The relationship between everyday problem solving and inconsistency in reaction time in older adults

Prefrontal event-related potential markers in association with mild cognitive impairment

Background

Alzheimer's disease (AD) is among the leading contributors of dementia globally with approximately 60-70% of its cases. Current research is focused on the mild cognitive impairment (MCI), which is associated with cognitive decline but does not disrupt routine activities. Event-related potential (ERP) research is essential in screening patients with MCI. Low-density channel electroencephalography (EEG) is frequently used due to its convenience, portability, and affordability, making it suitable for resource-constrained environments. Despite extensive research on neural biomarkers for cognitive impairment, there is a considerable gap in understanding the effects on early stages of cognitive processes, particularly when combining physiological and cognitive markers using portable devices. The present study aimed to examine cognitive shortfalls and behavioral changes in patients with MCI using prefrontal selective attention ERP recorded from a prefrontal two-channel EEG device.

Methods

We assessed cognitive decline using the Mini-Mental State Examination (MMSE) and the Seoul Neuropsychological Screening Battery (SNSB). We administered auditory selective attention tasks to 598 elderly participants, including those with MCI (160) and cognitively normal (CN) individuals (407). We conducted statistical analyses such as independent t-tests, Pearson's correlations, and univariate and multiple logistic regression analyses to assess group differences and associations between neuropsychological tests, ERP measures, behavioral measures, and MCI prevalence.

Results

Our findings revealed that patients with MCI demonstrated slower information-processing abilities, and exhibited poorer task execution, characterized by reduced accuracy, increased errors, and higher variability in response time, compared to CN adults. Multiple logistic regression analyses confirmed the association between some ERP and behavioral measures with MCI prevalence, independent of demographic and neuropsychological factors. A relationship was observed between neuropsychological scores, ERP, and behavioral measures.

Discussion

The slower information processing abilities, and poor task execution in the MCI group compared to the CN individuals suggests flawed neurological changes and reduced attentional maintenance during cognitive processing, respectively. Hence, the utilization of portable EEG devices to capture prefrontal selective attention ERPs, in combination with behavioral assessments, holds promise for the identification of mild cognitive deficits and neural alterations in individuals with MCI. This approach could potentially augment the traditional neuropsychological tests during clinical screening for MCI.

Discourse performance and related cognitive function in mild cognitive impairment and dementia: A preliminary study

OBJECTIVES

This study applied the discourse task and related cognitive items of the Brief Test of Cognitive-Communication Disorders (BCCD) to normal, mild cognitive impairment (MCI), and moderate dementia groups and compared the scores of each area. In addition, the cognitive functions affecting the discourse performance were investigated by group.

PARTICIPANTS

117 normal adults, 38 MCI, and 31 patients with moderate dementia (DEM) conducted BCCD, including discourse and cognitive items.

DESIGN/SETTING

The discourse item included repeating an explanatory discourse, and the total discourse score was calculated by summing the scores for each of the four areas of coherence, cohesion, proposition, and pause. The cognitive areas of BCCD were attention, visuospatial ability, memory, organization, reasoning, problem-solving, and executive function. This study performed a one-way multivariate analysis of covariance to compare the scores of the three groups and multiple regression analysis determined the cognitive functions influencing the total discourse score.

MEASUREMENTS

The discourse scores reporting differences among all groups were the pause and the total discourse scores, with the normal group showing a higher performance than the patient groups in the cohesion score and the DEM group in the propositions score, respectively. In addition, the cognitive functions affecting discourse performance were attention, organization, and problem-solving in the normal group, and organization and problem-solving in the MCI group.

CONCLUSIONS

Organizing information into a series of semantic units related to each other is necessary for coherent and efficient utterances, and the ability to correctly recognize the task and establish a strategy to grasp the core content is necessary for pragmatic language.

