Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 64 Page 65 Page 66 Page 67 Page 68 Page 69 Page 70 Page 71 Page 72 Page 73 Page 74 Page 75 Page 76 Page 77 Page 78 Page 79 Page 80 Page 81 Page 82 Page 83 Page 84 Page 85 Page 86 Page 87 Page 88 Page 89 Page 90 Page 91 Page 92 Page 93 Page 94 Page 95 Page 96 Page 97 Page 98 Page 99 Page 100 Page 101 Page 102 Page 103 Page 104 Page 105 Page 106 Page 107 Page 108CHAPTER 2 | THE AGING BR AIN impairment (MCI) are evolving as we learn more about dementia. Estimating the prevalence of dementia and related disorders depends not only on how diag- nostic criteria are defined but also on how they are translated into questions and assessments for research purposes. While several measures of cognitive functioning are widely used, differ- ent epidemiologic studies have used different measures and different cut-off scores to indicate disease threshold along the continuum. Scientists must weigh the tradeoffs involved in setting a particular threshold for diagnosis. Those set very high ensure that only true cases of dementia are counted yet risk increasing false negatives, thus underestimating the prevalence of disease. On the other hand, by setting a lower threshold sci- entists risk including false positives and inflating disease estimates. Against this backdrop, HRS researchers have sought to create public data that could be useful in addressing these and other important issues. When the HRS began in 1992, measures of cognitive functioning were uncommon in large epidemiologic studies. Notwithstanding the fact that the HRS was launched with a focus on health and aging in the transition from work to retire- ment, HRS embraced a broad definition of health to include aspects of mental health and cognitive functioning. Measures of cognitive functioning included in most waves of the HRS since 1992 include: 10-word immediate and delayed recall to assess memory (see example at right); a serial sev- ens subtraction test of working memory; counting backwards to assess attention and processing speed; object naming test to assess language; and recall of the date, president and vice president to assess orientation. Information from these survey measures is often summarized as a composite score ranging from zero to 35 with a higher score indicating better cognitive functioning. Early research sought to define ranges using this measure that would correspond to clinical states. For example, Langa et al. (2008) used a score of 11 or higher to define normal cognitive functioning, eight to 10 to indicate MCI and seven or lower as moderate to severe impairment. This composite measure has been widely used to study trajectories of cognitive functioning. However, without a clinical diagnosis —  a gold standard — to compare to, there was no way to be sure that severe dementia correspond- ed to a typical clinical diagnosis of dementia that a patient could receive during a diagnostic work-up in the health care system. Yet conduct- ing a clinical interview with the entire HRS sample was unrealistic and probably undesirable for younger participants. The solution to this problem was to select a subsample of the HRS population aged 71 and older, at higher risk for cognitive impairment, and administer a full neuropsychological assessment. ADAMS collect- ed extensive information designed to provide a diagnostic determination of dementia, cognitive Testing Cognitive Functioning HRS embraced a broad definition of health to include aspects of mental health and cognitive functioning. Immediate Word Recall I’ll read a set of 10 words and ask you to recall as many as you can. We have purposely made the list long so that it will be difficult for anyone to recall all the words—most people recall just a few. Please listen carefully as I read the set of words because I cannot repeat them. When I finish, I will ask you to recall aloud as many of the words as you can, in any order. 1. Hotel 2. River 3. Tree 4. Skin 5. Gold 6. Market 7. Paper 8. Child 9. King 10. Book