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Thalamic volume loss as an early sign of amnestic mild cognitive impairment. J Clin Neurosci 2019; 68:168-173. [DOI: 10.1016/j.jocn.2019.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/27/2019] [Accepted: 07/05/2019] [Indexed: 12/12/2022]
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Viklund H, Ausén B, Hagman G, Thorell LB. The Executive Checklist (EC-10) - a new rating instrument for clinicians assessing dysexecutive behavior. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:525-534. [PMID: 31526050 DOI: 10.1080/23279095.2019.1660881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Assessment of executive functions (EF) is often criticized for its lack of ecological validity. As a consequence, several self- and partner rating scales for EF have been developed, while rating scales designed for clinicians are lacking. We therefore developed the Executive Checklist (EC-10), a new rating scale for clinicians assessing dysexecutive behavior during neuropsychological assessment and examined its psychometric properties. Consecutive referrals from a memory clinic with subjective cognitive impairment (SCI; n = 27), mild cognitive impairment (MCI; n = 29), dementia (DEM; n = 16), as well as 11 healthy controls were assessed with the EC-10 while performing common neuropsychological tests. Results showed that the EC-10 had excellent inter-rater reliability, good internal consistency and modest relations to cognitive laboratory measures. The EC-10 increased the classification rate above and beyond the influence of neuropsychological tests when comparing patients with SCI and MCI or between cognitively impaired and non-impaired patients. Conclusively, the present study demonstrates that clinical observations can be quantified using the EC-10 and that this rating provides valuable information. As executive deficits are common in many neurological and neuropsychiatric disorders, validating the EC-10 in broader patient groups should be an important avenue for future research.
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Affiliation(s)
- Henrik Viklund
- Patient Area the Aging Brain, Functional Unit Neuro and Cognition, Karolinska University Hospital, Huddinge, Sweden
| | - Birgitta Ausén
- Patient Area the Aging Brain, Functional Unit Neuro and Cognition, Karolinska University Hospital, Huddinge, Sweden
| | - Göran Hagman
- Patient Area the Aging Brain, Functional Unit Neuro and Cognition, Karolinska University Hospital, Huddinge, Sweden
| | - Lisa B Thorell
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Caballero J, Ownby RL, Jacobs RJ, Pandya N, Hardigan PC, Ricabal LC. Predicting medication adherence in older Hispanic patients with type 2 diabetes. Am J Health Syst Pharm 2019; 75:e194-e201. [PMID: 29691262 DOI: 10.2146/ajhp170067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Potential cognitive and demographic correlates of medication nonadherence in older Hispanic adults with type 2 diabetes were investigated. METHODS Forty community-dwelling participants 65 years of age or older were recruited. Executive control function (ECF) was assessed using the executive clock drawing task (CLOX 1) test and the 25-item Executive Interview. Self-reported medication adherence was measured on a visual analog scale (VAS); measures of glycemic control included glycosylated hemoglobin (HbA1c) concentration. The primary objective was to determine if ECF performance correlated with medication adherence or glycemic control. RESULTS Participants' mean ± S.D. age was 74.95 ± 7.07 years, and 73% (n = 29) were female. Lower VAS scores correlated with worse CLOX 1 performance (r = 0.38, p = 0.02) and worse HbA1c status (r = -0.42, p = 0.007). Linear regression modeling indicated significant associations between VAS scores and both CLOX 1 results (beta coefficient [β] = 0.41, p = 0.01) and educational level (β = 0.345, p = 0.03). Receiver operating characteristic analysis of CLOX 1 scores (scoring range, 0-15; lower scores indicate greater impairment) showed that a highly sensitive cutoff score for predicting adherence of <90% would be 7, but a cutoff of 10 would provide more specificity. CONCLUSION Results of an evaluation of a small sample of Hispanic older adults with type 2 diabetes demonstrated a relationship between ECF, as measured by the CLOX 1 instrument, and self-reported medication adherence.
