Name: highlighting and reducing the impact of negative aging stereotypes during older adults' cognitive testing
Uploaded: 2020-01-24T12:00:00
Description: Watch this Scientific Journal Video about Highlighting and Reducing the Impact of Negative Aging Stereotypes During Older Adults' Cognitive Testing at JoVE.com

Part of this work was supported by Plan Alzheimer Foundation on a Humanities and Social Sciences grant (AAP SHS 2013: &#34;Sociocognitive aspects of Alzheimer disease&#34; to F. Rigalleau and M. Mazerolle).

The present research was carried out in accordance with French standards, each participant provided informed consent and procedures were consistent with the guidelines of the American Psychological Association.
1. Highlighting and reducing age-based stereotype threat on a lab memory test
<ol>
	<li>Participants screening
	<ol>
		<li>Recruit participants in the desired age range (e.g., younger participants: 18&#8722;35 years old; older participants: 60&#8722;85 years old) for a study on genera...

<ol>
	<li>Steele, C. M., Aronson, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stereotype+threat+and+the+intellectual+test+performance+of+African+Americans.">Stereotype threat and the intellectual test performance of African Americans.</a> Journal of Personality and Social Psychology. 69 (5), 797-811 (1995).</li><li>Steele, C. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+threat+in+the+air:+How+stereotypes+shape+intellectual+identity+and+performance.">A threat in the air: How stereotypes shape intellectual identity and performance.</a> American Psychologist. 52, 613-629 (1997).</li><li>Barber, S. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+examination+of+age-based+stereotype+threat+about+cognitive+decline:+Implications+for+stereotype-threat+research+and+theory+development.">An examination of age-based stereotype threat about cognitive decline: Implications for stereotype-threat research and theory development.</a> Perspectives on Psychological Science. 12 (1), 62-90 (2017).</li><li>Chasteen, A. L., Kang, S. K., Remedios, J. D., Inzlicht, M., Schmader, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Aging+and+stereotype+threat:+Development,+process,+and+interventions.">Aging and stereotype threat: Development, process, and interventions.</a> Stereotype threat: Theory, process, and application. , 202-216 (2012).</li><li>Lamont, R. A., Swift, H. J., Abrams, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Review+and+Meta-Analysis+of+Age-Based+Stereotype+Threat:+Negative+Stereotypes,+Not+Facts,+Do+the+Damage.">Review and Meta-Analysis of Age-Based Stereotype Threat: Negative Stereotypes, Not Facts, Do the Damage.</a> Psychology and Aging. 30 (1), 180-193 (2015).</li><li>Haslam, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term="When+the+age+is+in,+the+wit+is+out":+Age+related+self-categorization+and+deficit+expectations+reduce+performance+on+clinical+tests+used+in+dementia+assessment.">"When the age is in, the wit is out": Age related self-categorization and deficit expectations reduce performance on clinical tests used in dementia assessment.</a> Psychology and Aging. 27, 778-784 (2012).</li><li>Desrichard, O., K&#246;petz, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+threat+in+the+elder:+The+impact+of+task-instructions,+self-efficacy+and+performance+expectations+on+memory+performance+in+the+elderly.">A threat in the elder: The impact of task-instructions, self-efficacy and performance expectations on memory performance in the elderly.</a> European Journal of Social Psychology. 35, 537-552 (2005).</li><li>Kang, S. K., Chasteen, A. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+moderating+role+of+age-group+identification+and+perceived+threat+on+stereotype+threat+among+older+adults.">The moderating role of age-group identification and perceived threat on stereotype threat among older adults.</a> The International Journal of Aging and Human Development. 69, 201-220 (2009).</li><li>Rahhal, T. A., Hasher, L., Colcombe, S. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Instructional+manipulations+and+age+differences+in+memory:+Now+you+see+them,+now+you+don't.">Instructional manipulations and age differences in memory: Now you see them, now you don't.</a> Psychology and Aging. 16, 697-706 (2001).</li><li>Hess, T. M., Auman, C., Colcombe, S. J., Rahhal, T. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Impact+of+Stereotype+Threat+on+Age+Differences+in+Memory+Performance.">The Impact of Stereotype Threat on Age Differences in Memory Performance.</a> The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 58 (1), P3-P11 (2003).</li><li>Hess, T. M., Hinson, J. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Age-related+variation+in+the+influences+of+aging+stereotypes+on+memory+in+adulthood.">Age-related variation in the influences of aging stereotypes on memory in adulthood.</a> Psychology and Aging. 21 (3), 621-625 (2006).</li><li>Levy, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Improving+memory+in+old+age+through+implicit+self-stereotyping.">Improving memory in old age through implicit self-stereotyping.</a> Journal of Personality and Social Psychology. 71, 1092-1107 (1996).</li><li>Stein, R., Blanchard-Fields, F., Hertzog, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effects+of+age-stereotype+priming+on+the+memory+performance+of+older+adults.">The effects of age-stereotype priming on the memory performance of older adults.</a> Experimental Aging Research. 28 (2), 169-181 (2002).</li><li>Sachdev, P. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sydney+Memory,+Ageing+Study+Team.