Brain Imaging and Behavior

, Volume 6, Issue 4, pp 517–527

A composite score for executive functioning, validated in Alzheimer’s Disease Neuroimaging Initiative (ADNI) participants with baseline mild cognitive impairment

  • Laura E. Gibbons
  • Adam C. Carle
  • R. Scott Mackin
  • Danielle Harvey
  • Shubhabrata Mukherjee
  • Philip Insel
  • S. McKay Curtis
  • Dan Mungas
  • Paul K. Crane
  • for the Alzheimer’s Disease Neuroimaging Initiative
ADNI: Friday Harbor 2011 Workshop SPECIAL ISSUE


The Alzheimer’s Disease Neuroimaging Initiative (ADNI) measures abilities broadly related to executive function (EF), including WAIS-R Digit Symbol Substitution, Digit Span Backwards, Trails A and B, Category Fluency, and Clock Drawing. This study investigates whether a composite executive function measure based on these multiple indicators has better psychometric characteristics than the widely used individual components. We applied item response theory methods to 800 ADNI participants to derive an EF composite score (ADNI-EF) from the above measures. We then compared ADNI-EF with component measures in 390 longitudinally-followed participants with mild cognitive impairment (MCI) with respect to: (1) Ability to detect change over time; (2) Ability to predict conversion to dementia; (3) Strength of cross-sectional association with MRI-derived measures of structures involved in frontal systems, and (4) Strength of baseline association with cerebrospinal fluid (CSF) levels of amyloid β1-42, total tau, and phosphorylated tau181P. ADNI-EF showed the greatest change over time, followed closely by Category Fluency. ADNI-EF needed a 40 % smaller sample size to detect change. ADNI-EF was the strongest predictor of AD conversion. ADNI-EF was the only measure significantly associated with all the MRI regions, though other measures were more strongly associated in a few of the regions. ADNI-EF was associated with all the CSF measures. ADNI-EF appears to be a useful composite measure of EF in MCI, as good as or better than any of its composite parts. This study demonstrates an approach to developing a psychometrically sophisticated composite score from commonly-used tests.


Executive function Mild cognitive impairment Item response theory Composite scores 

Supplementary material

11682_2012_9176_MOESM1_ESM.pdf (29 kb)
Online Appendix 1(PDF 28 kb)
11682_2012_9176_MOESM2_ESM.pdf (23 kb)
Online Appendix 2(PDF 22 kb)
11682_2012_9176_MOESM3_ESM.pdf (82 kb)
Online Appendix 3(PDF 82 kb)


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Laura E. Gibbons
    • 1
  • Adam C. Carle
    • 2
  • R. Scott Mackin
    • 3
  • Danielle Harvey
    • 4
  • Shubhabrata Mukherjee
    • 1
  • Philip Insel
    • 3
  • S. McKay Curtis
    • 1
  • Dan Mungas
    • 5
  • Paul K. Crane
    • 1
  • for the Alzheimer’s Disease Neuroimaging Initiative
  1. 1.Harborview Medical CenterUniversity of WashingtonSeattleUSA
  2. 2.Cincinnati Children’s Hospital Medical CenterUniversity of Cincinnati School of Medicine and University of Cincinnati College of Arts and SciencesCincinnatiUSA
  3. 3.Center for Imaging of Neurodegenerative Diseases (CIND)San Francisco VA Medical CenterSan FranciscoUSA
  4. 4.Division of Biostatistics, Department of Public Health SciencesUniversity of CaliforniaDavisUSA
  5. 5.Department of NeurologyUC Davis Medical CenterSacramentoUSA

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