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Affiliation(s)
- Joshua Caballero
- Department of Clinical and Administrative Sciences, College of Pharmacy, Larkin University, Miami, FL
| | - Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL
| | | | - Naushira Pandya
- Department of Geriatrics, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL
| | | | - Lazara C Ricabal
- Department of Pharmacy Practice, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL
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Suhonen NM, Hallikainen I, Hänninen T, Jokelainen J, Krüger J, Hall A, Pikkarainen M, Soininen H, Remes AM. The Modified Frontal Behavioral Inventory (FBI-mod) for Patients with Frontotemporal Lobar Degeneration, Alzheimer’s Disease, and Mild Cognitive Impairment. J Alzheimers Dis 2017; 56:1241-1251. [DOI: 10.3233/jad-160983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Noora-Maria Suhonen
- Medical Research Center, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
| | - Ilona Hallikainen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tuomo Hänninen
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Jari Jokelainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland
| | - Johanna Krüger
- Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Anette Hall
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Maria Pikkarainen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Anne M. Remes
- Medical Research Center, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
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Dao E, Hsiung GYR, Sossi V, Jacova C, Tam R, Dinelle K, Best JR, Liu-Ambrose T. Exploring the effects of coexisting amyloid in subcortical vascular cognitive impairment. BMC Neurol 2015; 15:197. [PMID: 26459220 PMCID: PMC4604093 DOI: 10.1186/s12883-015-0459-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 10/04/2015] [Indexed: 01/18/2023] Open
Abstract
Background Mixed pathology, particularly Alzheimer’s disease with cerebrovascular lesions, is reported as the second most common cause of dementia. Research on mixed dementia typically includes people with a primary AD diagnosis and hence, little is known about the effects of co-existing amyloid pathology in people with vascular cognitive impairment (VCI). The purpose of this study was to understand whether individual differences in amyloid pathology might explain variations in cognitive impairment among individuals with clinical subcortical VCI (SVCI). Methods Twenty-two participants with SVCI completed an 11C Pittsburgh compound B (PIB) position emission tomography (PET) scan to quantify global amyloid deposition. Cognitive function was measured using: 1) MOCA; 2) ADAS-Cog; 3) EXIT-25; and 4) specific executive processes including a) Digits Forward and Backwards Test, b) Stroop-Colour Word Test, and c) Trail Making Test. To assess the effect of amyloid deposition on cognitive function we conducted Pearson bivariate correlations to determine which cognitive measures to include in our regression models. Cognitive variables that were significantly correlated with PIB retention values were entered in a hierarchical multiple linear regression analysis to determine the unique effect of amyloid on cognitive function. We controlled for age, education, and ApoE ε4 status. Results Bivariate correlation results showed that PIB binding was significantly correlated with ADAS-Cog (p < 0.01) and MOCA (p < 0.01); increased PIB binding was associated with worse cognitive function on both cognitive measures. PIB binding was not significantly correlated with the EXIT-25 or with specific executive processes (p > 0.05). Regression analyses controlling for age, education, and ApoE ε4 status indicated an independent association between PIB retention and the ADAS-Cog (adjusted R-square change of 15.0 %, Sig F Change = 0.03). PIB retention was also independently associated with MOCA scores (adjusted R-Square Change of 27.0 %, Sig F Change = 0.02). Conclusion We found that increased global amyloid deposition was significantly associated with greater memory and executive dysfunctions as measured by the ADAS-Cog and MOCA. Our findings point to the important role of co-existing amyloid deposition for cognitive function in those with a primary SVCI diagnosis. As such, therapeutic approaches targeting SVCI must consider the potential role of amyloid for the optimal care of those with mixed dementia. Trial registration NCT01027858
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Affiliation(s)
- Elizabeth Dao
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6S 0A9, Canada.
| | - Ging-Yuek Robin Hsiung
- Department of Medicine, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Vesna Sossi
- Department of Physics and Astronomy, University of British Columbia, 6224 Agricultural Road, Vancouver, BC, V6T 1Z1, Canada. .,UBC PET, Brain Research Centre, 2211 Westboork Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Claudia Jacova
- School of Professional Psychology, Pacific University, 190 SE 8th Avenue, Hillsboro, OR, 97123, USA.
| | - Roger Tam
- Department of Radiology, University of British Columbia, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1 M9, Canada. .,MS/MRI Research Group, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6S 0A9, Canada.
| | - Katie Dinelle
- UBC PET, Brain Research Centre, 2211 Westboork Mall, Vancouver, BC, V6T 2B5, Canada.