+Factors+predicting+reversion+from+mild+cognitive+impairment+to+normal+cognitive+functioning:+a+population-based+study.">Sydney Memory, Ageing Study Team. Factors predicting reversion from mild cognitive impairment to normal cognitive functioning: a population-based study.</a> PloS One. 8, e59649 (2013).</li><li>R&#233;gner, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Aging+stereotypes+must+be+taken+into+account+for+the+diagnosis+of+prodromal+and+early+Alzheimer's+disease.">Aging stereotypes must be taken into account for the diagnosis of prodromal and early Alzheimer's disease.</a> Alzheimer Disease &amp; Associated Disorders - An International Journal. 30 (1), 77-79 (2016).</li><li>Chasteen, A. L., Bhattacharyya, S., Horhota, M., Tam, R., Hasher, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=How+feelings+of+stereotype+threat+influence+older+adults'+memory+performance.">How feelings of stereotype threat influence older adults' memory performance.</a> Experimental Aging Research. 31 (3), 235-260 (2005).</li><li>Yesavage, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+and+validation+of+a+geriatric+depression+screening+scale:+a+preliminary+report.">Development and validation of a geriatric depression screening scale: a preliminary report.</a> Journal of Psychiatric Research. 17 (1), 37-49 (1982).</li><li>Spielberger, C. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Test+Anxiety+Inventory.">Test Anxiety Inventory.</a> The Corsini Encyclopedia of Psychology. , (2010).</li><li>Folstein, M. F., Folstein, S. E., McHugh, P. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term="Mini-mental+state.".">"Mini-mental state.".</a> Journal of Psychiatric Research. 12 (3), 189-198 (1975).</li><li>Crum, R. M., Anthony, J. C., Bassett, S. S., Folstein, M. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Population-based+norms+for+the+Mini-Mental+State+Examination+by+age+and+educational+level.">Population-based norms for the Mini-Mental State Examination by age and educational level.</a> The Journal of the American Medical Association. 269 (18), 2386-2391 (1993).</li><li>Gimmig, D., Huguet, P., Caverni, J. -. P., Cury, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Choking+under+pressure+and+working-memory+capacity:+When+performance+pressure+reduces+fluid+intelligence.">Choking under pressure and working-memory capacity: When performance pressure reduces fluid intelligence.</a> Psychonomic Bulletin &amp; Review. 13, 1005-1010 (2006).</li><li>Mazerolle, M., R&#233;gner, I., Morisset, P., Rigalleau, F., Huguet, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stereotype+Threat+Strengthens+Automatic+Recall+and+Undermines+Controlled+Processes+in+the+Elderly.">Stereotype Threat Strengthens Automatic Recall and Undermines Controlled Processes in the Elderly.</a> Psychological Science. 23, 723-727 (2012).</li><li>Daneman, M., Carpenter, P. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Individual+differences+in+working+memory+and+reading.">Individual differences in working memory and reading.</a> Journal of Verbal Learning and Verbal Behavior. 19, 450-466 (1980).</li><li>Nasreddine, Z. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Montreal+Cognitive+Assessment,+MoCA:+A+brief+screening+tool+for+mild+cognitive+impairment.">The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment.</a> Journal of the American Geriatrics Society. 53, 695-699 (2005).</li><li>Mazerolle, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Negative+Aging+Stereotypes+Impair+Performance+on+Brief+Cognitive+Tests+Used+to+Screen+for+Predementia.">Negative Aging Stereotypes Impair Performance on Brief Cognitive Tests Used to Screen for Predementia.</a> Journals of Gerontology, Series B: Psychological Sciences and Social Sciences. 72 (6), 932-936 (2017).</li><li>Brown, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+and+misuse+of+short+cognitive+tests+in+the+diagnosis+of+dementia.">The use and misuse of short cognitive tests in the diagnosis of dementia.</a> Journal of Neurology, Neurosurgery, and Psychiatry. 86, 680-685 (2015).</li><li>Le Couteur, D. G., Doust, J., Creasey, H., Brayne, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Political+drive+to+screen+for+pre-dementia:+not+evidence+based+and+ignores+the+harms+of+diagnosis.">Political drive to screen for pre-dementia: not evidence based and ignores the harms of diagnosis.</a> BMJ. 347, f5125 (2013).</li><li>Steele, C. M., Davies, P. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stereotype+Threat+and+Employment+Testing:+A+Commentary.">Stereotype Threat and Employment Testing: A Commentary.</a> Human Performance. 16 (3), 311-326 (2003).</li><li>Scholl, J. M., Sabat, S. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stereotypes,+stereotype+threat+and+ageing:+implications+for+the+understanding+and+treatment+of+people+with+Alzheimer&#39;s+disease.">Stereotypes, stereotype threat and ageing: implications for the understanding and treatment of people with Alzheimer&#39;s disease.</a> Ageing &amp; Society. 28 (1), 103-130 (2008).</li><li>Suhr, J. A., Gunstad, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term="Diagnosis+threat":+The+effect+of+negative+expectations+on+cognitive+performance+in+head+injury.">"Diagnosis threat": The effect of negative expectations on cognitive performance in head injury.</a> Journal of Clinical and Experimental Neuropsychology. 24 (4), 448-457 (2002).</li><li>Schlemmer, M., Desrichard, O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+Medical+Environment+Detrimental+to+Memory?+A+Test+of+A+White+Coat+Effect+on+Older+People's+Memory+Performance.">Is Medical Environment Detrimental to Memory? A Test of A White Coat Effect on Older People's Memory Performance.</a> Clinical Gerontologist. 41 (1), 77-81 (2018).</li></ol>

