Daily Assessment of Executive Functioning and Expressive Suppression Predict Daily Functioning among Community-Dwelling Older Adults

Computerized assessment of executive functioning: Validation of the CNS Vital Signs executive functioning scores in a sample of community-dwelling older adults

Objective: Computerized assessment of cognitive functioning has gained significant popularity over recent years, yet options for clinical assessment of executive functioning (EF) are lacking. One computerized testing platform, CNS Vital Signs (CNS-VS), offers tests designed to measure EF but requires further validation. The goal of the present study was to validate CNS-VS executive scores against standard clinical measures of EF. We also sought to determine whether a modified CNS-VS composite score that included variables purported to measure inhibition, switching, and working memory would outperform the currently available CNS-VS Executive Function Index. Method: A sample of 73 cognitively healthy older adults completed four tests from the Delis-Kaplan Executive Function System, the Digit Span subtest from the Wechsler Adult Intelligence Scale-fourth edition, and three CNS-VS tasks purported to measure inhibition, switching, and working memory. Results: Performances on the CNS-VS tests were predicted by performances on standard paper-and-pencil measures. Although the currently available CNS-VS Executive Function Index predicted unique variance in a well-validated paper-and-pencil EF composite score, our Modified CNS-VS EF composite accounted for unique variance above and beyond the original CNS-VS Executive Function Index, while the reverse was not true. Conclusions: The present results support the construct validity of CNS-VS EF tests but also suggest that modifications to their current composite scores would improve the prediction of EF performance.

Six elements test vs D-KEFS: what does "Ecological Validity" tell us?

OBJECTIVE

Extensive research shows that tests of executive functioning (EF) predict instrumental activities of daily living (IADLs) but are nevertheless often criticized for having poor ecological validity. The Modified Six Elements Test (MSET) is a pencil-and-paper test that was developed to mimic the demands of daily life, with the assumption that this would result in a more ecologically valid test. Although the MSET has been extensively validated in its ability to capture cognitive deficits in various populations, support for its ability to predict functioning in daily life is mixed. This study aimed to examine the MSET's ability to predict IADLs assessed via three different modalities relative to traditional EF measures.

METHOD

Participants (93 adults aged 60 - 85) completed the MSET, traditional measures of EF (Delis-Kaplan Executive Function System; D-KEFS), and self-reported and performance-based IADLs in the lab. Participants then completed three weeks of IADL tasks at home, using the Daily Assessment of Independent Living and Executive Skills (DAILIES) protocol.

RESULTS

The MSET predicted only IADLs completed at home, while the D-KEFS predicted IADLs across all three modalities. Further, the D-KEFS predicted home-based IADLs beyond the MSET when pitted against each other, whereas the MSET did not contribute beyond the D-KEFS.

CONCLUSIONS

Traditional EF tests (D-KEFS) appear to be superior to the MSET in predicting IADLs in community-dwelling older adults. The present results argue against replacing traditional measures with the MSET when addressing functional independence of generally high-functioning and cognitive healthy older adult patients.

Test of Practical Judgment (TOP-J): Construct, Criterion, and Incremental Validity in a Community Sample of Older Adults

OBJECTIVE

The Test of Practical Judgment (TOP-J) is a stand-alone judgment measure that is considered to tap into aspects of executive functioning (EF) and inform clinical predictions of daily functioning in older adults. Past validation research is variable and has some limitations. The present study sought to examine the reliability and construct, criterion, and incremental validities of scores on TOP-J 9-item version (TOP-J/9).

METHOD

Participants were 95 community-dwelling older adults aged 60 to 85. Participants completed TOP-J/9, measures of EF and global cognition, and three different modalities of instrumental activities of daily living (IADLs) (self-report, performance-based tasks conducted in the laboratory, and performance-based tasks completed at home over 3 weeks).

RESULTS

TOP-J/9 scores showed adequate internal consistency (α = 0.73) after correcting for the low number of items. TOP-J/9 was correlated with global cognition and EF, although EF did not survive correction for lower-order processes. Finally, although TOP-J/9 scores were associated with home-based IADL tasks (but not with self-report and laboratory-based IADLs), providing some evidence of criterion validity, they did not incrementally contribute to home-based IADL performance beyond other cognitive measures. However, when two items pertaining to social/ethical judgment were removed, this modified version of TOP-J did relate to EF beyond lower-order processes and contributed uniquely to prediction of home-based IADLs beyond other measures.

CONCLUSION

Results suggest that TOP-J/9 taps into global cognitive status (but not necessarily EF) and predicts "real-world" functioning (but not above and beyond other cognitive measures). TOP-J psychometrics may be improved by removing two social/ethical items.

Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW)

Interventions to preserve functional independence in older adults are critically needed to optimize 'successful aging' among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve functional independence. Contemporary conceptual models of chronic disease management and health habit theory suggest that this lack of optimal management may result from an underappreciated distinction within the health behavior literature: the behavioral domains critical for initiation of new behaviors (Initiation Phase) are largely distinct from those that facilitate their maintenance (Maintenance Phase). Psychological factors, particularly experiential acceptance and trait levels of openness are critical to engagement with new health behaviors, willingness to make difficult lifestyle changes, and the ability to tolerate aversive affective responses in the process. Cognitive factors, particularly executive function, are critical to learning new skills, using them effectively across different areas of life and contextual demands, and updating of skills to facilitate behavioral maintenance. Emerging data therefore suggests that individuals with greater executive function are better able to sustain behavior changes, which in turn protects against cognitive decline. In addition, social and structural supports of behavior change serve a critical buffering role across phases of behavior change. The present review attempts to address these gaps by proposing a novel biobehavioral intervention framework that incorporates both individual-level and social support system-level variables for the purpose of treatment tailoring. Our intervention framework triangulates on the central importance of self-regulatory functioning, proposing that both cognitive and psychological mechanisms ultimately influence an individuals' ability to engage in different aspects of self-management (individual level) in the service of maintaining independence. Importantly, the proposed linkages of cognitive and affective functioning align with emerging individual difference frameworks, suggesting that lower levels of cognitive and/or psychological flexibility represent an intermediate phenotype of risk. Individuals exhibiting self-regulatory lapses either due to the inability to regulate their emotional responses or due to the presence of executive functioning impairments are therefore the most likely to require assistance to preserve functional independence. In addition, these vulnerabilities will be more easily observable for individuals requiring greater complexity of self-management behavioral demands (e.g. complexity of medication regimen) and/or with lesser social support. Our proposed framework also intuits several distinct intervention pathways based on the profile of self-regulatory behaviors: we propose that individuals with intact affect regulation and impaired executive function will preferentially respond to 'top-down' training approaches (e.g., strategy and process work). Individuals with intact executive function and impaired affect regulation will respond to 'bottom-up' approaches (e.g., graded exposure). And individuals with impairments in both may require treatments targeting caregiving or structural supports, particularly in the context of elevated behavioral demands.

It's complicated: Executive functioning moderates impacts of daily busyness on everyday functioning in community-dwelling older adults

OBJECTIVE

Research shows that cognitively healthy older adults with mild executive function (EF) weaknesses are vulnerable to the negative impacts of life complexity (or daily busyness) when performing instrumental activities of daily living (IADLs). However, past research assessed life complexity only at one timepoint, not capturing daily fluctuations. Importantly, fluctuations in busyness can themselves have deleterious impacts on functioning. This study extended past research by examining whether (1) variability in daily busyness would be more detrimental than level of busyness to performance of IADLs, and (2) EF assessed at home would moderate deleterious impact of busyness on IADLs.

METHOD

Fifty-two community-dwelling older adults aged 60 to 95 completed daily IADL tasks and daily measures of EF and busyness via ecological momentary assessment, independently at home for 18 days.

RESULTS

(1) In a subset of participants with mild EF weaknesses, high variability in busyness across days was associated with fewer tasks completed correctly; and (2) across all participants (regardless of EF), high levels of daily busyness were associated with fewer tasks completed on time.

CONCLUSIONS

Findings indicate that high variability in daily busyness, potentially reflecting a lack of daily routine, was associated with IADL errors among cognitively healthy older adults with mild EF weaknesses. Additionally, consistently high levels of busyness were associated with failures to complete tasks, or failures to complete them on time, regardless of EF. These results further support the Contextually Valid Executive Assessment (ConVExA) model, which posits that EF and contextual factors interact to predict functional outcomes.

Know thyself: Executive functioning and sex predict self-appraisal of functional abilities in community-dwelling older adults

Objective: The capacity for accurate self-appraisals of age-related changes in cognitive and functional abilities is integral to the maintenance of independence in later life, yet there is little understanding of the factors that place nondemented older adults at risk for poor self-awareness. This study examined the potential contributions of executive functioning (EF), crystallized intelligence (IQ-Cr), and sex in predicting congruence between performance and self-appraisals of instrumental activities of daily living (IADL) in a group of community-dwelling older adults. Method: A group of 150 nondemented, community-dwelling older adults (White and majority highly educated) completed measures of EF and IQ-Cr. Participants also completed five timed IADL tasks and self-appraised their performance relative to others of similar age. Results: Sex [F(1,148)  =  7.75, p = .006, ηp2 = .05] and EF [(F(1,147) = 5.30, p = .02, ηp2 = .04)], but not IQ-Cr, predicted the relationship between performance and self-appraisals, such that those with lower EF and those of male sex overestimated their performance more than those with higher EF and females. Conclusions: Findings indicate that having average to below average EF abilities and being of male sex are risk factors for less accurate self-report of IADL abilities and as such might represent important considerations when assessing IADL abilities via self-report among largely independent, community-dwelling older adults.

