The relationship of neuropsychological function to instrumental activities of daily living in mild cognitive impairment

Concurrent Validity of Performance-Based Measures of Daily Functioning with Cognitive Measures and Informant Reported Everyday Functioning

OBJECTIVE

Despite the substantial need for reliable and valid assessment of functional ability in older adults, there is currently limited research on the emergence of early functional declines during prodromal dementia stages, such as subjective cognitive decline (SCD) and mild cognitive impairment (MCI). This study uses novel performance-based assessments to characterize subtle, yet clinically meaningful, changes in functional ability.

METHOD

A sample of 93 older adults classified as cognitively unimpaired (CU; n = 30, Mage = 73.57 ± 6.66), SCD (n = 34, Mage = 72.56 ± 6.43), or MCI (n = 29, Mage = 78.28 ± 7.55) underwent neuropsychological testing along with an informant-rated daily functional skills measure (Assessment of Functional Capacity Interview). Participants also completed the Night Out Task (NOT), an open-ended performance-based measure of functional assessment, and the Financial Capacity Instrument-Short Form (FCI-SF) that assesses financial skills.

RESULTS

The MCI group performed worse on the NOT and FCI-SF relative to SCD and CU. NOT and FCI scores were associated with measures of global cognitive function, executive function, processing speed, language and memory, and FCI-SF overall score was correlated with informant-rated functional ability. The NOT and FCI-SF were also predictive of informant-reported daily functioning over and above traditional cognitive data and demographics.

CONCLUSIONS

Performance-based measures of IADL may allow for earlier detection of subtle functional changes that might not be adequately captured by traditional measures. The measurement of early functional changes is an important global outcome to evaluate the efficacy of interventions in dementia research.

The effect of intermittent theta burst stimulation for cognitive dysfunction: a meta-analysis

BACKGROUND

Growing evidence suggests that cognitive dysfunction significantly impacts patients' quality of life. Intermittent theta burst stimulation (iTBS) has emerged as a potential intervention for cognitive dysfunction. However, consensus on the iTBS protocol for cognitive impairment is lacking.

METHODS

We conducted searches in the Cochrane Central Register of Controlled Trials, EMBASE, PubMed, Chinese National Knowledge Infrastructure, Wanfang Database and the Chongqing VIP Chinese Science and Technology Periodical Database from their inception to January 2024. Random-effects meta-analyzes were used to calculate standardized mean differences and 95% confidence intervals. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.

RESULTS

Twelve studies involving 506 participants were included in the meta-analysis. The analysis showed a trend toward improvement of total cognitive function, activities of daily living and P300 latency compared to sham stimulation in patients with cognitive dysfunction. Subgroup analysis demonstrated that these effects were restricted to patients with post-stroke cognitive impairment but not Alzheimer's disease or Parkinson's disease. Furthermore, subthreshold stimulation also exhibited a significant improvement.

CONCLUSIONS

The results suggest that iTBS may improve cognitive function in patients with cognitive dysfunction, although the quality of evidence remains low. Further studies with better methodological quality should explore the effects of iTBS on cognitive function.

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.

Prediction and mediation analysis for treatment responses to combined cognitive and physical training for older adults

Diminished cognitive and physical functions negatively affect the daily functions of individuals. Although combined cognitive and physical training prevents instrumental activities of daily living (IADL) disability in older adults, no predictive model or mediation analysis of IADL after combined training exists. This study aims to employ prediction and mediation analysis to identify the predictors of IADL performance and to elucidate the mediators of the association between baseline global cognition and subsequent IADL performance following combined cognitive and physical training. This study involved 177 participants aged 60 years and older who underwent combined training. Cognitive function was measured with the Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSST), Color Trails Test, Word List, and a dual task; physical function with the Timed Up and Go (TUG) test; daily function with the Lawton IADL Scale. We conducted regression analyses to identify the predictors of IADL performance, and mediation analysis to examine whether DSST and TUG mediate the relationship between MoCA and IADL. The pre-intervention DSST and TUG were significant independent predictors of post-intervention IADL. The association between the pre-intervention MoCA and post-intervention IADL was mediated by pre-intervention DSST and TUG. This study highlighted the importance of measuring and improving processing speed and functional mobility before and during interventions to enhance IADL outcomes.Trial registration: NCT03619577, 23/07/2018; NCT04689776, 29/12/2020.

Characteristic of process analysis on instrumental activities of daily living according to the severity of cognitive impairment in community-dwelling older adults with Alzheimer's disease

OBJECTIVES

To clarify the characteristic of impaired and unimpaired Instrumental Activities of daily living (IADL) processes with the severity of cognitive impairment in community-dwelling older adults with Alzheimer's disease (AD) using the Process Analysis of Daily Activity for Dementia (PADA-D).

DESIGN

Cross-sectional study.

SETTING

13 medical and care centers in Japan.

PARTICIPANTS

115 community-dwelling older adults with AD.

METHODS

The severity of cognitive impairment was classified by Mini-Mental State Examination (20 ≥ mild group, 20 < moderate group ≥ 10, 10 < severe group), and IADL scores and eight IADL items in PADA-D were compared among three groups after adjusting for covariates. Rate of five feasible processes included in each IADL of PADA-D was compared.

RESULTS

IADL score showed a decrease in independence with the severity of AD except for Use modes of transportation and Managing finances, which was especially pronounced in Shopping (F = 25.58), Ability to use the telephone (F = 16.75), and Managing medication (F = 13.1). However, when the PADA-D was examined by process, some processes that were impaired and unimpaired with the severity of cognitive impairment were clear. For example, Plan a meal was impaired (ES = 0.29) with the severity, but Prepare the food was not in Cooking performance.

CONCLUSIONS

We suggested that detailed process analysis in IADLs can clarify the characteristic of processes that are impaired and unimpaired with the severity of cognitive impairment in older adults with AD living in the community. Our findings may be useful for rehabilitation and care in IADL to continue living at home.

TECH preserves global cognition of older adults with MCI compared with a control group: a randomized controlled trial

BACKGROUND

Cognitive training using touchscreen tablet casual game applications (apps) has potential to be an effective treatment method for people with mild cognitive impairment (MCI).

AIMS

This study aimed to establish the effectiveness of 'Tablet Enhancement of Cognition and Health' (TECH), a novel cognitive intervention for improving/preserving cognition in older adults with MCI.

METHODS

A single-blind randomized controlled trial with assessments pre-, post-, and at 6-month follow-up was conducted. TECH entailed 5 weeks of daily self-training utilizing tablet apps, facilitated by weekly group sessions. Global cognition was assessed by the Montreal Cognitive Assessment (MoCA), and specific cognitive components were assessed using WebNeuro computerized battery. Short Form Health Survey (SF-12) assessed health-related quality of life (HRQoL). Intention-to-treat analysis was conducted and the %change was calculated between pre-post and between pre-follow-up. Cohen's d effect size was also calculated.

RESULTS

Sixty-one participants aged 65-89 years were randomly allocated to TECH (N = 31, 14 women) or to standard care (N = 30, 14 women). Pre-post and pre-follow-up MoCA %change scores were significantly higher in TECH than control (U = 329.5, p < .05; U = 294.5, p < .05) with intermediate effect size values (Cohen's d = .52, Cohen's d = .66). Forty percent of TECH participants versus 6.5% of control participants achieved a minimal clinical important difference in MoCA. Pre-post between-group differences for specific cognitive components were not found and HRQoL did not change.

DISCUSSION AND CONCLUSIONS

TECH encouraged daily self-training and showed to preserve global cognition of older adults with MCI. The implementation of TECH is recommended for older adults with MCI, who are at risk for further cognitive decline.

