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Raimo S, Maggi G, Ilardi CR, Cavallo ND, Torchia V, Pilgrom MA, Cropano M, Roldán-Tapia MD, Santangelo G. The relation between cognitive functioning and activities of daily living in normal aging, mild cognitive impairment, and dementia: a meta-analysis. Neurol Sci 2024; 45:2427-2443. [PMID: 38347298 DOI: 10.1007/s10072-024-07366-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/25/2024] [Indexed: 05/12/2024]
Abstract
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.
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Affiliation(s)
- Simona Raimo
- Department of Psychology, 'Luigi Vanvitelli' University of Campania, Caserta, Italy.
- Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro, Catanzaro, Italy.
| | - Gianpaolo Maggi
- Department of Psychology, 'Luigi Vanvitelli' University of Campania, Caserta, Italy
| | - Ciro Rosario Ilardi
- Department of Psychology, 'Luigi Vanvitelli' University of Campania, Caserta, Italy
| | | | - Valentina Torchia
- Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro, Catanzaro, Italy
| | | | - Maria Cropano
- Department of Psychology, 'Luigi Vanvitelli' University of Campania, Caserta, Italy
| | | | - Gabriella Santangelo
- Department of Psychology, 'Luigi Vanvitelli' University of Campania, Caserta, Italy
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3
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Suchy Y, Gereau Mora M, DesRuisseaux LA, Brothers SL. It's complicated: Executive functioning moderates impacts of daily busyness on everyday functioning in community-dwelling older adults. J Int Neuropsychol Soc 2023; 29:850-858. [PMID: 37057862 DOI: 10.1017/s1355617723000048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
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.
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Affiliation(s)
- Yana Suchy
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | | | | | - Stacey L Brothers
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
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Gonzalez C, Mimmack KJ, Amariglio RE, Becker JA, Chhatwal JP, Fitzpatrick CD, Gatchel JR, Johnson KA, Katz ZS, Kuppe MK, Locascio JJ, Udeogu OJ, Papp KV, Premnath P, Properzi MJ, Rentz DM, Schultz AP, Sperling RA, Vannini P, Wang S, Marshall GA. Associations of the Harvard Automated Phone Task and Alzheimer's Disease Pathology in Cognitively Normal Older Adults: Preliminary Findings. J Alzheimers Dis 2023; 94:217-226. [PMID: 37212093 PMCID: PMC10330453 DOI: 10.3233/jad-220885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Detecting clinically meaningful changes in instrumental activities of daily living (IADL) at the earliest stages of Alzheimer's disease (AD) is critical. OBJECTIVE The objective of this exploratory study was to examine the cross-sectional relationship between a performance-based IADL test, the Harvard Automated Phone Task (APT), and cerebral tau and amyloid burden in cognitively normal (CN) older adults. METHODS Seventy-seven CN participants underwent flortaucipir tau and Pittsburgh Compound B amyloid PET. IADL were assessed using the three Harvard APT tasks: prescription refill (APT-Script), health insurance company call (APT-PCP), and bank transaction (APT-Bank). Linear regression models were used to determine associations between each APT task and entorhinal cortex, inferior temporal, or precuneus tau with or without an interaction with amyloid. RESULTS Significant associations were found between APT-Bank task rate and interaction between amyloid and entorhinal cortex tau, and APT-PCP task and interactions between amyloid and inferior temporal and precuneus tau. No significant associations were found between the APT tasks and tau or amyloid alone. CONCLUSION Our preliminary findings suggest an association between a simulated real-life IADL test and interactions of amyloid and several regions of early tau accumulation in CN older adults. However, some analyses were underpowered due to the small number of participants with elevated amyloid, and findings should be interpreted with caution. Future studies will further explore these associations cross-sectionally and longitudinally in order to determine whether the Harvard APT can serve as a reliable IADL outcome measure for preclinical AD prevention trials and ultimately in the clinic setting.
