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Purpose/background:
Development of the Digit Symbol Substitution Test (DSST) was initiated over a century ago as an experimental tool to understand human associative learning. Its clinical utility, owing to its brevity and high discriminant validity, was first recognized in the 1940s, and now the DSST is among the most commonly used tests in clini...
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Context 1
... Digit Symbol Substitution Test (DSST) was initially de- veloped as an experimental tool over a century ago by researchers seeking to understand human associative learning. 1,2 The DSST is a paper-and-pencil cognitive test presented on a single sheet of paper that requires a subject to match symbols to numbers accord- ing to a key located on the top of the page. The subject copies the symbol into spaces below a row of numbers. The number of correct symbols within the allowed time, usually 90 to 120 seconds, consti- tutes the score (Fig. 1). 3 The DSST is perhaps the most commonly used test in all of neuropsychology, owing to several inherent properties: brevity, reliability, and the minimal impact of language, culture, and education on test performance. Yet, the question of "what it measures" still has no definitive answer, a consequence of the historical context from which it ...
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Purpose:
Family physicians need simple yet comprehensive algorithms to discriminate between community-dwelling older persons who are at increased risk of dementia and those who are not. We aimed to investigate associations between incident dementia and responses to a single question regarding subjective memory complaints (SMC) combined with scores...
Citations
... 5 The impact of MDD on patients of working age was further demonstrated in a cross-sectional study in Korea, known as Epidemiological Research on Functioning Outcomes Related to Major depressive disorder in South Korea (PERFORM-K), which reported that the majority of patients experienced cognitive dysfunction as well as work productivity losses, work time missed (absenteeism) and actual work impaired (presenteeism) due to MDD. 6 Therefore, there is a need to address the symptoms of MDD with an impact on the prognosis of working patients with MDD. 6,7 A particularly debilitating core feature of MDD is anhedonia, defined as a loss of pleasure and lack of reactivity to pleasurable stimuli. 8 It occurs in approximately 75% of MDD patients, 9 with anhedonia severity being directly related to severity of MDD. 10 A network-based analysis of MDD patients in China reported that compared with MDD patients with low anhedonia, those with high anhedonia presented with higher risk of suicidal ideation and depressive symptoms. ...
Background
Patients with major depressive disorder (MDD) experience depressive symptoms such as anhedonia as well as cognitive dysfunction which can subsequently impair their work performance.
Purpose
To assess the effectiveness and safety of vortioxetine in working patients with MDD in South Korea.
Patients and Methods
This was a subgroup analysis of a prospective, multicenter, non-interventional, non-comparative post-marketing surveillance (PMS) study. Vortioxetine-naïve patients aged >18 years who were administered with vortioxetine were followed for up to 24±2 weeks. Working patients were defined as those who were working or studying full- (≥6 hours/day) or part-time (<6 hours/day) at baseline. Effectiveness and adverse events (AEs), assessed by both clinician and patient-reported measured, were analyzed.
Results
A total of 1082 working patients (mean age: 39.56 years) were included in the subgroup analysis. Clinically significant improvements in depressive symptoms, including anhedonia, were observed over the 24 weeks of follow-up, with mean scores for the total Montgomery-Asberg Depression Rating Scale (MADRS) and anhedonia subscale both significantly decreasing from baseline by mean±standard deviation (SD) of 9.73±9.08 and 5.37±5.24 points, respectively, at 24 weeks (both p<0.001 vs baseline). The vast majority of patients (80.01%) treated with vortioxetine also showed improvements in mental health symptoms over the 24 weeks, measured using the Clinical Global Impression – Improvement (CGI-I) scores. Significant improvements in cognitive symptoms were also observed over the study period, measured by the Korean Version of the Perceived Deficits Questionnaire-Depression as well as Digit Symbol Substitution Test (all p<0.0001 from baseline at Visits 2 and 3). Vortioxetine was well tolerated in working patients, with the respective rates of any AEs and serious AEs being 18.67% and 1.20%.
Conclusion
Working patients treated with vortioxetine had improvements in their depressive symptoms (including anhedonia), cognitive function and performance. Vortioxetine was found to be well tolerated in this study.
