Impairment of activities of daily living requiring memory or complex reasoning as part of the MCI syndrome

Translating the Interplay of Cognition and Physical Performance in COPD and Interstitial Lung Disease: Meeting Report and Literature Review

TOPIC IMPORTANCE

Cognitive and physical limitations are common in individuals with chronic lung diseases, but their interactions with physical function and activities of daily living are not well characterized. Understanding these interactions and potential contributors may provide insights on disability and enable more tailored rehabilitation strategies.

REVIEW FINDINGS

This review summarizes a 2-day meeting of patient partners, clinicians, researchers, and lung associations to discuss the interplay between cognitive and physical function in people with chronic lung diseases. This report covers four areas: (1) cognitive-physical limitations in patients with chronic lung diseases; (2) cognitive assessments; (3) strategies to optimize cognition and motor control; and (4) future research directions. Cognitive and physical impairments have multiple effects on quality of life and daily function. Meeting participants acknowledged the need for a standardized cognitive assessment to complement physical assessments in patients with chronic lung diseases. Dyspnea, fatigue, and age were recognized as important contributors to cognition that can affect motor control and daily physical function. Pulmonary rehabilitation was highlighted as a multidisciplinary strategy that may improve respiratory and limb motor control through neuroplasticity and has the potential to improve physical function and quality of life.

SUMMARY

There was consensus that cognitive function and the cognitive interference of dyspnea in people with chronic lung diseases contribute to motor control impairments that can negatively affect daily function, which may be improved with pulmonary rehabilitation. The meeting generated several key research questions related to cognitive-physical interactions in individuals with chronic lung diseases.

Automated vehicles for older adults with cognitive impairment: a survey study

As the population is ageing, the number of older adults with cognitive impairment (CI) is increasing. Automated vehicles (AVs) can improve independence and enhance the mobility of these individuals. This study aimed to: (1) understand the perception of older adults (with and without CI) and stakeholders providing services and supports regarding care and transportation about AVs, and (2) suggest potential solutions to improve the perception of AVs for older adults with mild or moderate CI. A survey was conducted with 435 older adults with and without CI and 188 stakeholders (e.g. caregivers). The results were analysed using partial least square - structural equation modelling and multiple correspondence analysis. The findings suggested relationships between older adults' level of cognitive impairment, mobility, knowledge of AVs, and perception of AVs. The results provided recommendations to improve older adults' perception of AVs including education and adaptive driving simulation-based training.Practitioner summary: This study investigated the perception of older adults and other stakeholders regarding AVs. The findings suggested relationships between older adults' level of cognitive impairment, mobility, knowledge of AVs, and perception of AVs. The results provided guidelines to improve older adults' perception of AVs.

The relation between cognitive functioning and activities of daily living in normal aging, mild cognitive impairment, and dementia: a meta-analysis

Literature suggests that dementia and, more generally, cognitive impairment affect the capacity to carry out activities of daily living (ADL) in aging. However, it is important to decipher the weight of specific cognitive domains and neurodegenerative profiles mainly related to ADL difficulties. A meta-analysis was conducted to investigate the nature and strength of the association between cognitive functioning and ADL in healthy older adults, mild cognitive impairment (MCI), and dementia. A comprehensive search of the PubMed, PsycINFO (PROQUEST), and Scopus databases for cross-sectional or longitudinal studies up until December 2022. Our meta-analytic results revealed that: overall, instrumental ADL (IADL) showed a significant association with executive functioning, in particular, abstraction ability/concept formation, set-shifting, and processing speed/complex attention/working memory, regardless of type of participants (i.e., healthy older adults, MCI, and dementia); whereas ADL (both basic ADL, BADL, and IADL) significantly correlated with global cognitive functioning and long-term verbal memory, with a moderator effect of clinical condition (e.g., increasing ES based on the level of cognitive impairment). Moreover, visuospatial and language abilities significantly correlated with ADL, mainly when performance-based tasks were used for ADL assessment. These findings emphasize the importance of neuropsychological assessment in aging to early identify people most at risk of functional decline and shed light on the need to consider specific cognitive abilities in rehabilitation programs.

Blood-Based Biomarkers for Early Alzheimer's Disease Diagnosis in Real-World Settings

As our knowledge about the biology of Alzheimer's disease (AD) expands and we recognize the significance of early intervention for effective treatment, there is a shift in focus toward detecting the disease at an early stage. AD is characterized by the accumulation of misfolded amyloid-β (Aβ) and phosphorylated tau proteins in the brain, leading to the formation of senile plaques and neurofibrillary tangles. While a definitive diagnosis of AD can only be confirmed through autopsy by examining these pathological features, there are now reliable methods available for diagnosing the disease in living individuals. These methods involve analyzing cerebrospinal fluid and using positron emission tomography to accurately assess the presence of Aβ and tau proteins. While these diagnostic markers have shown high accuracy in memory-clinic populations, they do have limitations such as the requirement for invasive lumbar puncture or exposure to ionizing radiation. Additionally, they are not easily accessible outside of specialized healthcare settings. Blood-based biomarkers of the core pathological features of AD are being developed, showing promise for less invasive, scalable identification of AD cases in the community. The advantages for the healthcare systems of this development are obvious, but the diagnostic performance of blood-based biomarkers in broader, non-selected populations outside of retrospective analyses and research cohorts still requires further investigation, including the combination with more effective neuropsychological assessments such as digital cognitive test solutions.

Loss-of-Set and Strategy Application on the Menu Task: An Exploratory Study

Background. The Menu Task (MT) is an occupational therapy screening measure designed to identify people in need of functional cognitive (FC) assessment. Purpose. To explore whether test-taker strategy selection on the MT is clinically informative. Methods. Using a cross-sectional design we administered assessments of FC including the MT and the After MT interview, cognitive screening measures, and self-report instrumental activities of daily living assessment to a convenience sample of 55 community-dwelling adults. After MT interviews responses were qualitatively characterized as (a) loss of set (e.g., not recognizing that food preferences are irrelevant to task performance), (b) calorie counting, or (c) planning. Findings. Loss of set was associated with poorer performance on most study measures, calorie counting was associated with superior performance on most study measures, and no differences were observed relating to planning. Implications. Determining the test-takers approach to the MT adds information to that provided by the MT itself.

Validation of the Short Form of Korean-Everyday Cognition (K-ECog)

BACKGROUND

Evaluating the activities of daily living (ADL) is an important factor for diagnosing dementia. The Everyday Cognition (ECog) scale was developed to measure ADL changes that were correlated with specific neuropsychological impairments. A short form of the ECog (ECog-12) was also developed, consisting of 12 items, two from each of the six cognitive domains of the ECog. The Korean full version of ECog (K-ECog) has recently been standardized, but the need for a shortened version has been raised in clinical practice. The purpose of this study was to develop a Korean version of ECog-12 (K-ECog-12) and to verify its reliability and validity by comparing those to the full version of K-ECog.

METHODS

The participants were 267 cognitively normal older adults (CN), 183 patients with mild cognitive impairment (MCI), and 89 patients with dementia. The Korean-Mini Mental State Examination (K-MMSE), Korean-Montreal Cognitive Assessment (K-MoCA), and Short form of Geriatric Depression Scale (SGDS) were administered to all participants. The K-ECog and Korean-Instrumental Activities of Daily Living (K-IADL) were rated by the informants of patients.

RESULTS

K-ECog-12 was newly constructed by replacing one item for the visuospatial function in the original ECog-12 with another one through an item response theory analysis on Korean data. The internal consistencies (Cronbach's α) of K-ECog-12 and K-ECog were 0.95 and 0.99, respectively. The test-retest reliabilities (Pearson's r) were 0.67 for K-ECog-12 and 0.73 for K-ECog. The K-ECog-12 was significantly correlated with K-ECog as well as K-IADL, K-MMSE, and K-MoCA. The K-ECog-12 scores differed significantly between the CN, MCI, and dementia groups, as did the K-ECog scores. Receiver operating characteristic curve analyses showed that K-ECog-12, like K-ECog, could differentiate MCI and dementia patients from CN as well.

