Part of this work was supported by Plan Alzheimer Foundation on a Humanities and Social Sciences grant (AAP SHS 2013: &#34;Sociocognitive aspects of Alzheimer disease&#34; to F. Rigalleau and M. Mazerolle).

The present research was carried out in accordance with French standards, each participant provided informed consent and procedures were consistent with the guidelines of the American Psychological Association.
1. Highlighting and reducing age-based stereotype threat on a lab memory test
<ol>
	<li>Participants screening
	<ol>
		<li>Recruit participants in the desired age range (e.g., younger participants: 18&#8722;35 years old; older participants: 60&#8722;85 years old) for a study on general mental abilities and/or the impact of emotions on various cognitive tasks and questionnaires.</li>
		<li>Ensure that participants are native speakers, have normal or corrected-to-normal vision and hearing, are free of neurological and psychiatric disorders, and have no current depression (Geriatric Depression Scale17) nor abnormal anxiety (State-Trait Anxiety Inventory18).</li>
		<li>Screen older participants for cognitive impairment using the Mini-Mental State Examination (MMSE)19. Include older adults who meet or exceed a cutoff score corresponding to his/her age and educational level20, and who live at home.</li>
	</ol>
	</li>
	<li>Conditions and experimental design
	<ol>
		<li>Test each participant individually at home or in local community associations&#39; premises by an experimenter trained at neuropsychological testing.</li>
		<li>Run the study as a single session, but inform participants there are two separate studies.</li>
		<li>Use the &#34;first study&#34; as a baseline measure of participants&#39; working memory capacity. In the &#34;first study&#34;, minimize evaluative pressure, informing participants they will perform a cognitive task currently under elaboration. Encourage participants to do their very best21.</li>
		<li>Use the &#34;second study&#34; to evaluate the impact of stereotype threat on participants&#39; working memory capacity. That is, inform participants that they are going to perform a fully validated and diagnostic test of memory capacity.
		<ol>
			<li>Randomly assign participants to one of two conditions (threat versus reduced-threat conditions). 
			NOTE: See Figure 1 for a visual depiction of the procedure; full details on this research were published in Mazerolle et al.22.</li>
			<li>In the &#34;threat condition&#34;, simply tell participant that both younger and older adults are participating in the study.</li>
			<li>In the &#34;reduced threat condition&#34;, tell participants that both younger and older adults are participating in the study but add that younger and older adults usually obtain the same performances on the ongoing test.</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>Memory tests and procedure
	<ol>
		<li>Use a validated memory test that is typically used in cognitive lab studies. Because ST effects typically occur on difficult tasks, use a difficult test, such as the reading span test23.</li>
		<li>Use two alternative versions of the reading span test (one for the &#34;first study&#34; and the other one for the &#34;second&#34; study), with different sentences but match them in number of words and in length, frequency, and number of syllables of the last word.</li>
		<li>Use a reading span test that contains 42 sentences: 12 series of two to five sentences with 3 series per length.</li>
		<li>Present one sentence at a time and instruct participant to read it, at his/her own pace, while memorizing the last word of the sentence.</li>
		<li>Ask participant not to interrupt his reading and not to pause between two sentences.</li>
		<li>Have participant to recall the words immediately after he/she finished reading the last sentence of the block considered.</li>
		<li>Do not require participants&#39; recall being serial but constrain them not to start by recalling the final word of the last sentence read. Do not limit the recall time and invite participants to find as many words as possible.</li>
		<li>Do not inform participants of their errors, and do not give them a second chance to answer.</li>
		<li>Compute the final score of each participant using the mean proportion of correctly recalled words across the 12 series.</li>
	</ol>
	</li>
</ol>
2. Highlighting and reducing age-based stereotype threat on short cognitive tests used to screen for predementia in clinical settings
<ol>
	<li>Participants screening
	<ol>
		<li>Recruit older participants aged 60 to 85 for a study on general mental abilities and/or the impact of emotions on various cognitive tasks and questionnaires.</li>
		<li>Ensure that participants live at home, have no history of significant trauma nor chronic illness, have normal or corrected-to-normal vision and hearing, have no current depression (Geriatric Depression Scale17) nor abnormal anxiety (State-Trait Anxiety Inventory18).</li>
	</ol>
	</li>
	<li>Conditions and experimental design
	<ol>
		<li>Test each participant individually at home or in local community associations&#39; premises by an experimenter trained at neuropsychological testing.</li>
		<li>Have participants taking two short cognitive tests used to screen for predementia (or mild cognitive impairment [MCI]): the MMSE19 and the Montreal Cognitive Assessment (MoCA24) in a counterbalanced order.</li>
		<li>Randomly assign participants to one of the two order (MMSE then MoCA or MoCA then MMSE).</li>
		<li>Before taking the first test, randomly assign participants to one of two threat conditions (threat versus reduced-threat conditions).</li>
		<li>In the &#34;threat condition&#34;, inform participants that both younger and older adults are taking part in the study about memory capacity.</li>
		<li>In the &#34;reduced threat condition&#34;, inform participants that both younger and older adults are taking part in the study about memory capacity but add that younger and older adults typically obtain the same performances on the ongoing tests.</li>
		<li>Before taking the second test, use an educational intervention to debrief all participants (regardless of the threat condition they were previously assigned) about age-based stereotype threat. Tell participants that &#34;Numerous studies demonstrated that negative age-related beliefs, especially about memory capacity decline, trigger anxiety, which in turn prevents older adults from performing optimally. Actually, it is well-known that performance on memory tests may not accurately reflect people&#39;s true abilities, because performance can be affected by the testing context. In other words, people&#39;s negative reputation in an ability domain may impair their performance on tests that assess this stereotyped ability, for example when older adults complete a memory test. Therefore, if you feel anxious during the subsequent memory test, this does not mean that you are unable to complete the tests. It rather probably means that your feelings are affected by the general negative reputation of older adults regarding memory.&#34; 
		NOTE: See Figure 2 for a visual depiction of the educational intervention; full details on this research were published in Mazerolle et al.25.</li>
	</ol>
	</li>
	<li>Short cognitive neuropsychological tests and procedure
	<ol>
		<li>Administrate the 8 subtests of the MMSE19 (orientation, registration, attention and calculation, recall, language, copying) to evaluate memory, orientation to time and place, attention and executive functioning, language and visuospatial abilities. Follow Folstein, Folstein and McHugh&#39;s administration guidelines19 and compute the final score adding the scores of every subtest. Obtain a final score rated on 30-point scale.</li>
		<li>Administrate the 8 subtests of the MoCA24 (visuospatial/executive, naming, memory, attention, language, abstraction, delayed recall, orientation) to evaluate memory, orientation to time and place, attention and executive functioning, language and visuospatial abilities. Follow administration guidelines available at <a href="http://www.mocatest.org/" target="_blank">www.mocatest.org</a> and compute the final score adding the scores of every subtest. Obtain a final score rated on 30-point scale.</li>
	</ol>
	</li>
</ol>