Association Between Neuropsychological Functions and Activities of Daily Living in People with Mild Cognitive Impairment

OBJECTIVE

The aim of this study was to explore the relationship between performance in neurocognitive variables and daily functioning (basic or b- and instrumental or i-ADL) in people with mild cognitive impairment (MCI).

METHODS

A sample of 157 participants with MCI (73.65 ± 7.58 years) completed a battery of tests for assessing ADL and cognitive functions. t-test, Pearson's correlation and multiple linear regression (backward stepwise selection) were used for data analyses.

RESULTS

Significant correlations were found between b- and i-ADL, and several neuropsychological tests (p < .01). Multivariate analysis showed that difficulties in Blessed Rating Scales (BLS) explained 33.2% of the variation in b-ADL and that this variation rises to 42.9% when BLS is associated with Frontal Assessment Battery Flexibility, Trail Making Test A (TMT-A) and BLS Personality. For i-ADL, BLS and Dementia Rating Scale Total (DRS-T) explained 47.7% of the variation and the inclusion in the model of BLS, DRS-IP (Initiation/Perseveration), TMT-A and BLS Personality explained 53.5% of this variation. Executive functions explained 24.8% of the variation in i-ADL.

CONCLUSIONS

Cognitive functions are related to i- and b-ADL in people with MCI. The general indicators and those that assess executive functions and verbal- or visual-spatial memory should be considered to predict i-ADL.

Identifying subtle functional change in individuals with mild cognitive impairment: development and validation of the Healthy Brain Ageing - Functional Assessment Questionnaire

Accumulating research suggests that individuals with Mild Cognitive Impairment (MCI) experience subtle functional changes, but that available functional assessment tools are insensitive to this. To address this gap, we describe the development and validation of the self-report, "Healthy Brain Ageing Functional Assessment Questionnaire" (HBA-FAQ). We examined the factor structure and psychometric properties of the HBA-FAQ in 503 participants with normal cognition, subjective cognitive decline (SCD), MCI or dementia. Our results found the HBA-FAQ to have good reliability, validity and stronger discriminative ability between healthy control participants and those with SCD (0.734, p = .001), MCI (0.666, p = .012) and dementia (0.798, p < .001) compared to a widely-used instrumental activities of daily living screener. In conclusion, the HBA-FAQ is a valid, reliable self-report tool, providing an efficient and sensitive approach to identifying subtle changes in daily functioning in older people at risk of dementia.

The Benton Visual Form Discrimination Test as a Predictor of Neurocognitive Disorder in Older Veterans

OBJECTIVE

The Benton Visual Form Discrimination Test (VFDT) is a commonly used measure of visual discrimination and visual recognition memory and has shown promise in distinguishing between different levels of cognitive impairment. We assess the predictive diagnostic utility of the VFDT in a sample of older Veterans with cognitive concerns.

METHOD

Subjects included a total of 172 mostly male Veterans over the age of 64 (mean = 76.0; SD = 7.6) recruited from a VA clinic specializing in neuropsychological assessment of older Veterans. The clinical sample included 56 subjects diagnosed with Major Neurocognitive Disorder, 74 diagnosed with Mild Neurocognitive Disorder, and 42 with No Neurocognitive Impairment. Impairment categories were modeled in separate multinomial logistic regressions with two versions of the VFDT as predictors: the Visual Form Discrimination Test-Recognition Subtest (VFDT-Rec) test (visual recognition memory) and the Visual Form Discrimination Test-Matching Subtest VFDT-Mat test (visual form discrimination). Years of education were included as a covariate.

RESULTS

After adjusting for education, higher VFDT-Rec total scores were associated with lower odds of being categorized with a greater degree of cognitive/functional impairment (OR 0.66-0.83, p < .001). VFDT-Mat scores showed a similar pattern, but only reached statistical significance for the Major versus No Neurocognitive Impairment (OR = 0.77, p = .0010) and Major versus Mild comparisons (OR = 0.89, p = .0233).

CONCLUSIONS

The VFDT may enhance the confidence of differential diagnosis of dementia in older adult Veterans. Formal education-adjusted norms need to be established for clinical use.

Adherence to a Mediterranean Diet is associated with physical and cognitive health: A cross-sectional analysis of community-dwelling older Australians

Poor cognitive function is associated with reduced functional independence, risk of institutionalization and reduced health-related quality of life. The ability to independently perform instrumental activities of daily living (iADLs) is compromised in patients with mild cognitive impairment (MCI) or dementia. Emerging evidence suggests that adherence to a Mediterranean diet (MedDiet), may play an important protective role against cognitive decline and dementia risk, whilst preserving functional status. This cross-sectional study aimed to explore the independent associations between MedDiet adherence, cognitive risk, and functional status in community-dwelling older adults living in Australia. MedDiet adherence was assessed using the Mediterranean Diet Adherence Screener (MEDAS); a modified Lawton's iADL scale was used for the assessment of functional status and risk of cognitive impairment was assessed using the AD8 dementia screening intervention. A total of n = 294 participants were included in the final analyses (70.4 ± 6.2 years; Females, n = 201; Males, n = 91; n = 2 unspecified). Adherence to a MedDiet was positively associated with functional ability (β = 0.172; CI: 0.022, 0.132; P = 0.006) independent of age, gender, Body Mass Index (BMI), smoking status, sleep duration, physical activity duration, diabetes status, and level of education. Furthermore, MedDiet adherence was inversely associated with cognitive risk (β = -0.134; CI: -0.198, -0.007; P = 0.035) independent of all covariates. However, our sensitivity analyses further showed that adherence to a MedDiet was not associated with cognitive risk in older adults free from cognitive impairment. We showed that adherence to a MedDiet is associated with healthy physical and cognitive aging. Nevertheless, exploration of these findings in larger cohorts, using longitudinal analyses and controlling for important confounders to ascertain the direction of the relationship is warranted.

Influencing factors on instrumental activities of daily living functioning in people with mild cognitive disorder - a secondary investigation of cross-sectional data

BACKGROUND

Finding a strategy to reduce the impact of cognitive decline on everyday functioning in persons suffering from cognitive impairment is a public health priority. Instrumental activities of daily living (IADL) are key to everyday functioning. Hence, it is essential to understand the influencing factors on IADL to develop specific interventions to improve everyday functioning in persons with mild cognitive disorder. Therefore, this study aimed to 1) explore different influencing factors on IADL functioning considering all domains of the International Classification of Functioning, disability, and health and 2) rank these factors.

METHODS

We performed a secondary analysis of a cohort including participants with amnestic mild cognitive impairment (a-MCI) or mild Alzheimer's Dementia (mild AD). The IADL functioning model was used as a starting point to estimate the effects of cognitive and physical function factors and personal and environmental factors on IADL functioning using multiple linear regression analysis, including subgroup analysis in persons with a-MCI. We used standardized coefficient estimates to relate the size of the predictor effects in the final model.

RESULTS

We included 105 participants (64 a-MCI, 41 mild AD); the mean age was 81.9 years (SD 4.9), with 70% females. Based on a multi-step approach and model fit, the final model included IADL functioning as the response variable and memory, attention, executive function, vision and hearing, mobility, balance, education, and social support as predictors. The final model explained 75% of the variability. The significant predictors in the model were mobility, balance, attention, and education, and were the predictors with the most considerable effects based on standardized coefficient estimates. The subgroup analysis, including only a-MCI participants, revealed a similar pattern.

CONCLUSION

Our results confirm that IADL functioning in people with mild cognitive disorder is influenced by cognitive and physical function and personal factors. The study provides further insight into understanding IADL functioning impairments in persons with mild impaired cognition and may be used to develop specific non-pharmacological interventions.

