Home › Research › Getting a diagnosis
Language, literacy, and sensory impairments and missing cognitive test scores in the Harmonized Cognitive Assessment Protocol of the China Health and Retirement Longitudinal Study
Alden L. Gross, Ying Liu, Yuan S Zhang, Yaohui Zhao, Chihua Li, Erik Meijer, Jinkook Lee, Lindsay C. Kobayashi. Aging Clinical and Experimental Research, 2025-05-12
Topic: Risk, prevention and care in population studies
We observed high levels of missing data in most cognitive test items - on average 13% and as high as 65%. Low fluency in spoken Mandarin, illiteracy, and impairments in hearing and vision were each associated with greater odds of missingness on nearly all tests. Partly because of differential missingness, there was minimal evidence of DIF by these features in items in which we expected a priori to find DIF (e.g., repetition of a spoken phrase among those with hearing impairment). Several cognitive test items exhibited statistically significant DIF, however there was minimal evidence of meaningful DIF. Differential missingness in cognitive items by spoken language, literacy, and sensory impairments is potentially more of an inferential threat than measurement differences in test items.
Key findings
- We observed high levels of missing data in most cognitive test items - on average 13% and as high as 65%.
- Low fluency in spoken Mandarin, illiteracy, and impairments in hearing and vision were each associated with greater odds of missingness on nearly all tests.
- Partly because of differential missingness, there was minimal evidence of DIF by these features in items in which we expected a priori to find DIF (e.g., repetition of a spoken phrase among those with hearing impairment).
- Several cognitive test items exhibited statistically significant DIF, however there was minimal evidence of meaningful DIF.
- Differential missingness in cognitive items by spoken language, literacy, and sensory impairments is potentially more of an inferential threat than measurement differences in test items.
Why it matters
This study found high levels of missing cognitive test data in a large survey, with missingness linked to language fluency, literacy, and sensory impairments. It highlights that differential missingness is a potential threat to drawing conclusions from cognitive assessments, rather than reporting a treatment or cure.
New to this subject? Start with our plain-English guide: Getting a diagnosis →
Study details
- Study designlongitudinal study
- Participants9,755
- Evidence strengthModerate
How this study scored 57/100
Published in a peer-reviewed journal, and it is a longitudinal study following the same people over time. Scored zero for effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Aging Clinical and Experimental Research) |
| Journal's citation record | 1 / 4 | Aging Clinical and Experimental Research: journal h-index 125 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A longitudinal study following the same people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 3 / 4 | 9,755 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 7 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 2.3 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 3 / 6 | Cited 4.4× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 3 other studies in this library |
| Still being cited | 1 / 4 | Cited 7 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Lindsay C. Kobayashi: h-index 39 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Johns Hopkins University: institution h-index 2,306 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 6 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40355654) |
| Free to read | 2 / 2 | Free to read |
| Total | 57 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1007/s40520-025-03039-y
- PubMed: 40355654
- Original source →
- Free full text: Aging Clinical and Experimental Research →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 8 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Gross, A. L., Liu, Y., Zhang, Y. S., Zhao, Y., Li, C., Meijer, E., et al. (2025). Language, literacy, and sensory impairments and missing cognitive test scores in the Harmonized Cognitive Assessment Protocol of the China Health and Retirement Longitudinal Study. Aging Clinical and Experimental Research. https://doi.org/10.1007/s40520-025-03039-y
Vancouver
Gross AL, Liu Y, Zhang YS, Zhao Y, Li C, Meijer E, et al. Language, literacy, and sensory impairments and missing cognitive test scores in the Harmonized Cognitive Assessment Protocol of the China Health and Retirement Longitudinal Study. Aging Clinical and Experimental Research. 2025. doi:10.1007/s40520-025-03039-y. PMID: 40355654.
BibTeX
@article{gross2025-40355654,
author = {Gross, Alden L. and Liu, Ying and Zhang, Yuan S and Zhao, Yaohui and Li, Chihua and Meijer, Erik and Lee, Jinkook and Kobayashi, Lindsay C.},
title = {{Language, literacy, and sensory impairments and missing cognitive test scores in the Harmonized Cognitive Assessment Protocol of the China Health and Retirement Longitudinal Study}},
journal = {Aging Clinical and Experimental Research},
year = {2025},
doi = {10.1007/s40520-025-03039-y},
pmid = {40355654},
url = {https://doi.org/10.1007/s40520-025-03039-y}
}
Studies this one cites
Referenced by this study and also in the alzhub library, so you can read them here.
Later studies that cite this one
3 studies in the alzhub library list this one in their references.