... Each type of machine learning algorithm we evaluated performed best when identifying older adults with poor cognition based on processing speed, working memory, and attention as measured by the Digit Symbol Substitution Test (DSST). The DSST is well-suited to detect changes in cognitive function because it assesses multiple cognitive subdomains sensitive to aging and cognitive decline 19 , thus, our study indicates that monitoring the processing speed, working memory, and sustained attention of older adults using wearable device data may be a viable alternative to existing monitoring approaches. However, our study additionally highlights the need for caution to be taken when leveraging wearable device data given that predictive ability varied considerably across different cognitive subdomains. ...
... The DSST, adapted from the Wechsler Adult Intelligence Scale, is a cognitive performance test that evaluates processing speed, sustained attention, and working memory. It functions as an experimental instrument for comprehending associative learning in humans (Jaeger, 2018). Participants completed a two-minute task of replicating graphic symbols in 133 boxes. ...
Background
Obesity negatively impacts cognitive function. However, the correlation between the body roundness index (BRI) and cognitive performance remains inadequately explored.
Methods
This study used data from the National Health and Nutrition Examination Survey (NHANES) collected from 2011 to 2014 to examine the correlation between BRI and cognitive function in individuals aged 65 and older. Models of multiple linear regression were used to investigate the relationship between BRI and cognitive performance. Additionally, smoothed curve fittings explored potential non-linear associations. Interaction tests and subgroup analyses were also performed.
Results
One thousand eight hundred seventy participants were taken into account, revealing an important negative relationship between BRI levels and cognitive performance. In the fully adjusted model, elevated BRI was substantially correlated with lower Digit Symbol Substitution Test (DSST) scores ( β = −0.34, 95% CI = −0.64 to −0.05, p = 0.023), indicating that the higher BRI values are linked to worse cognitive performance. Sex differences were observed, with males showing a stronger negative association ( p for interaction = 0.040).
Conclusion
Elevated BRI is related to worse cognitive function in the elderly population.
... This task assesses the rapid generation and articulation of words from a specified category, offering insight into semantic memory and executive function [28]. The DSST is utilized to assess components of executive functioning and processing speed [29]. In this task, participants engage in a symbol-number matching exercise that evaluates their attention, speed, and visual-motor coordination. ...
Background
As one of the key features of sleep, sleep duration (SD) has been confirmed to be associated with multiple health outcomes. However, the link between SD and cognitive function (CF) is still not well understood.
Methods
We employed a combined approach utilizing data from the National Health and Nutrition Examination Survey (NHANES 2011–2014) and Mendelian Randomization (MR) methods to investigate the relationship between SD and CF. In the NHANES cross-sectional analysis, the association between these variables was primarily examined through multivariate linear regression to explore direct correlations and utilized smoothing curve fitting to assess potential nonlinear relationships. To ensure the robustness of our findings, subgroup analyses were also conducted. MR analysis was used to assess the causal relationship between SD and sleeplessness on CF. After excluding confounding factors, univariate and multivariate MR were performed using inverse variance weighting (IVW) as the main analysis method, and sensitivity analysis was performed.
Results
The results of our cross-sectional study indicate a notable negative association between SD and CF, forming an inverted U-shaped curve with the inflection point occurring at SD = 6 h. This relationship remains consistent and robust across subgroup analyses differentiated by variables such as age, levels of physical activity, and frequency of alcohol intake. In MR analysis, IVW analysis showed no causal relationship between SD and sleeplessness on CF (Both P > 0.05).
Conclusion
Cross-sectional studies suggest the existence of an inverted U-shaped correlation between SD and CF among the elderly. However, MR analysis did not reveal a causal relationship between SD and CF, which the lack of nonlinear MR analysis may limit. These findings provide evidence from a sleep perspective for optimizing cognitive strategies in older adults.
... The use of the DSST widened after becoming incorporated in the Wechsler-Bellevue Intelligence Scale (WBIS), developed in 1930s. The DSST is a highly valid tool that is sensitive to the presence of cognitive dysfunction and also, to change in cognitive function across a wide range of clinical populations [27,29]. In the current NHANES nationwide assessment, the DSST assessed response speed, sustained attention, visual-spatial skills, and associative learning and memory. ...
... The score consists of the number of correct symbols printed during the allotted time frame (minimum: 0 and maximum: 133). This test has been used widely in epidemiological studies and extensive details on the administration of these tests and performance within NHANES can be found elsewhere [24,25,27,29]. We dichotomized the categories into the bottom 25th percentile classified as having low cognitive performance (vs. ...