Associations of grip strength, walking pace, and the risk of incident dementia: A prospective cohort study of 340212 participants

INTRODUCTION

Grip strength and walking pace have been linked to cognitive dysfunction. Their relationships, however, demand further clarification as the evidence is derived primarily from less-comprehensive investigations.

METHODS

A total of 340212 UK Biobank participants without dementia and cardiovascular diseases at baseline were analyzed. Cox proportional hazard models assessed the longitudinal associations.

RESULTS

Over a mean follow-up of 8.51 ± 2.68 years, 2424 incident dementia cases were documented. A 5 kg increment of absolute grip strength was associated with lower risks of all-cause dementia (hazard ratio [HR] 0.857), Alzheimer's disease (HR 0.874), and vascular dementia (HR 0.788). The patterns of associations remained similar when grip strength was expressed in relative terms and quintiles. A slow walking pace demonstrated consistent associations with increased risks of all dementia types.

DISCUSSION

Our findings provide amplified evidence and suggest that muscle fitness, reflected by objective grip strength measures and self-reported walking pace, may be imperative for estimating the risks of dementia.

Daily Living Subjective Cognitive Decline Indicators in Older Adults with Depressive Symptoms: A Scoping Review and Categorization Using Classification of Functioning, Disability, and Health (ICF)

(1) Background: This scoping review identifies subjective cognitive decline (SCD) indicators in ADLs and instrumental activities of daily living (IADLs) in older adults with depressive symptoms using the WHO International Classification of Functioning, Disability, and Health (ICF). (2) Methods: We searched Medline via Ebscohost, Pubmed, and PsycINFO for articles published on activities of daily living (ADL) indicators of SCD in older adults with depressive symptoms, published in English language journals from January 2011 to November 2021. Following the flow diagram, 2032 titles and abstracts were screened for relevance based on the Population, Concept, and Context inclusion and exclusion criteria. (3) Results: Eight articles provided evidence about the ADL indicators of SCD in older adults with depressive symptoms. The analysis yielded indicators based on low and high cognitively demanding tasks assessed on five different scales. Framed on the ICF categorization and coding system, the SCD-ADL indicators are personal care, mobility, and general tasks and demands; SCD-IADL indicators are mobility, general tasks and demands, learning and applying knowledge, domestic life, communication, major life areas, and community, social, and civic life. (4) Conclusion: Highly cognitively demanding activities present more difficulties for individuals with SCD, making IADLs a stronger predictor of SCD than ADLs.

Health-related quality of life of patients with multiple sclerosis: Analysis of ten years of national data

BACKGROUND

Multiple sclerosis (MS) is a progressive autoimmune disease of the central nervous system. Both the physical and mental burden of MS affect patients' health-related quality of life (HRQoL). However, there is limited research at the national level evaluating the humanistic burden among MS patients.

OBJECTIVES

This study evaluated the HRQoL and functional limitations among MS patients using ten years of national survey data.

METHODS

Guided by the conceptual framework of the Wilson and Cleary model, this study compared HRQoL between adults diagnosed with MS (Clinical Classification Code= "080″) and non-MS adults using the 2006-2015 Medical Expenditure Panel Survey (MEPS) data. The humanistic burden included HRQoL and functional limitations. The HRQoL was evaluated using physical component summary (PCS) and mental component summary (MCS) based on the Short Form Health Survey (SF-12). The study applied the multivariable Generalized Linear Models (GLM) to estimate the marginal differences in PCS and MCS based on the SF-12. In addition, seeking help for activities of daily living (ADL) and instrumental activities of daily living (IADL) were modeled with multivariable logistic regression.

RESULTS

According to the MEPS, the estimated annual prevalence of MS was 0.52 million (95% Confidence Interval [CI]: 0.42-0.60). MS patients were mainly female (71.90%), middle aged (50-64 years, 40.21%), non-Hispanic whites (78.29%), and enrolled in private insurance plans (68.93%). The average PCS scores in MS and non-MS groups were 35.70 and 49.48, respectively. The average MCS scores were 45.58 and 51.25 for MS and non-MS groups, respectively. In addition, 18.26% of MS patients sought help for ADL, and 27.08% sought help for IADL. After adjusting for individual, biological, and environmental characteristics, the multivariable GLM with Poisson distribution indicated that the marginal difference of PCS score was 11.10 (95% CI: 9.50-12.61) units lower, and the MCS score was 4.89 (95% CI: 3.44-6.30) units lower among MS patients. In addition, MS patients were 17.32 (95% CI: 11.61-25.84) and 14.43 (95% CI: 10.09-20.65) times more likely to request assistance for ADL and IADL, respectively.

CONCLUSIONS

MS was associated with lower physical and mental HRQoL than their non-MS counterparts and MS patients were more likely to request help for ADL and IADL. More work is needed to evaluate the effect of treatment strategies on improving the HRQoL and functional limitations in MS.

The Cognitive Scale of Basic and Instrumental Activities of Daily Living for Multidomain Mild Cognitive Impairment and Dementia Patients: Validation of its Extended Version

OBJECTIVE

To validate an informant-based tool - the extended version of the Cognitive Scale of Basic and Instrumental Activities of Daily Living (BADL and IADL) or Ext. Cog-ADL Scale - in a larger sample and with a broader range of cognitive-functional items related to activities of daily living (ADL).

METHOD

The Ext. Cog-ADL Scale was administered to family informants of 42 patients with dementia, 43 patients with multidomain mild cognitive impairment (mdMCI), and 23 healthy control participants. We analyzed the convergent and concurrent validity and external validity of this scale.

RESULTS

The Ext. Cog-ADL Scale demonstrated good psychometric properties. Episodic and working memory tests were the main predictors of most cognitive-functional items of the scale. While patients with dementia obtained lower scores in most error categories of the scale, affecting both BADL and IADL, mdMCI patients showed a more specific pattern of difficulties. Apart from the typical alterations in IADL, mdMCI patients also showed difficulties in several error categories related to BADL (i.e., error detection, problem solving, task self-initiation, distraction inhibition, and restore).

CONCLUSIONS

The Ext. Cog-ADL Scale seems to be an adequate tool to capture the specific pattern of cognitive alterations related to IADL and BADL that differentiates dementia from mdMCI and healthy aging; it shows that mdMCI can involve specific cognitive difficulties that affect even BADL.

The Relationship between Cognitive Status and Retained Activity Participation among Community-Dwelling Older Adults

Identifying retained activity participation to old age can improve age-related changes in balance and cognition function. Subjects ≥ 60 years were enrolled in this study. Balance and Cognitive function include working memory, executive function, and sustained and divided attention was evaluated with “Fullerton advanced balance”, “n-back”, “Wisconsin card sort”, “sustain and divided attention test”, respectively. In addition, retained activity participation was measured using the Activity Card Sort questionnaire. The univariate and multivariate regression analyses of different domains of retained activity participation were used as independent variables, including instrumental activity, low-effort leisure, high-effort leisure, and social activity on balance and specific domains of cognition. Seventy-seven subjects (65.3 ± 4.4 years, 61% female) were included. About 47% of older adults had a college education, 32.3% had a diploma, and 20.7% had elementary−middle education. These results show that retained instrumental activity had a relationship with working memory (β = 0.079, p < 0.05). In addition, we found that retained high-effort leisure activity can increase balance, divided attention, and executive function score (β = 0.1, β = 0.05, β = 0.02, p < 0.05). Moreover, there was a positive relationship between retained low-effort activity and sustained attention (β = 0.08, p < 0.05). In addition, the coefficient of determination (R2) for balance, working memory, executive function, sustained, and divided attention were 0.45, 0.25, 0.13, 0.11 and 0.18, respectively. The study suggests that retained activity participation types may have various effects on balance and some selective cognitive components in older people.

