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Assessing Bias in Cognitive Testing for Older Adults with Sensory Impairment: An Analysis of Differential Item Functioning in the Baltimore Longitudinal Study on Aging (BLSA) and the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS)

Published online by Cambridge University Press:  26 April 2021

E. Nichols Open the ORCID record for E. Nichols [Opens in a new window] ,
J.A. Deal ,
B.K. Swenor ,
A.G. Abraham ,
N.M. Armstrong Open the ORCID record for N.M. Armstrong [Opens in a new window] ,
M.C. Carlson ,
M. Griswold ,
F.R. Lin ,
T.H. Mosley  and
P.Y. Ramulu
...Show all authors
E. Nichols*
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, W6508, Baltimore, MD, 21205, USA
J.A. Deal
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, W6508, Baltimore, MD, 21205, USA Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD21205, USA
B.K. Swenor
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, W6508, Baltimore, MD, 21205, USA Wilmer Eye Institute, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD21287, USA
A.G. Abraham
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, W6508, Baltimore, MD, 21205, USA Department of Epidemiology, School of Public Health, University of Colorado Anschutz Medical Campus, 1635 Aurora Ct, Aurora, CO 80045, USA
N.M. Armstrong
Affiliation:
Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, 700 Butler Dr, Box G-BH, Providence, RI02906, USA
M.C. Carlson
Affiliation:
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway St, 8th Floor, Baltimore, MD21205, USA
M. Griswold
Affiliation:
Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, 2500 North State St, Jackson, MS39216, USA
F.R. Lin
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, W6508, Baltimore, MD, 21205, USA Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD21205, USA Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway St, 8th Floor, Baltimore, MD21205, USA
T.H. Mosley
Affiliation:
Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, 2500 North State St, Jackson, MS39216, USA
P.Y. Ramulu
Affiliation:
Wilmer Eye Institute, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD21287, USA
N.S. Reed
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, W6508, Baltimore, MD, 21205, USA Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD21205, USA
S.M. Resnick
Affiliation:
Laboratory of Behavioral Neuroscience, National Institute on Aging, 251 Bayview Blvd, Suite 101, Baltimore, MD21224, USA
A.R. Sharrett
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, W6508, Baltimore, MD, 21205, USA
A.L. Gross
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, W6508, Baltimore, MD, 21205, USA
*
Correspondence and reprint requests to: Emma Nichols, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument St Suite 2-700, Baltimore, MD, USA. E-mail: [email protected]
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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.

Keywords

CognitionNeuropsychological testsEpidemiologyBiasHearing lossLow vision
Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 28 , Issue 2 , February 2022 , pp. 154 - 165
Copyright
Copyright © INS. Published by Cambridge University Press, 2021

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