| | - John R Best
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6S 0A9, Canada. .,Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Teresa Liu-Ambrose
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6S 0A9, Canada. .,Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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Jahn DR, Dressel JA, Gavett BE, O'Bryant SE. An item response theory analysis of the Executive Interview and development of the EXIT8: A Project FRONTIER Study. J Clin Exp Neuropsychol 2015; 37:229-42. [PMID: 25748691 DOI: 10.1080/13803395.2014.1002757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The Executive Interview (EXIT25) is an effective measure of executive dysfunction, but may be inefficient due to the time it takes to complete 25 interview-based items. The current study aimed to examine psychometric properties of the EXIT25, with a specific focus on determining whether a briefer version of the measure could comprehensively assess executive dysfunction. METHOD The current study applied a graded response model (a type of item response theory model for polytomous categorical data) to identify items that were most closely related to the underlying construct of executive functioning and best discriminated between varying levels of executive functioning. Participants were 660 adults ages 40 to 96 years living in West Texas, who were recruited through an ongoing epidemiological study of rural health and aging, called Project FRONTIER. The EXIT25 was the primary measure examined. Participants also completed the Trail Making Test and Controlled Oral Word Association Test, among other measures, to examine the convergent validity of a brief form of the EXIT25. RESULTS Eight items were identified that provided the majority of the information about the underlying construct of executive functioning; total scores on these items were associated with total scores on other measures of executive functioning and were able to differentiate between cognitively healthy, mildly cognitively impaired, and demented participants. In addition, cutoff scores were recommended based on sensitivity and specificity of scores. CONCLUSION A brief, eight-item version of the EXIT25 may be an effective and efficient screening for executive dysfunction among older adults.
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Affiliation(s)
- Danielle R Jahn
- a Department of Psychological Sciences , Texas Tech University , Lubbock , TX , USA
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Terracina KA, Aamodt WW, Schillerstrom JE. Executive Function Impairment and Recidivism in Adult Protective Services Clients Referred for a Decision Making Capacity Assessment. J Elder Abuse Negl 2014; 27:91-9. [DOI: 10.1080/08946566.2014.976894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Campbell GB, Whyte EM, Sereika SM, Dew MA, Reynolds CF, Butters MA. Reliability and validity of the Executive Interview (EXIT) and Quick EXIT among community dwelling older adults. Am J Geriatr Psychiatry 2014; 22:1444-51. [PMID: 24119860 PMCID: PMC3980173 DOI: 10.1016/j.jagp.2013.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 08/27/2013] [Accepted: 08/30/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To investigate the psychometric properties of the Executive Interview (EXIT) and Quick EXIT in community dwelling older adults. DESIGN Secondary analysis of data obtained as part of a longitudinal study of cognitive function in late-life depression. SETTING A university hospital. PARTICIPANTS Community-dwelling adults (N = 422), aged 59 years and older, with current or recent history of non-psychotic unipolar major depression, and never-depressed comparison subjects. MEASUREMENTS The EXIT and other measures of executive control functions (ECF), non-executive cognitive domains, and global cognitive function. We calculated Quick EXIT scores from the EXIT. RESULTS The EXIT demonstrated high inter-rater reliability (Intraclass correlation coefficient = 0.978, F(7, 21) = 174.85, p <0.001), and both the EXIT and Quick EXIT demonstrated moderate internal consistency (α = 0.66 and α = 0.68, respectively). Both tests also demonstrated acceptable convergent validity against several standard tests of ECF (rs -0.399 to 0.322, except for the Trail Making Test B, where rs was 0.057 to 0.063) as well as against measures of multifactorial cognitive function (rs -0.432 to 0.491). Both tests, however, demonstrated inconsistent discriminant validity against a variety of standard non-ECF tests (rs -0.013 to 0.376). CONCLUSIONS Both the EXIT and the Quick EXIT have adequate reliability and appear to require ECF in this population. However, both the EXIT and the Quick EXIT also reflect non-ECF domains. The EXIT and Quick EXIT should be considered to be measures of global cognitive function rather than pure ECF measures. Given similar reliability and validity, the Quick EXIT is recommended clinically as it is briefer and less burdensome than the full EXIT.
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Affiliation(s)
- Grace B. Campbell
- University of Pittsburgh School of Nursing Department of Acute/Tertiary Care
| | - Ellen M. Whyte
- University of Pittsburgh School of Medicine, Department of Psychiatry,University of Pittsburgh School of Medicine, Department of Physical Medicine and Rehabilitation
| | - Susan M. Sereika
- University of Pittsburgh School of Nursing Department of Health and Community Systems,University of Pittsburgh Graduate School of Public Health, Department of Biostatistics,University of Pittsburgh Graduate School of Public Health, Department of Epidemiology
| | - Mary Amanda Dew
- University of Pittsburgh School of Medicine, Department of Psychiatry,University of Pittsburgh Graduate School of Public Health, Department of Biostatistics,University of Pittsburgh Graduate School of Public Health, Department of Epidemiology,University of Pittsburgh Department of Psychology
| | | | - Meryl A. Butters
- University of Pittsburgh School of Medicine, Department of Psychiatry
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Abstract
Type 2 diabetes mellitus (T2DM) is associated with poorer performance on certain measures of cognitive function. However, little is known about the associations among working memory (WM), executive function (EF), and self-care in those with severe T2DM. This investigation explored these relationships among 67 middle-aged and older individuals with T2DM (mean age of 62.9 years). Severity of T2DM was measured with a health status composite (HSC) score from the Diabetes Care Profile, the number of prescribed medications, and the number of comorbid conditions. Cognitive assessments included the Working Memory Index and the Executive Interview 25 (EXIT 25). Self-care was measured using the Self-Care Inventory-Revised (SCI-R) and hemoglobin A1c (HgbA1c). WM was significantly correlated with all measures of severity of T2DM (HSC, r = .542, p < . 01; number of comorbidities, r = -.476, p < .01; and number of prescription medications, r = -.344, p < .01). EF was significantly correlated with all measures of severity of T2DM (HSC, r = -.504, p < .01; number of comorbidities, r = .492, p < .01; and number of prescription medications, r = .326, p < .01). The self-care measure HgbA1c was significantly correlated with WM (r = -.352, p < .01) and EF (r = .510, p < .01). The EXIT 25 score fully mediated the relationship between severity of T2DM and self-care as measured by HgbA1c (β = .431, p < .001). These findings provide preliminary evidence for the associations among severity of T2DM, WM, EF, and self-care.