"But at the age of 85? Forget it!": Internalized ageism, a barrier to technology use

The COVID-19 pandemic has underscored how everyday information and communication technology (EICT), such as online banking, e-shopping, or e-mail, are essential for individuals of all ages to maintain activity engagement, health, and well-being. Yet, older adults are often stereotypically portrayed as incapable, technophobic, or unwilling to engage in EICT. This may further contribute to the digital divide, as age stereotypes have the power to act like self-fulfilling prophecies and impede older adults' engagement in complex everyday life tasks. This study aimed to shed light on internalized ageism as manifested in older non-users' narrations about EICT use. It further explored how age stereotypes in the context of EICT are constructed and perpetuated through disempowering and ageist environments. A qualitative approach was applied, performing semi-structured interviews in participants' homes (N = 15). Data were analyzed following the principles of qualitative content analysis, applying both deductive categorization and inductive coding. Internalized ageism appeared to be an omnipresent element in older adults' narrations about EICT non-use. This was reflected in the four subcategories "competence and learning", "relevance and use", "technology design", and "intergenerational contact". Ageism, as manifested in the social environment and the design of technology, seemingly contributed to the internalization of age stereotypes and low EICT engagement. This research calls for inclusive technology designs, ageism-free EICT learning settings, and awareness campaigns about lifelong learning to help close the digital divide and ensure optimal aging experiences for older people.

Occupational Therapy Interventions to Improve Driving Performance in Older People With Mild Cognitive Impairment or Early-Stage Dementia: A Systematic Review

IMPORTANCE

For a person with mild cognitive impairment (MCI) or early-stage dementia, driving is important for independence. However, driving presents safety concerns for both the person and family members. It is important to determine whether occupational therapy interventions can prolong safe driving for this population.

OBJECTIVE

To determine the effectiveness of occupational therapy interventions to improve driving performance in older people with MCI or early-stage dementia.

DATA SOURCES

We conducted a search of MEDLINE, PsycINFO, CINAHL, and gray literature using Google Scholar. Study Selection and Data Collection: Studies were included if they evaluated interventions that (1) aimed to improve the driving performance of older people (M age ≥60 yr) with MCI or early-stage dementia and (2) could be designed or delivered by an occupational therapy practitioner who specializes in driving. Citations were reviewed independently by two authors, and quality appraisal was conducted using the Cochrane risk-of-bias guidelines.

FINDINGS

One Level I randomized controlled trial (RCT) and 4 Level III quasi-experimental studies were included; these studies had 231 participants in total with reported M ages of 65.6-72.5 yr. One study evaluated a compensatory approach, whereas the others evaluated a remedial approach. The studies used different measures to assess outcomes and reported mixed effects.

CONCLUSIONS AND RELEVANCE

Low strength of evidence suggests that occupational therapy interventions may improve the driving performance of older people with MCI or early-stage dementia. More RCTs are needed that include long-term follow-up measures and address clinically important outcomes. What This Article Adds: In the absence of conclusive evidence from research studies and best practice guidelines, occupational therapy practitioners must rely on their clinical experience and their clients' abilities. Development of evidence and guidelines in this area is critical. It is also important for practitioners to work closely with clients, families, and interdisciplinary team members to carefully monitor fitness to drive.

Cognitive functioning in everyday life: The development of a questionnaire on instrumental activities of daily living in multiple sclerosis

Neuropsychological test scores in people with MS (PwMS) do not fully reflect cognitive functioning in daily life. Therefore, we developed a questionnaire based on instrumental activities of daily living (IADL), using the Amsterdam IADL-Q^© for Alzheimer’s disease as starting point. Forty-eight items were evaluated on relevance and clarity by (inter)national experts (n = 30), PwMS (n = 61) and proxies (n = 30). Consequently, four items were omitted, two items were merged and seven items were added. Fifty items were included in the IADL questionnaire specific to cognitive functioning in MS (the MS-IADL-Q). Future studies are warranted to assess the psychometric properties of the MS-IADL-Q.

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.

Apathy, Cognitive Impairment, and Social Support Contribute to Participation in Cognitively Demanding Activities Poststroke

Objective

To understand the extent to which apathy, cognition, and social support predict participation in activities with cognitive demands.

Design

Prospective, quantitative correlational, cross-sectional study. Setting. Outpatient treatment centers and community stroke support groups located in St. Louis, MO, and Boston, MA. Participants. 81 community-dwelling individuals ≥ 6-month poststroke with and without aphasia. Measures. Participants completed the Activity Card Sort (ACS), Apathy Evaluation Scale (AES), Medical Outcomes Study Social Support Survey (MOS-SSS), and Delis-Kaplan Executive Function System (DKEFS) Design Fluency and Trail-Making subtests.

Results

Cognitive deficits limit participation in activities with high cognitive demands. Apathy and positive social interaction influence participation, regardless of high or low cognitive demands. Poststroke aphasia did not impact return to participation in activities with high and low cognitive demands. Conclusions and Relevance. Cognitive deficits seen poststroke contribute to participation only for activities with high cognitive demands. Apathy has a significant and negative influence on participation overall. Social support is a modifiable contextual factor that can facilitate participation. Poststroke apathy can be detrimental to participation but is not well recognized. The availability of companionship from others to enjoy time with can facilitate participation.

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.

Using a Discourse Task to Explore Semantic Ability in Persons With Cognitive Impairment

This paper uses a discourse task to explore aspects of semantic production in persons with various degree of cognitive impairment and healthy controls. The purpose of the study was to test if an in-depth semantic analysis of a cognitive-linguistic challenging discourse task could differentiate persons with a cognitive decline from those with a stable cognitive impairment. Both quantitative measures of semantic ability, using tests of oral lexical retrieval, and qualitative analysis of a narrative were used to detect semantic difficulties. Besides group comparisons a classification experiment was performed to investigate if the discourse features could be used to improve classification of the participants who had a stable cognitive impairment from those who had cognitively declined. In sum, both types of assessment methods captured difficulties between the groups, but tests of oral lexical retrieval most successfully differentiated between the cognitively stable and the cognitively declined group. Discourse features improved classification accuracy and the best combination of features discriminated between participants with a stable cognitive impairment and those who had cognitively declined with an area under the curve (AUC) of 0.93.

The effectiveness of dance interventions on cognition in patients with mild cognitive impairment: A meta-analysis of randomized controlled trials

This meta-analysis of randomized controlled trials (published or unpublished RCTs in English) examined the effectiveness of dance interventions compared to waitlist/active controls on cognitive functions in patients with mild cognitive impairment (MCI). Literature search was conducted on MEDLINE, EMBASE, CINAHL and related databases through 3 August 2019. Risk of bias was assessed with the PEDro scale regarding randomization, allocation concealment, group comparability, blinding, attrition and selective reporting. Five included RCTs (N = 358) used Latin, ballroom and aerobic dances (frequency: 1-3 session/week; intensity: light to moderate; time: 25-60 min/session; type: aerobic). Results show that dance interventions improve global cognition (SMD [95 % CI] = 0.48 [0.21, 0.74]), attention (SMD [95 % CI] = 0.33 [0.12, 0.54]), immediate (SMD [95 % CI] = 0.54 [0.38, 0.71]) and delayed recall (SMD [95 % CI] = 0.33 [0.01, 0.64]), and visuospatial ability (SMD [95 % CI] = 0.16 [0.01, 0.32]). Study limitations include a small number of RCTs and high heterogeneity in some cognitive domains. In summary, dance interventions improve some cognitive domains in MCI. (PROSPERO registration: CRD42019145418).