... In our analytic sample, we found that more than a tenth of older Americans have COPD and more than a third have some cognitive impairment, closely resembling the published estimates from other population-based U.S. studies [2,7,29]. Furthermore, our findings on the prevalence of COPD based on cognitive performance are in line with existing evidence on the association between cognitive impairment and COPD (15.3% of individuals with low cognitive performance had COPD vs. 11.7 of those who had normal cognitive performance) [20][21][22]. ...
Background/Objectives: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of mortality in the United States (U.S.), with rates varying by disease severity, comorbidities, and sociodemographic factors. Cognitive impairment has been independently associated with increased mortality, but has not been well studied in relation to COPD despite being a frequently overlooked comorbidity in COPD patients. The purpose of this nationwide study was to assess the relationship between low cognitive performance and the risk of mortality among older adults with COPD while adjusting for major sociodemographic and health-related characteristics.
Methods: This study utilized the 1999-2002 National Health and Nutrition Examination Survey (NHANES) and the respiratory mortality data of noninstitutionalized US adults aged over 65 years. Survival curves showing the combined effect of cognitive decline and COPD using the Kaplan-Meier product-limit method to estimate the percent survival of the subject at each point in time were used.
Results: The final sample included 2013 older adults, with 39.1% showing low cognitive performance and 12.7% having COPD. Those with low cognitive performance were older, less educated, had lower income, were more likely to be racial/ethnic minorities, and had a history of cardiovascular diseases (CVD); they were also more likely to have COPD or chronic kidney disease (CKD). The adjusted hazard ratio for respiratory-related mortality risk was highest for individuals with both COPD and low cognitive performance (hazards ratio = 8.53), people with COPD alone also had a higher respiratory-related mortality risk (hazards ratio = 4.92), but low cognitive performance alone did not significantly increase respiratory-related mortality risk.
Conclusions: These findings provide clearer insights into how cognitive impairment affects mortality risk in older adults with COPD and we discuss potential strategies to address this dual chronic health challenge effectively.
... Specifically, we predicted that higher CR (i.e., greater intrinsic network integrity) would attenuate negative associations between Aβ concentrations and cognitive and physical function. The digit symbol substitution test (DSST) [44] and expanded short physical performance battery (eSPPB) [45] were used as measures of cognitive and physical function, respectively, as it has been proposed that they share common neural mechanisms ...
... The Digit-Symbol Substitution Test (DSST) [44] was used to assess cognitive processing speed. This is a paper and pencil test where digits 1-9 are associated with a symbol. ...
Cognitive and physical function are interrelated in aging co-occurring impairments in both domains can be debilitating and lead to increased risk of developing dementia. Amyloid beta (Aβ) deposition in the brain is linked to cognitive decline and is also associated with poorer physical function in older adults. However, significant inter-individual variability exists with respect to the influence of increased brain Aβ concentrations on cognitive and physical outcomes. Identifying factors that explain inter-individual variability in associations between Aβ and clinical outcomes could inform interventions designed to delay declines in both cognitive and physical function. Cognitive reserve (CR) is considered a buffer that allows for cognitive performance that is better than expected for a given level of brain injury or pathology. Although the neural mechanisms underlying CR remain unknown, there is growing evidence that resting-state brain networks may serve as a neural surrogate for CR. The currently study evaluated whether functional brain networks modified associations between brain Aβ and cognitive and physical function in community-dwelling older adults from the Brain Networks and Mobility (B-NET) study. We found that the integrity of the central executive and basal ganglia networks modified associations of Aβ with cognitive and physical performance. Associations between brain Aβ and cognitive and physical function were less pronounced when brain network integrity was high. The current study introduces novel evidence for brain networks underlying CR as a buffer against the influence of Aβ accumulation on cognitive and physical function.
Significance Statement
There is a growing number of medications targeting beta amyloid for the treatment of Alzheimer’s disease. The treatments effectively lower brain amyloid but do not have as robust of an effect on clinical outcomes. The current study introduces novel evidence for brain networks as a buffer against the influence of Aβ accumulation on cognitive and physical function in older adults with normal cognition. Future studies should examine if brain network integrity underlies the variability in treatment response to amyloid-lowering drugs in patients with cognitive decline.
... A sum score was generated (range 0-21) on the basis of responses to 7 items on a Likert scale [49,50]. The Digit Symbol Substitution Test (DSST; [51]) was applied to assess cognitive functions, including motor speed, attention and visuoperceptual functions. Participants matched symbols to digits (1 to 9) on a sheet for 90 s, with the number of correct matches recorded (DSST1). ...
