评估有感官障碍的老年人认知测试中的偏差：巴尔的摩纵向衰老研究（BLSA）和社区动脉粥样硬化风险神经认知研究（ARIC-NCS）中的项目功能差异分析。
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).
作者信息
Nichols E, Deal J A, Swenor B K, Abraham A G, Armstrong N M, Carlson M C, Griswold M, Lin F R, Mosley T H, Ramulu P Y, Reed N S, Resnick S M, Sharrett A R, Gross A L
机构信息
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.
出版信息
J Int Neuropsychol Soc. 2022 Feb;28(2):154-165. doi: 10.1017/S1355617721000400. Epub 2021 Apr 26.
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.
目的
视力和听力障碍影响着55%的60岁及以上人群，并且与较低的认知测试表现相关；然而，这些测试依赖视力、听力或两者。我们假设，在控制潜在认知能力的情况下，依赖视力或听力的测试分数在有视力或听力障碍的人群中分别存在差异。
方法
利用来自巴尔的摩纵向衰老研究（BLSA）和社区动脉粥样硬化风险神经认知研究（ARIC-NCS）的横断面数据，我们使用项目反应理论来检验视力障碍（较好眼的视力低于20/40）和听力障碍（较好耳0.5 - 4千赫纯音平均听阈>25分贝）导致的项目功能差异（DIF）。
结果
我们发现，对于那些测试实施不依赖视力的测试，存在视力障碍导致的DIF[例如，ARIC-NCS中的延迟单词回忆：受损组与未受损组之间的对数差异为0.50（p = 0.04），在BLSA中为0.62对数（p = 0.02）]；对于那些测试实施不依赖听力的测试，存在听力障碍导致的DIF[BLSA中的数字符号替换测试：1.25对数（p = 0.001），ARIC-NCS中的 incidental learning测试：0.35对数（p = 0.001）]。然而，没有个体的未调整测量值与DIF调整测量值之间的差异大于测量标准误。
结论
认知测试中感觉障碍导致的DIF与测试实施特征无关，这可能表明感觉障碍人群中较高的认知负荷在测试表现中所起的作用比之前认为的更大。虽然这些结果出乎意料，但这些样本都不具有全国代表性，且每个样本都有独特的选择因素；因此，重复验证至关重要。
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