-administer a medication regimen as prescribed. Poor MMC is an issue in older adults often resulting in negative health outcomes and loss of independence. Therefore, understanding low-income older adults’ capacity to manage their medications may help identify individuals who are at risk for developing medication mismanagement and guide future intervention strategies based on an individual need to promote safe medication use and healthy aging in place in the community. Objectives: 1) To determine the cognitive and physical functional deficiencies in MMC among low-income older adults, 2) To identify variables that predict deficiencies in MMC in this population, 3) To determine the impact of using pharmaceutical aids/services on MMC, and 4) To examine the association between MMC and emergency room (ER) visits. Methods: This was a cross-sectional study of older adult residents living in low-income housing buildings served by the RHWP. At a study interview, information on demographics, medical history, and medication use was collected. MMC was evaluated using the Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE) tool. Cognitive and functional status, health literacy and depression symptoms were assessed. ER visits were determined retrospectively over the last six months Descriptive analyses were performed to identify cognitive and physical functional deficiencies in MMC. Linear regression analysis was conducted to identify variables that predict MMC and assess the relationship between MMC and using pharmaceutical aid/service. Logistic regression analysis was used to examine the association between ER visits and MMC. Results: A total of 107 participants were included, and 89% were African-American with an average age of 68.54 years (±7.23). They had an average of 4.92 (±2.85) comorbidities and used approximately 8 (±4.12) medications on a regular basis. The mean total deficiency in medication management was 3 (±2.00) as assessed by MedMaIDE. Lacking medication knowledge was common among the participants: 69.16% could not name and 46% state the indication of all of their medications, and 38.32% did not how and when all of their medications should be taken. When controlling for ADLs and falls, the mean total deficiency score in MedMaIDE increased among those with an educational level equal to high school or less compared with participants who had a higher educational level than high school [β=1.32, 1.24, p= 0.0195, 0.0415, respectively], and participants who reported difficulty reading prescription medication labels or opening medication bottles compared with those who did not report any difficulties [β=1.18, 1.43, p= 0.0036, 0.0047, respectively]. About 20.56% of participants were receiving assistance with medications from someone, and 79.44% used at least one pharmaceutical aid/service. However, receiving assistance with medications and using pharmaceutical aid/service were not significantly associated with MMC [p= 0.5334, 0.0853, respectively]. The participants reported a total of 23 (21.5%) ER visits within six months. The adjusted model for age, educational level, number of comorbidities, and ADLs suggested that for every one-unit increase in the total deficiency score, the odds of ER visits increased by 1.23 (p=0.1809) times. Conclusion: Many older adults who lived in low-income housing had impaired capacity to manage their medications independently. They appeared to have inadequate medication knowledge, which affects their cognitive ability to manage medications. Low educational level and health literacy and reporting trouble reading labels or opening medication bottles were predictors to deficient MMC. Future studies are needed to confirm whether or not MMC predicts those who may not able to remain living independently safely or who may need additional support with medications to remain independent

Psychological Assessment in South Africa

This book provides an overview of the research related to psychological assessment across South Africa. The thirty-six chapters provide a combination of psychometric theory and practical assessment applications in order to combine the currently disparate research that has been conducted locally in this field. Existing South African texts on psychological assessment are predominantly academic textbooks that explain psychometric theory and provide brief descriptions of a few testing instruments. Psychological Assessment in South Africa provides in-depth coverage of a range of areas within the broad field of psychological assessment, including research conducted with various psychological instruments. The chapters critically interrogate the current Eurocentric and Western cultural hegemonic practices that dominate the field of psychological assessment. The book therefore has the potential to function both as an academic text for graduate students, as well as a specialist resource for professionals, including psychologists, psychometrists, remedial teachers and human resource practitioners