Physical and Motor Fitness Tests for Older Adults Living in Nursing Homes: A Systematic Review

This systematic review aimed to identify the physical/motor fitness tests for nursing home residents and to examine their psychometric properties. Electronic databases were searched for articles published between January 2005 and October 2021 using MeSh terms and relevant keywords. Of the total of 4196 studies identified, 3914 were excluded based on title, abstracts, or because they were duplicates. The remaining 282 studies were full-text analyzed, and 41 were excluded, resulting in 241 studies included in the review. The most common physical component assessed was muscle strength; 174 (72.2%) studies assessed this component. Balance (138 studies, 57.3%) and agility (102 studies, 42.3%) were the second and third components, respectively, most widely assessed. In this review, we also describe the most used assessment tests for each physical/motor component. Some potentially relevant components such as manual dexterity and proprioception have been little considered. There are few studies assessing the psychometric properties of the tests for nursing home residents, although the data show that, in general, they are reliable. This review provides valuable information to researchers and health-care professionals regarding the physical/motor tests used in nursing home residences, helping them select the screening tools that could most closely fit their study objectives.

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

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

NavWell: A simplified virtual-reality platform for spatial navigation and memory experiments

Being able to navigate, recall important locations, and find the way home are critical skills, essential for survival for both humans and animals. These skills can be examined in the laboratory using the Morris water maze, often considered the gold standard test of animal navigation. In this task, animals are required to locate and recall the location of an escape platform hidden in a pool filled with water. Because animals can not see the platform directly, they must use various landmarks in the environment to escape. With recent advances in technology and virtual reality (VR), many tasks originally used in the animal literature can now be translated for human studies. The virtual water maze task is no exception. However, a number of issues are associated with these mazes, including cost, lack of flexibility, and lack of standardization in terms of experimental designs and procedures. Here we present a virtual water maze system (NavWell) that is readily downloadable and free to use. The system allows for the easy design of experiments and the testing of participants on a desktop computer or fully immersive VR environment. The data from four independent experiments are presented in order to validate the software. From these experiments, a set of procedures for use with a number of well-known memory tests is suggested. This potentially can help with the standardization of navigational research and with navigational testing in the clinic or in an educational environment. Finally, we discuss the limitations of the software and plans for its development and future use.

Subcortical Ischemic Vascular Cognitive Impairment: Insights from Reaction Time Measures

In this study, reaction time (RT), intraindividual variability (IIV), and errors, and the effects of practice and processing load upon such function, were compared in patients with subcortical ischemic vascular cognitive impairment (SIVCI) [n = 27] and cognitively healthy older adults (CH) [n = 26]. Compared to CH aging, SIVCI was characterized by a profile of significantly slowed RT, raised IIV, and higher error levels, particularly in the presence of distracting stimuli, indicating that the integrity and/or accessibility of the additional functions required to support high processing load, serial search strategies, are reduced in SIVCI. Furthermore, although practice speeded RT in SIVCI, unlike CH, practice did not lead to an improvement in IIV. This indicates that improvement in RT in SIVCI can in fact mask an abnormally high degree of IIV. Because IIV appears more related to disease, function, and health than RT, its status and potential for change may represent a particularly meaningful, and relevant, disease characteristic of SIVCI. Finally, a high level of within-group variation in the above measures was another characteristic of SIVCI, with such processing heterogeneity in patients with ostensibly the same diagnosis, possibly related to individual variation in pathological load. Detailed measurement of RT, IIV, errors, and practice effects therefore reveal a degree of functional impairment in brain processing not apparent by measuring RT in isolation.

Can Intraindividual Variability in Cognitive Speed Be Reduced by Physical Exercise? Results From the LIFE Study

OBJECTIVES

Findings are mixed regarding the potential to improve older adults' cognitive ability via training and activity interventions. One novel sensitive outcome may be intraindividual variability (IIV) in cognitive speed, or moment-to-moment changes in a person's performance. The present article evaluated if participants who participated in a moderate physical activity intervention showed a reduction in IIV, compared with a successful aging education control group.

