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

Exploring the Cognitive Profiles of Haemodialysis Patients using Objective and Subjective Indicators: A Cross-sectional Observational Study

BACKGROUND

Cognitive impairment is common in haemodialysis patients and associated with adverse health outcomes. Previous work focused primarily on neuropsychological tests, the gold standard measure of cognition. However, these tests reflect performance under optimal conditions rather than performance in everyday life. This study aims to assess both objective and subjective cognition in haemodialysis patients.

METHODS

Adult haemodialysis patients completed measures of objective cognitive impairment (Montreal Cognitive Assessment), subjective cognitive complaints, mood and fatigue symptoms, and provided sociodemographic information. Clinical data such as comorbidity were extracted from patients' medical record.

RESULTS

A total of 268 haemodialysis patients (mean age = 59.87 years; 42.5% female) participated. Only 25.0% of the sample had normal cognition, while the rest had either objective cognitive impairments or clinically significant cognitive complaints, or both (both objective impairments and subjective complaints: 26.1%; objective impairments without complaint: 38.4%; significant complaints without objective impairments: 10.4%). Lower education was associated with the presence of objective cognitive impairments, whereas depression was associated with the presence of clinically significant cognitive complaints. Patients who exhibited both objective cognitive impairments and significant cognitive complaints were more likely to have diabetes and higher dialysis dose (Kt/V). Patients with objective cognitive impairments but no significant complaints were significantly older.

CONCLUSIONS

The cognitive burden of haemodialysis patients can be manifested as objective impairments and/or subjective complaints. When combined the two indicators may better represent the overall cognitive well-being in this population. There is a need to screen for cognitive difficulties and develop cognitive rehabilitative strategies in dialysis settings.

The role of subjective cognitive complaints in self-management among haemodialysis patients: a cross-sectional study

Background

Subjective cognitive complaints refer to self-experienced difficulties with everyday cognitive tasks. Although there has been a fair amount of research on cognitive impairments and cognitive complaints in end-stage renal disease, the practical implications of these complaints remain unclear. The current study aims to examine the associations of cognitive complaints with sociodemographic and clinical variables, mood, as well as key patient-reported outcomes, i.e., self-efficacy, self-management skills, and treatment adherence.

Methods

A total of 305 haemodialysis patients (mean age = 53.97 years, 42.6% female) completed the Kidney Disease Quality of Life Cognitive Function subscale, a brief measure of cognitive complaints. The recommended cut-off point of 60 was used to identify probable cognitive impairment. Measures of self-efficacy, self-management skills (i.e., symptom coping, health monitoring, health service navigation), treatment adherence, and mood symptoms were also administered. Between-group comparisons and correlational analyses were performed to examine associations of cognitive complaints with sociodemographic, clinical, and health behaviour variables. Mediation analyses were also conducted to investigate the mediating role of self-efficacy on the relationship between cognitive complaints and treatment adherence.

Results

Nearly a quarter (23.0%) of haemodialysis patients reported cognitive complaints indicative of clinical impairments. Risk of probable impairments was higher for patients with hypertension, diabetes, those diagnosed with end-stage renal disease at an older age, and those with shorter time on dialysis. Subjective cognitive complaints (both rates of probable impairments as per cut-off and continuous scores) were significantly associated with lower disease and treatment self-efficacy, poorer self-management skills, lower treatment adherence, as well as higher symptoms of distress. Mediation analysis indicated that treatment self-efficacy mediated the relationship between cognitive complaints and treatment adherence.

Conclusions

The current study demonstrated the clinical characteristics of haemodialysis patients who report cognitive complaints indicative of probable cognitive impairments and showed the associations of these complaints with self-management outcomes. Future studies should adopt more comprehensive measures of cognitive complaints and longitudinal designs to confirm the current findings.