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Affiliation(s)
| | - K C Insel
- University of Arizona, Tucson, AZ, USA
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10
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Japanese versions of the executive interview (J-EXIT25) and the executive clock drawing task (J-CLOX) for older people. Int Psychogeriatr 2014; 26:1387-97. [PMID: 24832196 DOI: 10.1017/s104161021400088x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of the study was to develop the Japanese versions of Executive Interview (J-EXIT25) and Executive Clock Drawing Task (J-CLOX) and to evaluate the aspects of executive function that these two tests will be examining. METHODS The concurrent validity and reliability of J-EXIT25 and J-CLOX were first examined in all participants (n = 201). Next, the relationship between the two tests was examined using receiver operating characteristic (ROC), correlation, and regression analyses in healthy participants (n = 45) and participants with mild cognitive impairment (n = 36) and dementia (n = 95). RESULTS Satisfactory concurrent validity and reliability of J-EXIT25 and J-CLOX were shown. ROC analysis indicated that J-EXIT25 and J-CLOX1 were superior to the Frontal Assessment Battery, but inferior to the Mini-Mental State Examination (MMSE), in discriminating between non-dementia and dementia. J-EXIT25, J-CLOX1, and J-CLOX2 scores were significantly correlated with age, scores on the MMSE, Instrumental Activities of Daily Living (IADL) and Physical Self-Maintenance Scale (PSMS), and care level. In stepwise regression analyses of IADL scores, MMSE and J-EXIT25 were significantly independent predictors in men, and MMSE, age, and J-CLOX1 were significantly independent predictors in women. J-EXIT25, MMSE, and J-CLOX1 were significantly independent predictors in stepwise regression analysis of PSMS scores, and J-EXIT25 was the only significantly independent predictor in stepwise regression analysis of care level. CONCLUSIONS J-EXIT25 and J-CLOX are valid and reliable instruments for assessment of executive function in older people. The present results suggest that these tests have common and distinct psychometric properties in the assessment of executive function.
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Retracted: Executive functions in chronic hepatitis C virus infected elderly patients. Geriatr Gerontol Int 2014; 15:1105. [DOI: 10.1111/ggi.12187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Assessment of anxiety in long-term care: examination of the Geriatric Anxiety Inventory (GAI) and its short form. Int Psychogeriatr 2013; 25:1533-42. [PMID: 23782768 DOI: 10.1017/s1041610213000847] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Accurate assessment of anxiety in later life is critical, as anxiety among older adults is associated with social and functional impairment and poorer quality of life. The Geriatric Anxiety Inventory (GAI) and the GAI-Short Form (GAI-SF) were designed to detect anxiety symptoms among community-dwelling older adults, but the usefulness of the GAI and GAI-SF in long-term care is unknown. The present study examined the psychometric properties of the GAI and GAI-SF among residents at a long-term care facility. METHODS Seventy-five nursing home residents completed the GAI and measures of depression, executive functioning, and adaptive functioning. The mean age of residents was 69.60 years (SD = 10.76). Psychiatric diagnoses included dementia, psychotic disorders, mood disorders, anxiety disorders, substance abuse, sleep disorders, and mental retardation. RESULTS Internal consistency of the GAI was good (α = 0.92) and the GAI-SF was adequate (α = 0.73). GAI and GAI-SF scores were moderately correlated with depression scores, and weakly correlated with adaptive functioning scores and executive functioning scores, suggesting discriminant validity. Logistic regression analyses were conducted with GAI and GAI-SF scores predicting an anxiety disorders diagnosis. Results provided support for the predictive validity of the GAI and GAI-SF. Sensitivity, specificity, and the percentage of individuals correctly classified at various cut-off scores were also calculated. CONCLUSIONS Both the GAI and GAI-SF appear to be useful tools for assessing anxiety among nursing home residents with psychological disorders. The GAI-SF may be a viable replacement for the GAI as a screener for anxiety in long-term care.