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Affiliation(s)
- Christopher Gonzalez
- Department of Psychology, Illinois Institute of Technology,
Chicago, IL 60616, USA
| | - Kayden J. Mimmack
- Department of Neurology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, USA
| | - Rebecca E. Amariglio
- Department of Neurology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Neurology, Brigham and Women’s
Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - J. Alex Becker
- Department of Radiology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, USA
| | - Jasmeer P. Chhatwal
- Department of Neurology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Neurology, Brigham and Women’s
Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Colleen D. Fitzpatrick
- Department of Neurology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, USA
| | - Jennifer R. Gatchel
- Department of Psychiatry, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, USA
- Division of Geriatric Psychiatry, McLean Hospital, Harvard
Medical School, Belmont, MA 02478, USA
| | - Keith A. Johnson
- Department of Neurology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, USA
- Department of Radiology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Neurology, Brigham and Women’s
Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Zoe S. Katz
- Department of Neurology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, USA
| | - Madeline K. Kuppe
- Cognitive Neuroimaging Laboratory, Graduate Program for
Neuroscience, Boston University, Boston, MA 02215, USA
| | - Joseph J. Locascio
- Department of Neurology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, USA
| | - Onyinye J. Udeogu
- Department of Neurology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, USA
| | - Kathryn V. Papp
- Department of Neurology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Neurology, Brigham and Women’s
Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Pranitha Premnath
- Department of Psychology, The Graduate Center, City
University of New York, New York, NY 10016, USA
| | - Michael J. Properzi
- Department of Neurology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, USA
| | - Dorene M. Rentz
- Department of Neurology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Neurology, Brigham and Women’s
Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Aaron P. Schultz
- Department of Neurology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, USA
| | - Reisa A. Sperling
- Department of Neurology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Neurology, Brigham and Women’s
Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Patrizia Vannini
- Department of Neurology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Neurology, Brigham and Women’s
Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Sharon Wang
- Department of Neurology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, USA
| | - Gad A. Marshall
- Department of Neurology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Neurology, Brigham and Women’s
Hospital, Harvard Medical School, Boston, MA, 02115, USA
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Suchy Y, Lipio Brothers S, DesRuisseaux LA, Gereau MM, Davis JR, Chilton RLC, Schmitter-Edgecombe M. Ecological validity reconsidered: the Night Out Task versus the D-KEFS. J Clin Exp Neuropsychol 2022; 44:562-579. [PMID: 36412540 DOI: 10.1080/13803395.2022.2142527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Although executive functioning (EF) correlates with execution of instrumental activities of daily living (IADLs), tests of EF have been criticized for having poor ecological validity. Attempts have been made to develop new tests that approximate naturalistic daily tasks. However, the incremental utility of such tests has not been convincingly demonstrated. The Night Out Task (NOT) is a novel measure designed to increase ecological validity. This study examined whether the NOT correlates with traditional lab- and home-based measures of EF and IADLs, and whether it outperforms traditional measures of EF in predicting IADLs. METHOD Participants (50 adults aged 60 to 95) completed (1) the Delis Kaplan Executive Function System (D-KEFS) and IADLs in the laboratory, and (2) ecological momentary assessment of EF and daily IADL tasks at home across three weeks (using the Daily Assessment of Independent Living and Executive Skills protocol; DAILIES). RESULTS The NOT correlated with a lab-based measure of EF beyond covariates, and lab-based IADLs beyond covariates and beyond the D-KEFS. However, it was unrelated to at-home variables beyond covariates. In contrast, the D-KEFS was a significant predictor of at-home IADLs, and this association was mediated by at-home EF performance. CONCLUSION This study provides a preliminary validation of the NOT as a correlate of office-based performances in a primarily college educated white sample. Despite its high face validity, the NOT does not appear to sufficiently tap EF processes needed for home-based IADLs as measured by the DAILIES, although small sample size limits the interpretability of this negative finding.