The present studies show that stereotype threat, a neglected source of stress in many testing situations, can lead older adults to perform below their true abilities on memory tests. The method presented here highlights the crucial importance of the instructions given to participants and patients before testing memory. Simply mentioning that younger adults are taking part in the study (without mentioning any expected age-related differences in performance) is sufficient to inflate by 40% (MMSE and MoCA averaged) the numb...

A growing field of laboratory research in social cognition conducted in the healthy population has demonstrated that members of groups whose abilities are negatively stereotyped typically underperform when the negative stereotypes are made relevant to the performance at hand, a phenomenon called stereotype threat (ST). In addition to the normal anxiety associated with taking cognitive tests, the fear of confirming negative stereotypes creates extra pressure that may interfere with cognitive functioning and lead to perform below one&#39;s abilities1,2. Many findings demonstrate that negative aging stereotypes (e.g., the culturally shared beliefs that aging inescapably causes severe cognitive decline and diseases such as Alzheimer&#39;s disease [AD]) contribute, at least in part, to the differences classically observed in the healthy population between younger and older adults in memory tasks3,4,5. Without denying the impact of aging on cognitive functioning, research clearly demonstrates that age-related stereotypes are powerful enough to artificially decrease older adults&#39; performance on memory tests.
Detrimental age-based ST effects are readily observable and fairly easy to produce with instructional manipulations6, such as simply emphasizing the memory component of the test7,8,9, highlighting differences in performance between young and older adults10,11, or implicitly activating negative aging stereotypes12,13. Given the results obtained in laboratory studies, it is very likely that negative aging stereotypes also permeate, at least implicitly, the standard neuropsychological testing settings during the screening for pre-dementia. Indeed, because of the lengthening of life expectancy, more and more people are concerned with the possibility of getting AD or other forms of dementia. Importantly, false-positive errors are quite frequent in the diagnosis of prodromal state of AD14, which could be explained, at least in part, by transitory impaired performances in older adults due to the age-based ST phenomenon15.
For these reasons, it is important to provide efficient methods to deactivate the influence of negative aging stereotypes and thereby help older people to perform at their maximum during memory assessment in general and during neuropsychological testing specifically. Some methods, such as de-emphasizing the memory component of the test (e.g., characterizing the task as a vocabulary test), have already proved efficient to eliminate ST effects in older adults on explicit memory tests taken in the context of lab studies7,9,16. However, such instructions are not compatible with the ecological clinical context of the neuropsychological testing, in which older adults come to have their memory abilities assessed. The goal of our articles is to present two methods likely to alleviate age-based ST effects among older adults, either in the lab or in the clinical contexts. The first one, especially suited for the lab context, consists in telling older adults that performance on the ongoing memory tests usually does not differ between younger and older adults (i.e., age-fair instructions). The second method, which can be implemented in both lab and clinical contexts, consists in explaining to older adults (or patients) the negative impact of aging stereotypes, which may help them reappraise the situation, reduce evaluative pressure, and feel less threatened during the testing.

