Adequate proverb interpretation is associated with performance on the Independent Living Scales

Longitudinal changes on the Independent Living Scale in amnestic mild cognitive impairment

The Independent Living Scales (ILS) is an objective measure of day-to-day functioning, which can be used to aid in diagnosing dementia in older adults with cognitive impairments. However, no studies have examined this measure longitudinally in individuals with mild cognitive impairment (MCI), a prodromal phase of dementia. Three subscales of the ILS (Managing Money, Managing Home and Transportation, Health and Safety) were administered to a sample of 94 individuals with amnestic MCI twice across 15 months. A measure of global cognition (Total Scale score on the Repeatable Battery for the Assessment of Neuropsychological Status [RBANS]) was also administered twice. In this MCI sample, two of the three subscales of the ILS showed a significant decline over time, where the third ILS subscale and the Total Scale score of the RBANS did not change. Regression-based change models showed that baseline ILS scores were most strongly predictive of follow-up ILS scores compared to RBANS scores at baseline and follow-up and demographic variables (age, education, and sex). These results provide additional information on the longitudinal change on the ILS in a sizeable cohort of older individuals with amnestic MCI, which may make this scale more useful in identifying progression to dementia.

Predicting daily functioning with the modified Telephone Interview for Cognitive Status

Background

The modified Telephone Interview for Cognitive Status (mTICS) is a frequently used telephone-based cognitive screening measure that can distinguish between normal aging, mild cognitive impairment (MCI), and dementia. Although it has been used to predict current and future cognitive function in older adults, no studies have examined if the mTICS can predict daily functioning.

Aims

The current study sought to examine the relationship between the mTICS and a performance-based measure of daily functioning.

Methods

The mTICS and demographic information (age, sex, education) were collected during a telephone screening visit for 149 older adults (65–91 years in age) with amnestic MCI. Three subscales of the Independent Living Scales (ILS; Managing Money, Managing Home and Transportation, Health and Safety) were collected during a baseline visit and during a 16 month follow-up visit in a subsample of 93 individuals.

Results

Using simple hierarchical regression, baseline mTICS total score combined with demographic variables significantly predicted 19–22% of baseline ILS subscale scores. Similarly, in a subsample of 93 participants with 16 month follow-up data, baseline mTICS and demographic information predicted 9–31% of ILS subscale scores at follow-up.

Conclusions

The mTICS appears able to predict daily functioning in older individuals with MCI. Remote tracking of cognition and daily functioning in this at-risk group seems particularly beneficial to geriatricians and other providers, especially during COVID-19.

The independent living scale in amnestic mild cognitive impairment: Relationships to demographic variables and cognitive performance

INTRODUCTION

The Independent Living Scales (ILS) is an objective measure of day-to-day functioning, which can be used to aid in diagnosing dementia in older adults with cognitive impairments. However, no studies have examined this measure in individuals with Mild Cognitive Impairment (MCI), a prodromal phase of dementia.

METHOD

Therefore, we sought to examine three subscales of the ILS (Managing Money, Managing Home and Transportation, Health and Safety) in a sample of 132 individuals with amnestic MCI, focusing on the relationship of the ILS with demographic variables (age, education, sex) and cognitive abilities (assessed with the Repeatable Battery for the Assessment of Neuropsychological Status [RBANS]).

RESULTS

This MCI sample showed intact daily functioning on the three ILS subscales. In a series of three, separate hierarchical linear regression models, the Managing Money, Managing Home and Transportation, and Health and Safety subscales were all significantly related to demographic variables, and the RBANS Total Scale score significantly added to all models. These models would also allow one to predict an ILS score based on demographic and cognitive data, which could be compared to an observed ILS score to see if it meets expectations.

CONCLUSIONS

Overall, these results indicate that daily functioning, as measured with the ILS, is related to cognitive abilities in amnestic MCI, and that demographic variables also influenced ILS scores in this cohort. Although the ILS may be appropriate for identifying functional abilities in MCI, the consideration of these moderating variables seems necessary.