The Hong Kong Grocery Shopping Dialog Task (HK-GSDT): A Quick Screening Test for Neurocognitive Disorders

The Hong Kong Grocery Shopping Dialog Task (HK-GSDT) is a short and easy-to-administer cognitive test developed for quickly screening neurocognitive disorders (NCDs). In the test, participants are instructed to do a hypothetical instrumental activity of daily living task of purchasing ingredients for a dish from a grocery store and verbally describe the specific shopping procedures. The current study aimed to validate the test with a sample of 545 Hong Kong older adults (58.8% female; aged 73.4 ± 8.37 years), including 464 adults with normal cognitive function, 39 with mild NCD, and 42 with major NCD. Demographic characteristics (i.e., sex, age, education) and clinical diagnosis of cognitive states (i.e., major NCD, mild NCD, and normal aging) were collected. Cognitive functioning was measured using the HK-GSDT and several standardized NCD-screening tests. The results showed good reliability (i.e., internal consistency) and structural validity in the HK-GSDT. It discriminated among different cognitive conditions, particularly between major NCDs and the other conditions, as effectively as did the existing standardized neurocognitive tests (e.g., Montreal Cognitive Assessment, Hong Kong List Learning Test). Moreover, the HK-GSDT explained additional variance of cognitive condition on top of those standardized neurocognitive tests. These results indicate that the HK-GSDT can be used alone, or in combination with other tests, to screen for NCDs.

Novel 3-D action video game mechanics reveal differentiable cognitive constructs in young players, but not in old

Video game research predominantly uses a “one game-one function” approach—researchers deploy a constellation of task-like minigames to span multiple domains or consider a complex video game to essentially represent one cognitive construct. To profile cognitive functioning in a more ecologically valid setting, we developed a novel 3-D action shooter video game explicitly designed to engage multiple cognitive domains. We compared gameplay data with results from a web-based cognitive battery (WebCNP) for 158 participants (aged 18–74). There were significant negative main effects on game performance from age and gender, even when controlling for prior video game exposure. Among younger players, game mechanics displayed significant and unique correlations to cognitive constructs such as aim accuracy with attention and stealth with abstract thinking within the same session. Among older players the relation between game components and cognitive domains was unclear. Findings suggest that while game mechanics within a single game can be deconstructed to correspond to existing cognitive metrics, how game mechanics are understood and utilized likely differs between the young and old. We argue that while complex games can be utilized to measure distinct cognitive functions, the translation scheme of gameplay to cognitive function should not be one-size-fits-all across all demographics.

Effects of functional task exercise on everyday problem-solving ability and functional status in older adults with mild cognitive impairment-a randomised controlled trial

OBJECTIVE

To investigate the effect of functional task exercise on everyday problem-solving ability and functional status in older adults with mild cognitive impairment compared to single exercise or cognitive training and no treatment control.

DESIGN

A single-blind, four-arm randomised controlled trial.

SETTING

Out-patient clinic and community centre.

PARTICIPANTS

Older adults with mild cognitive impairment aged ≥60 living in community.

METHODS

Participants (N = 145) were randomised to 8-week functional task exercise (N = 34), cognitive training (N = 38), exercise training (N = 37), or wait-list control (N = 36) group. Outcomes measures: Neurobehavioral Cognitive Status Examination, Category Verbal Fluency Test, Trail Making Test, Problems in Everyday Living Test, Activities of Daily Living Questionnaire, Instrumental Activities of Daily Living Scale; Chair stand test, Berg Balance Scale, and Short Form-12 Health Survey were conducted at baseline, post-intervention and 5-months follow-up.

RESULTS

Post-intervention results of ANCOVA revealed cognitive training improved everyday problem-solving (P = 0.012) and exercise training improved functional status (P = 0.003) compared to wait-list control. Functional task exercise group demonstrated highest improvement compared to cognitive training, exercise training and wait-list control groups in executive function (P range = 0.003-0.018); everyday problem-solving (P < 0.001); functional status (P range = <.001-0.002); and physical performance (P = 0.008) at post-intervention, with all remained significant at 5-month follow-up, and further significant improvement in mental well-being (P = 0.043).

CONCLUSIONS

Functional task exercise could be an effective intervention to improve everyday problem-solving ability and functional status in older adults with mild cognitive impairment. The findings support combining cognitive and exercise intervention may give additive and even synergistic effects.