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The authors have nothing to disclose.

The present studies show that stereotype threat, a neglected source of stress in many testing situations, can lead older adults to perform below their true abilities on memory tests. The method presented here highlights the crucial importance of the instructions given to participants and patients before testing memory. Simply mentioning that younger adults are taking part in the study (without mentioning any expected age-related differences in performance) is sufficient to inflate by 40% (MMSE and MoCA averaged) the number of older adults meeting clinical criteria for predementia on short cognitive tests. The present findings also showed that presenting the memory tests as age fair or explaining to older adults the negative impact of aging stereotypes on their performances are two efficient strategies to help them resist to age-based stereotype threat. Taken together, these results highlight the critical importance of taking into account stereotype treat effects when assessing older adults&#39; memory using short cognitive tests, especially given the current pressure on general practitioners to participate in the screening for predementia26,27. It is also important for experimental studies about cognitive aging because short cognitive tests are used to exclude participants who are suspected to show predementia symptoms only because they scored below a cutoff.
Some of the critical aspects of the method deserve particular attention. A typical mistake when one discovers stereotype threat research28 consists in assuming that a stereotype threat condition requires the implementation of an extra pressure that does not exist in conventional real-life testing, and that standard real-life testing instructions can be used to operationalize a no-stereotype threat control condition. Actually, it is quite the contrary: The standard real-life testing settings are likely to induce stereotype threat, either implicitly or explicitly, because of the words used to present the tests and/or any environmental cues that are related to negative aging stereotypes (e.g., the presence of flyers or posters on Alzheimer&#39;s disease or other dementia). It is much more difficult to find a way to eliminate stereotype threat in a testing situation. Therefore, any modification to the instructions that have been found efficient to reduce stereotype threat should be carefully considered to avoid the belief that one is comparing a threat and a reduced-threat condition while, in fact, one is comparing two stereotype threat conditions.
Although the present findings were obtained on lab memory tests and short cognitive tests, they raise the question of whether age-based stereotype threat effects can also affect older patients&#39; performances on complete neuropsychological batteries used in memory clinics for the diagnosis of MCI, the prodromal stage of AD. In our view, it seems very likely that age-based stereotype threat effects contribute, at least in part, to the 53% of false positive errors observed in the diagnosis of MCI. Without denying that aging may be associated with cognitive decline and neurodegenerative diseases such as MCI or AD for many people, our findings suggest paying special attention to the influence of negative aging stereotypes that have been largely overlooked in the context of neuropsychological testing.
Several individual factors can make older adults more or less vulnerable to age-based stereotype threat effects. As indicated by a recent review5, these moderators include older adults&#39; level of education, physical and psychological health, subjective age, stigma consciousness, domain identification (i.e., importance attached to memory), and memory self- efficacy. Future research, especially those conducted within the clinical setting where a diagnosis is requested, should thus consider some of these factors to provide fairer evaluation of patients&#39; memory abilities.
Our experimental design offers new recommendations to healthcare professionals to improve the accuracy of predementia diagnosis. Characterizing the memory tests as age fair or informing older adults about the age-based stereotype threat phenomenon are two simple and easily implementable instructions likely to help older people to perform at an optimal level during neuropsychological testing. These recommendations may help medical staff to deliver more accurate and potentially less threatening information to the patients and/or their family (thereby significantly improving their well-being and quality of life). It should be noted, however, that these recommendations may need to be adapted to consider other types of threat that could be simultaneously triggered by the clinical context (e.g., the specific threat of AD as a dramatic disease29, the threat of being at hospital30, and the threat of the white coat31).