Pragmatic aspects of verbal communication in elderly people: A study of Polish seniors

BACKGROUND

Behavioural and neuropsychological studies on elderly populations concentrate on many aspects of cognitive functioning, but significantly less research concerns communication processes, including aspects of verbal communication skills, pragmatic issues that are important for performing social tasks at every age.

AIMS

To characterize the variability in changes that occur with age in the domain of pragmatic aspects of verbal communication skills in a group of individuals aged > 65 years and to define their determinants.

METHODS & PROCEDURES

A group of 109 normally ageing individuals (aged 64.9-90 years) participated in the study (62 women and 47 men). Participants were divided into two age groups: < 70 and > 71 years old. The verbal communication skills were examined using the Polish version of the Right Hemisphere Language Battery (RHLB-PL), and cognitive skills using the Mini Mental State Examination (MMSE).

OUTCOMES & RESULTS

Comparison between the subgroups showed that there was a significant decline in the older group in all the subtests except for the Discourse Analysis. Age did not differentiate discursive abilities in seniors. These data apparently confirm the hypothesis that discursive competences are stable throughout one's lifespan. In order to compare younger and older seniors in terms of the 11 aspects of pragmatic communication, two performance profiles were prepared for the groups and subjected to comparative analyses. The shape of the two profiles of all communication competences was similar. The biggest differences were identified between the groups in the Comments, Humour and Metaphor comprehension and explanation subtests. Analysis of the determinants of changes in pragmatic aspects of verbal communication skills in elderly individuals revealed that the important factors include age, overall level of cognitive function, higher education and female sex.

CONCLUSION & IMPLICATIONS

The relationship between age and pragmatic aspects of verbal communication skills is complex. The results indicate that treating seniors as a homogenous group in terms of pragmatic aspects of verbal communication functioning is incorrect. Age differentially affects the various aspects of communication functions. The level of cognitive functioning mediates the relationship between age and pragmatic aspects of verbal communication skills. What this paper adds What is already known on the subject? Behavioural and neuropsychological studies on elderly populations concentrate on many aspects of mnestic functions, executive functions, cognitive flexibility, fluency, cognitive control, working memory, semantic processing, arithmetic competences and perception speed. Significantly less research concerns communication processes, including verbal communication. Older and younger people have usually been compared in particular areas of communication: discourse, understanding of metaphors or prosody. At present there is a paucity of research regarding changes in communication functions at different stages of ageing and profiles of various aspects of verbal communication in old age. What this paper adds to existing knowledge The study indicates that normally ageing individuals are a non-homogeneous group in terms of pragmatic aspects of verbal communication. Various communication functions change at different rate at various stages of ageing. The study clarified the determinants of changes in pragmatic aspects of verbal communication skills in elderly individuals. These aspects are cognitive abilities, age, a high education level and sex. What are the potential or actual clinical implications of this work? The research shows that diagnosis of communication competencies in elderly individuals is necessary. Furthermore, the kind of abilities is very important for social relationships and quality of life. It is essential to inform a senior's family about communication changes that occur in normal ageing. Understanding potential verbal communication difficulties in seniors and their determinants are fundamental issues.

Neuropsychological predictors of health and safety abilities in dementia

The Independent Living Scales Health and Safety (ILS HS) scale is commonly used by neuropsychologists when evaluating older adults' instrumental activities of daily living (IADLs). However, there is a minimal amount of research on its use in dementia populations and, specifically, its relationship to other neuropsychological measures. The present study investigated relationships between the ILS HS scale and measures of cognition and depression. The study utilized archival data from a sample (N = 142) of older adults (mean age = 77.85) diagnosed with dementia, who were evaluated at Saint Louis University Medical Center and administered the ILS HS scale as part of a larger clinical neuropsychological evaluation. Multiple regression analyses demonstrated that up to 37% of the variance in ILS HS performance was accounted for by demographic variables, premorbid intelligence, and cognitive functioning (e.g., global cognition, delayed verbal recall, and executive functioning), and regression models demonstrated medium to large effect sizes. Depression and self- or informant-reported IADLs were unrelated to the ILS HS scale. Results suggest that older adults' ability to function in health and safety-related situations requires a range of cognitive abilities. Performance on these measures may help guide clinical decision making regarding independent living and treatment planning.