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Johnson LA, Hall JR, O'Bryant SE. A depressive endophenotype of mild cognitive impairment and Alzheimer's disease. PLoS One 2013; 8:e68848. [PMID: 23874786 PMCID: PMC3708919 DOI: 10.1371/journal.pone.0068848] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 06/05/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) is a devastating public health problem that affects over 5.4 million Americans. Depression increases the risk of Mild Cognitive Impairment (MCI) and AD. By understanding the influence of depression on cognition, the potential exists to identify subgroups of depressed elders at greater risk for cognitive decline and AD. The current study sought to: 1) clinically identify a sub group of geriatric patients who suffer from depression related cognitive impairment; 2) cross validate this depressive endophenotype of MCI/AD in an independent cohort. METHODS AND FINDINGS Data was analyzed from 519 participants of Project FRONTIER. Depression was assessed with the GDS30 and cognition was assessed using the EXIT 25 and RBANS. Five GDS items were used to create the Depressive endophenotype of MCI and AD (DepE). DepE was significantly negatively related to RBANS index scores of Immediate Memory (B=-2.22, SE=.37, p<0.001), visuospatial skills (B=-1.11, SE=0.26, p<0.001), Language (B=-1.03, SE=0.21, p<0.001), Attention (B=-2.56, SE=0.49, p<0.001), and Delayed Memory (B=-1.54, SE = 037, p<0.001), and higher DepE scores were related to poorer executive functioning (EXIT25; B=0.65, SE=0.19, p=0.001). DepE scores significantly increased risk for MCI diagnosis (odds ratio [OR] = 2.04; 95% CI=1.54-2.69). Data from 235 participants in the TARCC (Texas Alzheimer's Research & Care Consortium) were analyzed for cross-validation of findings in an independent cohort. The DepE was significantly related to poorer scores on all measures, and a significantly predicted of cognitive change over 12- and 24-months. CONCLUSION The current findings suggest that a depressive endophenotype of MCI and AD exists and can be clinically identified using the GDS-30. Higher scores increased risk for MCI and was cross-validated by predicting AD in the TARCC. A key purpose for the search for distinct subgroups of individuals at risk for AD and MCI is to identify novel treatment and preventative opportunities.
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Affiliation(s)
- Leigh A Johnson
- Department of Internal Medicine, University of North Texas Health Science Center, Fort Worth, Texas, United States of America.
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Hjorthøj CR, Vesterager L, Nordentoft M. Test-retest reliability of the Danish Adult Reading Test in patients with comorbid psychosis and cannabis-use disorder. Nord J Psychiatry 2013; 67:159-63. [PMID: 22624828 DOI: 10.3109/08039488.2012.691544] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The New Adult Reading Test is a common instrument for assessing pre-morbid IQ for patients with, for instance, schizophrenia. However, test-retest reliability has not been established for patients dually diagnosed with psychosis and substance use disorder. Furthermore, test-retest reliability of the Danish adaptation has never been established in any population. AIMS To determine the test-retest reliability of the Danish Adult Reading Test (DART) (adapted from the National Adult Reading Test, NART) for patients dually diagnosed with psychosis and cannabis-use disorder. METHODS This was a secondary analysis of the CapOpus randomized trial. As part of the trial, 103 patients were randomized, and completed the DART up to three times. Pearson's r and pairwise t-tests were calculated. RESULTS DART score was independent of randomization, cannabis-use frequency and psychopathology. Scores at the last interview were slightly higher than at the first two. Correlation over time was very strong (0.8 < r <0.9) for all pairwise comparisons of interviews. Variations in DART scores and estimated pre-morbid IQ over time were sometimes of borderline statistical significance but not of clinical relevance. CONCLUSIONS DART and NART have high test-retest reliability, but apparently non-systematic, clinically irrelevant variation over time does occur. CLINICAL IMPLICATION The Danish adaptation of the New Adult Reading Test possesses good test-retest reliability, making it an appropriate choice for assessment of pre-morbid IQ, and in patients with dually diagnosed psychosis and cannabis-use disorder.
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Affiliation(s)
- Carsten Rygaard Hjorthøj
- Copenhagen University Hospital, Mental Health Center Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark.
