Improving the Assessment of Practical Judgment Ability in Older Adults

Judgment is an important aspect of executive functioning and critical to many aspects of real-world behavior. As the older adult population and incidence of dementia rises, the assessment of judgment during neuropsychological evaluations is important for informing diagnosis, understanding functional and cognitive competence, and designing effective treatment plans. The Test of Practical Judgment (TOP-J) is an objective verbal measure with two versions (i.e., 9 items and 15 items) that is increasingly used by neuropsychologists; however, initial validation research was conducted with a small, highly-educated non-Hispanic White sample. As a result, normative data and content may not be appropriate for individuals with limited education or other cultural backgrounds. In addition, only one version was developed, limiting the TOP-J’s usefulness in repeat assessment situations. Furthermore, no informant measures of judgment exist—even though neuropsychologists routinely gather such data. These identified needs prompted three studies to: (1) update TOP-J administration/scoring guidance and normative data (N = 348); (2) develop and assess psychometric evidence of an alternate form (N = 130); and (3) develop and assess psychometric evidence of an informant form (N = 189). In study one, an item was replaced on the 9-item version, now called TOP-J Form A, due to confirmatory factor analysis findings. The normative sample size was increased from 39 to 261 with education stratification and improved representation (0% to 31%) of individuals from other racial/ethnic backgrounds. Evidence of reliability and validity were comparable to original validation findings. A comprehensive manual with updated scoring criteria was developed and normative data presented. In study two, results revealed an adequate alternate form of the TOP-J (i.e., Form B) with similar means and standard deviation (i.e., \u3c 1 point difference in each metric for 9-item and \u3c 2 points for 15-item). Normative data (n = 73) were established with 27% representation of racial/ethnic backgrounds other than non-Hispanic White. The TOP-J Form B showed strong psychometric properties, including good unidimensional model fit and preliminary reliability and validity evidence. In study three, reliability and validity evidence also emerged for the informant form (i.e., TOP-J-Informant). Patient diagnostic groups were significantly discriminated in the expected direction. Taken together, this dissertation improved the utility of the TOP-J. The updated TOP-J Form A, TOP-J Form B, and TOP-J-Informant should prove useful in diverse settings to inform diagnosis and provide valuable information to help safeguard older adults at risk for functional decline, exploitation, and dangerous decision making

Teaching Critical Reflection in Occupational Therapy: A Quantitative Pre/Post Evaluation of Student Learning

This study was designed to answer the question, “Does student recognition of the assumptions underlying occupational therapy practice increase after participation in guided exercises of critical reflection?” The project is grounded in critical occupational therapy (as first named by Whiteford and Townsend) to promote students to reflect actively on dominant disciplinary ideologies and self-reflect on how one’s social positionality impacts understandings of occupational participation. The concept of non-sanctioned occupations was drawn on as a means to facilitate changes in student recognition. A one group, quantitative pre/post design with six open-ended responses was undertaken with master’s-level students (N = 53) at two private universities. A learning module involving an interactive 90-min lecture with a pre-assigned reading and associated reflection guide was used to facilitate questioning of disciplinary ideologies. Even when introduced in small amounts, the use of critical occupational therapy in education shows benefits. Wilcoxon signed rank tests indicated the learning model increased student recognition of underlying personal assumptions. Thematic qualitative analysis confirmed these results and described patterns of change between pre/post surveys. This study demonstrates the potential for occupational therapy curricula to embed methods that instill critical self-reflection in emerging practitioners, with the promise of transforming clinical assessment and practice

The Role of the Radial Orbit Instability in Dark Matter Halo Formation and Structure

For a decade, N-body simulations have revealed a nearly universal dark matter density profile, which appears to be robust to changes in the overall density of the universe and the underlying power spectrum. Despite its universality, the physical origin of this profile has not yet been well understood. Semi--analytic models by Barnes et al. (2005) have suggested that the density structure of dark matter halos is determined by the onset of the radial orbit instability (ROI). We have tested this hypothesis using N-body simulations of collapsing dark matter halos with a variety of initial conditions. For dynamically cold initial conditions, the resulting halo structures are triaxial in shape, due to the mild aspect of the instability. We examine how variations in initial velocity dispersion affect the onset of the instability, and find that an isotropic velocity dispersion can suppress the ROI entirely, while a purely radial dispersion does not. The quantity sigma^2/vc^2 is a criterion for instability, where regions with sigma^2/vc^2 <~1 become triaxial due to the ROI or other perturbations. We also find that the radial orbit instability sets a scale length at which the velocity dispersion changes rapidly from isotropic to radially anisotropic. This scale length is proportional to the radius at which the density profile changes shape, as is the case in the semi--analytic models; however, the coefficient of proportionality is different by a factor of ~2.5. We conclude that the radial orbit instability is likely to be a key physical mechanism responsible for the nearly universal profiles of simulated dark matter halos.Comment: 13 pages, 12 figures, accepted to Ap