Performance-Based Everyday Problem-Solving in Patients With TBI

OBJECTIVE

The present study examined whether the everyday problems test (EPT), a performance-based measure of everyday problem-solving, can be considered a useful test in assessing functional independence in patients with traumatic brain injury (TBI). The relationship between EPT, cognitive abilities (i.e., selective attention, set switching, and working memory) and self-rated measures of everyday functioning and disability in these patients was also assessed.

METHOD

In this case-control study 25 postcomatose outpatients with TBI (age M = 35.9, SD = 14.21) from a neurorehabilitation unit and 25 matched controls were enrolled. Participants were administered the EPT along with neuropsychological tests of selective attention, set switching and working memory, and self-rated measures of everyday functioning and disability.

RESULTS

Patients with TBI were less accurate and slower than controls in the EPT; the two groups were accurately classified based on EPT completion time (likelihood ratio test χ2 = 28.67, R2 = 0.72, p < .001). In the patient group education and selective attention explained a large portion of variance in EPT accuracy (R2 = 0.53, p = .001), while only selective attention explained a significant portion of variance in EPT time (R2 = 0.24, p < .01). Self-rated measures of everyday functioning and disability did not significantly contribute to EPT performance variance.

CONCLUSION

Including performance-based measures as the EPT in a multifactorial approach to assessment can be useful for unraveling cognitive factors contributing to TBI's impact on everyday functioning. Since attentional processes seem to play a significant role in determining EPT performance, rehabilitation of functional independence should target this ability first.

Emotion regulation and decision-making in persons with dementia: A scoping review

BACKGROUND AND OBJECTIVES

Emotion is integral to decision-making, and emotion regulation is associated with improved well-being in older age. Persons with dementia are likely to experience impairments in emotion regulation processes that can potentially contribute to differential decision-making and well-being outcomes. To promote the development of theoretical models of well-being in dementia, we review the quantitative evidence concerning the associations between emotion regulation and decision-making in dementia.

METHODS

Scoping review.

RESULTS

Seven studies of persons with dementia met our criteria. In persons with frontotemporal lobar degeneration, emotion regulation processes that precede the emotional experience were associated with decision-making in a moral (but not uncertainty) context. Independent of type of dementia, evidence concerning the associations between emotion regulation processes that occur after emotion is experienced and decision-making was mixed and drew on different methodologies. No studies relating to the associations between decision-making in dementia and several emotion regulation processes and strategies were found.

CONCLUSIONS

In this review, we sought to clarify the concept of everyday decision-making in dementia and map the current state of evidence concerning its associations with emotion regulation. Our findings show that emotion regulation processes are associated with decision-making in dementia, depending on type of decision-making assessment and emotional experience. We outline the gaps in the literature to set a research agenda for promoting our understanding of how emotion regulation processes can shape the various decisions that are made by persons with dementia on a daily basis.

Factors influencing length of hospital stay in an acute psychogeriatric unit

BACKGROUND

Dementia patients represent a significant volume of hospital admissions and impose a high cost on the health system. There is a significantly higher length of hospital stay (LOHS) for elderly demented patients.

METHODS

This study was carried out in an acute psychogeriatric unit specialising in behavioural and psychological symptoms in dementia. Socio-demographic, cognitive and nutritional variables were taken into account. We first compared the patients returning home (group 1) after hospital discharge with those transferred to the rehabilitation psychogeriatric unit (group 2). We secondarily explored the correlation of LOHS with the variables described above for the two groups.

RESULTS

We retained 92 patients (of 375 admitted) for our study, mean age 83.9 ± 6.6, Mini-Mental State Examination 12.8 ± 9.6, initial weight 61.7 ± 13.2 kg and body mass index 24.8 ± 4.7. We noticed significant differences in cognitive status but not in nutritional variables or in socio-demographic characteristics between the two groups. Only weight in nutritional variables was significantly associated with LOHS in the acute psychogeriatric unit.