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Menon CV, Jahn DR, Mauer CB, O'Bryant SE. Executive functioning as a mediator of the relationship between premorbid verbal intelligence and health risk behaviors in a rural-dwelling cohort: a Project FRONTIER study. Arch Clin Neuropsychol 2013; 28:169-79. [PMID: 23192834 PMCID: PMC3569949 DOI: 10.1093/arclin/acs102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2012] [Indexed: 12/23/2022] Open
Abstract
Limited research is available regarding the impact of neuropsychological functioning on health risk behaviors in rural-dwelling elderly populations. This cross-sectional study examined the relationships between estimated premorbid verbal IQ (AMNART), executive functioning impairment (EXIT25), and health risk behaviors including alcohol use (AUDIT), smoking, compliance with recommended cancer screenings, and obesity (BMI). The total sample included 456 English-speaking adults and older adults of non-Hispanic White and Hispanic origin seen as part of an ongoing study of rural cognitive aging, Project FRONTIER. Regression analyses revealed significant independent effects of AMNART and EXIT25 on most health risk behaviors, and supported the hypothesized mediating role of EXIT25 on the relationships between AMNART and smoking, cancer screenings, and BMI in both cognitively impaired and healthy subgroups. This study clarifies the relationships between executive functioning, premorbid IQ, and health risk behaviors in diverse groups, and confirms that premorbid IQ represents an important determinant of health behaviors and neurocognitive outcomes.
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Affiliation(s)
- Chloe V. Menon
- Department of Psychology, Texas Tech University, Lubbock, TX, USA
| | - Danielle R. Jahn
- Department of Psychology, Texas Tech University, Lubbock, TX, USA
| | - Cortney B. Mauer
- Department of Psychology, Texas Tech University, Lubbock, TX, USA
| | - Sid E. O'Bryant
- Department of Internal Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
- Institute for Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, TX, USA
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Association of depression, anxiety, and impairment in executive functions in patients with obstructive sleep apnea. MIDDLE EAST CURRENT PSYCHIATRY 2013. [DOI: 10.1097/01.xme.0000422808.09000.59] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Martyr A, Clare L. Executive function and activities of daily living in Alzheimer's disease: a correlational meta-analysis. Dement Geriatr Cogn Disord 2012; 33:189-203. [PMID: 22572810 DOI: 10.1159/000338233] [Citation(s) in RCA: 163] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2012] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The assessment of executive function (EF) and activities of daily living (ADL) are important elements in the diagnosis of Alzheimer's disease. METHODS Following a comprehensive search in three databases, a random-effects meta-analysis was used to investigate the association between ADL ability and seventeen tests of EF, three tests of attention and working memory and the Mini-Mental State Examination. The association between EF and ADL ability was further investigated in relation to four different methods of assessing ADL, and one specific ADL, driving. RESULTS Forty-nine studies met the inclusion criteria, and a total of 3,663 participants were included, the majority of whom were diagnosed with Alzheimer's disease. Most of the individual tests, including commonly used tests of EF such as the Clock Drawing Test, Letter Fluency and the Trail Making Test Part B, showed a significant moderate association with ADL. Associations between EF and ADL ability were similar for all four methods of assessing ADL ability. Driving ability was also moderately associated with EF. CONCLUSION The meta-analysis suggests a consistent moderate association between ADL and EF, supporting the growing evidence for a link between ADL and executive dysfunction in early dementia.
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Affiliation(s)
- Anthony Martyr
- School of Psychology, Bangor University, Bangor, Gwynedd, UK.
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Menon C, Hall J, Hobson V, Johnson L, O’Bryant SE. Normative performance on the executive clock drawing task in a multi-ethnic bilingual cohort: a project FRONTIER study. Int J Geriatr Psychiatry 2012; 27:959-66. [PMID: 22052628 PMCID: PMC4142441 DOI: 10.1002/gps.2810] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 09/12/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND The executive clock drawing task (CLOX) test is a neuropsychological measure intended to aid in the assessment and detection of dementia in older populations. Few studies have provided normative data for this measure, with even less research available regarding the impact of sociodemographic factors on test scores. This study presents normative data for the CLOX in a sample of English and Spanish-speaking Hispanic and non-Hispanic Whites. METHODS The total sample included 445 cognitively healthy older adults seen as part of an ongoing study of rural cognitive aging, project FRONTIER. Unlike previous studies, criteria for "normality" (i.e., unimpaired) for CLOX1 and CLOX2 were based not merely on global impairment, but also on domain-specific impairment of executive functioning on the Executive Interview 25-item Examination and/or Trail Making Test B, or visuospatial/constructional impairment on the Line Orientation and Figure Copy subtests of the Repeatable Battery for the Assessment of Neuropsychological Status, respectively. RESULTS Hierarchical regression analyses revealed that CLOX1 scores require adjustment by Age across ethnicities, whereas Education and Gender are necessary stratification markers for CLOX1 performance only in non-Hispanic Whites. None of the demographic variables were valid predictors of CLOX2 performance, negating the need for such adjustments. CONCLUSION In addition to being the first study to provide separate normative data for CLOX performance in Hispanic and non-Hispanic White samples, the current study offers a novel approach to defining "normal" by cognitive domain. We also highlight the need to directly examine the impact of sociodemographic factors before applying normative corrections based on factors that have negligible impact on test scores.
