By the year 2050, as many as 16 million persons in the U.S. will express symptoms of Alzheimer?s disease (AD). The 2015 White House Conference on Aging emphasized the need to improve the detection of diminished cognitive capacity, maximize independent living, and increase protection of older adults from financial exploitation and other abuses. Judgment is an important aspect of executive functioning and is critical to many aspects of real-world functioning among older adults (e.g., financial and medical decision-making ability). Current methods of assessing judgment, however, lack robust psychometric properties, lack ecological validity, and are too costly to be routinely administered. To address these concerns the Test of Practical Judgment (TOP-J) was first published in 2007. Initially validated on a small, highly-educated Caucasian sample, the TOP-J is an open-ended objective test that has sound psychometric properties. Further, patient scores on the TOP-J were shown to correlate with cortical density of two brain regions (i.e., left inferior and superior frontal gyri) known to be associated with judgment. The TOP-J is increasingly used by neuropsychologists in the United States and internationally. Currently, further refinement of the initial TOP-J items is being conducted, including development of alternate and informant forms. To date, there is no standardized measure of judgment available to aging researchers and clinicians with alternate and informant forms. In this study, we will: (1) update normative data for the original TOP-J using a diverse sample of older adults with normal cognition, subjective cognitive decline, mild cognitive impairment (early, amnestic, non- amnestic), and Alzheimer?s disease, (2) develop and validate an alternate form of the TOP-J, and (3) develop and validate an informant version of the TOP-J. To achieve aim 1, retrospective data will be pooled from research collected at the Albert Einstein College of Medicine (Einstein), Geisel School of Medicine at Dartmouth University, and Indiana University School of Medicine. To achieve aim 2, participants in the longitudinal aging study at Einstein will be administered the original and newly developed TOP-J items in a randomized order when they present for their annual study visit. To achieve aim 3, participants and their informants will be assessed at Nassau University Medical Center?s Department of Physical Medicine & Rehabilitation and University of Nebraska Medical Center Department of Neurological Sciences. The achievement of our stated aims will result in improved ability to detect and characterize emerging impairments in judgment in patients whose diagnoses range from subtle cognitive impairment through dementia, to more easily monitor changes in judgment ability, to assess risk, and to devise interventions for safe and independent living in older adulthood.
As the population of older adults in the United States with Alzheimer?s disease is expected to increase to over 16 million by 2050, this disease will be a leading cause of degradation in the ability of patients to live safely and independently. Assessment of a broad array of cognitive domains, including judgment, may identify the presence of unsafe living situations and safeguard patients from abuse or exploitation, while also informing plans for retirement and enhancing long-term care. The proposed study will allow for the expansion of an increasingly used, standardized measure of judgment that will be more broadly applicable to patients of varying educational level and socioeconomic status.