METHOD

For approximately 2.6 years, sedentary adults aged 70-90 years participated in the Lifestyle Interventions and Independence for Elders (LIFE) Study (n = 1,635), a multisite Phase 3 randomized controlled trial to reduce major mobility disability. They completed 4 reaction time tests at baseline and at approximately 24 months post-test.

RESULTS

Analyses were conducted following both the intent-to-treat principle and complier average casual effect modeling. Results indicated that participants in the physical activity group did not show a reduction in their IIV.

DISCUSSION

The lack of a significant reduction in IIV may be due to the mild nature of the physical activity program and the cognitively healthy sample. It is also possible that other types of lifestyle activity interventions (e.g., social and cognitive engagement) can elicit reductions in IIV for older adults.

Going beyond the mean: Intraindividual variability of cognitive performance in prodromal and early neurodegenerative disorders

OBJECTIVE

Intraindividual variability (IIV), generally defined as short-term variations in behavior, has been proposed as a sign of subtle early impairment in neurodegenerative disorders, presumably associated with the disintegration of neuronal network connectivity. We aim to provide a review of IIV as a sensitive cognitive marker in prodromal neurodegenerative disorders.

METHOD

A narrative review focusing not only on theoretical and methodological definitions, including an overview on the neural correlates of IIV, but mainly on results from population-based and clinical-based studies on the role of IIV as a reliable predictor of mild cognitive impairment (MCI) and conversion to dementia in neurodegenerative disorders, mostly Alzheimer's and Parkinson's disease.

RESULTS

Most studies focus on MCI and Alzheimer's disease and demonstrate that IIV is a reliable cognitive marker. IIV is partly more sensitive than mean performance in the prediction of cognitive impairment or progressive deterioration and is independent of socio-demographic variables and disease mediators (e.g., genetic susceptibility). Neuroimaging data, mostly from healthy subjects, suggest a relationship between IIV and dysfunction of the default mode network, presumably mediated by white matter disintegration in frontal and parietal areas.

CONCLUSIONS

IIV measures may provide valuable information about diagnosis and progression in prodromal stages of neurodegenerative disorders. Thus, further conceptual and methodological clarifications are needed to justify the inclusion of IIV as a sensible cognitive marker in routine clinical neuropsychological assessment.

Intraindividual variability in neurocognitive performance is associated with time-based prospective memory in older adults

INTRODUCTION

Older adults demonstrate poorer prospective memory (PM) performance than younger adults, particularly for time-based cues and other strategically demanding PM tasks. Intraindividual variability (IIV) in neurocognitive test performance is an index of cognitive control that may be related to the execution of strategically demanding PM tasks.

METHOD

Participants included 194 older Australian adults (age 50 to 88 years) who completed the Memory for Intentions Screening Test (MIST), the Prospective and Retrospective Memory Questionnaire (PRMQ), and clinical measures of executive functions. A measure of naturalistic time-based PM was also administered, in which participants were asked to call the examiner 24 hours after their appointment to report how many hours they slept. IIV was calculated as the mean-adjusted coefficient of variation (CoV) across subtests of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS).

RESULTS

IIV was significantly associated with time-based PM in the laboratory, independent of demographics. Additionally, IIV significantly predicted performance on a naturalistic time-based PM trial, independent of demographics and chronic medical conditions. IIV was not related to event-based laboratory PM or self-reported PM symptoms in daily life. Clinical measures of executive functions were similarly associated with time-based PM and the naturalistic PM task, but not with event-based PM or subjective PM symptoms.

CONCLUSIONS

These results indicate that cognitive control, as indexed by IIV in neurocognitive performance, may play a role in naturalistic PM, as well as in highly strategic, but not automatic, laboratory-based PM among older adults.

Effectiveness of Intraindividual Variability in Detecting Subtle Cognitive Performance Deficits in Breast Cancer Patients

OBJECTIVES

The purpose of this study was to determine if intraindividual variability would be more sensitive than speed or accuracy in detecting subtle cancer-related cognitive disturbance.