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Affiliation(s)
- Yana Suchy
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | | | | | - Michelle M Gereau
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Justin R Davis
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
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Arora C, Frantz C, Toglia J. Awareness of Performance on a Functional Cognitive Performance-Based Assessment Across the Adult Lifespan. Front Psychol 2021; 12:753016. [PMID: 34803834 PMCID: PMC8602564 DOI: 10.3389/fpsyg.2021.753016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/19/2021] [Indexed: 11/15/2022] Open
Abstract
As people age, their cognitive skills and ability to complete complex instrumental activities of daily living often decline in subtle ways. Older adults who are aware of these slight cognitive and functional changes spontaneously adapt and implement strategies to maximize performance. On the other hand, older adults with limited self-awareness are less likely to adjust performance or initiate compensatory strategies as they may not recognize the need to do so. This places them at higher risk of functional decline and loss of independence. Research on awareness of functional performance in healthy adults is, however, limited, and there is a paucity of assessment tools available to address questions of awareness and strategy use in functional tasks. We used the Weekly Calendar Planning Activity (WCPA) - a performance-based assessment of functional cognition including measures of awareness and strategy use - to investigate differences in performance, awareness, and strategy use across the adult lifespan. The WCPA requires examinees to schedule appointments into a weekly calendar while following rules designed to increase task demands. Healthy adults (n=342) from ages 18-92 were observed for strategy use and error recognition, while a post-test interview probed participants' reported strategy use and estimation of accuracy. The discrepancy between participant estimation and actual accuracy provided a measure of online awareness of performance where a larger estimation discrepancy indicated over-estimation of performance. Performance on the WCPA declined across the adult lifespan. Older adults were less likely to use self-monitoring strategies and used less effective strategies overall. Overestimation was associated with use of fewer strategies and lower accuracy in all age groups. Importantly, twice as many older adults overestimated compared to younger adults. Furthermore, the subset of older adults who had good awareness of performance was more likely to use effective strategies, to recognize errors, and achieved accuracy on par with their younger counterparts. Our results emphasize the importance of examining self-awareness of performance and analyzing the strategies used to perform a complex functional task. This information can provide a foundation for early detection of functional decline in aging and for designing interventions to maximize functional independence in aging.
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Affiliation(s)
- Catherine Arora
- Department of Occupational Therapy, School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, United States
| | - Carina Frantz
- Department of Occupational Therapy, School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, United States
| | - Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, United States
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Sardella A, Bellone F, Morabito N, Minisola S, Basile G, Corica F, Catalano A. The association between hypoparathyroidism and cognitive impairment: a systematic review. J Endocrinol Invest 2021; 44:905-919. [PMID: 32926396 DOI: 10.1007/s40618-020-01423-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 09/08/2020] [Indexed: 12/01/2022]
Abstract
CONTEXT AND PURPOSE Hypocalcemia and low parathyroid hormone levels have been commonly suggested as factors able to induce central nervous system disturbances. However, evidences on the occurrence of cognitive impairment are limited or underestimated. The aim of this review is, therefore, to systematically summarize the available evidence concerning the occurrence of cognitive impairment among subjects suffering from idiopathic or secondary hypoparathyroidism. METHODS A systematic selection of the available literature was performed by searching the online databases PubMed, Scopus and Web of Knowledge. RESULTS The present systematic review included sixteen case report articles and one cross-sectional controlled study. Case reports were the most representative literature sources and involved ten women and seven men. The presence of cognitive impairment was mostly discussed in association with idiopathic hypoparathyroidism (HPT); five articles described the occurrence of cognitive impairment following postsurgical HPT. The case-controlled study reported a significant presence of peculiar cognitive deficits (e.g. reduced inhibitory control, impairment in visuo-spatial functioning among, and psychomotor retardation) among HPT subjects compared to healthy controls, with serum total calcium and its product with phosphorus as independent predictors of neuropsychological dysfunctions. CONCLUSION Even though mostly based on single case reports, the presence of neuropsychological dysfunctions in the context of HPT appears to be a consistent core finding.
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Affiliation(s)
- A Sardella
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - F Bellone
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - N Morabito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - S Minisola
- Department of Internal Medicine and Medical Disciplines, "Sapienza" Rome University, Rome, Italy
| | - G Basile
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - F Corica
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - A Catalano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
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