The frequency of self-reported memory failures is influenced by everyday context across the lifespan: Implications for neuropsychology research and clinical practice

An evaluation of the moderating effects of routine and busyness on the relationship between prospective memory and everyday functioning in older persons with HIV disease

INTRODUCTION

People living with HIV (PLWH) often experience difficulties in everyday functioning, which can arise in part from deficits in the strategic/executive aspects of prospective memory (PM). Using Suchy's Contextually Valid Executive Assessment (ConVExA) framework, this study sought to determine whether the contextual factors of busyness and routine moderate the relationship between the strategic/executive aspects of PM and everyday functioning in older PLWH.

METHODS

Participants in this cross-sectional analysis were 145 PLWH aged 50 years and older who had completed the Martin and Park Environmental Demands (MPED) questionnaire of routine and busyness, the performance-based Cambridge Test of Prospective Memory, and self-report measures of activities of daily living (ADLs) and cognitive symptoms in daily life.

RESULTS

Multiple regression analyses covarying for relevant comorbidities showed that higher levels of busyness - but not routine - were associated with more frequent cognitive symptoms in daily life. Neither busyness nor routine interacted with PM in association with cognitive symptoms. However, routine and a strategic/executive measure of PM interacted in predicting ADLs; specifically, the association between time-based PM and ADLs was stronger in persons with higher levels of routine in their daily lives. Parallel analyses with less executively-demanding event-based PM were null and small.

CONCLUSIONS

Overall, findings provided mixed - and unexpected - evidence for the associations between contextual factors (i.e. routine and busyness), everyday functioning, and PM in this sample of older adults with HIV disease. Results and clinical implications are interpreted and discussed in the framework of the ConVExA model.

Attorney demands for protected psychological test information: Is access necessary for cross examination or does it lead to misinformation? An interorganizational* position paper

Objective: Some attorneys claim that to adequately cross examine neuropsychological experts, they require direct access to protected test information, rather than having test data analyzed by retained neuropsychological experts. The objective of this paper is to critically examine whether direct access to protected test materials by attorneys is indeed necessary, appropriate, and useful to the trier-of-fact. Method: Examples are provided of the types of nonscientific misinformation that occur when attorneys, who lack adequate training in testing, attempt to independently interpret neurocognitive/psychological test data. Results: Release of protected test information to attorneys introduces inaccurate information to the trier of fact, and jeopardizes future use of tests because non-psychologists are not ethically bound to protect test content. Conclusion: The public policy underlying the right of attorneys to seek possibly relevant documents should not outweigh the damage to tests and resultant misinformation that arise when protected test information is released directly to attorneys. The solution recommended by neuropsychological/psychological organizations and test publishers is to have protected psychological test information exchanged directly and only between clinical psychologist/neuropsychologist experts.

Preliminary validation of the Virtual Kitchen Challenge as an objective and sensitive measure of everyday function associated with cerebrovascular disease

Preliminary validity of a computer-based test of everyday function (Virtual Kitchen Challenge [VKC]) was examined against brain-imaging markers of cerebrovascular disease and in contrast to conventional neuropsychological and self-report measures. Twenty community-dwelling older adults (n = 6 mild cognitive impairment) performed simulated breakfast and lunch tasks using a computer touchscreen (VKC). Automated measures (completion time, proportion time off screen, etc.) were computed during training and test conditions. White matter hyperintensity (WMH) volumes from brain magnetic resonance imaging and conventional measures of cognition and function also were obtained. VKC completion time and proportion time off screen improved significantly from training to test and were significantly associated with WMH volume (r > 0.573). VKC measures and WMH were not significantly correlated with conventional cognitive or self-report measures. The VKC holds promise as a valid measure of subtle functional difficulties in older adults that is sensitive to change and cerebrovascular pathology, highlighting its potential for clinical trials.

Highlights

Virtual Kitchen Challenge (VKC) scores showed significant improvement from training to test conditions.VKC scores (completion time and proportion of time off screen) were associated with a neuroimaging biomarker of brain health (white matter hyperintensities).

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.