CONCLUSIONS

Our main finding underlined the key role of cognitive factors in patient discharge home. And only initial weigh seems have an influence in LOHS instead of cognitive status or socio-demographic characteristics.

The Montreal Cognitive Assessment: Is It Suitable for Identifying Mild Cognitive Impairment in Parkinson's Disease?

BACKGROUND

Administering an abbreviated global cognitive test, such as the Montreal Cognitive Assessment (MoCA), is necessary for the recommended first-level diagnostic criteria for mild cognitive impairment (MCI) in Parkinson's disease (PD). Level II requires administering cognitive functioning neuropsychological tests. The MoCA's suitability for identifying PD-MCI is questionable and, despite the importance of cognitive deficits reflected through daily functioning in identifying PD-MCI, knowledge about it is scarce.

OBJECTIVES

To explore neuropsychological test scores of patients with PD who were categorized based on their MoCA scores and to analyze correlations between this categorization and patients' self-reports about daily functional-related cognitive abilities.

METHODS

A total of 78 patients aged 42 to 78 years participated: 46 with low MoCA scores (22-25) and 32 with high MoCA scores (26-30). Medical assessments and level II neuropsychological assessment tools were administered along with standardized self-report questionnaires about daily functioning that reflects patients' cognitive abilities.

RESULTS

A high percentage of the low MoCA group obtained neuropsychological test scores within the normal range; a notable number in the high MoCA group were identified with MCI-level scores on various neuropsychological tests. Suspected PD-MCI according to the level I criteria did not correspond well with the level II criteria. Positive correlations were found among the 3 self-report questionnaires.

CONCLUSIONS

These results support the ongoing discussion of the complexity of capturing PD-MCI. Considering the neuropsychological tests results, assessments that reflect cognitive encounters in real life daily confrontations are warranted among people diagnosed with PD who are at risk for cognitive decline.

Hospital Discharge Decisions Concerning Older Patients: Understanding the Underlying Process

ABSTRACTWe aimed to understand clinical decision-making processes that influence the orientation of older patients after hospital discharge. We compared discharge decisions (i.e., discharge home, or nursing home stay) of the hospital team with those of an expert panel. Both panel and hospital team made their decisions independently. The blind study included 102 patients (mean age: 83.13 ± 6.74). There is a statistically significant difference between expert and hospital team decisions (p &lt; .001; kappa coefficient: 0.468). Panel decisions were more closely associated with isolation (p = .018), reliable caregivers (p = .004), social problems (p = .001), and behavioural symptoms perceived as aggressive (p = .001). Both decision processes considered refusal of care (p = 0,025 and 0.016 respectively) and social problems (p = .001 and &lt; 0.001 respectively). Discharge planning models differ depending on the country, team and patient's condition. Our study suggests more precise evaluation of patients' needs.

Effectiveness of multidisciplinary consultation for older adults with Alzheimer's disease in response to acute situations

BACKGROUND

To avoid emergency hospitalisation of elderly people with dementia, which often has negative consequences, there are two main approaches: consultation and day care hospitalisation. However, it usually takes some time to arrange a consultation, and geriatric day hospital facilities are over-subscribed and costly. In 2014, we created a "consultation de crise" (CMC) programme in our sector of Paris, with several special features: a short wait for an appointment, a consultation involving an interdisciplinary team, a weekly multi-disciplinary meeting to reassess complex patients, and the possibility of a rapid referral to a social worker.

METHODS

To determine whether the CMC programme is a useful way to minimise hospitalization among elderly community-dwelling populations, and to examine its design criteria. Retrospective review of all CMC requests from April 2014 to January 2017 in comparison with consultation at the Memory Center and geriatric day hospital. CMC patients were followed up at one month after their assessment.

RESULTS

Mini Mental Status and Neuro Psychiatric Inventory vary significantly different between the 3 groups. The CMC group had the lowest score on the MMSE scale and the highest for NPI. After one month, 60% of CMC patients were still at home (33 patients) or in the same nursing home (6 patients) and about 23% were hospitalized during the follow-up period.