... Participants matched symbols to digits (1 to 9) on a sheet for 90 s, with the number of correct matches recorded (DSST1). After that, the test participants wrote down the correct symbols for each digit from memory on a separate page, and the number of correct responses (DSST2) was noted [51]. ...
Background
Rehabilitation plays a crucial role in restoring work ability and facilitating the reintegration of post-COVID patients into the workforce. The impact of rehabilitation on work ability and return to work (RTW) of post-COVID patients remains poorly understood. This study was conducted to assess the work ability and RTW of post-COVID patients before rehabilitation and 12 months after rehabilitation and to identify physical and neuropsychological health factors influencing RTW 12 months after rehabilitation.
Methods
This longitudinal observational study included 114 post-COVID patients with work-related SARS-CoV-2 infection who underwent inpatient post-COVID rehabilitation with indicative focus on pulmonology and/or psychotraumatology (interval between date of SARS-CoV-2 infection and start of rehabilitation: M = 412.90 days). Employment status, work ability, and the subjective prognosis of employment (SPE) scale were assessed before rehabilitation (T1) and 12 months after rehabilitation (T4). The predictors analysed at T4 were functional exercise capacity, physical activity, subjective physical and mental health status, fatigue, depression, and cognitive function. Longitudinal analyses were performed via the Wilcoxon signed-rank test. Logistic and linear regression analyses identified predictors of work ability and return to work (RTW), whereas mediation analyses examined the relationships between these predictors and work ability.
Results
At T4, the median of WAI total score indicated poor work ability, which significantly worsened over time (p < 0.001; r = 0.484). The SPE scale significantly increased from T1 to T4 (p = 0.022, r = -0.216). A total of 48.6% of patients had returned to work 12 months after rehabilitation. Fatigue was identified as the main predictor of reduced work ability and RTW, with each unit increase in fatigue severity decreasing the odds of RTW by 3.1%. In addition, physical capacity and subjective health status were significant predictors of perceived work ability.
Conclusions
The findings highlight the significant challenges that post-COVID patients face in regaining work ability and achieving successful RTW 12 months after rehabilitation. Fatigue appears to be an important predictor of work ability and RTW. To optimize recovery and enhance both biopsychosocial health and work ability, it is crucial to develop and implement personalised interventions that address fatigue, improve physical capacity, and support mental health.
Trial registration
This study is registered in the German Clinical Trials Register under DRKS00022928.
... Alcohol use was measured using the timeline follow-back (TLFB) (Sobell & Sobell, 1992) over 90 days prior to screening. Participants (counterbalanced with visit 4) also underwent the cognitive baseline for the digit symbol substitution (DSST) (Jaeger, 2018) and cued go/no-go (Holland & Ferner, 2017;Mellanby, 1919) tasks. After a study physician approved the medical history and clinical laboratory tests, the participants were scheduled for Visit 2. ...
... Cognitive performance was assessed using two computer-based tasks: the DSST (number of trials attempted, the proportion of correct responses, errors, and the latency between responses) (Jaeger, 2018) and the go/no-go (hit rate, false alarm rate, and the reaction time) (Holland & Ferner, 2017;Mellanby, 1919) tasks, with an alcohol-free session inserted as covariate in the model, and tested the effect of the study medications. Data for the alcohol-free session was collected either during visit 1 (screening) or visit 4 (follow-up) as a counterbalance to account for potential learning bias in these baseline measures. ...
Background
This study shows the first evidence for pannexin 1 channels as a new target to develop medications for alcohol use disorder (AUD). Due to its history of long‐term safe clinical use and preclinical evidence of reducing excessive alcohol intake in rodents, probenecid has clinical potential for AUD.
Methods
We conducted a Phase I/IIa randomized, double‐blind, placebo‐controlled, crossover trial investigating the safety, tolerability, and efficacy of an oral dose of probenecid (2 g) when administered with alcohol (0.08 g/dL) in individuals who regularly consume alcohol to the 0.08 g/dL level (N = 35) and in individuals with mild to severe AUD. Alcohol pharmacokinetics and subjective responses were evaluated to assess potential interactions between probenecid and alcohol. Alcohol craving, inflammatory biomarkers, cognitive assessments, and hemodynamics were assessed as additional alcohol research domains. All outcomes were assessed both in the ascending and descending limb of alcohol intoxication using Generalized Estimating Equation.
