The Incremental Validity of Primacy as a Predictor of Everyday Functioning

• Published in: Neuropsychology 2022-01, Vol.36 (1), p.23-34
• Main Authors: Weitzner, Daniel S., Divers, Ross, Calamia, Matthew
• Format: Article
• Language: English
• Subjects: Ability Level; Aged; Alzheimer Disease; Alzheimer's Disease; Brain Training; Cognitive Dysfunction - diagnosis; Demographic Characteristics; Female; Free Recall; Human; Humans; Incremental Validity; Male; Memory; Memory, Short-Term; Mental Recall; Mild Cognitive Impairment; Neuropsychological Tests; Primacy Effect; Serial Position Effect
• ISSN: 0894-4105; 1931-1559
• DOI: 10.1037/neu0000778

Objective: Verbal memory is a predictor of later functional deficits. However, it is unclear if a specific aspect of immediate free-recall is driving this relationship. Serial position effects (i.e., relationship between a word's placement on a word-list and its likelihood of being recalled) have been shown to predict conversion from mild cognitive impairment (MCI) to Alzheimer's disease (AD). The goal of this study was to determine if serial position effects predict functioning 10-year postbaseline when controlling for demographic variables and total cognitive scores. Method: Data from 2,802 participants in the Advanced Cognitive Training for Independent and Vital Elderly trial were examined to predict subjective (i.e., Minimum Data Set Home Care questionnaire subscales) and performance-based (i.e., Observed Tasks of Daily Living and Everyday Problems Test) functioning 10-year postbaseline. Multilevel modeling was used to examine the association between functioning 10-year postbaseline and scores at baseline. Results: Primacy performance demonstrated the most consistent associations with overall subjective and performance-based functioning measures 10-year postbaseline. Specifically, higher primacy performance was associated with less decline in subjective and performance-based functioning over time, particularly when primacy was analyzed from the Rey Auditory Verbal Learning Test. Fewer associations were found between middle and recency scores with subjective and performance-based functioning measures. Conclusion: The present study suggests that serial position effects predict future subjective and performance-based functional changes, beyond demographic information and global cognition. The study adds to a growing literature about the relative importance of primacy, especially in the prediction of functional changes. Key Points Question : Are we better able to predict those who will have difficulty with future everyday functioning by examining primacy performance (i.e., recalling words from the beginning portion of a word list) in addition to global cognition? Findings : Primacy performance predicted subjective and performance-based functioning 10 years after baseline testing above and beyond demographics and global cognition. Importance : These findings extend previous work showing that primacy performance is associated with cognitive change and the onset of dementia by demonstrating that higher primacy performance at baseline is associated with less d