METHODS

Data were from a previous study in which 60 breast cancer (BC) patients underwent neuropsychological assessment before commencement of chemotherapy and again following each chemotherapy cycle. Sixty healthy controls were tested at equivalent intervals. Hierarchical linear modeling was used to compare the BC and control groups in terms of accuracy, mean reaction time, and intraindividual variability in reaction time on a computerized continuous performance test with three conditions: a simple reaction time task, a "1-back" task, and a "2-back" task.

RESULTS

An increase in accuracy and response speed over sessions was noted on some tasks in the sample as a whole but there were no differences in these parameters between the BC patients and the controls on any condition. There was a significant group difference in change in intraindividual variability across sessions (i.e., a "group × session interaction"), albeit only on the most complex "2-back" task. Intraindividual variability declined in the control group (i.e., consistency improved with practice) but this practice effect was significantly attenuated in the BC patients. There was no main effect of group on the "2-back" task.

CONCLUSIONS

Results support our hypothesis that intraindividual variability is a more sensitive indicator of subtle cognitive disturbance than conventional speed or accuracy measures and may have potential in the assessment of mild cognitive impairment in patients with non-central nervous system cancers. (JINS, 2018, 24, 724-734).

An investigation of intra-individual variability in children with fetal alcohol spectrum disorder (FASD)

Intra-individual variability (IIV) is defined as systematic within-person variation in performance either across test sessions (e.g., test/retest performance on the same task) or in one session (e.g., variations in performance on multiple trials of a single task). Higher levels of IIV have been noted as a characteristic of neurodevelopmental disorders such as attention deficit/hyperactivity disorder​ (ADHD), but IIV is yet to be investigated in fetal alcohol spectrum disorder (FASD). FASD is a term used to describe a range of conditions resulting from prenatal exposure to alcohol. As part of a comprehensive neuropsychological battery, four study groups (1. fetal alcohol syndrome/partial fetal alcohol syndrome; 2. static encephalopathy/alcohol exposed; 3. neurobehavioral disorder/alcohol exposed as diagnosed using the University of Washington FASD 4-Digit Code; 4. typically-developing (TD) age-matched children with no prenatal alcohol exposure) were administered measures of motor response and inhibitory control, attention, and adaptive behavior. The results indicate increased levels of IIV in those with FASD compared to the TD controls. It was found that IIV uniquely contributes to predicting adaptive behavior above and beyond attention, while attention partially mediates the relationship between IIV and adaptive behavior. This is the first study to the authors' knowledge to show the presence of increased IIV in children with FASD. It additionally provides evidence that IIV measures some inherent variability in performance independent of poor attention in children with FASD.

Cognitive Performance in Adults' Daily Lives: Is There a Lab-Life Gap?

This article addresses the "lab-life gap" in cognitive aging research as an important issue of ecological validity in developmental research. Older adults often function competently in complex everyday situations despite age-related deficits on laboratory-based cognitive tasks. Therefore, to what extent do lab-based cognitive tasks predict real-life outcomes in older adults? Our review shows that although they are similar, measures of everyday cognitive competence predict relevant outcomes beyond basic measures. We provide our perspective on critical questions concerning the relevance of everyday cognitive tests in our ever-changing world, new methods of everyday cognitive assessment, and whether everyday cognition can be improved.

Intraindividual reaction time variability predicts prospective memory failures in older adults

This study investigated the relationship between intraindividual variability (IIV) in reaction time and prospective memory errors in older adults using data from the Zurich Longitudinal Study of Cognitive Aging (n = 336 individuals aged 66-81 years). The results indicated that increased IIV measured from independent tasks was associated with a greater proportion of prospective memory errors. These significant findings were not influenced by age and did not vary according to prospective memory cue type. Variability is thought to reflect fluctuations in attentional and executive control and these attentional processes may also impact on prospective memory through failure to detect the target cue. The findings suggest, therefore, that measures of variability may have some potential in the identification of older persons who are more vulnerable to everyday errors such as prospective memory failures.