<table>
	<tbody>
		<tr>
			<td>Table</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>2 chairs (one for the participant and one for experimenter)</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Laptop/computer with Reading span test described in the protocol</td>
			<td>Apple iMac (Cupertino, CA)</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Software</td>
			<td>Psyscope</td>
			<td></td>
			<td><a href="http://psy.ck.sissa.it/psy_cmu_edu/index.html" target="_blank">http://psy.ck.sissa.it/psy_cmu_edu/index.html</a></td>
		</tr>
		<tr>
			<td>Paper and pencil for MMSE, MoCA, Geriatric depression Scale, State-Trait Anxiety Inventory</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Mini Mental State Examination</td>
			<td>Folstein, M. F., Folstein, S. E., McHugh, P. R. &#34;Mini-mental state.&#34; Journal of Psychiatric Research. 12 (3), 189&#8211;198 (1975).</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Montreal Cognitive Assessment</td>
			<td>Nasreddine, Z. S. et al. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society. 53, 695&#8211;699 (2005).</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Geriatric depression Scale</td>
			<td>Spielberger, C. D. Test Anxiety Inventory. The Corsini Encyclopedia of Psychology. John Wiley &#38; Sons, Inc., Hoboken (2010).</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>State-Trait Anxiety Inventory</td>
			<td>Yesavage, J. A. et al. Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research. 17 (1), 37&#8211;49 (1982).</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

highlighting and reducing the impact of negative aging stereotypes during older adults' cognitive testing

As life expectancy increases, aging has become a major health challenge, resulting in a huge effort to better discriminate between normal and pathological cognitive decline. It is thus essential that cognitive tests and their administration are as fair as possible. However, an important source of bias during cognitive testing comes from negative aging stereotypes that can impair the memory performance of older adults and inflate age differences on cognitive tasks. The fear of confirming negative aging stereotypes creates an extra pressure among older adults which interferes with their intellectual functioning and leads them to perform below their true abilities. Here, we present a protocol that highlights simple but efficient interventions to alleviate this age-based stereotype threat effect. The first study showed that simply informing older participants about the presence of younger participants (threat condition) led older adults to underperform on a standardized memory test compared with younger participants, and that this performance difference was eliminated when the test was presented as age-fair (reduced-threat condition). The second study replicated these findings on short cognitive tests used to screen for predementia in clinical settings and showed that teaching older adults about stereotype threat inoculated them against its effects. These results provide useful recommendations about how to improve older adults' memory assessment both in Iab studies and in clinical settings.

We addressed the hypothesis that stereotype threat impairs the working memory performance of older adults and that this effect can be reduced or eliminated by a simple instruction. The expected interaction between age group and threat instructions was significant, F(1, 214) = 4.85, p &#60; 0.03, &#951;p2 = 0.02, and is depicted in Figure 3. In the threat condition, older participants underperformed (mean [M] = ...

Watch this Scientific Journal Video about Highlighting and Reducing the Impact of Negative Aging Stereotypes During Older Adults' Cognitive Testing at JoVE.com

Highlighting and Reducing the Impact of Negative Aging Stereotypes During Older Adults' Cognitive Testing

Here, we present a protocol designed to show how negative aging stereotypes can impair memory performance of older adults during cognitive testing and how to reduce this deleterious effect. This method can help older people to perform at an optimal level during testing in both lab studies and clinical settings.

As life expectancy increases, aging has become a major health challenge, resulting in a huge effort to better discriminate between normal and pathological ...

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