CONCLUSION

The K-ECog-12 is as reliable and valid as the K-ECog in assessing ADL. Therefore, K-ECog-12 can be used as an alternative to the K-ECog in clinical and community settings in Korea.

Memory performance on the ChAMP in autism spectrum disorder with and without attention-deficit/hyperactivity disorder

Memory difficulties have been identified in youth with neurodevelopmental conditions including autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). The Child and Adolescent Memory Profile (ChAMP) is a newer memory measure with a burgeoning research base. This study seeks to explore memory performance on the Lists and Objects subtests of the ChAMP in a clinical sample of those with ASD with/without co-occurring ADHD. Participants were 146 youth referred for a neuropsychological evaluation (M age = 11.8 years; 76.03% male) diagnosed with ASD (N = 92 with ADHD, N = 54 without). Logistic regression (p = .393) indicated ChAMP performance is not predictive of whether the ASD group had co-occurring ADHD indicating there is no additive effect on memory. Compared to the ChAMP examiner's manual ASD sample, this study sample performed significantly better (p <.001) on all ChAMP measures. While the ChAMP is sensitive to memory difficulties in neurodevelopmental disorders, as indicated by the performance of the manual sample, the ASD sample of the manual may differ from other ASD samples. There were no differences between verbal and visual memory performance across the present study's sample.

The feasibility and acceptability of an app-based cognitive strategy training programme for older people

BACKGROUND

Increasing numbers of people are living with mild cognitive impairment in later life and seeking therapy to maintain cognition to remain as independent as possible in daily life. Based on a review of the literature, an app-based programme using perceptual-encoding strategies called Enhancing Memory in Daily Life (E-MinD Life) was developed. An expert panel reviewed the programme's appropriateness for older people with and without mild cognitive impairment. As part of the design process, the feasibility and acceptability of the E-MinD Life programme were then assessed in relation to its use by healthy older adults, with findings informing the application of the programme to older people with mild cognitive impairment in the future.

METHODS

Phase 1: The E-MinD Life programme was reviewed by an expert panel of occupational therapists. Experts rated the programme on a Likert scale and answered open-ended questions in relation to feasibility, clarity, and relevancy. Phase 2 involved field-testing the 9-week programme with a sample of nine healthy older people. Participants rated the acceptability of the programme on a Likert scale questionnaire. Data on recruitment rates and retention, and adherence and duration of sessions were collected to determine the feasibility of the programme. Responses to the Likert scale were analysed using descriptive statistics. Open-ended responses were categorised qualitatively using a constant comparative approach.

RESULTS

Phase 1: Experts indicated that the E-MinD Life programme was feasible and included relevant activities for community living. Although experts felt that an older user with mild NCD would be able to independently complete the programme, the qualitative analysis suggests formatting changes in future iterations of the programme to enhance visual clarity. Phase 2: All participants completed the 9-week programme. The average number of self-administered sessions attempted over the 9-week period was 13.44 (SD = 6.73) out of 18 scheduled sessions. Overall, most participants found the programme relevant, logical and easy to understand, and perceived it to be effective for functional cognitive problems.

CONCLUSION

The E-MinD Life programme shows promise for inclusion into trial designs to determine the effectiveness of the cognitive strategy programme for older people with and without cognitive impairment.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03430401. Registered 1 February 2018.

Psychometric properties of the Alzheimer's Disease Cooperative Study - Activities of Daily Living for Mild Cognitive Impairment (ADCS-MCI-ADL) scale: a post hoc analysis of the ADCS ADC-008 trial

BACKGROUND

The Alzheimer's Disease Cooperative Study - Activities of Daily Living Scale for use in Mild Cognitive Impairment (MCI), the ADCS-ADL-MCI, is an evaluation scale with information provided by an informant/caregiver to describe the functional impairment of patients with MCI. As the ADCS-ADL-MCI has yet to undergo a full psychometric evaluation, this study aimed to evaluate the measurement properties of the ADCS-ADL-MCI in subjects with amnestic MCI.

METHODS

Measurement properties, including item-level analysis, internal consistency reliability, test-retest reliability, construct validity (convergent/discriminant, known-groups validity), and responsiveness were evaluated using data from the ADCS ADC-008 trial, a 36-month, multicenter, placebo-controlled study in 769 subjects with amnestic MCI (defined by clinical criteria and a global clinical dementia rating, CDR, score of 0.5). Due to most subjects' mild condition at baseline and resulting low variance in scores, psychometric properties were assessed using both baseline and 36-month data.

RESULTS

Ceiling effects were not apparent at the total score level, with 3% of the cohort reaching the maximum score of 53, despite most subjects having a relatively high score at baseline (mean score = 46.0 [standard deviation = 4.8]). Item-total correlations were overall weak at baseline, most likely due to low variability in responses; however, at month 36, good item homogeneity was found. Cronbach's alpha values ranged from acceptable (0.64 at baseline) to good (0.87 at month 36), indicating overall very good internal consistency reliability. Further, moderate to good test-retest reliability was found (intraclass correlation coefficients ranging from 0.62-0.73). The analyses also largely supported convergent/discriminant validity, especially at month 36. Finally, the ADCS-ADL-MCI discriminated well between groups showing good known-groups validity, and was responsive in patients who indicated a longitudinal change in other instruments.

CONCLUSIONS

This study provides a comprehensive psychometric evaluation of the ADCS-ADL-MCI. Findings suggest that the ADCS-ADL-MCI is a reliable, valid and responsive measure capable of capturing functional abilities in patients with amnestic MCI.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT00000173.

The CERAD Word List Memory Test: Normative Data Based on a Norwegian Population-Based Sample of Healthy Older Adults 70 Years and Above. The HUNT Study

BACKGROUND

The CERAD Word List Memory Test (WLMT) is widely used in the assessment of older adults with suspected dementia. Although normative data of the WLMT exist in many different regions of the world, normative data based on large population-based cohorts from the Scandinavian countries are lacking.

OBJECTIVE

To develop normative data for the WLMT based on a large population-based Norwegian sample of healthy older adults aged 70 years and above, stratified by age, gender, and education.

METHODS

A total of 6,356 older adults from two population-based studies in Norway, HUNT4 70 + and HUNT4 Trondheim 70+, were administered the WLMT. Only persons with normal cognitive function were included. We excluded persons with a diagnosis of mild cognitive impairment (MCI) and dementia, and persons with a history of stroke and/or depression. This resulted in 3,951 persons aged between 70 and 90 years, of whom 56.2% were females. Regression-based normative data were developed for this sample.

RESULTS

Age, gender, and education were significant predictors of performance on the WLMT list-learning subtests and the delayed recall subtest, i.e., participants of younger age, female sex, and higher education level attained higher scores compared to participants of older age, male sex, and lower level of education.

CONCLUSION

Regression-based normative data from the WMLT, stratified by age, gender, and education from a large population-based Norwegian sample of cognitively healthy older adults aged 70 to 90 years are presented. An online norm calculator is available to facilitate scoring of the subtests (in percentiles and z-scores).

VR for Cognition and Memory

This chapter will provide a review of research into human cognition through the lens of VR-based paradigms for studying memory. Emphasis is placed on why VR increases the ecological validity of memory research and the implications of such enhancements.

Broadened assessments, health education and cognitive aids in the remote memory clinic

The prevalence of dementia is increasing and poses a health challenge for individuals and society. Despite the desire to know their risks and the importance of initiating early therapeutic options, large parts of the population do not get access to memory clinic-based assessments. Remote memory clinics facilitate low-level access to cognitive assessments by eschewing the need for face-to-face meetings. At the same time, patients with detected impairment or increased risk can receive non-pharmacological treatment remotely. Sensor technology can evaluate the efficiency of this remote treatment and identify cognitive decline. With remote and (partly) automatized technology the process of cognitive decline can be monitored but more importantly also modified by guiding early interventions and a dementia preventative lifestyle. We highlight how sensor technology aids the expansion of assessments beyond cognition and to other domains, e.g., depression. We also illustrate applications for aiding remote treatment and describe how remote tools can facilitate health education which is the cornerstone for long-lasting lifestyle changes. Tools such as transcranial electric stimulation or sleep-based interventions have currently mostly been used in a face-to-face context but have the potential of remote deployment-a step already taken with memory training apps. Many of the presented methods are readily scalable and of low costs and there is a range of target populations, from the worried well to late-stage dementia.