A growing field of laboratory research in social cognition conducted in the healthy population has demonstrated that members of groups whose abilities are negatively stereotyped typically underperform when the negative stereotypes are made relevant to the performance at hand, a phenomenon called stereotype threat (ST). In addition to the normal anxiety associated with taking cognitive tests, the fear of confirming negative stereotypes creates extra pressure that may interfere with cognitive functioning and lead to perform below one&#39;s abilities1,2. Many findings demonstrate that negative aging stereotypes (e.g., the culturally shared beliefs that aging inescapably causes severe cognitive decline and diseases such as Alzheimer&#39;s disease [AD]) contribute, at least in part, to the differences classically observed in the healthy population between younger and older adults in memory tasks3,4,5. Without denying the impact of aging on cognitive functioning, research clearly demonstrates that age-related stereotypes are powerful enough to artificially decrease older adults&#39; performance on memory tests.
Detrimental age-based ST effects are readily observable and fairly easy to produce with instructional manipulations6, such as simply emphasizing the memory component of the test7,8,9, highlighting differences in performance between young and older adults10,11, or implicitly activating negative aging stereotypes12,13. Given the results obtained in laboratory studies, it is very likely that negative aging stereotypes also permeate, at least implicitly, the standard neuropsychological testing settings during the screening for pre-dementia. Indeed, because of the lengthening of life expectancy, more and more people are concerned with the possibility of getting AD or other forms of dementia. Importantly, false-positive errors are quite frequent in the diagnosis of prodromal state of AD14, which could be explained, at least in part, by transitory impaired performances in older adults due to the age-based ST phenomenon15.
For these reasons, it is important to provide efficient methods to deactivate the influence of negative aging stereotypes and thereby help older people to perform at their maximum during memory assessment in general and during neuropsychological testing specifically. Some methods, such as de-emphasizing the memory component of the test (e.g., characterizing the task as a vocabulary test), have already proved efficient to eliminate ST effects in older adults on explicit memory tests taken in the context of lab studies7,9,16. However, such instructions are not compatible with the ecological clinical context of the neuropsychological testing, in which older adults come to have their memory abilities assessed. The goal of our articles is to present two methods likely to alleviate age-based ST effects among older adults, either in the lab or in the clinical contexts. The first one, especially suited for the lab context, consists in telling older adults that performance on the ongoing memory tests usually does not differ between younger and older adults (i.e., age-fair instructions). The second method, which can be implemented in both lab and clinical contexts, consists in explaining to older adults (or patients) the negative impact of aging stereotypes, which may help them reappraise the situation, reduce evaluative pressure, and feel less threatened during the testing.

<table><tbody><tr><td>Table</td><td></td><td></td><td></td></tr><tr><td>2 chairs (one for the participant and one for experimenter)</td><td></td><td></td><td></td></tr><tr><td>Laptop/computer with Reading span test described in the protocol</td><td>Apple iMac (Cupertino, CA)</td><td></td><td></td></tr><tr><td>Software</td><td>Psyscope</td><td></td><td>&lt;a href=&quot;http://psy.ck.sissa.it/psy_cmu_edu/index.html&quot; target=&quot;_blank&quot;&gt;http://psy.ck.sissa.it/psy_cmu_edu/index.html&lt;/a&gt;</td></tr><tr><td>Paper and pencil for MMSE, MoCA, Geriatric depression Scale, State-Trait Anxiety Inventory</td><td></td><td></td><td></td></tr><tr><td>Mini Mental State Examination</td><td>Folstein, M. F., Folstein, S. E., McHugh, P. R. &quot;Mini-mental state.&quot; Journal of Psychiatric Research. 12 (3), 189&amp;ndash;198 (1975).</td><td></td><td></td></tr><tr><td>Montreal Cognitive Assessment</td><td>Nasreddine, Z. S. et al. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society. 53, 695&amp;ndash;699 (2005).</td><td></td><td></td></tr><tr><td>Geriatric depression Scale</td><td>Spielberger, C. D. Test Anxiety Inventory. The Corsini Encyclopedia of Psychology. John Wiley &amp;amp; Sons, Inc., Hoboken (2010).</td><td></td><td></td></tr><tr><td>State-Trait Anxiety Inventory</td><td>Yesavage, J. A. et al. Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research. 17 (1), 37&amp;ndash;49 (1982).</td><td></td><td></td></tr></tbody></table>

highlighting and reducing the impact of negative aging stereotypes during older adults' cognitive testing

As life expectancy increases, aging has become a major health challenge, resulting in a huge effort to better discriminate between normal and pathological cognitive decline. It is thus essential that cognitive tests and their administration are as fair as possible. However, an important source of bias during cognitive testing comes from negative aging stereotypes that can impair the memory performance of older adults and inflate age differences on cognitive tasks. The fear of confirming negative aging stereotypes creates an extra pressure among older adults which interferes with their intellectual functioning and leads them to perform below their true abilities. Here, we present a protocol that highlights simple but efficient interventions to alleviate this age-based stereotype threat effect. The first study showed that simply informing older participants about the presence of younger participants (threat condition) led older adults to underperform on a standardized memory test compared with younger participants, and that this performance difference was eliminated when the test was presented as age-fair (reduced-threat condition). The second study replicated these findings on short cognitive tests used to screen for predementia in clinical settings and showed that teaching older adults about stereotype threat inoculated them against its effects. These results provide useful recommendations about how to improve older adults' memory assessment both in Iab studies and in clinical settings.

