Do people with Alzheimer's disease improve with repeated testing? Unpacking the role of content and context in retest effects
Do people with Alzheimer's disease improve with repeated testing? Unpacking the role of content and context in retest effects
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DOI：
10.1093/ageing/afy136
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发表时间：
2018-11-01
期刊：
影响因子：
6.7
通讯作者：
Jones, Richard N.
中科院分区：
文献类型：
--
作者：
Gross, Alden L.;Chu, Nadia;Jones, Richard N.
目的：重测效果可能归因于神经心理学测试中的“重复内容”，例如单词列表学习测试中的单词，或涉及程序记忆和重复执行后测试焦虑减少的“测试上下文”。阿尔茨海默病 (AD) 会严重损害情景记忆，因此对痴呆症患者进行纵向认知测试可能会揭示内容与情境对神经心理测试中重新测试效果的相对贡献。方法：我们使用了关键路径研究所安慰剂组数据存储库中的数据，这些数据来自参与制药公司进行的痴呆症随机对照试验 (RCT)（N = 990 人，4,170 次研究访问，长达 2.4 年的随访）。为了估计简易精神状态检查 (MMSE) 的重测效果，我们使用了对人和时间具有随机效应的线性回归，并调整了年龄、性别和种族，以及纵向分位数回归。结果：平均 MMSE 得分（16.6 分，SD = 5.5，范围 1, 27）每年下降 2.0 分（95% 置信区间，CI：-2.3，-1.8）。第二次评估时（平均基线后 4 个月），平均重测效果为 0.6 分（95% CI：0.4，0.8）。在基线以及 MMSE 分布的第 30、50 和 70 个百分位数上，有或没有任何回忆的参与者的重测效果相似，表明从轻度到重度痴呆病例的重测效果相似。结论：尽管情景记忆减少，重测效果在痴呆症患者中仍然很明显，这表明测试环境在随机对照试验和队列研究中发挥着重要作用。
Objective: retest effects may be attributed to 'repeated content' in neuropsychological tests such as words in word list-learning tests, or the 'testing context' which involves procedural memory and reduced test anxiety following repeated administration. Alzheimer's Disease (AD) severely impairs episodic memory, so longitudinal cognitive testing among people with dementia may reveal the relative contributions of content versus context to retest effects in neuropsychological testing.Method: we used data from the Critical Path Institute's repository of placebo arm data from randomized controlled trials (RCTs) of dementia conducted by participating pharmaceutical companies (N = 990 people, 4,170 study visits, up to 2.4 years of follow-up). To estimate retest effects on the Mini-Mental State Examination (MMSE), we used linear regressions with random effects for people and time, adjusting for age, sex and race, and longitudinal quantile regressions.Results: average MMSE score (16.6 points, SD = 5.5, range 1, 27) declined by 2.0 points/year (95% confidence interval, CI: -2.3, -1.8). Mean retest effect was 0.6 points (95% CI: 0.4, 0.8) at second assessment (average 4 months after baseline). Retest effects were similar among participants with and without any recall on the short-delay word recall subscale score at baseline, and at the 30th, 50th and 70th percentiles of the MMSE distribution, suggesting similar retest effects across the spectrum from mild to severe cases of dementia.Conclusions: retest effects are apparent in people with dementia despite reduced episodic memory, suggesting a prominent role of the testing context in RCTs and cohort studies.