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Misinterpreting cognitive change over multiple timepoints: When practice effects meet age-related decline.

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Practice effects artificially inflate cognitive test scores. A participant-replacement method accurately reveals cognitive decline in older adults and mild cognitive impairment patients, enabling earlier detection of deficits.

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Area of Science:

  • Neuroscience
  • Cognitive Psychology
  • Gerontology

Background:

  • Practice effects (PE) in cognitive testing can mask true cognitive decline.
  • Accurate assessment of cognitive change is crucial for older adults and those with progressive diseases.
  • Traditional methods struggle to differentiate PEs from genuine cognitive changes over multiple time points.

Purpose of the Study:

  • To implement and evaluate a participant-replacement method for quantifying PEs across three time points.
  • To assess the impact of PEs on cognitive function in cognitively unimpaired older adults and those with mild cognitive impairment (MCI).
  • To determine if PEs diminish after the first follow-up or persist over time.

Main Methods:

  • A cohort of 1,190 older adults (809 cognitively unimpaired, 381 MCI) completed six neuropsychological tests at baseline, 12, and 24 months.
  • A participant-replacement strategy using generalized estimating equations was employed to calculate PEs.
  • Comparisons were made between returning participants and newly enrolled participants (replacements) at each time point.

Main Results:

  • Without PE adjustment, cognitive function appeared stable or improved.
  • The participant-replacement method revealed significant PEs in both unimpaired and MCI groups at all time points.
  • PEs did not consistently decrease; some measures, particularly episodic memory, showed increasing PEs beyond the initial follow-up.

Conclusions:

  • The participant-replacement method effectively identified significant PEs across two follow-up periods.
  • Accounting for PEs revealed expected cognitive decline in older adults, contrasting with apparent stability or improvement.
  • This method allows for earlier detection of cognitive impairment and MCI progression, leading to more accurate longitudinal cognitive assessments.