Results
Probenecid did not exert any significant effect on alcohol pharmacokinetics and did not affect alcohol stimulation or sedation. Probenecid, compared to placebo, significantly decreased alcohol craving during the alcohol ascending limb. Inflammatory biomarkers, cognitive performance following alcohol ingestion, and hemodynamics were likewise not affected by probenecid administration. Analysis of sex as a biological variable revealed no differences of probenecid compared to placebo.
Conclusions
Taken together, our data support the potential of probenecid for treatment of AUD and suggest that pannexin 1 channels represent a novel emerging therapeutic target for the development of new pharmacotherapies for treating AUD.
... DSST assesses multiple cognitive collaterals, including processing speed, attention, and executive function, by measuring how quickly and accurately an individual matches numbers to symbols within a limited time frame, and the results can help physicians and researchers identify and monitor the progression of cognitive impairment. The DSST can detect cognitive impairments in multiple affected domains, and people with AD generally exhibit subpar performance on mental tasks that require intricate information processing, such as the DSST 26,27 . ...
The main aim of this study was to explore the correlation between the platelet/high-density lipoprotein cholesterol ratio (PHR) and cognitive function in elderly individuals from the United States. This investigation leveraged data encompassing 2299 participants, all aged 60 years and above, from the National Health and Nutrition Examination Survey conducted from 2011 to 2014. Inclusion criteria were based on the availability of complete datasets for PHR and cognitive function assessments. The analytical approach incorporated multivariate logistic regression to discern the association between PHR and cognitive function. Additionally, the study employed restricted cubic splines (RCS) to explore potential non-linear relationships and subgroup analyses to identify variations in the observed associations across different demographic and clinical subgroups. In the fully adjusted model, an increment of 10 units in PHR was associated with a decline of 0.014 in cognitive scores (β=-0.014, 95% CI: -0.025, -0.002; P < 0.05). Compared to the lowest quartile, participants in the highest quartile exhibited a 38.4% increased prevalence of cognitive impairment per one-unit increase in PHR (OR = 1.384, 95% CI: 1.012, 1.893; P < 0.05). Subgroup analysis revealed consistent results regarding the relationship between PHR and cognitive impairment across all subgroups. A non-linear relationship between PHR and cognitive impairment was observed using RCS, indicating that an increase in PHR above 111.49 significantly elevated the incidence of cognitive impairment (P < 0.05). Our study demonstrates that a higher PHR is associated with a greater risk of cognitive decline in an older U.S. population, and although further validation is needed, this warrants consideration in clinical assessments and interventions.
... The Wechsler Adult Intelligence Scale, Third Edition Digit-Symbol Substitution Test (DSST) was used to measure cognitive function. The DSST requires participants to match symbols to numbers based on a provided key, and the correct matches are summed [22]. A higher DSST score indicates higher cognitive function. ...
... The DSST is a reliable and valid test that measures cognitive function and is sensitive to cognitive deficits across many conditions. The DSST measures motor speed, attention, visual perception, writing ability, associative learning, and executive function, including working memory [22,29]. Studies using the DSST have shown that a four-point difference in DSST score is clinically relevant and can translate to meaningful improvements in activities of daily living [30,31]. ...
Background/Objectives: Impaired cognition is a key trait of the diseases of aging and is an important quality of life factor for older adults and their families. Over the past decade, there has been an increasing appreciation for the role of the microbiome in cognition, as well as emerging evidence that probiotics, such as those in yogurt and other dairy products, can have a positive impact on cognitive function. However, it is unclear to what extent the consumption of yogurt is associated with improved cognitive function in older adults. Methods: Therefore, we compared the scores for the Wechsler Adult Intelligence Scale, Digit–Symbol Substitution Test between respondents who self-reported daily yogurt/dairy consumption with those who claimed they did not in an NHANES. Results: We found that cognitive scores were significantly higher (40.03 ± 0.64 vs. 36.28 ± 1.26, p = 0.017) in respondents reporting daily yogurt/dairy consumption, though only a trend remained after adjusting for sociodemographic covariates (p = 0.074). Conclusions: Further studies are required to confirm that this is a cause–effect relationship and whether changing diets is a low-cost means of protecting aging populations from cognitive decline and improving their quality of life.