Examining Voting Capacity in Older Adults with and without Cognitive Decline

BACKGROUND

Nowadays, controversy exists regarding the stage of cognitive decline and/or dementia where voting capacity is diminished.

AIM

To evaluate whether general cognitive status in advancing age predicts voting capacity in its specific aspects.

METHODS

The study sample comprised 391 people: 88 cognitively healthy older adults (CH), 150 people with Mild Cognitive Impairment (MCI), and 153 people with Alzheimer's disease dementia (ADD). The assessment included CAT-V for the voting capacity and Mini Mental State Examination (MMSE) for general cognitive ability. ANOVAs and ROC curves were the tools of statistical analysis towards (a) indicating under which MMSE rate participants are incapable of voting and (b) whether the CAT-V total score can discriminate people with dementia (PwADD) from people without dementia (PwtD).

RESULTS

Out of the six CAT-V questions, one question was associated with a low MMSE cutoff score (19.50), having excellent sensitivity (92.5%) and specificity (77.20%), whilst the other five questions presented a higher MMSE cutoff score, with a good sensitivity (78.4% to 87.6%) and specificity (75.3% to 81.7%), indicating that voting difficulties are associated with cognitive status. Secondarily, the total CAT-V score discriminates PwADD from PwtD of 51-65 years (sensitivity 93.2%/specificity 100%-excellent), PwADD from PwtD of 66-75 years (sensitivity 73.3%/specificity 97.1%-good), PwADD from PwtD of 76-85 years (sensitivity 92.2%/specificity 64.7%-good), whilst for 86-95 years, a cutoff of 9.5 resulted in perfect sensitivity and specificity (100%).

CONCLUSION

According to MMSE, PwADD have no full voting competence, whilst PwtD seem to have intact voting capacity. The calculated cut-off scores indicate that only people who score more than 28 points on the MMSE have voting capacity.

The role of structured exercise interventions on cognitive function in older individuals with stable Chronic Obstructive Pulmonary Disease: A scoping review

A decline in cognitive performance has been associated with disease severity, exacerbations rate, presence of comorbidities, and low activity level in people with chronic obstructive pulmonary disease (COPD). Participation in exercise programs appears to have neuroprotective effects and to improve cognitive performance in older people. The present work undertook a scoping review of the effects of exercise-based interventions on cognitive function in older individuals with stable COPD.

METHODS

The methodological framework for scoping review was used and electronic searches of five databases performed. Original research and observational studies published between January 2010 and December 2021, administering exercise-based interventions and cognitive function evaluation, were included.

RESULTS

Of 13 full-text manuscripts assessed for eligibility, five were allocated to analysis. Three studies administered exercise training within pulmonary outpatient rehabilitation program (PR), and one inpatient PR. The fifth study conducted a structured training intervention in which either aerobic or a combination with resistance exercises were included. Twelve cognitive function screening tools were used in the five studies included in the analysis. Results extracted were based on 245 COPD (33% female) with moderate to very-severe airflow limitation. Interventions ranged from 12 to 36 sessions. Studies reported statistically significant improvements after intervention in different cognitive function domains, such as global cognition, immediate and delayed recall ability, cognitive flexibility, verbal fluency, attention, abstract reasoning, praxis ability.

CONCLUSIONS

Exercise-based interventions improve several areas of cognitive function in patients with stable COPD. However, the magnitude of gain varies among studies, and this is possibly due to the heterogeneity of tests used. Future research is needed to validate the optimal battery of screening tests, and to support the definition of guidelines for cognitive function evaluation in COPD.

Clinical Data Interchange Standards in Clinical Trials on Alzheimer's Disease

OBJECTIVE

The Clinical Data Interchange Standards Consortium (CDISC) proposed outcome measures for clinical trials on Alzheimer's disease (AD) in the Therapeutic Area User Guide for AD (TAUG-AD). To investigate how well the clinical trials on AD registered in the ClinicalTrials.gov complied with the recommendations on outcome measures by the CDISC.

METHODS

We compared the outcome measures proposed in the TAUG-AD version 2.0.1 with those employed in the protocols of clinical trials on AD registered in ClinicalTrials.gov.

RESULTS

We analyzed 101 outcome measures from 305 protocols. The TAUG-AD listed ten scales for outcome measures of clinical trials on AD. The scales for cognition, activities of daily living, behavioral and psychological symptoms of dementia, and global severity listed in TAUG-AD were most frequently employed in the clinical trials on AD. However, TAUG-AD did not include any scale on quality of life. Also, several scales such as Montreal Cognitive Assessment, Alzheimer's Disease Cooperative Study-Activities of Daily Living, and Cohen- Mansfield Agitation Inventory not listed in the TAUG-AD were commonly employed in the clinical trials on AD and changed over time.

CONCLUSION

To properly standardize the data from clinical trials on AD, the gap between the TAUG-AD and the measures employed in real-world clinical trials should be filled.

The ecological validity of the Uniform Data Set 3.0 neuropsychological battery in individuals with mild cognitive impairment and dementia

Objective: Ecological validity refers to the ability of neuropsychological measures to predict real world performance. Questions remain as to the ecological validity of commonly used measures, particularly regarding their relationships to global versus specific activities of daily living among those with neurodegenerative disease. We explored these issues through the lens of the Uniform Data Set 3.0 Neuropsychological battery (UDS3NB) in individuals with mild cognitive impairment and dementia. Method: UDS3NB and informant rated Functional Activities Questionnaire scales were evaluated from 2,253 individuals with mild cognitive impairment and dementia. Ordinal regression equations were used to explore the relationships of demographic and cognitive variables with overall and specific instrumental activities of daily living. Results: Delayed recall for visual and verbal material, and performance on trail making tests were consistent predictors of global and specific functions. Specific skills (i.e. naming or figure copy) showed differential relationships with specific activities, while phonemic fluency was not related to any particular activity. Conclusions: Measures in the UDS3NB predicted activities of daily living in individuals with MCI and dementia, providing initial support for the ecological validity of these tests. Specifically, measures that tap core deficits of Alzheimer's disease, such as delayed recall and sequencing/shifting, are consistent predictors of performance in daily tasks.

Challenge of a dual burden in rapidly aging Delaware: Comorbid chronic conditions and subjective cognitive decline

BACKGROUND

Epidemiologic trends forecast a "dual burden"- increase in both physical chronic diseases and Alzheimer's disease (AD)- for Delaware. Estimating the burden and characteristics of this "dual burden" is critical. Cognizant of the unavailability of precise models to measure AD, SCD-a population-based measure- was used as an alternative. The primary objective was to delineate selected chronic conditions among Delaware adults with SCD in order to present: (i) prevalence of SCD by select sociodemographic characteristics, (ii) compare the prevalence of chronic conditions among people with and without SCD, and (iii) compare the prevalence of SCD associated functional limitations in Delawareans with and without comorbid chronic conditions.

METHODS

Combined data (2016 and 2020) for Delaware were obtained from the Behavioral Risk Factor Surveillance System. Analyses included 4,897 respondents aged 45 years or older who answered the SCD screening question as "yes" (n = 430) or "no" (n = 4,467). Descriptive statistics examined sociodemographic characteristics and chronic conditions in Delawareans with and without SCD.

RESULTS

Overall, 8.4% (CI: 7.4-9.5) of Delaware adults reported SCD. Delawareans with SCD were more likely to be in the younger age group (45-54 years), less educated, low income and living alone. Over 68 percent had not discussed cognitive decline with a health care professional. More than three in four Delawareans with SCD had a 1.5 times higher prevalence of having any one of the nine select chronic conditions as compared to those without SCD. Adults with SCD and at least one comorbid chronic condition were more likely to report SCD-related functional limitations.

CONCLUSIONS

Delaware cannot afford to postpone public policies to address the dual burden of SCD and chronic conditions. Results from this study can help public health stakeholders in Delaware to be informed and prepared for the challenges associated with cognitive decline and comorbidity.