We addressed the hypothesis that stereotype threat impairs the working memory performance of older adults and that this effect can be reduced or eliminated by a simple instruction. The expected interaction between age group and threat instructions was significant, F(1, 214) = 4.85, p &#60; 0.03, &#951;p2 = 0.02, and is depicted in Figure 3. In the threat condition, older participants underperformed (mean [M] = 0.73, standard error [SE] = 0.01) relative to younger participants (M = 0.78, SE = 0.01), F(1, 214) = 12.87, p &#60; 0.001, &#951;p2 = 0.06, whereas the two age groups performed equally well in the reduced-threat condition (F &#60; 1). Moreover, older participants in the reduced-threat condition obtained a better working memory score (M = 0.77, SE = 0.01) relative to those in the threat condition (M = 0.73, SE = 0.01), F(1, 214) = 9.42, p &#60; 0.002, &#951;p2 = 0.04. The performance of younger participants did not differ across the two conditions (threat condition: M = 0.78, SE = 0.01; reduced-threat condition: M = 0.78, SE = 0.01; F &#60; 1). More details about this research can be found in Mazerolle et al.22. These findings highlight the deleterious impact of very subtle cues in the environment (e.g., mentioning the presence of younger adults in a study about memory) on older adults&#39; performance on a laboratory test. Because stereotype threat seems to be powerful enough to create significant differences between younger and older adults, we went further and tested its impact on brief cognitive tests classically used by primary care clinicians for the diagnosis of predementia.
We tested the impact of stereotype threat on older adults&#39; performance on two brief cognitive tests used to screen for predementia states: the MoCA and the MMSE. As shown in Figure 4 (left panel), during test 1 (before debriefing), participants&#39; performance was higher in the reduced-threat condition (M = 28.50; SE = 0.47) than in the threat condition (M = 26.40; SE = 0.43) on the MMSE, F(1, 76) = 12.506, p = 0.001, &#951;p2 = 0.141. The same pattern occurred on MoCA, with participants underperforming in the threat condition (M = 24.80; SE = 0.53) as compared to the reduced-threat condition (M = 27.45; SE = 0.53), F(1, 76) = 10.153, p = 0.002, &#951;p2 = 0.118). These results show that the performances of older adults on short cognitive tests are susceptible to stereotype threat effects.
Because these tests are used to screen for predementia state, we also examined the proportion of participants meeting the clinical criteria of MCI on MoCA and MMSE (using a cutoff at 26 for both tests). During test 1, stereotype threat was powerful enough on the MoCA to result in 50% of our sample performing under the cutoff score of 26/30 in the threat condition, versus 15% in the reduced-threat condition (p = 0.041, Fischer&#39;s exact test). The same pattern occurred on MMSE, with 30% of the participants scoring below 26 in the threat condition, against 5% in reduced-threat condition (p = 0.038, Fisher&#39;s exact test). More information about this study can be found in Mazerolle et al.25.
We also hypothesized that an educational intervention (debriefing) consisting in informing older adults about the stereotype threat phenomenon and alleviating the evaluative pressure of the test, would reduce the impact of negative aging stereotypes on their performance. As shown in Figure 4 (right panel), after the educational intervention (debriefing), older adults performed equally well on test 2 (be it MoCA or MMSE), regardless of the administration condition of their previous test 1, threat or reduced-threat. In other words, lower performance of participants at test 1 due to threat instructions was restored at test 2 thanks to the educational intervention. More details about these findings can be found in Mazerolle et al.25.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/59922/59922fig1.jpg" /> 
Figure 1: Visual depiction of the procedure to test age-based stereotype threat on a lab memory test. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/59922/59922fig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/59922/59922fig2.jpg" /> 
Figure 2: Visual depiction of the educational intervention to reduce age-based stereotype threat effects. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/59922/59922fig2large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/59922/59922fig3.jpg" /> 
Figure 3: Reading span score (adjusted for covariates) as a function of instructions condition and age group. Error bars indicate standard errors of the mean. This figure has been modified from Mazerolle et al.22. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/59922/59922fig3large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/59922/59922fig4.jpg" /> 
Figure 4: MMSE and MoCA scores as a function of threat conditions before debriefing and after debriefing participants about the impact of stereotype threat. Error bars represent standard errors of the mean. This figure has been modified from Mazerolle et al.25. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/59922/59922fig4large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>

Watch this Scientific Journal Video about Highlighting and Reducing the Impact of Negative Aging Stereotypes During Older Adults' Cognitive Testing at JoVE.com

Highlighting and Reducing the Impact of Negative Aging Stereotypes During Older Adults' Cognitive Testing

Here, we present a protocol designed to show how negative aging stereotypes can impair memory performance of older adults during cognitive testing and how to reduce this deleterious effect. This method can help older people to perform at an optimal level during testing in both lab studies and clinical settings.

As life expectancy increases, aging has become a major health challenge, resulting in a huge effort to better discriminate between normal and pathological ...

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Nanyang Technological University

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Social Psychology

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Foundations of Social Psychology

Stereotypes, Prejudice, and Discrimination

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7.2K Views.  Université Bourgogne Franche-Comté. Here, we present a protocol designed to show how negative aging stereotypes can impair memory performance of older adults during cognitive testing and how to reduce this deleterious effect. This method can help older people to perform at an optimal level during testing in both lab studies and clinical settings.

Video: Highlighting and Reducing the Impact of Negative Aging Stereotypes During Older Adults' Cognitive Testing

Assessment of Age-related Changes in Cognitive Functions Using EmoCogMeter, a Novel Tablet-computer Based Approach

The main goal of this study was to assess the usability of a tablet-computer-based application (EmoCogMeter) in investigating the effects of age on cognitive functions across the lifespan in a sample of 378 healthy subjects (age range 18-89 years). Consistent with previous findings we found an age-related cognitive decline across a wide range of neuropsychological domains (memory, attention, executive functions), thereby proving the usability of our tablet-based application. Regardless of prior computer experience, subjects of all age groups were able to perform the tasks without instruction or feedback from an experimenter. Increased motivation and compliance proved to be beneficial for task performance, thereby potentially increasing the validity of the results. Our promising findings underline the great clinical and practical potential of a tablet-based application for detection and monitoring of cognitive dysfunction.

We tested the usability of a tablet-computer-based application (EmoCogMeter) in investigating the effects of age on cognition. Results show an age-related cognitive decline, thereby proving the usability of our application. Findings underline the great clinical and practical potential of a tablet-based application for detection and monitoring of cognitive dysfunction.

The main goal of this study was to assess the usability of a tablet-computer-based application (EmoCogMeter) in investigating the effects of age on ...

A Cognitive Paradigm to Investigate Interference in Working Memory by Distractions and Interruptions

Goal-directed behavior is often impaired by interference from the external environment, either in the form of distraction by irrelevant information that one attempts to ignore, or by interrupting information that demands attention as part of another (secondary) task goal. Both forms of external interference have been shown to detrimentally impact the ability to maintain information in working memory (WM). Emerging evidence suggests that these different types of external interference exert different effects on behavior and may be mediated by distinct neural mechanisms. Better characterizing the distinct neuro-behavioral impact of irrelevant distractions versus attended interruptions is essential for advancing an understanding of top-down attention, resolution of external interference, and how these abilities become degraded in healthy aging and in neuropsychiatric conditions. This manuscript describes a novel cognitive paradigm developed the Gazzaley lab that has now been modified into several distinct versions used to elucidate behavioral and neural correlates of interference, by to-be-ignored distractors versus to-be-attended interruptors. Details are provided on variants of this paradigm for investigating interference in visual and auditory modalities, at multiple levels of stimulus complexity, and with experimental timing optimized for electroencephalography (EEG) or functional magnetic resonance imaging (fMRI) studies. In addition, data from younger and older adult participants obtained using this paradigm is reviewed and discussed in the context of its relationship with the broader literatures on external interference and age-related neuro-behavioral changes in resolving interference in working memory.