Development of a model on factors affecting instrumental activities of daily living in people with mild cognitive impairment - a Delphi study

Introduction

The level of function of instrumental activities of daily living (IADL) is crucial for a person’s autonomy. A clear understanding of the nature of IADL and its limitations in people with mild cognitive impairment (MCI) is lacking. Literature suggests numerous possible influencing factors, e.g. cognitive function, but has not considered other domains of human functioning, such as environmental factors. Our aim was to develop a comprehensive model of IADL functioning that depicts the relevant influencing factors.

Methods

We conducted a four-round online Delphi study with a sample of international IADL experts (N = 69). In the first round, panelists were asked to mention all possible relevant cognitive and physical function factors, as well as environmental and personal factors, that influence IADL functioning. In the subsequent rounds, panelists rated the relevance of these factors. Consensus was defined as: 1) ≥70% agreement between panelists on a factor, and 2) stability over two successive rounds.

Results

Response rates from the four rounds were high (83 to 100%). In the first round, 229 influencing factors were mentioned, whereof 13 factors reached consensus in the subsequent rounds. These consensual factors were used to build a model of IADL functioning. The final model included: five cognitive function factors (i.e. memory, attention, executive function, and two executive function subdomains -problem solving / reasoning and organization / planning); five physical function factors (i.e. seeing functions, hearing functions, balance, gait / mobility functions and functional mobility functions); two environmental factors (i.e. social network / environment and support of social network / environment); and one personal factor (i.e. education).

Conclusions

This study proposes a comprehensive model of IADL functioning in people with MCI. The results from this Delphi study suggest that IADL functioning is not merely affected by cognitive function factors, but also by physical function factors, environmental factors and personal factors. The multiplicity of factors mentioned in the first round also underlines the individuality of IADL functioning in people with MCI. This model may serve as a basis for future research in IADL functioning in people with MCI.

Identification of a Cascade of Changes in Activities of Daily Living Preceding Short-Term Clinical Deterioration in Mild Alzheimer's Disease Dementia via Lead-Lag Analysis

BACKGROUND

Cognitive functions and activities of daily living (ADL) become increasingly impaired with progressing Alzheimer's disease. However, the temporal dynamics of this decline are inconsistent.

OBJECTIVE

To gain insight into the classical temporal cascade of specific cognitive and ADL changes, which may aid in improving detection of an impending clinical deterioration in patients, and to select ADL items and tests most sensitive to change in a specific disease stage.

METHODS

Patients with mild Alzheimer's dementia (AD; MMSE = 23.9±2.88) were followed at 12 and 24 months. Lead-lag analysis of changes in cognitive and functional outcome measures (CDR-SOB, 12 neuropsychological subtest scores from the CERAD + test battery, 25 Bayer-ADL items) was applied to rank the temporal sequence of changes on an ordinal scale.

RESULTS

Of 164 patients with mild AD, moderate disease progression was identified in 84 patients over 24 months (ΔMMSE 5.8±8.64; ΔCDR-SOB 4.32±4.03). Ten Bayer-ADL item measures were altered early in moderate progressors and included in a new ADL composite score. Accordingly, the new ADL score surpassed all neuropsychological measures in repeated lead-lag analysis. The Bayer-ADL total score, TMT-A, and MMSE were lagging variables in all lead-lag analyses.

CONCLUSION

Short-term clinical deterioration in mild AD is initially preceded by changes (i.e., decline) in a well-defined set of ADL and not in classical cognitive measures.

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.

Depression, everyday technology use and life satisfaction in older adults with cognitive impairments: a cross-sectional exploratory study

RATIONAL

Life satisfaction is strongly associated with participation in everyday life activities. Yet, older adults with cognitive impairments have been found to experience difficulties in accessing and engaging in more complex everyday activities, especially, if these involve everyday technology. Considering the rapidly advancing technological landscape, this may substantially affect individuals' life satisfaction and their participation in meaningful community-based and home-based activities.

OBJECTIVES

This study aimed to explore the associations between life satisfaction, ability to use everyday technology and number of relevant everyday technologies used in older adults (n = 117) with and without mild cognitive impairment (MCI) and Alzheimer's disease (AD). It also aimed to understand the role of depression, activity involvement and diagnosis regarding life satisfaction in this sample.

METHOD

Descriptive statistics, Mann-Whitney U tests and t-tests were applied to compare those satisfied and those dissatisfied with life regarding ability to use everyday technology and number of relevant everyday technologies used.

FINDINGS

The number of relevant community-based everyday technologies currently not used was significantly associated with being dissatisfied with life (p < 0.05). Further, depression and withdrawal from activities and interests significantly differed across life satisfaction groups, while no group differences were found regarding overall number of everyday technologies in use and ability to use everyday technology.

CONCLUSION

Attention from healthcare professionals and researchers to early withdrawal from activities that rely on community-based everyday technologies is called for, especially in older adults with depression. Preventing everyday technology-related barriers in community life may increase life satisfaction.

The Factor Structure of Cognitive Functioning in Cognitively Healthy Participants: a Meta-Analysis and Meta-Analysis of Individual Participant Data

Many neuropsychologists are of the opinion that the multitude of cognitive tests may be grouped into a much smaller number of cognitive domains. However, there is little consensus on how many domains exist, what these domains are, nor on which cognitive tests belong to which domain. This incertitude can be solved by factor analysis, provided that the analysis includes a broad range of cognitive tests that have been administered to a very large number of people. In this article, two such factor analyses were performed, each combining multiple studies. However, because it was not possible to obtain complete multivariate data on more than the most common test variables in the field, not all possible domains were examined here. The first analysis was a factor meta-analysis of correlation matrices combining data of 60,398 healthy participants from 52 studies. Several models from the literature were fitted, of which a version based on the Cattell-Horn-Carroll (CHC) model was found to describe the correlations better than the others. The second analysis was a factor analysis of the Advanced Neuropsychological Diagnostics Infrastructure (ANDI) database, combining scores of 11,881 participants from 54 Dutch and Belgian studies not included in the first meta-analysis. Again, the model fit was better for the CHC model than for other models. Therefore, we conclude that the CHC model best characterizes both cognitive domains and which test belongs to each domain. Therefore, although originally developed in the intelligence literature, the CHC model deserves more attention in neuropsychology.

Cognitive Function in Cardiac Patients: Exploring the Occupational Therapy Role in Lifestyle Medicine

Patients with cardiac dysfunction are at increased risk of mild cognitive impairment, which can affect their ability to successfully engage in daily activities important for home and community safety and in maintaining health and well-being. This risk increases in accordance with the number of cardiac conditions and cardiovascular risk factors or comorbidities. Occupational therapy has a role in chronic disease management in assessing and improving functional abilities affected by physical, emotional, and cognitive domains. With a holistic and client-centered approach, occupational therapy can complement lifestyle medicine principles through promotion and enablement of engagement in purposeful activity and self-management practices. It is suggested that the clinical management of patients with cardiac dysfunction expands beyond the traditional physical aspects of care to encompass cognitive considerations and incorporate occupational therapy in practice.

Temporal precedence of cognitive function and functional abilities: A latent difference score model of the Chinese community-dwelling elders

OBJECTIVES

Little research has explored how cognitive function and activities of daily living (ADL) affect each other over time. In addition, no current finding provides a clear hint to the temporal precedence between them. The present study tries to address these limitations of prior studies by utilizing a longitudinal data and advanced statistical modeling.

METHODS

This study analyzed the data from the China Health and Retirement Longitudinal Study (CHARLS), a prospective observational study performed every 2 years for a total of three waves between 2011 and 2015 using a multistage probability sampling. Cognitive function was measured on the basis of three aspects of cognitive performance. Functional abilities were assessed using six types of activities of ADL and five types of instrumental ADL (IADL). Latent difference score modeling was employed to investigate the temporal precedence between cognitive function and ADL.