A time-lagged association between the gut microbiome, nestling weight and nestling survival in wild great tits

Natal body mass is a key predictor of viability and fitness in many animals. While variation in body mass and therefore juvenile viability may be explained by genetic and environmental factors, emerging evidence points to the gut microbiota as an important factor influencing host health. The gut microbiota is known to change during development, but it remains unclear whether the microbiome predicts fitness, and if it does, at which developmental stage it affects fitness traits. We collected data on two traits associated with fitness in wild nestling great tits Parus major: weight and survival to fledging. We characterised the gut microbiome using 16S rRNA sequencing from nestling faeces and investigated temporal associations between the gut microbiome and fitness traits across development at Day-8 (D8) and Day-15 (D15) post-hatching. We also explored whether particular microbial taxa were ‘indicator species’ that reflected whether nestlings survived or not. There was no link between mass and microbial diversity on D8 or D15. However, we detected a time-lagged relationship where weight at D15 was negatively associated with the microbial diversity at D8, controlling for weight at D8, therefore reflecting relative weight gain over the intervening period. Indicator species analysis revealed that specificity values were high and fidelity values were low, suggesting that indicator taxa were primarily detected within either the survived or not survived groups, but not always detected in birds that either survived or died. Therefore these indicator taxa may be sufficient, but not necessary for determining either survival or mortality, perhaps owing to functional overlap in microbiota. We highlight that measuring microbiome-fitness relationships at just one time point may be misleading, especially early in life. Instead, microbial-host fitness effects may be best investigated longitudinally to detect critical development windows for key microbiota and host traits associated with neonatal weight. Our findings should inform future hypothesis testing to pinpoint which features of the gut microbial community impact on host fitness, and when during development this occurs. Such confirmatory research will shed light on population level processes and could have the potential to support conservation

The Grizzly, September 25, 2003

The State of Iraq: Critical, but not Hopeless says Trudy Rubin • Family Day Celebrates Students\u27 Second Home • The Journey of a Lifetime • Aftermath of Isabel: A Photo Essay • SERV Serves Students During Campus Emergencies • Opinions: Common Sentiments About the Common Experience; UC Fashion: Mood-Based; People Want to Know the Real Truth; WTO Talks Collapse: Possibly a Good Thing; Out of the Middle East: Part 3 • Collegeville\u27s Hot Spots • Playwriting Debut • Meet the Star Among Us • London Living: A Warm City • The Outhouse Revisited: A Review • Field Hockey: Young Sets School Record in 5-0 win • Men\u27s Soccer: Continuing to Battle Against Tough Competition • UC Football: Albright Stomps the Bearshttps://digitalcommons.ursinus.edu/grizzlynews/1542/thumbnail.jp

The Grizzly, October 9, 2003

Choose to Reuse: Recycling at Ursinus • Volunteer Program Breaks the Bank • Get Registered to Get Out the Vote • Meet the Democratic Candidates for President • A Look at the Response to Rape at Ursinus • Opinions: How Safe do we Feel?; Out of the Middle East: End of a Journey; Text Messaging Behind Your S.O.\u27s Back; New Addiction: AIM; Domo Arigato, Dr. Roboto • Guster: Having Fun Being Young • Halloween Fun Around Collegeville • The Eger Gateway • Field Hockey Still Undefeated in Conference Play • Ursinus XC Takes on Div. 1 and 2 Opponents • Volleyball Splits First C.C Matches • Women\u27s Soccer Continues to Impress • Men\u27s Soccer Trying to Battle • Josh Kemp: Changing the Record Bookshttps://digitalcommons.ursinus.edu/grizzlynews/1544/thumbnail.jp