A novel cognitive paradigm is developed to elucidate behavioral and neural correlates of interference by to-be-ignored distractors versus interference by to-be-attended interruptors during a working memory task. In this manuscript, several variants of this paradigm are detailed, and data obtained with this paradigm in younger/older adult participants is reviewed.

Goal-directed behavior is often impaired by interference from the external environment, either in the form of distraction by irrelevant information that ...

The 4 Mountains Test: A Short Test of Spatial Memory with High Sensitivity for the Diagnosis of Pre-dementia Alzheimer's Disease

This protocol describes the administration of the 4 Mountains Test (4MT), a short test of spatial memory, in which memory for the topographical layout of four mountains within a computer-generated landscape is tested using a delayed match-to-sample paradigm. Allocentric spatial memory is assessed by altering the viewpoint, colors and textures between the initially presented and target images.
Allocentric spatial memory is a key function of the hippocampus, one of the earliest brain regions to be affected in Alzheimer&#39;s disease (AD) and impairment of hippocampal function predates the onset of dementia. It was hypothesized that performance on the 4MT would aid the diagnosis of predementia AD, which manifests clinically as Mild Cognitive Impairment (MCI).
The 4MT was applied to patients with MCI, stratified further based on cerebrospinal fluid (CSF) AD biomarker status (10 MCI biomarker positive, 9 MCI biomarker negative), and with mild AD dementia, as well as healthy controls. Comparator tests included tests of episodic memory and attention widely accepted as sensitive measures of early AD. Behavioral data were correlated with quantitative MRI measures of the hippocampus, precuneus and posterior cingulate gyrus.
4MT scores were significantly different between the two MCI groups (p = 0.001), with a test score of &#8804;8/15 associated with 100% sensitivity and 78% specificity for the classification of MCI with positive AD biomarkers, i.e., predementia AD. 4MT test scores correlated with hippocampal volume (r = 0.42) and cortical thickness of the precuneus (r = 0.55).
In conclusion, the 4MT is effective in identifying the early stages of AD. The short duration, easy application and scoring, and favorable psychometric properties of the 4MT fulfil the need for a simple but accurate diagnostic test for predementia AD.

This article describes the 4 Mountains Test (4MT), a hippocampus-dependent test of working allocentric spatial memory. The hippocampus is affected early in Alzheimer's disease (AD) and this article outlines the 4MT methodology and results of patient testing, which demonstrates the value of the 4MT in the diagnosis of pre-dementia AD.

This protocol describes the administration of the 4 Mountains Test (4MT), a short test of spatial memory, in which memory for the topographical layout of ...

Automated, Long-term Behavioral Assay for Cognitive Functions in Multiple Genetic Models of Alzheimer's Disease, Using IntelliCage

Multiple factors&#8212;such as aging and genes&#8212;are frequently associated with cognitive decline. Genetically modified mouse models of cognitive decline, such as Alzheimer&#39;s disease (AD), have become a promising tool to elucidate the underlying mechanisms and promote the therapeutic advances. An important step is the validation and characterization of expected behavioral abnormality in the models, in the case of AD, cognitive decline. The long-term behavioral investigations of laboratory animals to study the effect of aging demand substantial efforts from researchers. The IntelliCage system is a high-throughput and cost-effective test battery for mice that eliminates the need for daily human handling. Here, we describe how the system is utilized in the long-term phenotyping of a genetic Alzheimer&#39;s disease model, specifically focusing on the cognitive functions. The experiment employs repeated battery of tests that assess spatial learning and executive functions. This cost-effective age-dependent phenotyping allows us to identify the transient and/or permanent effects of genes on various cognitive aspects.

This paper describes a protocol for cognitive assessments for genetic models of the Alzheimer&#39;s disease using the IntelliCage system, which is a high throughput automated behavioral monitoring system with operant conditioning.

Multiple factors&#8212;such as aging and genes&#8212;are frequently associated with cognitive decline. Genetically modified mouse models of cognitive ...

A Machine Learning Approach to Design an Efficient Selective Screening of Mild Cognitive Impairment

Mild cognitive impairment (MCI) is the first sign of dementia among elderly populations and its early detection is crucial in our aging societies. Common MCI tests are time-consuming such that indiscriminate massive screening would not be cost-effective. Here, we describe a protocol that uses machine learning techniques to rapidly select candidates for further screening via a question-based MCI test. This minimizes the number of resources required for screening because only patients who are potentially MCI positive are tested further.
This methodology was applied in an initial MCI research study that formed the starting point for the design of a selective screening decision tree. The initial study collected many demographic and lifestyle variables as well as details about patient medications. The Short Portable Mental Status Questionnaire (SPMSQ) and the Mini-Mental State Examination (MMSE) were used to detect possible cases of MCI. Finally, we used this method to design an efficient process for classifying individuals at risk of MCI. This work also provides insights into lifestyle-related factors associated with MCI that could be leveraged in the prevention and early detection of MCI among elderly populations.

This methodology produces decision trees that target population groups more prone to suffering from mild cognitive impairment and are useful for cost-effective selective screening of the disease.

Mild cognitive impairment (MCI) is the first sign of dementia among elderly populations and its early detection is crucial in our aging societies. Common ...