Does within-person variability predict errors in healthy adults aged 18-90?

This study investigated within-person variability on basic psychomotor tasks in relation to errors on a higher order cognitive task. We were interested in whether more variable individuals were more prone to making errors, and whether this relationship varied with age. Variability was assessed using simple and choice reaction time, while errors of omission (misses) and commission (false alarms) were obtained from simple and complex visual search tasks. Data from 557 participants aged 18-90 years were included in the analysis. Greater variability was associated with more misses, and distribution analyses showed that slower responses were behind this effect. Variability was also associated with false alarms, but the pattern was inconsistent. Taking age into account revealed that the association between variability and misses in the simple visual search condition was stronger in older (aged 65-90 years) participants. The results suggest the relationship between greater variability and errors of omission (misses) may be related to inattention. Measures of variability may therefore provide valuable insights into individual differences in error rates and, more broadly, may also offer early warning of persons who are more prone to errors in visual search.

Pretreatment Differences in Intraindividual Variability in Reaction Time between Women Diagnosed with Breast Cancer and Healthy Controls

OBJECTIVES

Chemotherapy has adverse effects on cognitive performance in women treated for breast cancer, but less is known about the period before chemotherapy. Studies have focused on mean level of performance, yet there is increasing recognition that variability in performance within an individual is also an important behavioral indicator of cognitive functioning and underlying neural integrity.

METHODS

We examined intraindividual variability (IIV) before chemotherapy and surgery in women diagnosed with breast cancer (n=31), and a healthy control group matched on age and education (n=25). IIV was calculated across trials of a computerized Stroop task, including an examination of the slowest and fastest trials of reaction time (RT) responses.

RESULTS

The groups were equivalent on overall accuracy and speed, and participants in both groups were less accurate and slower on incongruent trials compared with congruent trials. However, women with breast cancer became more variable with increased task difficulty relative to healthy controls. Among the slowest RT responses, women with breast cancer were significantly more variable than healthy controls on incongruent trials. This suggests that a specific variability-producing process (e.g., attentional lapses) occurs in task conditions that require executive control (e.g., incongruent trials).

CONCLUSIONS

Results are consistent with other evidence of executive dysfunction among women treated for breast cancer. These findings highlight the importance of pretreatment assessment and show that variability in performance provides information about cognition that measures of central tendency do not.

Comparing individual differences in inconsistency and plasticity as predictors of cognitive function in older adults

INTRODUCTION

Recent theorizing differentiates key constraints on cognition, including one's current range of processing efficiency (i.e., flexibility or inconsistency) as well as the capacity to expand flexibility over time (i.e., plasticity). The present study uses intensive assessment of response time data to examine the interplay between markers of intraindividual variability (inconsistency) and gains across biweekly retest sessions (plasticity) in relation to age-related cognitive function.

METHOD

Participants included 304 adults (aged 64 to 92 years: M = 74.02, SD = 5.95) from Project MIND, a longitudinal burst design study assessing performance across micro and macro intervals (response latency trials, weekly bursts, annual retests). For two reaction time (RT) measures (choice RT and one-back choice RT), baseline measures of RT inconsistency (intraindividual standard deviation, ISD, across trials at the first testing session) and plasticity (within-person performance gains in average RT across the 5 biweekly burst sessions) were computed and were then employed in linear mixed models as predictors of individual differences in cognitive function and longitudinal (6-year) rates of cognitive change.

RESULTS

Independent of chronological age and years of education, higher RT inconsistency was associated uniformly with poorer cognitive function at baseline and with increased cognitive decline for measures of episodic memory and crystallized verbal ability. In contrast, predictive associations for plasticity were more modest for baseline cognitive function and were absent for 6-year cognitive change.

CONCLUSIONS

These findings underscore the potential utility of response times for articulating inconsistency and plasticity as dynamic predictors of cognitive function in older adults.