Nonwearable Sensor-Based In-Home Assessment of Subtle Daily Behavioral Changes as a Candidate Biomarker for Mild Cognitive Impairment

Patients show subtle changes in daily behavioral patterns, revealed by traditional assessments (e.g., performance- or questionnaire-based assessments) even in the early stage of Alzheimer's disease (AD; i.e., the mild cognitive impairment (MCI) stage). An increase in studies on the assessment of daily behavioral changes in patients with MCI and AD using digital technologies (e.g., wearable and nonwearable sensor-based assessment) has been noted in recent years. In addition, more objective, quantitative, and realistic evidence of altered daily behavioral patterns in patients with MCI and AD has been provided by digital technologies rather than traditional assessments. Therefore, this study hypothesized that the assessment of daily behavioral changes with digital technologies can replace or assist traditional assessment methods for early MCI and AD detection. In this review, we focused on research using nonwearable sensor-based in-home assessment. Previous studies on the assessment of behavioral changes in MCI and AD using traditional performance- or questionnaire-based assessments are first described. Next, an overview of previous studies on the assessment of behavioral changes in MCI and AD using nonwearable sensor-based in-home assessment is provided. Finally, the usefulness and problems of nonwearable sensor-based in-home assessment for early MCI and AD detection are discussed. In conclusion, this review stresses that subtle changes in daily behavioral patterns detected by nonwearable sensor-based in-home assessment can be early MCI and AD biomarkers.

Mediating role of instrumental activities of daily living ability on cognitive function of older adults living alone: A 4-year longitudinal study from the Kasama study

The aim of this study was to clarify the effect of living alone on the cognitive function of older people and the mediating effect of instrumental activities of daily living (IADL) ability.The data for a final sample of 3276 participants aged 65 years and above who did not require long-term care at the baseline were used from a 4-year prospective cohort study conducted in Kasama City, Japan. Demographic data including age, sex, and depression at baseline were used as covariates. The Kihon checklist evaluated the IADL ability at baseline and cognitive function at follow-up. The characteristics of those living alone and with others were compared using the student t test and χ2 test. The effect of living alone on cognitive function was analyzed using logistic regression analysis. Mediation analyses determined the mediating effects of IADL.A total of 325 participants were living alone; they were significantly older than those living with others, more likely to be female, not provide emotional support, and have low physical function, more severe depression, and lower IADL disability. Living alone had a significantly lower risk of cognitive decline at follow-up than living with others. The mediation analysis revealed that IADL disability at follow-up was significantly associated with cognitive decline. Thus, greater IADL ability decreased cognitive decline risk.Older people living alone had a significantly lower risk of cognitive decline, and cognitive function significantly mediated IADL ability. Health support for enhancing IADL abilities may help older people living alone maintain good cognitive function.

Using a Timed Motor Task to Predict One-Year Functional Decline in Amnestic Mild Cognitive Impairment

Affordable, noninvasive methods of predicting functional decline are needed for individuals at risk for Alzheimer's disease. This study tested whether a timed upper-extremity motor task predicted functional decline over one year in 79 adults diagnosed with amnestic mild cognitive impairment. Participants completed subjective and objective measures of daily functioning at baseline and one year later. Motor task performance and delayed memory were also evaluated at baseline. Motor task performance was a significant predictor of one-year follow-up daily functioning, improving model fits by 18- 35%. Thus, motor behavior has potential to be an affordable enrichment strategy that is sensitive to functional decline.

Validation of the Cognitive Telephone Screening Instruments COGTEL and COGTEL+ in Identifying Clinically Diagnosed Neurocognitive Disorder Due to Alzheimer's Disease in a Naturalistic Clinical Setting

Background:

Telephone-based neurocognitive instruments embody valuable tools in identifying cognitive impairment in research settings and lately also in clinical contexts due to the pandemic crisis. The accuracy of the Cognitive Telephone Screening Instrument (COGTEL) in detecting mild- (MiND) and major (MaND) neurocognitive disorder has not been studied yet.

Objective:

Comparison of the utility of COGTEL and COGTEL+, which is enriched with orientation items, with the modified Mini-Mental State Examination (3MS) in detecting MiND and MaND due to Alzheimer’s disease (AD) and assessment of the impact of COGTEL face-to-face-versus telephone administration on individual performance.

Methods:

The study included 197 cognitively intact individuals (CI), being at least 45 years old, 95 and 65 patients with MiND and MaND due to AD, respectively. In 20 individuals COGTEL was administered both in face-to-face and telephone sessions. Statistical analyses included proportional odds logistic regression models, stratified repeated random subsampling used to recursive partitioning to training and validation set (70/30 ratio), and an appropriate F-test.

Results:

All studied instruments were significant predictors of diagnostic outcome, but COGTEL+ and 3MS explained more variance relative to the original COGTEL. Except for the validation regression models including COGTEL in which the average misclassification error slightly exceeded 15%, in all other cases the average misclassification errors (%) were lower than 15%. COGTEL administration modality was not related to systematic over- or underestimation of performance on COGTEL.

Conclusion:

COGTEL+ is a valuable instrument in detecting MiND and MaND and can be administered in face-to-face or telephone sessions.

Racial and ethnic disparities in subjective cognitive decline: a closer look, United States, 2015-2018

BACKGROUND

Subjective cognitive decline (SCD), characterized by self-experience of deterioration in cognitive performance may be a precursor to Alzheimer's disease (AD). Given the association of AD with dependence and disability for a long duration, earlier the detection, the sooner people and their families can receive information regarding better management. It is critical to explore disparities amongst racial and ethnic populations with SCD in order to facilitate targeted interventions. The primary objective was to identify disparities in prevalence of SCD amongst Whites, Blacks and Hispanics by select sociodemographic characteristics and functional limitations in a U.S. population-based sample of non-institutionalized adults aged 45 and older. The secondary objective was to assess the association between SCD and select chronic conditions (angina, heart attack, stroke, diabetes, high blood pressure and high cholesterol) by race/ethnicity.

METHODS

Combined data (2015-2018) were obtained from the Behavioral Risk Factor Surveillance System (BRFSS) to conduct a population -based study. Analyses included 179,852 respondents aged 45 years or older who answered the SCD screening question as "yes" (n = 19,276) or "no" (n = 160,576). Descriptive statistics examined sociodemographic characteristics including functional limitations amongst racial/ethnic groups with SCD. Association of SCD with chronic conditions by race/ethnicity was also calculated.

RESULTS

Overall, 10.8% (CI: 10.6-11.1) of adults aged 45 years or older reported SCD.10.7% Whites, 12.3% Blacks and 9.9% Hispanics experienced SCD. Blacks and Hispanics with SCD were more likely to be in the younger age group (45-54 years), less educated, low income, without access to health care, living alone and with functional limitations. Only half had discussed cognitive decline with a health care professional. Prevalence of selected chronic conditions was significantly higher in all racial/ethnic groups with SCD.

CONCLUSIONS

Demographic trends predict a larger proportion of Hispanics and Blacks with SCD in the coming years. This information can lead to identification of opportunities for addressing negative SCD outcomes in minorities affected by inequitable conditions.

Impacts of stroke and cognitive impairment on activities of daily living in the Taiwan longitudinal study on aging

Stroke and cognitive impairment are common in older population. They often occur together and their combined effects significantly increase disability in both basic (BADLs) and instrumental (IADLs) activities of daily living. We investigated the individual and combined impacts of stroke and cognitive impairment on BADLs and IADLs. A total of 3331 community-dwelling older adults were enrolled from the Taiwan longitudinal study on aging in 2011. Both BADLs and IADLs were analyzed. Combination of stroke and cognitive impairment increased severity of ADL disabilities, but similar prevalence, similar numbers of summed BADL and IADL tasks with disability, and similar levels of difficulty for each BADL and IADL task were found between the stroke group and cognitive impairment group. The former had more difficult in dressing while the latter had more difficult in using the telephone, transport, and managing finances. A hierarchy of ADLs was also observed in all groups. ADL skill training supplemented with cognitive and physical interventions should focus on secondary prevention of dementia and improve motor functional capacity to reduce loss of ADLs.