An Experimental Paradigm for Measuring the Effects of Ageing on Sentence Processing

Previous studies have found that older adults have greater difficulties in processing syntactically complex sentences than younger adults. However, the exact regions where the difficulties arise have not been fully identified. In this study, a maze task was implemented to investigate how older adults and younger adults differentially processed two types of sentences with different levels of syntactic complexity, namely subject relative clauses and object relative clauses. Participants were asked to choose between two alternatives at each segment of the sentences. The task required participants to engage in a strictly incremental mode of processing. The reading times for each segment were recorded, allowing the quantification of the difficulty of sentence reading. The task allowed us to identify the exact locations of the processing difficulty and thus facilitate a more accurate assessment of the age-related decline in sentence processing. The results indicate that the effect of ageing was found mainly at the head nouns, but not at other regions of the sentences, a finding which suggests that the maze task is an effective method to identify the exact location of the ageing effect on sentence processing. The implications of this experimental paradigm for investigating the effect of ageing on sentence processing are discussed.

Here, we present a protocol to examine the age-related decline in sentence processing using a maze task that allowed us to localize the processing difficulty at each word of the sentences during reading.

Previous studies have found that older adults have greater difficulties in processing syntactically complex sentences than younger adults. However, the ...

Working Memory Training for Older Participants: A Control Group Training Regimen and Initial Intellectual Functioning Assessment

The efficacy of cognitive training interventions is recently highly debated. There is no consensus on what kind of training regimen is the most effective. Also, individual characteristics as predictors of training outcome are still being investigated. In this article, we show the attempt to address this issue by examining not only the impact of working memory (WM) training on cognitive effectiveness in older adults but also the influence of the initial WM capacity (WMC) on the training&#39;s outcome. We describe in detail how to perform 5 weeks of an adaptive dual n-back training with an active control group (memory quiz). We are focusing here on technical aspects of the training as well as on the initial assessment of participants&#39; WMC. The evaluation of pre and post training performance of other cognitive dimensions was based on the results of tests of memory updating, inhibition, attention shifting, short-term memory (STM) and reasoning. We have found that the initial level of WMC predicts the efficiency of the n-back training intervention. We have also noticed the post training improvement in almost all aspects of cognitive functioning we measured, but those effects were mostly intervention independent.

A cognitive training intervention in elderly population together with the assessment of the pre training cognitive abilities is presented. We show two versions of training - experimental and active control - and demonstrate their effects on the array of cognitive tests.

The efficacy of cognitive training interventions is recently highly debated. There is no consensus on what kind of training regimen is the most effective. ...

A Computerized Functional Skills Assessment and Training Program Targeting Technology Based Everyday Functional Skills

Today, many functional skills are technology-based, so development of a technology-based training program has broad importance. Here we present a computerized functional skills training program that was paired in half of the participants with a commercially available cognitive training (CCT) program.
Non-impaired older individuals (NC) aged 60+ (n=45) and similarly aged individuals with mild cognitive impairment (MCI; n=50) were randomized to receive 12 weeks of twice-weekly computerized functional skills training (CFST) or 12 weeks of twice-weekly sessions split between CCT and CFST. Skills trained were use of an ATM; internet banking; ticket kiosk; telephone and internet prescription refill; medication management; and internet shopping. As with previous functional capacity assessments, we focus on completion time for each simulation.
51 participants completed the training program, either by mastering all 6 tasks (34) or completing 12 weeks of training. 44 more participants completed 4 or more training sessions so they were also analyzed for improvement up to their last training session. Completion time for all 6 tests significantly improved from the baseline assessment to the final training session in both groups of participants (all p&#60;0.001 with an average improvement in task completion time of 45%). Further, there was no differential improvement in MCI and NC in the 6 tests from baseline to end of training (all t&#60;1.66, all p&#62;0.12). Finally, combined CCT plus CFST did not differ from CSFT alone on any of the percent-change score measures (all t&#60;1.64, all p&#62;0.11).
Both NC and MCI groups evidenced substantial improvements in performance. CCT supplementation led to similar functional gains with half as many training sessions. The NC participants proceeded through the training fairly rapidly even without CCT supplementation; MCI participants required more training but learned equivalently. These findings suggest that even in cases with memory impairments, functional skills can be efficiently learned with training.

This training protocol uses computerized training to teach technology-related everyday functional skills. These skills include financial skills, travel and transit, as well as medication management.

Today, many functional skills are technology-based, so development of a technology-based training program has broad importance. Here we present a ...

Medicine

Humans are very diverse and although we share many similarities, we also have many differences. The social groups we belong to help form our identities (Tajfel, 1974). These differences may be difficult for some people to reconcile, which may lead to prejudice toward people who are different. Prejudice is a negative attitude and feeling toward an individual based solely on one&rsquo;s membership in a particular social group (Allport, 1954; Brown, 2010). Prejudice is common against people who are members of an unfamiliar cultural group. Thus, certain types of education, contact, interactions, and building relationships with members of different cultural groups can reduce the tendency toward prejudice. In fact, simply imagining interacting with members of different cultural groups might affect prejudice. Indeed, when experimental participants were asked to imagine themselves positively interacting with someone from a different group, this led to an increased positive attitude toward the other group and an increase in positive traits associated with the other group. Furthermore, imagined social interaction can reduce anxiety associated with inter-group interactions (Crisp &amp; Turner, 2009). What are some examples of social groups that you belong to that contribute to your identity? Social groups can include gender, race, ethnicity, nationality, social class, religion, sexual orientation, profession, and many more. And, as is true for social roles, you can simultaneously be a member of more than one social group. An example of prejudice is having a negative attitude toward people who are not born in the United States. Although people holding this prejudiced attitude do not know all people who were not born in the United States, they dislike them due to their status as foreigners.

Can you think of a prejudiced attitude you have held toward a group of people? How did your prejudice develop? Prejudice often begins in the form of a stereotype&mdash;that is, a specific belief or assumption about individuals based solely on their membership in a group, regardless of their individual characteristics. Stereotypes become overgeneralized and applied to all members of a group. For example, someone holding prejudiced attitudes toward older adults, may believe that older adults are slow and incompetent (Cuddy, Norton, &amp; Fiske, 2005; Nelson, 2004). We cannot possibly know each individual person of advanced age to know that all older adults are slow and incompetent. Therefore, this negative belief is overgeneralized to all members of the group, even though many of the individual group members may in fact be spry and intelligent.