A daily examination of executive functioning and chronotype in bedtime procrastination

STUDY OBJECTIVES

Bedtime procrastination, or delays in bedtime not attributable to external obligations, is a behavioral tendency that undermines sleep and is conceptualized as a consequence of poor self-regulation. Prior studies investigating the mechanistic role of self-regulation in bedtime procrastination relied on cross-sectional methods and self-reported self-regulation. The present study examined the association between bedtime procrastination and both objective and self-reported executive functioning (EF) as indices of self-regulation, as well as the moderating role of chronotype, using methods that examined these associations at the daily level.

METHODS

A total of 273 young adult participants (78% female; Mage = 24.4) completed daily measures of objective EF (i.e., Stroop task), self-reported EF (i.e., self-reported cognitive, behavioral, and emotional regulation difficulties), and bedtime procrastination over 14 days, in addition to measures of chronotype. Multilevel models were constructed to examine the associations between bedtime procrastination and EF, as well as EF-chronotype interactions.

RESULTS

Poorer daily objective EF and self-reported behavioral regulation were associated with greater same-night bedtime procrastination. Additionally, poorer subjective cognitive and emotional regulation were associated with greater average bedtime procrastination across 14 days. Later chronotypes reported greater bedtime procrastination than early chronotypes.

CONCLUSIONS

The present study provides support for the association between EF and bedtime procrastination, but finds no evidence for the moderating role of chronotype in this association. Results suggest that some EF processes may be more relevant to bedtime procrastination than others. Current findings have implications for assessment and intervention for this consequential sleep-relevant behavioral tendency.

Pilot validation of a verbal practical judgement assessment (VPJ) among community-dwelling older adults in Israel: the first step toward a national standard

Increased longevity and subsequent increase in older populations emphasize the importance of assisting older people to continue living in safe and residential situations for as long as possible. Judgement, an important aspect of cognition, and a predictor of function may become impaired and compromise safe living. Yet, judgement is difficult to assess, and few valid instruments are utilized in clinical settings that accurately evaluate judgement in older people.

Objectives

This pilot study aimed to translate, culturally adapt, and initiate the validation of the Hebrew version of the verbal practical judgement (VPJ) assessment among community-dwelling older people.

Methods

A total of 50 older adults, aged over 65 years, living in the community in Israel, half of whom were independent (n=27, 54%), and the rest dependent participants in a day centre with some level of cognitive/functional decline, completed the VPJ evaluation and comparison assessments.

Results

Positive and significant (p<0.05) relationships between VPJ and standard assessments were found, demonstrating convergent validity. By comparing VPJ scores between independent and dependent older adults, results also supported discriminant validity. Finally, a multiple hierarchical regression demonstrated a positive relationship between instrumental activities of daily living and judgement.

Conclusions

This pilot study found the VPJ feasible, likely valid, and culturally adaptable to assess judgement in Israeli older adults. Assessing judgement will provide older adults and their families with essential information regarding function, cognition, and safety and will enable them to live/return home in accordance with their autonomy, safety, and well-being.

Reappraising cognitive reappraisal: The taxing impact of emotion regulation on executive functioning in older adults

OBJECTIVE

Cognitive reappraisal (CR) and expressive suppression (ES) are two common emotion regulation strategies that share similar cognitive and neural underpinnings. Prior research has consistently shown that recent engagement in ES (both self-reported and experimentally manipulated) is associated with subsequent temporary decrements in executive functioning (EF). Thus far, only one study has examined the association between CR and EF, with null results. However, that study was limited by examining only zero-order correlations and by assessing only the speed, not accuracy, of EF performance. The present study examined multivariate relationships among recent CR, recent ES, and EF (both speed and accuracy), as well as the potential impacts of more chronic engagements in, and trait-level preferences between, the two emotion regulation strategies.

METHOD

Participants were 201 community-dwelling older adults aged 60 to 93 who had participated in three separate studies examining the relationship between self-reported emotion regulation and EF.

RESULTS

Recent CR was associated with EF performance accuracy above and beyond chronic CR. Both recent CR and ES contributed to EF performance accuracy uniquely beyond each other and beyond chronic and preferred emotion regulation.

CONCLUSIONS

Both recent ES and CR appear to have a deleterious impact on EF performance accuracy, potentially due to utilization of similar resources; both should be accounted for when assessing emotion regulation and its impacts on EF.