Effects of combined training on neuropsychiatric symptoms and quality of life in patients with cognitive decline

BACKGROUND AND AIMS

Cognitive impairments associated with aging and dementia are major sources of neuropsychiatric symptoms (NPs) and deterioration in quality of life (QoL). Preventive measures to both reduce disease and improve QoL in those affected are increasingly targeting individuals with mild cognitive impairment (MCI) at early disease stage. However, NPs and QoL outcomes are too commonly overlooked in intervention trials. The purpose of this study was to test the effects of physical and cognitive training on NPs and QoL in MCI.

METHODS

Baseline data from an MCI court (N = 93, mean age 74.9 ± 4.7) enrolled in the Train the Brain (TtB) study were collected. Subjects were randomized in two groups: a group participated to a cognitive and physical training program, while the other sticked to usual standard care. Both groups underwent a follow-up re-evaluation after 7 months from baseline. NPs were assessed using the Neuropsychiatric Inventory (NPI) and QoL was assessed using Quality of Life-Alzheimer's Disease (QOL-AD) scale.

RESULTS

After 7 months of training, training group exhibited a significant reduction of NPs and a significant increase in QOL-AD with respect to no-training group (p = 0.0155, p = 0.0013, respectively). Our preliminary results suggest that a combined training can reduce NPs and improve QoL.

CONCLUSIONS

Measuring QoL outcomes is a potentially important factor in ensuring that a person with cognitive deficits can 'live well' with pathology. Future data from non-pharmacological interventions, with a larger sample and a longer follow-up period, could confirm the results and the possible implications for such prevention strategies for early cognitive decline.

Assessment of judgment ability in a Brazilian sample of patients with mild cognitive impairment and dementia

Judgment is the ability to make sound decisions after consideration of relevant information, possible solutions, likely outcomes, and contextual factors. Loss of judgment is common in patients with mild cognitive impairment (MCI) and dementia. The Test of Practical Judgment (TOP-J) evaluates practical judgment in adults and the elderly, with 15- and 9-item versions that require individuals to listen to scenarios about everyday problems and report their solutions.

Differences between episodic and semantic memory in predicting observation-based activities of daily living in mild cognitive impairment and Alzheimer's disease

Individuals with mild cognitive impairment (MCI) can often progress into Alzheimer's Disease (AD). Research suggests that decline in episodic memory and semantic memory, as well as functional abilities, can be sensitive in predicting disease progression. This study aimed to (a) investigate episodic and semantic memory performance differences between AD and MCI, (b) determine if memory performance predicts observation-based activities of daily living (ADLs), and (c) explore whether semantic memory mediates the relationship between episodic memory and ADLs. Fifty-eight AD, 53 MCI, and 72 healthy control participants were administered the Rey-O, California Verbal Learning Test, Animal Fluency Test, Boston Naming Test, and Direct Assessment of Functional Status (DAFS). The results revealed, first, that AD participants performed significantly lower than the MCI participants across semantic memory and episodic memory tasks, with the exception of the Boston Naming Test. Second, hierarchical-stepwise regression analyses found that semantic memory significantly predicted DAFS orientation, communication, and financial skills in AD, but episodic memory predicted shopping skills. Furthermore, semantic memory significantly predicted DAFS transportation skills in AD and MCI. Third, within the overall sample, semantic memory mediated the relationship between episodic memory and ADLs. Taken together, the findings suggest decline in semantic memory (as measured by confrontational naming and category fluency) and episodic memory (as measured by list and complex visual design learning and recall) may lead to decline in different and specific aspects of functional abilities in AD and MCI.

Everyday Memory Failures in Older Adults with Amnestic Mild Cognitive Impairment

Identifying people with amnestic mild cognitive impairment (aMCI), who are at increased risk of developing Alzheimer's disease, is important for improving early disease management and care. Although self- or informant-reported memory problems constitute one of the diagnostic criteria of aMCI, there is currently little empirical knowledge about the frequency and nature of everyday memory failures in aMCI compared to age-matched healthy controls. Consequently, clinicians rely on their personal judgements when assessing the seriousness of reported memory failures. To address this gap in our knowledge, 32 aMCI participants and 38 healthy controls recorded their everyday memory failures as and when they occurred during a 7-day period, in a portable diary-booklet, by filling in a short questionnaire on a diary page. Descriptions of memory failures were coded into several subcategories of retrospective memory, prospective memory, and absent-minded failures. Results showed that a total number of recorded failures was significantly higher in participants with aMCI than controls. This group difference was mainly due to aMCI participants recording a higher number of retrospective memory failures, while groups did not differ in the number of prospective memory and absent-minded failures. Additionally, while certain types of failures (i.e., forgetting appointments and well-learned procedures) were recorded by a proportion of aMCI patients, they were never reported in a control group. Overall compliance rates were high and did not differ across the groups, suggesting that a structured diary method is feasible to use with aMCI patients, and can provide useful information about everyday memory functioning in this population.

Change in Depression, Confidence, and Physical Function Among Older Adults With Mild Cognitive Impairment

BACKGROUND AND PURPOSE

Nearly a quarter of those in the United States older than 71 years experience mild cognitive impairment. Persons with mild cognitive impairment battle depression and progressive disengagement from daily activities, which contribute to participation restriction and activity limitation. Daily engagement in meaningful activity (DEMA) is a tailored intervention designed to benefit persons with mild cognitive impairment and their caregivers through preserved engagement and supported adjustment to cognitive changes. This secondary analysis was guided by the International Classification of Functioning, Disability and Health (ICF) model. Aims were to (i) explore the extent to which change in self-rated activity performance and physical function can predict change in depressive symptoms, (ii) evaluate for difference in confidence and depressive symptoms at ICF levels of activity and participation, and (iii) quantify the impact of daily engagement at the ICF level of participation on physical function.

METHODS

A secondary analysis was conducted using data from the parent study, which was a 2-group randomized trial involving persons with mild cognitive impairment and their informal caregivers participating in the Indiana Alzheimer Disease Center DEMA program. Quantitative analysis (dyads: DEMA N = 20, Information Support N = 20) examined outcomes at posttest and follow-up. Analysis employed linear regression to model the relationship between explanatory and dependent variables and independent t test to examine for difference in confidence, depression, and physical function.

RESULTS AND DISCUSSION

At posttest, change in self-rated performance predicted change in depressive symptoms. Those in the DEMA group who engaged in activity at the ICF level of participation demonstrated a significant increase in confidence and physical function. Although not significant, the control group posttest results showed a mean decrease in confidence.

CONCLUSIONS

Results demonstrate a positive impact of DEMA on depressive symptoms, confidence, and physical function. Change in occupational performance predicted change in depressive symptoms. Confidence significantly improved among those who engaged at the ICF participation level. A larger, randomized controlled longitudinal trial is needed to better assess the impact of DEMA on physical function, activity, participation restriction, and quality of life.

Influencing Factors and Exercise Intervention of Cognitive Impairment in Elderly Patients with Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a common respiratory condition characterized by airflow limitation in the elderly. Airflow limitation is partially reversible and progressive. COPD not only causes a gradual decline in lung function but also affects the function of other systems throughout the body; it also has adverse effects on the central nervous system that can lead to cognitive impairment, especially in elderly patients. Therefore, understanding the influencing factors of cognitive impairment in elderly patients with COPD and applying early intervention are crucial in improving the quality of life of patients and reducing the burden on their families and society. This article mainly discusses the related factors of cognitive impairment in elderly patients with COPD and expands the possible mechanism of exercise in improving cognitive impairment in patients with COPD to provide a reference for the clinical prevention and treatment of cognitive impairment in elderly patients with COPD.