RESULTS

The best fitting model indicates poor cognitive function precede worsening in ADL function, whereas the current findings did not support that poor ADL predate the cognition decline or reciprocal influence hypotheses.

CONCLUSIONS

The elderly with poor cognitive function may be more vulnerable to deterioration in ADL. Findings underscore the importance of early screening for cognitive function among the elderly as the key strategy to prevent further ADL impairment and keep independence.

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.

The relationship between basic, instrumental, and advanced activities of daily living and executive functioning in geriatric patients with neurocognitive disorders

OBJECTIVE

Although many studies explored the relationship between executive functions (EF) and activities of daily living (ADLs) in cognitive disorders, previous studies used measurements without well-defined levels of ADLs. This study explored the relationship between EF and the threefold classification of everyday functioning (basic or b-, instrumental or i-, and advanced or a-ADLs) and examined how EF account for the variance in this triad of everyday functioning.

METHODS

A sample of 44 cognitively healthy persons, 41 persons with mild cognitive impairment, and 35 persons with Alzheimer disease were assessed with comprehensive measures of EF and the b-, i-, and a-ADL tools.

RESULTS

Correlations demonstrated that subjects with higher executive dysfunctions have more limitations in b-, i-, and a-ADLs. The highest significant correlations with measures of EF were seen in i- and a-ADLs (ranging from r = -0.193 to r = -0.559, P < 0.05). However, correlations with a-ADLs were not stronger than with i-ADLs. The multivariate analyses revealed Trail Making Test A (TMT-A) as a significant contributor of everyday functioning in b-ADLs, as well as i- and a-ADLs, and Clock Drawing Test (CDT) and Animal Fluency Test (AFT) seemed to contribute significantly to variance in i- and a-ADLs.

CONCLUSIONS

EF are less related to b-ADLs than i- and a-ADLs and contribute to the same amount of variance to limitations in both i- and a-ADLs. This study recommends using the TMT-A, CDT, and AFT as screening tools to indicate the need for profound evaluation of ADLs in older persons with neurocognitive disorders.

Validity and reliability of Bayer Activities of Daily Living (Bayer- ADL) scale in the Iranian elderly dementia population: Is there distinguish between illiterate and literate demented in functional dependency?

This validation study is discriminant and concurrent, with the Bayer-Activities of Daily Living (Bayer-ADL) tool among the Iranian elderly dementia illiterate and literate. The tools Bayer-ADL, Global Deterioration Scale (GDS), Mini Mental State Examination (MMSE), ADL-Barthel, and instrumental activities of daily living (IADL) were applied to find Bayer-ADL correlations in 311 dementia outpatients that were ≥60 years old. The Iranian version Bayer-ADL scores between illiterate and literate dementia elderly, based on GDS, observed good discrimination values (0.923 sensitivity and 0.750 specificity) in illiterate people, and excellent discrimination values were achieved (sensitivity 0.919 and 0. 986 specificity) in literate dementia elderly. The suggested cutoff points were 1.79 for illiterate and for the Iranian literate dementia elderly 1.82, based on GDS. Both forms (24 and 25 items) of Bayer-ADL were correlated to GDS, ADL, and IADL. Bayer-ADL is a valid tool to distinguish physical dysfunction between illiterate and literate of the Iranian dementia elderly; however, some revisions in the components are needed for the illiterate elderly. Generally, the findings presented in the Iranian version Bayer-ADL could be useful to both clinical purpose and international studies.

The relationship of longitudinal cognitive change to self-reported IADL in a general population

This study examined the relationship between cognitive change and instrumental activities of daily living (IADL) in a large, national, population-based sample. Cognitive change was assessed via verbal fluency, word list learning (WLL), and word list delayed recall (WLD). Incident cognitive impairment was defined by change in Six-Item Screener (SIS) status over a period of 10 years. Impaired IADL was defined as self-reported difficulty or needing assistance performing any IADL at Year 10. A one-word decrease in WLL over a 10-year span increased the odds of impaired IADL by 16% (95% CI 1.08-1.24) and incident cognitive impairment increased the odds of impaired IADL by 59% (95% CI 1.36-1.85) when adjusting for demographic factors, health-related behaviors, vascular risk factors and disease, and depressive symptoms. Cognitive change most strongly predicted impairment in managing finances (OR 2.47, 95% CI 2.04-3.00) and driving (OR 2.06, 95% CI 1.73-2.44).

Evaluation of the content coverage of questionnaires containing basic and instrumental activities of daily living (ADL) used in adult patients with brain tumors

Background

Everyday functioning can be assessed using measures of basic activities of daily living (BADL) or instrumental activities of daily living (IADL). The aim of this review was to provide an overview of the scope and specific content of BADL and/or IADL covered by currently used questionnaires in adult brain tumor patient studies.

Methods

Electronic databases were searched up to April 2017 to identify all eligible questionnaires with items regarding BADL/IADL in studies with adult brain tumor patients. Articles were selected using predetermined in- and exclusion criteria. Items with similar content were clustered into domains based on type of activity.

Results

Thirty-one unique questionnaires containing at least one BADL and/or IADL item were identified; 21 and 29 questionnaires containing ≥ 1 BADL or IADL item, respectively. The percentage of ADL items in these questionnaires ranged from 4 to 100%. Only two questionnaires were specifically developed to measure BADL (Barthel Index and Katz-ADL) and two specifically for IADL (Lawton-Brody IADL and preliminary IADL-BN). Content clustering revealed that IADL had a larger variation in content (31 domains, e.g. work or leisure time activities) compared to BADL (15 domains, e.g. mobility or bathing/washing).

Conclusion

Thirty-one questionnaires previously used in brain tumor studies contained items on BADL and/or IADL and covered a wide range of content, in particular for IADL. It is currently unclear which BADL/IADL are most relevant for brain tumor patients, and this should therefore be evaluated. Next, existing questionnaires could be adapted or validated, or new measures can be developed to meet these needs.

Electronic supplementary material

The online version of this article (10.1007/s11060-019-03136-9) contains supplementary material, which is available to authorized users.

Windows to functional decline: Naturalistic eye movements in older and younger adults

Subtle changes in everyday tasks precede and predict future disability in older adults. Eye tracking may provide a sensitive tool for detecting subtle disruption of everyday task performance and informing the mechanism(s) of breakdown. We tracked eye movements of healthy older adults (OA, n = 24) and younger adults (YA, n = 25) while they passively viewed a naturalistic scene (Passive Viewing condition) and then verbally reported the necessary steps for achieving a task goal (e.g., pack a lunch; Verbalize Goal condition). Participants also completed a performance-based task of packing a lunch using real objects as well as neuropsychological tests. Group (young vs. old) by Condition (Passive Viewing vs. Verbalize Goal) ANOVAs were conducted to analyze eye tracking variables (i.e., fixation rate, number/duration of fixations to target/distractor objects and off objects). Both the younger and older adults made significantly fewer fixations to distractors during Verbalize Goal than Passive Viewing. Also, significant Group × Condition interactions were observed, indicating that younger adults, but not older adults, spent significantly more time viewing targets and less time off-objects in the goal driven, Verbalize Goal condition than the Passive Viewing condition. Goal-directed eye movements correlated with everyday action errors and tests of executive functioning. Taken together, results support theories of age-related decline in top-down cognitive control and indicate the potential utility of this eye tracking paradigm in detecting subtle age-related functional changes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Mild cognitive impairment in combination with comorbid diabetes mellitus and hypertension is negatively associated with health-related quality of life among older persons in Taiwan

PURPOSE

To fill the gap in knowledge about associations of health-related quality of life (HRQoL) with comorbid diabetes mellitus (DM), hypertension (HTN), and/or mild cognitive impairment (MCI) in the elderly, we explored associations of comorbid DM, HTN, and/or MCI with HRQoL.