Daily Fluctuations in Everyday Cognition: Is It Meaningful?

OBJECTIVE

This study examined whether there are daily fluctuations in everyday cognition that are consistent with daily fluctuations often observed in traditional measures of basic cognitive abilities.

METHOD

Two hundred six independently living older adults (age range = 60-91 years) were asked to complete a computerized cognitive battery over eight occasions within a 2- to 3-week period.

RESULTS

Using multilevel model, significant within-person variability was observed across the Daily Everyday Cognition Assessment (DECA; 46%), with 54% between-person variability. At each occasion, better performance on the DECA was significantly associated with better performance on simple reaction time ( p < .01) and memory (Auditory Verbal Learning Task, p < .01) even after accounting for time, age, education, and performance on other cognitive measures.

CONCLUSION

These findings demonstrate that within-person performance fluctuations can be observed for everyday cognition tasks, and these fluctuations are consistent with daily changes in basic cognitive abilities.

Intra-individual variability in women with breast cancer

Studies assessing cognitive functioning in women treated for breast cancer have used primarily standardized neuropsychological tests and examined accuracy and/or reaction time as outcome measures: they have been inconsistent in identifying the cognitive domains affected and the severity of deficits. In other contexts of neural development and disorders, measures of Intra-individual variability (IIV) have proven useful in identifying subtleties in performance deficits that are not captured by measures of central tendency. This article presents proof of concept that assessing IIV may also increase understanding of the cognitive effects of cancer treatment. We analyzed mean accuracy and reaction time, as well as IIV from 65 women with breast cancer and 28 age and education matched controls who performed the Conner's Continuous Performance Test, a "Go-NoGo" task. Although there were no significant differences between groups using measures of central tendency, there was a group × inter-stimulus interval (ISI) interaction for IIV Dispersion (p < .001). Patient Dispersion was more variable at shorter ISI than controls and less variable at long ISI, suggesting greater sensitivity to presentation speed. Interpretation of IIV differences requires further investigation. Our results suggest that future studies would benefit from designs that allow analysis of IIV measures in studies assessing cognition in cancer survivors.

Translation and validation of Chinese version of the problems in everyday living (PEDL) test in patients with mild cognitive impairment

BACKGROUND

Cognitive impairment places older adults at increased risk of functional decline, injuries, and hospitalization. Assessments to determine whether older persons are still capable of meeting the cognitive challenges of everyday living are crucial to ensure their safe and independent living in the community. The present study aims to translate and validate the Chinese version of the Problems in Everyday Living (PEDL) test for use in Chinese population with mild cognitive impairment (MCI).

METHODS

The cultural relevancy and content validity of the Chinese version of PEDL (C-PEDL) was evaluated by a seven-member expert panel. Forty patients with MCI and 40 cognitively healthy participants were recruited to examine the psychometric properties of C-PEDL.

RESULTS

Significant differences in the C-PEDL scores were found between the patients with MCI and the cognitively healthy controls in both educated (F = 9.96, p = 0.003) and illiterate (F = 10.43, p = 0.004) populations. The C-PEDL had excellent test-retest and inter-rater reliabilities, with intraclass correlation coefficient at 0.95 and 0.99 respectively. The internal consistency of C-PEDL was acceptable with Chronbach's α at 0.69. The C-PEDL had moderate correlation with the Mini-Mental State Examination (r = 0.45, p = 0.004) and the Category Verbal Fluency Test (r = 0.40, p = 0.012), and a moderate negative Spearman's correlation with the Global Deteriorating Scale (r = -0.42, p = 0.007).

CONCLUSIONS

The C-PEDL is a valid and reliable test for assessing the everyday problem-solving ability in Chinese older population with MCI.