A Meta-Analysis of Neuropsychological Predictors of Outcome Following Stroke and Other Non-Traumatic Acquired Brain Injuries in Adults

A number of cognitive abilities have been reported to predict outcome following a non-traumatic acquired brain injury (ABI) in adults. However, the results are inconsistent. Furthermore, the unique and combined capacity of these cognitive abilities to predict ABI outcome has not been evaluated. Consequently, we employed meta-analysis and multiple regression to evaluate the capacity of various neuropsychological domains to predict two separate outcome variables in adults: (1) activities of daily living; and (2) quality of life. Based on the activities of daily living meta-analysis (N = 2384), we estimated the following significant bivariate effects: memory (r = .31, 95% CI: .20/.41]), language (r = .33, 95% CI:.26/.40), attention (r = .38, 95% CI: .30/.46]), executive functions (r = .29, 95% CI: .19/.39]), and visuospatial abilities (r = .41, 95% CI: .34/ .48). Based on the quality of life meta-analysis (N = 1037), we estimated the following significant bivariate effects: memory (r = .12, 95% CI: .03/.20]), language (r = .19, 95% CI: .06/ .32), attention (r = .30, 95% CI: .16/.44]), executive functions (r = .24, 95% CI: .12/.37) and visuospatial/constructional abilities (r = .30, 95% CI: .14/.46). Meta-analytic structural equation modelling (metaSEM) identified two significant, unique predictors of activities of daily living, attention and visuospatial abilities, and the model accounted for 21% of the variance (multiple R² = .21, 95%CI: .16/.26). For the corresponding quality of life metaSEM, no statistically significant unique predictors were identified, however, a significant multiple correlation was observed, multiple R² = .11 (95%CI: 04/.18). We conclude that practitioners may be able to predict, with some degree of accuracy, functional outcome following a stroke and other non-traumatic ABI in adults. We also provide some critical commentary on the nature and quality of the measures used in this area of research to represent the cognitive dimensions of interest.

Relationship between instrumental activities of daily living performance and incidence of mild cognitive impairment among older adults: A 48-month follow-up study

Early prevention of mild cognitive impairment MCI is crucial because individuals with MCI are at high risk for progression to dementia. The purpose of the present study was to examine the relationship between the performance of instrumental activities of daily living IADL and future incidence of MCI among community-dwelling older adults in Japan. A total of 1595 individuals without cognitive impairment at baseline participated in this prospective cohort study with a 48-month follow-up period. Performance on the following IADL was assessed at baseline: handling cash and banking, shopping for necessities, going out using buses/trains, using maps to travel to unfamiliar places, and operating video/DVD players. Objective cognitive screening using the National Center for Geriatrics and Gerontology-Functional Assessment Tool and Mini-Mental State Examination was conducted at baseline and follow-up; new MCI incidence over the 48 months was determined. Of all participants, 922 (57.8 %) had a limitation in at least one IADL at baseline. During the follow-up period, 179 (11.2 %) participants experienced a transition from normal cognition to MCI. Participants who had not engaged in "going out using buses/trains" or "using maps to travel to unfamiliar places" at baseline showed a significantly higher risk of MCI incidence than those who had engaged in such activities. Limitations in outdoor IADL were associated with MCI onset. Individuals with such limitations need to be monitored, as these limitations are strong indicators of cognitive decline and MCI.

Selecting Remote Measurement Technologies to Optimize Assessment of Function in Early Alzheimer's Disease: A Case Study

Despite the importance of function in early Alzheimer's disease (AD), current measures are outdated and insensitive. Moreover, COVID-19 has heighted the need for remote assessment in older people, who are at higher risk of being infection and are particularly advised to use social distancing measures, yet the importance of diagnosis and treatment of dementia remains unchanged. The emergence of remote measurement technologies (RMTs) allows for more precise and objective measures of function. However, RMT selection is a critical challenge. Therefore, this case study outlines the processes through which we identified relevant functional domains, engaged with stakeholder groups to understand participants' perspectives and worked with technical experts to select relevant RMTs to examine function. After an extensive literature review to select functional domains relevant to AD biomarkers, quality of life, rate of disease progression and loss of independence, functional domains were ranked and grouped by the empirical evidence for each. For all functional domains, we amalgamated feedback from a patient advisory board. The results were prioritized into: highly relevant, relevant, neutral, and less relevant. This prioritized list of functional domains was then passed onto a group of experts in the use of RMTs in clinical and epidemiological studies to complete the selection process, which consisted of: (i) identifying relevant functional domains and RMTs; (ii) synthesizing proposals into final RMT selection, and (iii) verifying the quality of these decisions. Highly relevant functional domains were, "difficulties at work," "spatial navigation and memory," and "planning skills and memory required for task completion." All functional domains were successfully allocated commercially available RMTs that make remote measurement of function feasible. This case study provides a set of prioritized functional domains sensitive to the early stages of AD and a set of RMTs capable of targeting them. RMTs have huge potential to transform the way we assess function in AD-monitoring for change and stability continuously within the home environment, rather than during infrequent clinic visits. Our decomposition of RMT and functional domain selection into identify, synthesize, and verify activities, provides a pragmatic structure with potential to be adapted for use in future RMT selection processes.

Characterizing functional alterations in instrumental activities of daily living using latent class analysis: a population-based study (NEDICES)

Background and Objectives: The existence of different patterns of functional impairment in older adults has scarcely been addressed. This research investigates major patterns of functional impairment based on Pfeffer's Functional Activity Questionnaire (FAQ).Research Design and Methods: The participants come from NEDICES (Neurological Disorders in Central Spain), a prospective population-based cohort study. A total of 3837 individuals without dementia who completed the Spanish version of the FAQ was selected. Latent Class Analysis (LCA) was carried out to examine potential cluster subgroups based on FAQ responses.Results: The FAQ showed good internal consistency (Cronbach's alpha: 0.86) and moderate correlation (r = -.40) with cognitive performance on the Mini-Mental State Examination (MMSE-37). The response patterns revealed the presence of three latent classes: absence of functional alteration (Class 1), established functional alteration (Class 2), and minimal functional alteration (Class 3). Moreover, the probability of resolving Items 2 ('shopping alone for…'), 3 ('heating water…'), 4 ('preparing a balanced meal'), and 9 ('travelling out of neighbourhood…') was close to 0% for Class 2 membership, while those with the lowest probability of resolution for Class 3 were Items 2 and 9. Items 3 and 4 were the best to discriminate between different grades of functional alterations (Class 2 vs. Class 3).Discussion and Implications: Our findings indicate that the combination of overall FAQ score and item response pattern may help to classify individuals with different subtypes of functional impairment. The Spanish version of the FAQ is a useful tool for detection of functional impairment in older adults.

The Association between the Montreal Cognitive Assessment and Functional Activity Questionnaire in the Systolic Blood Pressure Intervention Trial (SPRINT)

OBJECTIVE

To examine the association of global cognitive function assessed via the Montreal Cognitive Assessment (MoCA) and deficiencies in instrumental activities of daily living (IADL) on the Functional Activity Questionnaire (FAQ) in hypertensive older adults in the Systolic Blood Pressure Intervention Trial (SPRINT).

METHODS

In cross-sectional analysis, 9,296 SPRINT participants completed the MoCA at baseline. The FAQ was obtained from 2,705 informants for SPRINT participants scoring <21 or <22 on the MoCA, depending on education. FAQ severity ranged from no dysfunction (Score = 0) to moderate/severe dysfunction (Score = 5+).

RESULTS

Participants who triggered FAQ administration were older, less educated, and more likely to be Black or Hispanic (p < 0.001). Sixty-one percent (n = 1,661) of participants' informants reported no functional difficulties in IADLs. An informant report, however, of any difficulty on the FAQ was associated with lower MoCA scores after controlling for age, sex, race/ethnicity, and education (p < 0.05). Partial proportional odds regression indicates that participants scoring lower on the MoCA (in the 10th to <25th, fifth to <10th, and <fifth percentiles) had higher adjusted odds of their informant indicating dysfunction on the FAQ, relative to participants scoring at or above the 25th percentile on the MoCA (p < 0.001).

CONCLUSIONS

While lower global cognitive function was strongly associated with IADL deficits on FAQ, informants indicated no functional difficulties for the majority of SPRINT participants, despite low MoCA scores. These findings can help with designing future studies which aim to detect mild cognitive impairment and/or dementia in large, community-dwelling populations.