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Affiliation(s)
- Chloe Menon
- Department of Psychology, Texas Tech University, Lubbock, TX, U.S.A
| | - James Hall
- Institute of Aging and Alzheimer's Disease Research, University of North Texas Health Sciences Center, Fort Worth, TX, U.S.A
- Department of Psychiatry and Neuroscience, University of North Texas Health Sciences Center, Fort Worth, TX, U.S.A
| | - Valerie Hobson
- Department of Psychology, Texas Tech University, Lubbock, TX, U.S.A
| | - Leigh Johnson
- Laura W. Bush Institute for Women’s Health, Texas Tech University Health Sciences Center, Amarillo, TX, U.S.A
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, U.S.A
| | - Sid E. O’Bryant
- F. Marie Hall Institute for Rural & Community Health, Texas Tech University Health Science Center, Lubbock, TX, U.S.A
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX, U.S.A
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19
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Borroni B, Grassi M, Premi E, Gazzina S, Alberici A, Cosseddu M, Paghera B, Padovani A. Neuroanatomical correlates of behavioural phenotypes in behavioural variant of frontotemporal dementia. Behav Brain Res 2012; 235:124-9. [PMID: 22902293 DOI: 10.1016/j.bbr.2012.08.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 07/28/2012] [Accepted: 08/02/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Behavioural variant of frontotemporal dementia (bvFTD) frequently presents complex behavioural changes, that rarely occur in isolation. Targeting behavioural phenotypes instead of single behavioural symptoms may potentially provide a disease model in which to investigate brain substrates of behavioural abnormalities. OBJECTIVE To identify behavioural phenotypes and to assess the associated brain correlates in a cohort of patients with bvFTD. METHODS Two hundred and seven consecutive individuals fulfilling clinical criteria for bvFTD were enrolled. Each participant's caregiver completed frontal behavioural inventory on 24 key behavioural disturbances. Confirmatory factor analysis (CFA) models were applied, and behavioural phenotypes identified. For each phenotype, a score was derived based on the "best" CFA model (Bifactor CFA). One hundred two participants underwent SPECT scan. A regression analysis between scores for each factor and regional cerebral blood flow was carried out (P<0.001). RESULTS One "general" behavioural phenotype and four factors were identified, that were termed "disinhibited", "apathetic", "aggressive", and "language" phenotypes. The most robust brain correlate was identified for "disinhibited" phenotype, in the region of the anterior cingulated and anterior temporal cortex, bilaterally, and for apathetic phenotype in the left dorsolateral frontal cortex. As expected, language phenotype correlated with greater hypoperfusion in the left frontotemporal lobes. No significant correlation between aggressive phenotype and regional cerebral blood flow was found. Moreover, the "general" behavioural severity was associated with greater damage in the right frontal lobe. CONCLUSIONS Behavioural phenotypes are associated with specific brain damage in bvFTD, involving distinct cerebral networks.
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Affiliation(s)
- B Borroni
- Center for Aging Brain and Dementia, Department of Neurology, University of Brescia, Brescia, Italy.
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20
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Rainville C, Lepage E, Gauthier S, Kergoat MJ, Belleville S. Executive function deficits in persons with mild cognitive impairment: a study with a Tower of London task. J Clin Exp Neuropsychol 2012; 34:306-24. [PMID: 22235943 DOI: 10.1080/13803395.2011.639298] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This study assessed executive functions in persons with mild cognitive impairment (MCI) using the Tower of London (TOL). A second objective was to study the impact of three types of problem selected according to the presence or absence of a "trigger." A trigger (T) is an incitation to the participant, at the first move, to move a ball to its final position according to the model. A positive trigger (T+) is helpful, while a negative trigger (T-) creates an obstruction. Some problems have no trigger (N). This study includes 81 participants with MCI. After follow-up, one year later, two subgroups were distinguished: (a) 51 (63%) participants did not convert or decline (stable MCI); (b) 30 (37%) participants showed significant decline or progressed to dementia (decliner MCI). Persons with MCI were compared to an older adult group matched with respect to sex, age, and education. For the successes, there was a significant group difference between the three types of problem. The post hoc analysis showed that T+ took significantly less time than N or T-. There were significantly more successes for T+ than N, and these two types of problem had more success than T-. For "total number of moves," there was no significant difference between the groups. In post hoc analysis, T- involved more moves than N or T+. In qualitative analysis, T- MCI decliners produced significantly more rule breakings than the stable MCI and controls. A dysfunction in self-monitoring is a characteristic feature of persons with MCI.