METHODS

Data for this study were from a population-based cross-sectional survey of elderly Taiwanese (≥ 65 years old). Participants (N = 4,634; 47.9% male) were categorized into eight chronic-illness groups: DM only (n = 224); HTN only (n = 1226); DM and HTN (n = 365); MCI only (n = 497); DM and MCI (n = 58); HTN and MCI (n = 303); DM, HTN, and MCI (n = 101); and none (healthy; n = 1860). Associations were examined between the eight chronic-illness groups and HRQoL (measured by EQ-5D scores) using binary logistic regression analyses and generalized linear models adjusted for covariates. Index scores were calculated from EQ-5D scores using Taiwan's general population-preference weights.

RESULTS

Compared to the healthy group, after adjusting covariates, MCI alone or with other comorbidities was significantly, negatively associated with HRQoL. Among all chronic-illness groups, comorbid DM, HTN, and MCI exhibited the lowest HRQoL. After adjusting covariates, between-group odds ratios for index scores were significant when comparing comorbid DM and MCI to DM only, comparing comorbid HTN and MCI to HTN only and comorbid DM, comparing HTN and MCI to comorbid DM and HTN, suggesting that MCI additively affects HRQoL.

CONCLUSIONS

HRQoL of older Taiwanese adults was negatively associated with having MCI. Thus, clinicians managing older persons with chronic illnesses should assess their cognitive function to identify high-risk groups needing HRQoL assistance.

The influence of anesthetic techniques on postoperative cognitive function in elderly patients undergoing hip fracture surgery: General vs spinal anesthesia

BACKGROUND

Hip fracture is common and morbid in elderly patients. Postoperative cognitive dysfunction (POCD) is also very common in these subjects undergoing surgery with an incidence which exceeds 40% in some reports. To date, the evidence is ambiguous as to whether anesthetic technique may affect the patients' outcome as far as postoperative cognitive function is concerned.

OBJECTIVE

The aim of this study was to compare the effect of general and subarachnoid (spinal) anesthesia on the development of POCD up to 30 days after surgery in elderly patients undergoing hip fracture surgery. Methods Subjects over 65 years with hip fracture undergoing surgery were recruited for this study. They were enrolled and randomized to receive either general anesthesia (GA group) or subarachnoid (spinal) anesthesia (S group). Cognitive function was assessed using a battery of neuropsychological tests undertaken preoperatively and at 30 days postoperatively. The incidence of delirium was examined during the same period and their functional status, in terms of activities of daily living was also recorded.

RESULTS

A total of seventy patients, 33 men and 37 females, mean age of 76 years were analyzed. Thirty-three patients received general anesthesia (GA group) and 37 subarachnoid (spinal) anesthesia (S group). The two groups of patients were similar with respect to baseline characteristics, comorbidities and perioperative data. The results of neuropsychological testing showed that there were no significant differences between the groups in eight out of ten neurocognitive tests at baseline and 30 days after surgery. There was a statistically significant decline of the Instrumental Activities of Daily Living Scale score in S group compared with group GA on the 30th postoperative day (p = 0.043). A significant decline was also present in Color-Word Task test in S group compared with group GA at baseline (p = 0.014) and 30 days postoperatively (p = 0.003). Postoperative delirium was present in four patients (12%) for the GA group, and in 10 patients (27%) for the group receiving subarachnoid anesthesia.

CONCLUSION

We concluded that the choice of anesthesia modality does not appear to influence the emergence of postoperative cognitive dysfunction in elderly patients undergoing hip fracture surgery.

The Role of Adult Day Services in Supporting the Occupational Participation of People with Dementia and Their Carers: An Integrative Review

The increasing numbers of people with dementia places considerable stress on health and aged care services and has resulted in the development of community adult day services. Aim: The aim of this integrative review is to determine the extent to which these services support the occupational participation of people with dementia, and how they impact their primary carers. Method: The mixed-methods appraisal tool (MMAT) was used to identify relevant studies in the period 2011–2016. Results: Nine databases were searched and yielded 16 articles with a variety of research designs for inclusion in the review. Conclusions: Findings indicate that adult day services use a range of approaches to support attendees and their carers. In spite of these efforts, there appears to be a lack of interest in utilizing these services while a person is in the early stages of dementia. This suggests that policies in aged care, such as aging-in-place, need to consider the pressure and stress they exert on carer’s quality of life. Another consideration is to better promote the benefits of participating in adult day services in the early stages of dementia for both the attendees and their carers, thereby delaying the tendency towards early institutionalization.

Functional Reserve: Experience Participating in Instrumental Activities of Daily Living is Associated with Gender and Functional Independence in Mild Cognitive Impairment

BACKGROUND

Gender differences in instrumental activities of daily living (IADLs) in mild cognitive impairment (MCI) and Alzheimer's disease may be explained by gender differences in IADL involvement.

OBJECTIVE

We introduce a novel theoretical construct, termed functional reserve, and empirically examine gender differences in IADL experience as a proxy of this reserve.

METHODS

We cross-sectionally examined men (n = 502) and women (n = 340) with MCI from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Demographic factors, depressive symptoms, neuropsychological scores, and IADL experience were included as independent variables and total Functional Activities Questionnaire (FAQ) scores as the dependent variable. Regression analyses were performed on the full cohort and stratified by gender to identify differential predictive relationships for men and women.

RESULTS

Gender was associated with total FAQ (p < 0.05) until adjusting for IADL experience. Furthermore, the combination of cognitive measures accounted for the most variance in functional dependence (12% explained, p < 0.001), although IADL experience was the most important single variable (4.8% explained, p < 0.001). Stratification by gender revealed that IADL experience accounted for 6.6% of the variance in FAQ score in men (p < 0.001) but only 2.4% in women (p = 0.001); however, the interaction between gender and experience was not statistically significant.

DISCUSSION

A small effect of men showing greater functional dependence in MCI may be explained by lower IADL experience. Additionally, IADL experience was associated with superior functioning in all analyses, potentially through increased functional reserve. This concept of functional reserve may have implications for identifying individuals at risk for IADL dependence, preventing or delaying decline, and potentially treating functional impairment.

Effects of tai chi on cognition and instrumental activities of daily living in community dwelling older people with mild cognitive impairment

Background

Cognitive impairment places older adults at high risk of functional disability in their daily-life activities, and thus affecting their quality of life. This study aimed to examine the effects of Tai Chi on general cognitive functions and instrumental activities of daily living (IADL) in community-dwelling older people with mild cognitive impairment (MCI) in Hong Kong.

Methods

The study adopted a multi-site nonequivalent control-group pretest-posttest design. 160 community-dwelling older people, aged ≥60, with MCI, from four community elderly centers participated in the study. The intervention group (IG, n = 80) received training in the Yang-style simple form of Tai Chi, at a frequency of two lessons per week for 16 weeks. Each lesson lasted for one hour. The control group (CG, n = 80) had no treatment regime and joined different recreational activity groups in community centers as usual within the study period. Outcome measures included measures of global cognitive status and IADL. The Chinese version of the Mini-Mental State Examination (CMMSE) was used for global cognitive assessment. The Hong Kong Chinese version of Lawton’s Instrumental Activities of Daily Living (IADL-CV) was used to assess the participants’ IADL levels. General Estimating Equations (GEE) was used to examine each of the outcome variables for the two groups at the two study time points (the baseline and at the end of the study). Meanwhile, minimum detectable change (MDC) was calculated to estimate the magnitude of changes required to eradicate the possibility of measurement error of outcome measures.