The efficacy of cognitive interventions on the performance of instrumental activities of daily living in individuals with mild cognitive impairment or mild dementia: protocol for a systematic review and meta-analysis

BACKGROUND

Cognitive changes associated with mild cognitive impairment or mild dementia can lead to difficulties in completing instrumental activities of daily living. The ability to live independently at home and in the community is often compromised due to the inability to complete these activities. Cognitive interventions have been reported as beneficial in maintaining or improving cognitive functions among this group of adults. However, the effectiveness of different types of cognitive interventions on the performance of instrumental activities of daily living in older adults with mild cognitive impairment and mild dementia is not well established. The aim of this paper is to develop a protocol for a systematic review and meta-analysis to investigate the effectiveness of cognitive interventions in maintaining or improving the performance of instrumental activities of daily living in individuals with mild cognitive impairment or mild dementia.

METHODS

Randomised control studies which investigate the effectiveness of cognitive interventions on the performance in instrumental activities of daily living for older adults with mild cognitive impairment and mild dementia will be sought. A systematic search will be conducted in five databases: CINAHL, MEDLINE, EMBASE, PsycINFO and Cochrane Central Register of Controlled Trials. The search strategy was developed with assistance from a health science librarian. Two independent reviewers will perform the study selection and data extraction. Quality assessment will be implemented using the Physiotherapy Evidence Database (PEDro) scale. A narrative synthesis of the findings will be used to report outcomes of all included studies. If appropriate, a meta-analysis will combine the results of individual studies.

DISCUSSION

This systematic review and meta-analysis will determine the effectiveness of cognitive interventions in maintaining or improving the performance of IADL in individuals with MCI or mild dementia. It is anticipated that the results will inform rehabilitation professionals of the most effective cognitive interventions to be implemented into clinical practice. It will potentially provide substantial benefit to both the persons with MCI or dementia and the health care system by keeping more people out of full-time care and allowing those in full-time care to require less intensive support.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42016042364.

An augmented reality approach for ADL support in Alzheimer's disease: a crossover trial

Background

Dementia of the Alzheimer’s type can impair the performance of activities of daily living and therefore severely impact independent living. Assistive technologies can support such patients when carrying out daily tasks.

Methods

In this crossover study, we used an augmented reality approach using a Microsoft HoloLens to support patients in a tea making task. During task execution, subjects received three-dimensional dynamic holograms of the sub-steps necessary to complete the task. Ten patients suffering from Alzheimer’s disease were tested and post-hoc semi-structured interviews were conducted to assess usability.

Results

The patients committed errors when executing the task with and without holographic assistance. No differences in success rates or error frequencies were observed (p_success = .250, p_errors = .887). Patients revealed prolonged trial durations (Glass’ Δ = 1.475) when wearing the augmented reality headset. A model of multiple linear regression (R²_adjusted = .958) revealed an influence of the errors in the control condition and a moderation by the errors in the experimental condition. Patients with more severe problems in the natural performance of the task showed lower increases in trial durations when wearing the HoloLens.

Conclusions

We assume that the application was a secondary task requesting its own resources and impairing performance on its own. The regression suggests however that the given assistance was compensating these additional costs in patients with stronger needs of support. Interview data on usability revealed an overall positive feedback towards the application although the hardware was considered uncomfortable and too large. We conclude that the approach proved feasible and the acceptability was overall high, although advances in hardware and the patient-interface are necessary to assist patients suffering from Alzheimer’s disease in daily activities.

Trial registration

DRKS, DRKS00014870. Registered 11 June 2018 - Retrospectively registered, TrialID = DRKS00014870.

Robot-Enabled Support of Daily Activities in Smart Home Environments

Smart environments offer valuable technologies for activity monitoring and health assessment. Here, we describe an integration of robots into smart environments to provide more interactive support of individuals with functional limitations. RAS, our Robot Activity Support system, partners smart environment sensing, object detection and mapping, and robot interaction to detect and assist with activity errors that may occur in everyday settings. We describe the components of the RAS system and demonstrate its use in a smart home testbed. To evaluate the usability of RAS, we also collected and analyzed feedback from participants who received assistance from RAS in a smart home setting as they performed routine activities.

The effectiveness of diverse technology-based instructions in assisting people with Alzheimer's disease with medication management

Purpose: In patients with mild cognitive impairment and Alzheimer's disease (AD), faculties associated with instrumental activities of daily living (IADL) decline owing to reduced cognitive function. One type of IADL is medication behaviour. Medication management is critical for patients with AD. Previous studies have reported that presentations using speech and images are effective for facilitating IADL autonomy but there are few examinations of effective presentation methods. Therefore, we examined what kind of display methods are effective in helping patients with AD with medication management.Materials and methods: Ten healthy elderly and 9 patients with mild AD were asked to perform the task of taking out medicine bags from a case at a designated time. We gave 3 kinds of instructions and examined the differences in participants' reaction times. Task 1 included verbal instructions alone, Task 2 included verbal instructions and pictorial and written instructions, and Task 3 used a video conference system (presenting pictorial, written, and verbal instructions) at a designated time. Task 3 could be conducted remotely over the internet. The relationship between these results and neuropsychological tests was also explored.Results: Task 3 was an effective method for patients with mild AD. In addition, we found correlations between the methods of Tasks 1-3 and the Japanese version of the Mini-Mental State Examination (MMSE-J).Conclusions: The method of Task 3 may lead to home support for patients with AD. The MMSE-J could be used to identify changes in the adaptive functioning of patients exposed to distinct presentation methods.Implications for rehabilitationAppropriate transmission methods will increase the IADL autonomy of patients with mild AD who have memory impairment. While still images alone are not effective for patients with mild AD, when combined with verbal instructions, they prove effective for this group.The results of this study are useful for providing patients with mild AD with support in their IADLs, especially when methods that use images plus speech are employed. As participants were instructed via the internet, this study shows a way to help patients with mild AD even from a remote location.Until now, no studies have examined the adaptation criteria for instructive methods for patients with mild AD. This study shows that the MMSE could be used to determine the applicability of these instructive methods. The identification of cut-off values in future research could lead to more effective IADL support.

Association Between Functional Performance and Alzheimer's Disease Biomarkers in Individuals Without Dementia

OBJECTIVES

To examine the cross-sectional association between functional performance and Alzheimer's disease (AD) neuroimaging biomarkers in individuals without dementia (cognitively unimpaired (CU), and those with mild cognitive impairment (MCI)).

DESIGN

Cross-sectional.

SETTING

Olmsted County, Minnesota.

PARTICIPANTS

Population-based Mayo Clinic Study of Aging (MCSA) participants (aged ≥ 50, mean age 71.3 ± 10.2; 53.4% male; 28.3% apolipoprotein (APO)E ε4 allele carriers, 1,578 CU, 204 MCI) who underwent ¹¹ C-Pittsburgh compound B (¹¹ C-PiB) positron emission tomography (PET) (N=1,782).

MEASUREMENTS

We defined an abnormal (high) ¹¹ C-PiB-PET retention ratio as a standardized uptake value ratio greater than 1.42 (high amyloid; A+), abnormal (reduced) AD signature cortical thickness (neurodegeneration; N+) as less than 2.67 mm (MRI measurement), and biomarker groups according to the combination of abnormality (or not) for amyloid accumulation (A+/A-) and neurodegeneration (N+/N-). Functional performance was assessed using the Clinical Dementia Rating (CDR) Sum of Boxes (SOB) for functional domains and the Functional Activities Questionnaire (FAQ).

RESULTS

Participants with a CDR-SOB (functional) score greater than 0 were almost 4 times as likely to have N + (odds ratio (OR)=3.92, 95% confidence interval (CI)=1.77-8.67, adjusting for age, sex, education, global cognitive z-score, and APOE ε4 allele status; p<.001) and those with a FAQ score greater than 0 were 1.5 times as likely to have A + (OR=1.48, 95% CI=1.04-2.11, p=.03). Higher FAQ scores were associated with greater odds of A+N + and A-N + in CU participants.