Another example of a well-known stereotype involves beliefs about racial differences among athletes. As Hodge, Burden, Robinson, and Bennett (2008) point out, Black male athletes are often believed to be more athletic, yet less intelligent, than their White male counterparts. These beliefs persist despite a number of high profile examples to the contrary. Sadly, such beliefs often influence how these athletes are treated by others and how they view themselves and their own capabilities. Whether or not you agree with a stereotype, stereotypes are generally well-known within in a given culture (Devine, 1989).

Sometimes people will act on their prejudiced attitudes toward a group of people, and this behavior is known as discrimination. Discrimination is negative action toward an individual as a result of one&rsquo;s membership in a particular group (Allport, 1954; Dovidio &amp; Gaertner, 2004). As a result of holding negative beliefs (stereotypes) and negative attitudes (prejudice) about a particular group, people often treat the target of prejudice poorly, such as excluding older adults from their circle of friends. An example of a psychologist experiencing gender discrimination is found in the life and studies of Mary Whiton Calkins. Calkins was given special permission to attend graduate seminars at Harvard (at that time in the late 1880s, Harvard did not accept women) and at one point was the sole student of the famous psychologist William James. She passed all the requirements needed for a PhD and was described by psychologist Hugo M&uuml;nsterberg as &ldquo;one of the strongest professors of psychology in this country.&rdquo; However, Harvard refused to grant Calkins a PhD because she was a woman (Harvard University, 2019).&nbsp;Have you ever been the target of discrimination? If so, how did this negative treatment make you feel?

The discussion of stereotypes, prejudice, and discrimination most often uses negative and problematic thoughts, feelings, and behaviors.&nbsp;However, people can hold positive thoughts, feelings, and behaviors toward individuals based on group membership; for example, they would show preferential treatment for people who are like themselves&mdash;that is, who share the same gender, race, or favorite sports team.

Types of Prejudice and Discrimination 

When we meet strangers we automatically process three pieces of information about them: their race, gender, and age (Ito &amp; Urland, 2003). Why are these aspects of an unfamiliar person so important? Why don&rsquo;t we instead notice whether their eyes are friendly, whether they are smiling, their height, the type of clothes they are wearing? Although these secondary characteristics are important in forming a first impression of a stranger, the social categories of race, gender, and age provide a wealth of information about an individual. This information, however, often is based on stereotypes. We may have different expectations of strangers depending on their race, gender, and age. What stereotypes and prejudices do you hold about people who are from a race, gender, and age group different from your own? Find out your implicit associations by taking an Implicit Association Test <a href="https://implicit.harvard.edu/implicit/" target="_blank">here</a>!

Racism 

Racism is prejudice and discrimination against an individual based solely on one&rsquo;s membership in a specific racial group (such as toward African Americans, Asian Americans, Latinos, Native Americans, European Americans). What are some stereotypes of various racial or ethnic groups? Research suggests cultural stereotypes for Asian Americans include cold, sly, and intelligent; for Latinos, cold and unintelligent; for European Americans, cold and intelligent; and for African Americans, aggressive, athletic, and more likely to be law breakers (Devine &amp; Elliot, 1995; Fiske, Cuddy, Glick, &amp; Xu, 2002; Sommers &amp; Ellsworth, 2000; Dixon &amp; Linz, 2000).

Racism exists for many racial and ethnic groups. For example, Blacks are significantly more likely to have their vehicles searched during traffic stops than Whites, particularly when Blacks are driving in predominately White neighborhoods, (a phenomenon often termed &ldquo;DWB,&rdquo; or &ldquo;driving while Black.&rdquo;; Rojek, Rosenfeld, &amp; Decker, 2012).

Mexican Americans and other Latino groups also are targets of racism from the police and other members of the community. For example, when purchasing items with a personal check, Latino shoppers are more likely than White shoppers to be asked to show formal identification (Dovidio et al., 2010).

In one case of alleged harassment by the police, several East Haven, Connecticut, police officers were arrested on federal charges due to reportedly continued harassment and brutalization of Latinos. When the accusations came out, the mayor of East Haven was asked, &ldquo;What are you doing for the Latino community today?&rdquo; The Mayor responded, &ldquo;I might have tacos when I go home, I&rsquo;m not quite sure yet&rdquo; (&ldquo;East Haven Mayor,&rdquo; 2012). This statement undermines the important issue of racial profiling and police harassment of Latinos, while belittling Latino culture by emphasizing an interest in a food product stereotypically associated with Latinos.

Racism is prevalent toward many other groups in the United States including Native Americans, Arab Americans, Jewish Americans, and Asian Americans. Have you witnessed racism toward any of these racial or ethnic groups? Are you aware of racism in your community?

One reason modern forms of racism, and prejudice in general, are hard to detect is related to the dual attitudes model (Wilson, Lindsey, &amp; Schooler, 2000). Humans have two forms of attitudes: explicit attitudes, which are conscious and controllable, and implicit attitudes, which are unconscious and uncontrollable (Devine, 1989; Olson &amp; Fazio, 2003). Because holding egalitarian views is socially desirable (Plant &amp; Devine, 1998), most people do not show extreme racial bias or other prejudices on measures of their explicit attitudes. However, measures of implicit attitudes often show evidence of mild to strong racial bias or other prejudices (Greenwald, McGee, &amp; Schwartz, 1998; Olson &amp; Fazio, 2003).