Results

Seventy four participants in the IG and 71 participants in the CG completed the study. With adjustments for differences in age, education, marital status and living conditions, the findings revealed that the participants in the IG scored significantly better on the CMMSE test (P = 0.001), and the instrumental ADL questionnaire (P = 0.004). However, those scores changes did not exceed the limits of the respective MDCs in the study, the possibility of measurement variation due to error could not be excluded.

Conclusion

Tai Chi may be an effective strategy to enhance cognitive health and maintain functional abilities in instrumental ADL in older people with MCI.

Trial registration

NCT03404765 (Retrospectively registered January 19, 2018)

Electronic supplementary material

The online version of this article (10.1186/s12877-018-0720-8) contains supplementary material, which is available to authorized users.

The independent influences of age and education on functional brain networks and cognition in healthy older adults

Healthy aging is accompanied by a constellation of changes in cognitive processes and alterations in functional brain networks. The relationships between brain networks and cognition during aging in later life are moderated by demographic and environmental factors, such as prior education, in a poorly understood manner. Using multivariate analyses, we identified three latent patterns (or modes) linking resting-state functional connectivity to demographic and cognitive measures in 101 cognitively normal elders. The first mode (P = 0.00043) captures an opposing association between age and core cognitive processes such as attention and processing speed on functional connectivity patterns. The functional subnetwork expressed by this mode links bilateral sensorimotor and visual regions through key areas such as the parietal operculum. A strong, independent association between years of education and functional connectivity loads onto a second mode (P = 0.012), characterized by the involvement of key hub regions. A third mode (P = 0.041) captures weak, residual brain-behavior relations. Our findings suggest that circuits supporting lower level cognitive processes are most sensitive to the influence of age in healthy older adults. Education, and to a lesser extent, executive functions, load independently onto functional networks-suggesting that the moderating effect of education acts upon networks distinct from those vulnerable with aging. This has important implications in understanding the contribution of education to cognitive reserve during healthy aging. Hum Brain Mapp 38:5094-5114, 2017. © 2017 Wiley Periodicals, Inc.

Adult Age and Cultural Differences in Performance on the Weekly Calendar Planning Activity (WCPA)

OBJECTIVE. We compared performance on a cognitively demanding task, the Weekly Calendar Planning Activity, of participants in three age groups and two countries (United States and Israel).

METHOD. A sample of 375 U.S. and 433 Israeli healthy adults participated. During the activity, participants were observed for speed, accuracy, strategy use, and efficiency.

RESULTS. Accuracy scores were similar in both countries; however, Israeli participants were slower and less efficient (p &lt; .05). The younger and middle-aged Israeli groups were more strategic and the older Israeli group followed fewer rules than the corresponding U.S. groups (p &lt; .05). Older participants in both countries were less accurate, efficient, and strategic than younger participants (p &lt; .05).

CONCLUSION. Limited strategy use and poor time allocation may contribute to difficulty managing cognitively demanding activities for older adults and may also be influenced by culture. Practitioners should consider these factors when screening people for occupational performance difficulties.

Measurement of Functional Cognition and Complex Everyday Activities in Older Adults with Mild Cognitive Impairment and Mild Dementia: Validity of the Large Allen's Cognitive Level Screen

OBJECTIVE

To explore the validity of the Large Allen's Cognitive Level Screen-5 (LACLS-5) as a performance-based measure of functional cognition, representing an ability to perform complex everyday activities in older adults with mild cognitive impairment (MCI) and mild dementia living in the community.

METHODS

Using cross-sectional data from the Sydney Memory and Ageing Study, 160 community-dwelling older adults with normal cognition (CN; N = 87), MCI (N = 43), or dementia (N = 30) were studied. Functional cognition (LACLS-5), complex everyday activities (Disability Assessment for Dementia [DAD]), Assessment of Motor and Process Skills [AMPS]), and neuropsychological measures were used.

RESULTS

Participants with dementia performed worse than CN on all clinical measures, and MCI participants were intermediate. Correlational analyses showed that LACLS-5 was most strongly related to AMPS Process scores, DAD instrumental activities of daily living subscale, Mini-Mental State Exam, Block Design, Logical Memory, and Trail Making Test B. Multiple regression analysis indicated that both cognitive (Block Design) and functional measures (AMPS Process score) and sex predicted LACLS-5 performance. Finally, LACLS-5 was able to adequately discriminate between CN and dementia and between MCI and dementia but was unable to reliably distinguish between CN and MCI.

CONCLUSION

Construct validity, including convergent and discriminative validity, was supported. LACLS-5 is a valid performance-based measure for evaluating functional cognition. Discriminativevalidity is acceptable for identifying mild dementia but requires further refinement for detecting MCI.

Operationalizing the Diagnostic Criteria for Mild Cognitive Impairment: The Salience of Objective Measures in Predicting Incident Dementia

OBJECTIVE

Mild cognitive impairment (MCI) is considered an intermediate stage between normal aging and dementia. It is diagnosed in the presence of subjective cognitive decline and objective cognitive impairment without significant functional impairment, although there are no standard operationalizations for each of these criteria. The objective of this study is to determine which operationalization of the MCI criteria is most accurate at predicting dementia.

DESIGN

Six-year longitudinal study, part of the Sydney Memory and Ageing Study.

SETTING

Community-based.

PARTICIPANTS

873 community-dwelling dementia-free adults between 70 and 90 years of age. Persons from a non-English speaking background were excluded.

MEASUREMENTS

Seven different operationalizations for subjective cognitive decline and eight measures of objective cognitive impairment (resulting in 56 different MCI operational algorithms) were applied. The accuracy of each algorithm to predict progression to dementia over 6 years was examined for 618 individuals.

RESULTS

Baseline MCI prevalence varied between 0.4% and 30.2% and dementia conversion between 15.9% and 61.9% across different algorithms. The predictive accuracy for progression to dementia was poor. The highest accuracy was achieved based on objective cognitive impairment alone. Inclusion of subjective cognitive decline or mild functional impairment did not improve dementia prediction accuracy.

CONCLUSIONS

Not MCI, but objective cognitive impairment alone, is the best predictor for progression to dementia in a community sample. Nevertheless, clinical assessment procedures need to be refined to improve the identification of pre-dementia individuals.

Early Functional Limitations in Cognitively Normal Older Adults Predict Diagnostic Conversion to Mild Cognitive Impairment

OBJECTIVES

To examine whether specific types of early functional limitations in cognitively normal older adults are associated with subsequent development of mild cognitive impairment (MCI), as well as the relative predictive value of self versus informant report in predicting diagnostic conversion to MCI.

DESIGN

As a part of a longitudinal study design, participants underwent baseline and annual multidisciplinary clinical evaluations, including a physical and neurological examination, imaging, laboratory work, and neuropsychological testing.

SETTING

Data used in this study were collected as part of longitudinal research at the University of California, Davis Alzheimer's Disease Center.

PARTICIPANTS

Individuals diagnosed as having normal cognition at study baseline who had an informant who could complete informant-based ratings and at least one follow-up visit (N = 324).

MEASUREMENTS

Participants and informants each completed the Everyday Cognition Scale (ECog), an instrument designed to measure everyday function in six cognitively relevant domains.

RESULTS

Self- and informant-reported functional limitations on the ECog were associated with significantly greater risk of diagnostic conversion to MCI (informant: hazard ratio (HR) = 2.0, 95% confidence interval (CI) = 1.3-3.2, P = .002), with self-report having a slightly higher hazard (HR = 2.3, 95% CI = 1.4-3.6, P < .001). When controlling for baseline cognitive abilities, the effect remained significant for self- and informant-reported functional limitations.

CONCLUSION

Deficits in everyday memory and executive function domains were the strongest predictors of diagnostic conversion to MCI. Detection of early functional limitations may be clinically useful in assessing the future risk of developing cognitive impairment in cognitively normal older adults.