The Grizzly, October 2, 2003

Sexual Assault Reported on Campus • Water Worries Burst in Reimert • Senior in the Market for Success • Tough Crowd: Bush Speaks to the United Nations • Opinions: Out of the Middle East, Part 4; Pharming: The Scariest New Drug Fad; To Tan or Not to Tan?; Maples-palooza! • Is Collegeville Boring? • Smart Shopping • CAB Events • The Glory of Ursinus: Bomberger Memorial Hall • Bears Obliterate Mt. Ida, 47-0 • Women\u27s Soccer Take Two • Volleyball Ends Losing Streak • Bears Overtake Quakers in Hockey Season Opener • Japanese Women Wrestlers • UC Field Hockey Team Continues Domination in C.C. Play • Ursinus XC Invades Celtic Fest 2003https://digitalcommons.ursinus.edu/grizzlynews/1543/thumbnail.jp

Associations of lifestyle and vascular risk factors with Alzheimer\u27s brain biomarker changes during middle age: a 3 year longitudinal study in the broader New York City area

Objective To investigate the associations between lifestyle and vascular risk factors and changes in Alzheimer’s disease (AD) biomarkers (beta-amyloid load via 11C-PiB PET, glucose metabolism via 18F-FDG PET and neurodegeneration via structural MRI) and global cognition in middle-aged asymptomatic participants at risk for AD. Design Prospective, longitudinal. Setting The study was conducted at New York University Langone/Weill Cornell Medical Centres in New York City. Participants Seventy cognitively normal participants from multiple community sources, aged 30–60 years with lifestyle measures (diet, intellectual activity and physical activity), vascular risk measures and two imaging biomarkers visits over at least 2 years, were included in the study. Outcome measures We examined MRI-based cortical thickness, fluoro-deoxy-glucose (FDG) glucose metabolism and PiB beta-amyloid in AD-vulnerable regions. A global cognitive z-score served as our summary cognition measure. We used regression change models to investigate the associations of clinical, lifestyle and vascular risk measures with changes in AD biomarkers and global cognition. Results Diet influenced changes in glucose metabolism, but not amyloid or cortical thickness changes. With and without accounting for demographic measures, vascular risk and baseline FDG measures, lower adherence to a Mediterranean-style diet was associated with faster rates of FDG decline in the posterior cingulate cortex (p≤0.05) and marginally in the frontal cortex (p=0.07). None of the other lifestyle variables or vascular measures showed associations with AD biomarker changes. Higher baseline plasma homocysteine was associated with faster rates of decline in global cognition, with and without accounting for lifestyle and biomarker measures (p=0.048). None of the lifestyle variables were associated with cognition. Conclusions Diet influenced brain glucose metabolism in middle-aged participants, while plasma homocysteine explained variability in cognitive performance. These findings suggest that these modifiable risk factors affect AD risk through different pathways and support further investigation of risk reduction strategies in midlife

Lifestyle and vascular risk effects on MRI-based biomarkers of Alzheimer’s disease: a cross-sectional study of middle-aged adults from the broader New York City area

Objective To investigate the effects of lifestyle and vascular-related risk factors for Alzheimer’s disease (AD) on in vivo MRI-based brain atrophy in asymptomatic young to middle-aged adults. Design Cross-sectional, observational. Setting Broader New York City area. Two research centres affiliated with the Alzheimer’s disease Core Center at New York University School of Medicine. Participants We studied 116 cognitively normal healthy research participants aged 30–60 years, who completed a three-dimensional T1-weighted volumetric MRI and had lifestyle (diet, physical activity and intellectual enrichment), vascular risk (overweight, hypertension, insulin resistance, elevated cholesterol and homocysteine) and cognition (memory, executive function, language) data. Estimates of cortical thickness for entorhinal (EC), posterior cingulate, orbitofrontal, inferior and middle temporal cortex were obtained by use of automated segmentation tools. We applied confirmatory factor analysis and structural equation modelling to evaluate the associations between lifestyle, vascular risk, brain and cognition. Results Adherence to a Mediterranean-style diet (MeDi) and insulin sensitivity were both positively associated with MRI-based cortical thickness (diet: βs≥0.26, insulin sensitivity βs≥0.58, P≤0.008). After accounting for vascular risk, EC in turn explained variance in memory (P≤0.001). None of the other lifestyle and vascular risk variables were associated with brain thickness. In addition, the path associations between intellectual enrichment and better cognition were significant (βs≥0.25 P≤0.001), as were those between overweight and lower cognition (βs≥-0.22, P≤0.01). Conclusions In cognitively normal middle-aged adults, MeDi and insulin sensitivity explained cortical thickness in key brain regions for AD, and EC thickness predicted memory performance in turn. Intellectual activity and overweight were associated with cognitive performance through different pathways. Our findings support further investigation of lifestyle and vascular risk factor modification against brain ageing and AD. More studies with larger samples are needed to replicate these research findings in more diverse, community-based settings