CONCLUSION

Our study showed the potential value of a less expensive multidisciplinary consultation, and confirmed that collaborative care resulted in a significant improvement in the quality of care.

Can functional task exercise improve executive function and contribute to functional balance in older adults with mild cognitive impairment? A pilot study

Introduction

Individuals with cognitive impairment are more susceptible to falls associated with decreased executive function and balance. This pilot study investigated whether functional task exercise could improve executive function, which might further affect the functional balance in older adults with mild cognitive impairment.

Method

This was a single-group pre-test/post-test pilot. A total of 43 participants completed a 10-week structured functional task exercise programme, performing simulated functional tasks. Paired-samples t-test was performed to evaluate intervention effects. Associations between variables were examined using Pearson's correlation coefficient. Multiple regression analysis was performed to explore the contribution of cognitive variables to functional balance.

Results

Significant improvements were shown in general cognitive functions, executive function, functional balance and functional status. All executive function outcomes were significantly associated with functional balance. Everyday problem-solving ability was the only significant cognitive contributor ( β = 0.407, p < 0.05) to functional balance after controlling for the confounding factors.

Conclusion

This pilot showed functional task exercise using simulated functional task as a means of intervention was feasible and was associated with observed improvements in executive function and functional balance in older adults with mild cognitive impairment, whereas everyday problem-solving ability was found to be associated with functional balance. Further well-designed controlled studies are needed to draw more definitive conclusions.

Performance-based everyday functional competence measures across the adult lifespan: the role of cognitive abilities

BACKGROUND

The effects of age on the ability to manage everyday functioning, crucial to ensure a healthy aging process, have been rarely examined and when, self-report measures have been used. The aim of the present study was to examine age effects across the adult lifespan in everyday functioning with two performance-based measures: the Everyday Problems Test (EPT), and the Timed Instrumental Activities of Daily Living (TIADL) tasks. The role of some crucial cognitive abilities, i.e. working memory (WM), processing speed, reasoning, vocabulary, and text comprehension in the EPT and the TIADL were also assessed to see whether or not they have a similar influence (and to what extent) in accounting for age-related effects in these two performance-based measures.

METHOD

Two hundred and seventy-six healthy participants, from 40 to 89 years of age were presented with the EPT, the TIADL, as well as WM, processing speed, reasoning, text comprehension, and vocabulary tasks.

RESULTS

Path models indicated an indirect effect of age and education on the EPT, which was mediated by all the cognitive variables considered, with WM and reasoning being the strongest predictors of performance. An indirect quadratic effect of age, but not of education, was found on the TIADL score, and an accelerated decline in processing speed mediated the relationship between age and the TIADL score.

CONCLUSION

This study revealed age-related effects in performance-based measures, which are mediated by different cognitive abilities depending on the measure considered. The findings highlight the importance of assessing everyday functioning even in healthy older adults.

Dual Task of Fine Motor Skill and Problem Solving in Individuals With Multiple Sclerosis: A Pilot Study

OBJECTIVES

To (1) examine and compare dual-task performance in patients with multiple sclerosis (MS) and healthy controls (HCs) using mathematical problem-solving questions that included an everyday competence component while performing an upper extremity fine motor task; and (2) examine whether difficulties in dual-task performance are associated with problems in performing an everyday internet task.

DESIGN

Pilot study, mixed-design with both a within and between subjects' factor.

SETTING

A nonprofit rehabilitation research institution and the community.

PARTICIPANTS

Participants (N=38) included persons with MS (n=19) and HCs (n=19) who were recruited from a nonprofit rehabilitation research institution and from the community.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participant were presented with 2 testing conditions: (1) solving mathematical everyday problems or placing bolts into divots (single-task condition); and (2) solving problems while putting bolts into divots (dual-task condition). Additionally, participants were required to perform a test of everyday internet competence.

RESULTS

As expected, dual-task performance was significantly worse than either of the single-task tasks (ie, number of bolts into divots or correct answers, and time to answer the questions). Cognitive but not motor dual-task cost was associated with worse performance in activities of everyday internet tasks.