Sexism

Sexism is prejudice and discrimination toward individuals based on their sex. Typically, sexism takes the form of men holding biases against women, but either sex can show sexism toward their own or their opposite sex. Like racism, sexism may be subtle and difficult to detect. Common forms of sexism in modern society include gender role expectations, such as expecting women to be the caretakers of the household. Sexism also includes people&rsquo;s expectations for how members of a gender group should behave. For example, women are expected to be friendly, passive, and nurturing, and when women behave in an unfriendly, assertive, or neglectful manner they often are disliked for violating their gender role (Rudman, 1998). Research by Laurie Rudman (1998) finds that when female job applicants self-promote, they are likely to be viewed as competent, but they may be disliked and are less likely to be hired because they violated gender expectations for modesty. Sexism can exist on a societal level such as in hiring, employment opportunities, and education. Women are less likely to be hired or promoted in male-dominated professions such as engineering, aviation, and construction&nbsp;(Blau, Ferber, &amp; Winkler, 2010; Ceci &amp; Williams, 2011). Have you ever experienced or witnessed sexism? Think about your family members&rsquo; jobs or careers. Why do you think there are differences in the jobs women and men have, such as more women nurses but more male surgeons (Betz, 2008)?

Ageism

People often form judgments and hold expectations about people based on their age. These judgments and expectations can lead to ageism, or prejudice and discrimination toward individuals based solely on their age. Typically, ageism occurs against older adults, but ageism also can occur toward younger adults. Think of expectations you hold for older adults. How could someone&rsquo;s expectations influence the feelings they hold toward individuals from older age groups? Ageism is widespread in U.S. culture (Nosek, 2005), and a common ageist attitude toward older adults is that they are incompetent, physically weak, and slow (Greenberg, Schimel, &amp; Martens, 2002) and some people consider older adults less attractive. However, some cultures,&nbsp;including some Asian, Latino, and African American cultures, both outside and within the United States afford older adults respect and honor.

Ageism can also occur toward younger adults. What expectations do you hold toward younger people? Does society expect younger adults to be immature and irresponsible? How might these two forms of ageism affect a younger and older adult who are applying for a sales clerk position?

Homophobia 

Another form of prejudice is homophobia: prejudice and discrimination of individuals based solely on their sexual orientation. Like ageism, homophobia is a widespread prejudice in U.S. society that is tolerated by many people (Herek &amp; McLemore, 2013; Nosek, 2005). Negative feelings often result in discrimination, such as the exclusion of lesbian, gay, bisexual, and transgender (LGBT) people from social groups and the avoidance of LGBT neighbors and co-workers. This discrimination also extends to employers deliberately declining to hire qualified LGBT job applicants. Have you experienced or witnessed homophobia? If so, what stereotypes, prejudiced attitudes, and discrimination were evident?

Why Do Prejudice and Discrimination Exist? 

Prejudice and discrimination persist in society due to social learning and conformity to social norms. Children learn prejudiced attitudes and beliefs from society: their parents, teachers, friends, the media, and other sources of socialization, such as Facebook (O&rsquo;Keeffe &amp; Clarke-Pearson, 2011). If certain types of prejudice and discrimination are acceptable in a society, there may be normative pressures to conform and share those prejudiced beliefs, attitudes, and behaviors. For example, public and private schools are still somewhat segregated by social class. Historically, only children from wealthy families could afford to attend private schools, whereas children from middle- and low-income families typically attended public schools. If a child from a low-income family received a merit scholarship to attend a private school, how might the child be treated by classmates? Can you recall a time when you held prejudiced attitudes or beliefs or acted in a discriminatory manner because your group of friends expected you to?

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This text is adapted from <a href="https://cnx.org/contents/Sr8Ev5Og@10.24:nhpI4cUs@13/12-5-Prejudice-and-Discrimination" target="_blank">OpenStax, Psychology. OpenStax CNX.</a>

Stereotypes, Prejudice, Discrimination, Implicit Association Test

Humans are very diverse and although we share many similarities, we also have many differences. The social groups we belong to help form our identities ...

KEY TERMS AND CONCEPTS

Cognitive Development During Adulthood

Cognitive development continues throughout adulthood, undergoing significant shifts across early, middle, and late stages. Individual transition occurs from adolescent idealism to pragmatic and adaptable thinking in early adulthood. During this period, individuals learn to integrate personal beliefs with the recognition that other perspectives are equally valid. Exposure to the complexities of modern society, diverse experiences, and higher education contribute to this adaptive thought process, promoting reflective judgment, or the ability to evaluate evidence and accept multiple viewpoints.
During middle adulthood, individuals generally peak in cognitive capabilities, particularly vocabulary, verbal memory, and inductive reasoning. Research indicates that intellectual abilities tend to stabilize during this stage, with only minor declines in some areas, like processing speed. Fluid intelligence &#8212; skills that involve rapid problem-solving, abstract thinking, and memory &#8212; may show slight reductions; however, crystallized intelligence &#8212; knowledge and skills accumulated over time &#8212; often remains robust or even improves. These changes reflect the balance between experience-based knowledge and natural cognitive ability, allowing individuals in middle adulthood to apply accumulated expertise in problem-solving and decision-making.
In late adulthood, the aging process tends to influence cognitive functioning more visibly, particularly in fluid intelligence. Declines in processing speed and memory are common, though crystallized intelligence typically remains stable. Retaining this type of intelligence supports the continued application of lifelong knowledge and problem-solving strategies. Neurological changes, such as reductions in brain volume and connectivity, may also contribute to slower responses. Engaging in mentally stimulating activities, such as reading, puzzles, or learning new skills, can help mitigate these declines. Physical activities and social interactions also play a vital role in maintaining cognitive function, as these activities promote neuroplasticity and overall brain health.
Cognitive rehabilitation therapies like virtual reality simulations offer promising results for older adults experiencing dementia or other cognitive impairments. By recreating daily activities, these interventions enhance memory, maintain language skills, and foster a sense of independence. Virtual environments can also provide a safe and engaging setting for practicing cognitive skills, supporting mental health and quality of life in later years.

Cognitive development in adulthood progresses through early, middle, and late adulthood, each characterized by distinct cognitive changes.
In early ...