CONCLUSION

The findings of this cross-sectional study supplement limited available information that supports an association between functional performance and AD neuroimaging biomarkers very early in the dementia pathophysiology. The associations should be validated in longitudinal studies. J Am Geriatr Soc 66:2274-2281, 2018.

The Erlangen test of activities of daily living in persons with mild dementia or mild cognitive impairment (ETAM) - an extended validation

BACKGROUND

The ability to perform activities of daily living (ADLs) is a central marker in the diagnosis and progression of the dementia syndrome. ADLs can be identified as basic ADLs (BADLs), which are fairly easy to perform, or instrumental ADLs (IADLs), which involve more complex activities. Presently, the only performance-based assessment of IADL capabilities in persons with cognitive impairment is the Erlangen Test of Activities of Daily Living in Persons with Mild Dementia or Mild Cognitive Impairment (ETAM). The aim of the present study was to revalidate the ETAM in persons with mild cognitive impairment (MCI) or mild dementia and to analyze its application to persons with moderate dementia.

METHODS

We used baseline data from a cluster randomized controlled trial involving a sample of 443 users of 34 day-care centers in Germany. We analyzed groups of persons with MCI, mild dementia, and moderate dementia, categorized on the basis of the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). An item analysis was performed, and new discriminant validities were calculated. We computed a confirmatory factor analysis (CFA) to examine the postulated theoretical model of the ETAM with all six items loading on a single IADL factor. This was the first time that the ETAM's sensitivity to change was analyzed after a time period of 6 months.

RESULTS

The overall sample scored on average 17.3 points (SD = 7.2) on the ETAM (range: 0-30 points). Persons with MCI scored on average 23.2 points, persons with mild dementia scored 18.4 points, and persons with moderate dementia scored 12.9 points, p < .001 (ANOVA). The item analysis yielded good difficulty indices and discrimination powers. The CFA indicated a good fit between the model and the observed data. After 6 months, both the ETAM score at baseline and the change in MMSE score (t0-t1) were significant predictors of the ETAM score at t1.

CONCLUSIONS

The ETAM is a valid and reliable instrument for assessing IADL capabilities in persons with MCI or mild dementia. It is sensitive to changes in cognitive abilities. The test parameters confirm its application to persons with moderate dementia.

TRIAL REGISTRATION

Identifier: ISRCTN16412551 (Registration date: 30 July 2014, registered retrospectively).

Re-standardization of the Korean-Instrumental Activities of Daily Living (K-IADL): Clinical Usefulness for Various Neurodegenerative Diseases

Background and Purpose

Evaluating instrumental activities of daily living (IADL) is an important part of procedure to diagnose dementia. The Korean-Instrumental Activities of Daily Living (K-IADL) has been used extensively in Korea. However, its cut-off score has not been reformulated since 2002. The purpose of this study was to yield a new optimal cut-off score for the K-IADL and confirm the validity of this new cut-off score with various dementia groups.

Methods

We retrospectively collected a total of 2,347 patients' K-IADL data from 6 general hospitals in Korea. These patients had mild cognitive impairment (MCI) or dementia with various etiologies for cognitive impairment. We also recruited a normal control group (n=254) from the community. Korean-Mini Mental State Examination, Short version of the Geriatric Depression Scale, Clinical Dementia Rating, and Global Deterioration Scale were administered to all participants. Caregivers completed K-IADL and Barthel Index.

Results

K-IADL scores were significantly different among dementia subgroups, but not significantly different among MCI subgroups. Based on internal consistency, correlations with other scales, and factor analysis, K-IADL showed excellent reliability and validity. The new optimal cut-off score to diagnose dementia was 0.40, which gave a sensitivity of 0.901 and a specificity of 0.916. Positive predictive value for dementia using the new cut-off score was 94.2% for Alzheimer's disease, 100% for vascular dementia, and 84% for Parkinson's disease.

Conclusions

Our results illustrate that the new K-IADL cut-off score of 0.40 is reliable and valid for screening impairments of daily functioning resulting from various etiologies.

Step by Step: Kinematics of the Reciprocal Trail Making Task Predict Slowness of Activities of Daily Living Performance in Alzheimer's Disease

Dementia impairs the ability to perform everyday activities. Reduced motor capacity and executive functions as well as loss of memory function and forms of apraxia and action disorganization syndrome can be reasons for such impairments. In this study, an analysis of the hand trajectories during the sequential movements in an adapted version of the trail making task, the reciprocal trail making task (RTMT), was used to predict performance in activities of daily living (ADL) of patients suffering from mild cognitive impairment and dementia. 1 patient with dementia of the Alzheimer’s type and 15 healthy, age-matched adults were tested in the standardized ADL of tea making and document filing. The characteristics of the kinematic performance in the RTMT were assessed, and models of multiple linear regression were computed to predict the durations of the ADL. Patients showed increased trial durations (TDs) in the ADL (Cohen’s d: tea making 1.64, document filing 1.25). Parameters and explained variability differed across patients and control as well as between different activities. The models for the patient sample were stronger and particularly high for the document filing task for which kinematics explained 71% of the variance (Radjusted2: tea making 0.62, document filing 0.71; both tasks combined patients 0.55, controls 0.25). The most relevant factors for the models were the TD and a parameter characterizing movement fluency and variability (“movement harmonicity”) in the RTMT. The models of multiple linear regression suggested that the patients’ activity of daily living performance was limited by cognitive demands, namely, identifying the varying targets during sequencing and the healthy controls’ performance by their motor capacity. Such models could be used to estimate the severity of ADL impairments in patients.

Sleep Disturbance, Activities of Daily Living, and Depressive Symptoms among Older Adults

OBJECTIVE

Research suggests sleep disturbance plays a role in depression and risk for suicidal behavior (i.e., ideation, attempts, death by suicide). How sleep disturbance affects suicide risk is unclear and one's ability to perform activities of daily living (ADLs) may help explain this relation. This study examined associations between sleep problems, ADLs, and either depressive symptoms or suicide risk among older adults. We hypothesized that ADLs would mediate relations between sleep problems and depressive symptoms and suicide risk.

METHOD

Participants (N = 134; age ≥65) were recruited through Amazon's Mechanical Turk. Participants completed questionnaires that assessed insomnia symptoms, nightmares, ADLs, depressive symptoms, and suicidal behaviors.

RESULTS

Nightmares were associated with depressive symptoms and suicide risk but not independently associated with ADLs. Insomnia symptoms were associated with depressive symptoms, suicide risk, and ADLs. ADLs mediated the relation between insomnia symptoms and depressive symptoms. The insomnia symptom-suicidal behavior relation and the nightmare-suicidal behavior relation were significantly mediated by a pathway containing ADLs and depressive symptoms.

DISCUSSION

ADLs help explain how insomnia symptoms and nightmares confer suicide risk among older adults, either independently or in association with depressive symptoms.

CLINICAL IMPLICATIONS

Practitioners should attend to ADL performance when treating older adults with insomnia and depression.

What is the Relationship between Health, Mood, and Mild Cognitive Impairment?

Mild cognitive impairment (MCI) often co-exists with mood problems, and both cognitive functioning and mood are known to be linked with health. This study aims to investigate how health, mood, and cognitive impairment interact. Health is often assessed using a single proxy measure, but the use of a range of measures can provide a more informative picture and allows for combination into a comprehensive measure of health. We report an analysis of data from the Cognitive Function and Ageing Study Wales (CFAS Wales, N = 3,173), in which structured interviews with older people captured measures of cognition, mood, and health. Each measure of health was assessed independently in relation to cognition and mood, and then all measures were combined to form a latent health variable and tested using structural equation modeling (SEM). SEM confirmed the association between health and cognition, with depression acting as a mediator. All measures of health were individually associated with levels of anxiety and depression. Participants reporting mood problems were less likely to engage in physical activity and more likely to report poor or fair health, have more comorbid health conditions, use more services, and experience difficulties with instrumental activities of daily living. Perceived health was associated with cognitive status; participants with MCI were more likely to report fair or poor health than participants who were cognitively unimpaired. Careful intervention and encouragement to maintain healthy lifestyles as people age could help to reduce the risk of both mood problems and cognitive decline.