CONCLUSIONS

Cognitive dual-task cost is significantly associated with worse performance of everyday technology. This was not observed in the motor dual-task cost. The implications of dual-task costs on everyday activity are discussed.

Screening for Functional Cognition in Postacute Care and the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014

Occupational therapists have a long history of assessing functional cognition, defined as the ability to use and integrate thinking and performance skills to accomplish complex everyday activities. In response to passage of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 (Pub. L. 113-185), the American Occupational Therapy Association has been advocating that the Centers for Medicare and Medicaid Services consider functional cognition for inclusion in routine patient assessment in postacute care settings, with important implications for occupational therapy. These efforts have the potential to increase referrals to occupational therapy, emphasize the importance of addressing functional cognition in occupational therapy practice, and support the value of occupational therapy in achieving optimal postacute care outcomes.

Factors influencing time between onset of signs/symptoms and referral for dementia in elderly outpatients

BACKGROUND

The few studies that have focused on Time between Onset of Signs and Symptoms and Referral (TOSR) for dementia to a memory center suggest a substantial delay of 1-3 years. This delay has a negative impact on both patients' and their caregivers' quality of life.

OBJECTIVE

This study aimed to evaluate this delay and the factors associated with it in a cohort of community-dwelling elderly people attending a memory clinic, as well as assess the impact of the Third French National Alzheimer Plan (2008-2012).

METHODS

All patients referred to the Bretonneau Memory Clinic for the first time between January 2006 (the clinic has maintained a specific database since then) and March 2016 were included in the study.

RESULTS

Of the 8543 patients attending our Memory Clinic during the study period, 3353 attending for the first time and with complete data were included. Briefly, their ages were 82±7 years, and 67.2% were female; MMSE score was 21.2±6.6, IADL was 4.06±0.78 and the social-needs category of the Groupes Iso Ressources (GIR); Iso-Resource Group (IRG) scale was 4.04±0.37. The TOSR was, on average, 35.4±30.24 months, and increased after implementation of the Third French National Alzheimer Plan, from 26.68±26.28 months before 2009 to 40.08±31.2 months after 2009. Age and MMSE were associated with TOSR, but not the type of dementia, household composition and social characteristics. Also, there was a shorter TOSR for mild cognitive impairment than for dementia patients.

CONCLUSION

Our results emphasize the need for more education and information among the general public about the early signs of cognitive impairment, especially in elderly people.

Detecting functional decline from normal aging to dementia: Development and validation of a short version of the Amsterdam IADL Questionnaire

Introduction

Detecting functional decline from normal aging to dementia is relevant for diagnostic and prognostic purposes. Therefore, the Amsterdam IADL Questionnaire (A-IADL-Q) was developed: a 70-item proxy-based tool with good psychometric properties. We aimed to design a short version while preserving its psychometric quality.

Methods

Study partners of subjects (n = 1355), ranging from cognitively normal to dementia subjects, completed the original A-IADL-Q. We selected the short version items using a stepwise procedure combining missing data, Item Response Theory, and input from respondents and experts. We investigated internal consistency of the short version and concordance with the original version. To assess its construct validity, we additionally investigated concordance between the short version and the Mini–Mental State Examination (MMSE) and Disability Assessment for Dementia (DAD). Finally, we investigated differences in instrumental activities of daily living (IADL) scores between diagnostic groups across the dementia spectrum.

Results

We selected 30 items covering the entire spectrum of IADL functioning. Internal consistency (0.98) and concordance with the original version (0.97) were very high. Concordance with the MMSE (0.72) and DAD (0.87) scores was high. IADL impairment scores increased across the spectrum from normal cognition to dementia.

Discussion

The A-IADL-Q short version (A-IADL-Q-SV) consists of 30 items and has maintained the psychometric quality of the original A-IADL-Q. As such, the A-IADL-Q-SV is a concise measure of functional decline.

