E Nichols1, J A Deal1,2, B K Swenor1,3, A G Abraham1,4, N M Armstrong5, M C Carlson6, M Griswold7, F R Lin1,2,6, T H Mosley7, P Y Ramulu3, N S Reed1,2, S M Resnick8, A R Sharrett1, A L Gross1. 1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, W6508, Baltimore, MD, 21205, USA. 2. Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD21205, USA. 3. Wilmer Eye Institute, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD21287, USA. 4. Department of Epidemiology, School of Public Health, University of Colorado Anschutz Medical Campus, 1635 Aurora Ct, Aurora, CO 80045, USA. 5. Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, 700 Butler Dr, Box G-BH, Providence, RI02906, USA. 6. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway St, 8th Floor, Baltimore, MD21205, USA. 7. Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, 2500 North State St, Jackson, MS39216, USA. 8. Laboratory of Behavioral Neuroscience, National Institute on Aging, 251 Bayview Blvd, Suite 101, Baltimore, MD21224, USA.
Abstract
OBJECTIVES: Vision and hearing impairments affect 55% of people aged 60+ years and are associated with lower cognitive test performance; however, tests rely on vision, hearing, or both. We hypothesized that scores on tests that depend on vision or hearing are different among those with vision or hearing impairments, respectively, controlling for underlying cognition. METHODS: Leveraging cross-sectional data from the Baltimore Longitudinal Study of Aging (BLSA) and the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS), we used item response theory to test for differential item functioning (DIF) by vision impairment (better eye presenting visual acuity worse than 20/40) and hearing impairment (better ear .5-4 kHz pure-tone average > 25 decibels). RESULTS: We identified DIF by vision impairment for tests whose administrations do not rely on vision [e.g., Delayed Word Recall both in ARIC-NCS: .50 logit difference between impaired and unimpaired (p = .04) and in BLSA: .62 logits (p = .02)] and DIF by hearing impairment for tests whose administrations do not rely on hearing [Digit Symbol Substitution test in BLSA: 1.25 logits (p = .001) and Incidental Learning test in ARIC-NCS: .35 logits (p = .001)]. However, no individuals had differences between unadjusted and DIF-adjusted measures of greater than the standard error of measurement. CONCLUSIONS: DIF by sensory impairment in cognitive tests was independent of administration characteristics, which could indicate that elevated cognitive load among persons with sensory impairment plays a larger role in test performance than previously acknowledged. While these results were unexpected, neither of these samples are nationally representative and each has unique selection factors; thus, replication is critical.
OBJECTIVES: Vision and hearing impairments affect 55% of people aged 60+ years and are associated with lower cognitive test performance; however, tests rely on vision, hearing, or both. We hypothesized that scores on tests that depend on vision or hearing are different among those with vision or hearing impairments, respectively, controlling for underlying cognition. METHODS: Leveraging cross-sectional data from the Baltimore Longitudinal Study of Aging (BLSA) and the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS), we used item response theory to test for differential item functioning (DIF) by vision impairment (better eye presenting visual acuity worse than 20/40) and hearing impairment (better ear .5-4 kHz pure-tone average > 25 decibels). RESULTS: We identified DIF by vision impairment for tests whose administrations do not rely on vision [e.g., Delayed Word Recall both in ARIC-NCS: .50 logit difference between impaired and unimpaired (p = .04) and in BLSA: .62 logits (p = .02)] and DIF by hearing impairment for tests whose administrations do not rely on hearing [Digit Symbol Substitution test in BLSA: 1.25 logits (p = .001) and Incidental Learning test in ARIC-NCS: .35 logits (p = .001)]. However, no individuals had differences between unadjusted and DIF-adjusted measures of greater than the standard error of measurement. CONCLUSIONS: DIF by sensory impairment in cognitive tests was independent of administration characteristics, which could indicate that elevated cognitive load among persons with sensory impairment plays a larger role in test performance than previously acknowledged. While these results were unexpected, neither of these samples are nationally representative and each has unique selection factors; thus, replication is critical.
Authors: Bonnielin K Swenor; Pradeep Y Ramulu; Jeffery R Willis; David Friedman; Frank R Lin Journal: JAMA Intern Med Date: 2013-02-25 Impact factor: 21.873
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