Response time measurements in the iOS app-based Token Test, the Brief Token Test in the elderly

AIM

A pen and paper Token Test utilizing binary scoring of accuracy-inaccuracy in responses evaluates linguistic functions including verbal comprehension. However, the test might not be sensitive enough to detect the aging effect on performance in normal older adults unless the test utilizes a multidimensional scoring system. We hypothesized that the measurement of response time (RT) instead of accuracy would be a feasible way to measure deterioration of verbal comprehension as a function of age in this linguistically vulnerable population.

METHODS

Data were acquired from 174 community-dwelling normal older adults (147 females and 27 males, mean age 75.9 ± 6.13 years, range 65-94 years). In order to automatically quantify accuracies and RT, we developed an iOS app-based Token Test, comprising of four subtests (24 items, 6 items in each subtest), and administered it to each participant.

RESULTS

RT of the second, third and fourth subtests (P<0.001, P<0.01, P<0.05, respectively) and the average RT across all four subtests (P<0.01) had significant partial correlation coefficients with age. The results of the multiple linear regression analyses showed that the models for RT and average RT analyses of the three subtests (2, 3 and 4) included the age variable.

CONCLUSION

RT measurement of the iOS app-based Token Test could be highly useful and convenient to better detect abnormalities in linguistic efficiency. RT measurement in the Token Test could be used as a screening tool for linguistic slowing in the elderly population.

Measures of everyday competence in older adults with cognitive impairment: a systematic review

BACKGROUND

The issue of safety of the cognitively impaired elderly people living alone has been continuously raised. Traditional psychometric measures of cognitive abilities may not adequately reflect older adults' functioning in a real everyday context.

OBJECTIVES

To conduct a systematic review on instruments available for evaluating the everyday problem-solving or everyday competence of the elderly with cognitive impairment and to critically review the measurement properties of the identified instruments.

METHODS

We searched the databases such as Cinahl, Medline, PsycINFO, AARP Ageline, ProQuest and the Cochrane Library for the time period between January 1995 and December 2010. Reference lists of the included papers were also manually searched.

RESULTS

Five instruments were included. All the instruments focused their framework on Instrumental Activities of Daily Living (IADL) domains which meet well with suggestions from other studies on the importance of IADL in determining an elderly individual's capability to live independently in the community. No available instruments for the moderate to severe impairment group were identified under this review.

CONCLUSIONS

Few existing instruments to assess the ability of everyday problem-solving of the elderly with cognitive impairment can be identified in the literature. Further research validating them against functional, real-world outcomes is needed.

Everyday problem solving across the adult life span: solution diversity and efficacy

Everyday problem solving involves examining the solutions that individuals generate when faced with problems that take place in their everyday experiences. Problems can range from medication adherence and meal preparation to disagreeing with a physician over a recommended medical procedure or compromising with extended family members over where to host Thanksgiving dinner. Across the life span, research has demonstrated divergent patterns of change in performance based on the type of everyday problems used as well as based on the way that problem-solving efficacy is operationally defined. Advancing age is associated with worsening performance when tasks involve single-solution or fluency-based definitions of effectiveness. However, when efficacy is defined in terms of the diversity of strategies used, as well as by the social and emotional impact of solution choice on the individual, performance is remarkably stable and sometimes even improves in the latter half of life. This article discusses how both of these approaches to everyday problem solving inform research on the influence that aging has on everyday functioning.

Judgment in Mild Cognitive Impairment and Alzheimer's disease

Judgment is the capacity to make decisions after considering available information, contextual factors, possible solutions and probable outcomes. Our aim was to investigate previous research studies regarding assessment of judgment in older adults with different degrees of cognitive impairment. To this end, a search of Pubmed and Lilacs electronic databases for studies published from January 1990 until August 2011 in English, Spanish and Portuguese was carried out. The terms used were "judgment" combined with the terms "dementia" or "Mild Cognitive Impairment" (MCI) or "Alzheimer's disease" (AD). Some studies showed that MCI and AD patients had impaired judgment. There is a lack of specific methods to measure judgment capacity, and data on judgment abilities in older adults with MCI and dementia are scarce. No studies with specific measures of judgment capacity in other dementias were found.