Functional Disability in Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

Accumulating evidence suggests that the pre-dementia syndrome mild cognitive impairment (MCI) is characterized by decrements in instrumental activities of daily living (IADL). The current review was a quantitative synthesis of the available literature to objectively characterize IADL disability in MCI while clarifying inconsistencies in findings across studies. It was hypothesized that individuals with MCI would display significantly greater functional impairment relative to cognitively intact controls. Candidate moderators specified a priori included functional assessment approach, MCI subtype, depressive symptoms, and language conducted. Online databases (PubMed/MEDLINE and PsycINFO) and reference lists were searched to identify peer-reviewed publications assessing IADL in MCI compared to normal aging. A total of 151 effect sizes derived from 106 studies met inclusionary criteria (N = 62,260). Random effects models yielded a large overall summary effect size (Hedges' g = 0.76, 95 % confidence interval: 0.68 - 0.83, p < .001) confirmed in multi-level analyses adjusted for nesting of effect sizes within studies (g = 0.78, 95 % confidence interval: 0.69 - 0.87). Functional assessment strategy and MCI subtype were significant moderators of effect size, whereas depressive symptoms and language were not. Results convincingly demonstrate that MCI is associated with significant difficulties in the performance of complex everyday tasks. It appears that functional decline, like cognitive decline, exists on a continuum from healthy aging to dementia onset. Implications for clinical practice and research priorities are discussed.

Discriminative power of the advanced activities of daily living (a-ADL) tool in the diagnosis of mild cognitive impairment in an older population

BACKGROUND

Mild cognitive impairment (MCI) is characterized by subjective and objective memory impairments in the absence of manifest functional decline. Mild changes in activities of daily living (ADL) can be present and probably predict conversion to dementia. A new advanced (a)-ADL tool was developed, evaluating high-level activities and, taking each participant as their own reference, distinguishing a global Disability Index (a-ADL-DI), a Cognitive Disability Index (a-ADL-CDI), and a Physical Disability Index (a-ADL-PDI), based on the number of activities performed and the severity and causes of the functional problem. This study evaluates the discriminative validity of the a-ADL in MCI.

METHOD

Based upon clinical evaluation and a set of global, cognitive, mood, and functional assessments, 150 community-dwelling participants (average age 80.3 years (SD 5; 66-91)) were included and diagnosed as (1) cognitively healthy participants (n = 50); (2) patients with a-MCI (n = 48), or (3) mild to moderate AD (n = 52). The a-ADL tool was not a part of the clinical evaluation.

RESULTS

The a-ADL-DI and the a-ADL-CDI showed a sensitivity and specificity ranging from 70% to 94.2%, Positive Predictive Value ranging from 70% till 93.8%, and Negative Predictive Value from 64.4% and 93.8%, an area under the curve (AUC) ranging from 0.791 to 0.960. Functional decline related to physical deficits, as assessed by the a-ADL-PDI, did not discriminate between the different groups.

CONCLUSION

The a-ADL tool has a good ability to distinguish normal and pathological cognitive aging. Its discriminative power for underlying causes of limitations may be an advantage.

Effects of functional tasks exercise on older adults with cognitive impairment at risk of Alzheimer's disease: a randomised controlled trial

OBJECTIVE

the aim of this study was to compare the effects of a functional tasks exercise programme to a cognitive training programme in older adults with mild cognitive impairment.

DESIGN

a single-blind randomised control trial with the intervention group compared with an active control group.

SETTING

out-patient clinic.

PARTICIPANTS

older adults with mild cognitive impairment (n = 83) aged 60 and older living in the community.

METHODS

participants were randomised to either a functional task exercise group (n = 43) or an active cognitive training group (n = 40) for 10 weeks. All outcome measures were undertaken at baseline, post-intervention and 6-month follow-up using Neurobehavioral Cognitive Status Examination, Trail Making Test, Chinese Version Verbal Learning Test, Category Verbal Learning Test, Lawton Instrumental Activities of Daily Living Scale and Problems in Everyday Living Test.

RESULTS

the functional task exercise group showed significant between-group differences in general cognitive functions, memory, executive function, functional status and everyday problem solving ability. The improvements were sustained over time at 6-month follow-up.

CONCLUSION

a functional tasks exercise programme is feasible for improving cognitive functions and functional status of older adults with mild cognitive impairment. This may serve as a cost-effective adjunct to the existing interventions for populations with mild cognitive impairment.

TRIAL REGISTRATION NUMBER

ACTRN12610001025022.

A qualitative review of instrumental activities of daily living in dementia: what's cooking?

SUMMARY 

The measurement of instrumental activities of daily living (IADL) is common in clinical practice and research into dementia. IADL are cognitively complex daily activities, such as cooking and doing finances. Their measurement is required for the diagnostic process of dementia, and also useful for the monitoring of disease progression. Since problems in IADL contribute to the disease burden of both patient and caregiver, it is a relevant outcome measure for disease-modifying and non-pharmacological interventions. Despite the widespread use of IADL instruments, an overview of its theoretical background, measurement methods, and potential sources of bias is lacking. In the current manuscript, we therefore aim to provide a selective overview of these topics.

Effects of combined cognitive and exercise interventions on cognition in older adults with and without cognitive impairment: a systematic review

Global concern on the potential impact of dementia is mounting. There are emerging calls for studies in older populations to investigate the potential benefits of combining cognitive and exercise interventions for cognitive functions. The purpose of this systematic review is to examine the efficacy of combined cognitive and exercise training in older adults with or without cognitive impairment and evaluate the methodological quality of the intervention studies. A systematic search of Cinahl, Medline, PsycINFO, ProQuest, EMBASE databases and the Cochrane Library was conducted. Manual searches of the reference list from the included papers and additional internet searches were also done. Eight studies were identified in this review, five of which included a cognitively impaired population and three studies included a cognitively healthy population. The results showed that combined cognitive and exercise training can be effective for improving the cognitive functions and functional status of older adults with and without cognitive impairment. However, limited evidence can be found in populations with cognitive impairment when the evaluation included an active control group comparison. Further well-designed studies are still needed to explore the potential benefits of this new intervention paradigm.

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.

Ascertainment bias in dementias: a secondary to tertiary centre analysis in Central Italy and conceptual review

BACKGROUND AND AIMS

Ascertainment bias (AB) indicates a bias of an evaluation centre in estimating the prevalence/incidence of a disease due to the specific expertise of the centre. The aim of our study was to evaluate classification of different types of dementia in new cases appearing in secondary and tertiary centres, in order to evidence possible occurrence of AB in the various (secondary to tertiary) dementia centres.

METHODS

To assess the mechanism of AB, the rates of new cases of the different forms of dementia reported by different centres were compared. The centres involved in the study were 11 hospital-based centres including a tertiary centre, located in the University Department of Clinical Neurology. The tertiary centre is endowed with state-of-the-art diagnostic facilities and its scientific production is prominently focused on dementia with Lewy bodies (DLB) thus suggesting the possible occurrence of a bias. Four main categories of dementia were identified: Alzheimer's disease (AD), DLB, fronto-temporal dementia (FTD), vascular dementia (VaD), with other forms in a category apart. The classification rate of new cases of dementia in the tertiary centre was compared with rates reported by secondary centres and rates of recoding were calculated during a follow-up of 2 years.

RESULTS

The study classified 2,042 newly diagnosed cases of dementia in a population of 1,370,000 inhabitants of which 315,000 were older than 65. AD was categorized in 48-52 % of cases, DLB in 25-28 %, FTD in 2-4 % and VaD in 17-28 %. During the 2-year follow-up the diagnosis was re-classified in 40 patients (3 %). The rate of recoding was 5 % in the tertiary centre, 2-8 % in referrals from secondary to tertiary centre, 2-10 % in recodings performed in secondary centres and addressed to tertiary centre. Recoding or percentages of new cases of AD or DLB were not different in the comparison between secondary or between secondary and tertiary centres. FTD and VaD were instead significantly recoded.

CONCLUSION

The results of the study suggest that in a homogeneous area, AB is not interfering with diagnosis of AD or DLB.