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Affiliation(s)
- Constant Rainville
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada.
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21
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Huh Y, Yang EJ, Lee SA, Lim JY, Kim KW, Paik NJ. Association between executive function and physical performance in older Korean adults: findings from the Korean Longitudinal Study on Health and Aging (KLoSHA). Arch Gerontol Geriatr 2010; 52:e156-61. [PMID: 21075462 DOI: 10.1016/j.archger.2010.10.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Revised: 10/13/2010] [Accepted: 10/16/2010] [Indexed: 12/25/2022]
Abstract
Reduced executive function and physical performance are common age-related conditions. This study evaluated the associations between executive function and physical performance in a representative sample of older adults. Cross-sectional data were analyzed from a population-based sample of 629 men and women aged 65 or older and living in one typical city in Korea. Specific aspects of executive function were assessed using the trail making test, digit span test, and lexical fluency test to measure set shifting, working memory and cognitive flexibility functions. Physical performance was measured using performance-oriented mobility assessment (POMA) scores and isokinetic muscle strength. Subjects' self-efficacy was also assessed using the activities-specific balance confidence (ABC) scale. Results of the lexical fluency test were associated with POMA scores and muscle strength, independent of age, gender, education, comorbidity, physical activity status, depression, and global cognition, suggesting that reduced cognitive flexibility is associated with reduced physical performance and muscle strength. Self-efficacy was also independently associated with physical performance and muscle strength. Clinicians need to consider the association between executive function and physical performance when working to improve physical functioning in an aged population.
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Affiliation(s)
- Yoonseok Huh
- Department of Neurospsychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South Korea
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22
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Carroll DW. Assessment of capacity for medical decision making. J Gerontol Nurs 2010; 36:47-52. [PMID: 20349850 DOI: 10.3928/00989134-20100303-03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 11/05/2009] [Indexed: 11/20/2022]
Abstract
Determination of a patient's capacity for medical decision making can be simple or complex, depending on the issue being considered; likewise, the degree of capacity required to make decisions varies with the complexity of the situation. A capacity examination is a focused and impartial evaluation of mental status and medical, surgical, psychiatric, and psychosocial histories. The examination is composed of several basic steps, beginning with an assessment of the patient's ability to communicate, followed by determination of his or her understanding of the proposed care, followed by the patient's rationale for decisions about that care. When a patient is deemed to lack capacity, mechanisms should be in place to ensure the patient receives the care needed. This article provides an overview of the concept of capacity, how it is determined, and how to proceed when the patient is found to lack it.
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Affiliation(s)
- David Wayne Carroll
- Department of Family Nursing, University of Texas Health Science Center at San Antonio, Texas 78229, USA.
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Rasch analysis of the Executive Interview (The EXIT-25) and introduction of an abridged version (The Quick EXIT). Arch Phys Med Rehabil 2010; 91:389-94. [PMID: 20298829 DOI: 10.1016/j.apmr.2009.11.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 11/13/2009] [Accepted: 11/17/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the psychometric properties of the Executive Interview (EXIT-25) and to propose modifications that will improve those properties. DESIGN Rasch analysis of existing datasets contributed by 3 prior projects, all of which examined criterion-related validity of the EXIT-25. SETTING A large, urban, academic free-standing rehabilitation facility. PARTICIPANTS The sample of 147 was comprised of 109 adults diagnosed with stroke evaluated during inpatient rehabilitation and 38 adults with traumatic brain injury evaluated during inpatient (n=11) or outpatient rehabilitation (n=27). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The EXIT-25, Repeatable Battery for the Assessment of Neuropsychological Status, and Trails A and B. RESULTS Eleven of the 25 items correlated weakly with the total measure and misfit the rating scale model. Deleting these 11 items improved the internal consistency of the remaining 14 items and enhanced the measure's criterion-related validity. CONCLUSIONS The EXIT-25 can be reduced from 25 to 14 items without reducing internal consistency. Convergent validity of the abbreviated measure is supported by moderate-size correlations with standard measures of cognitive deficits.
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Burnett J, Dyer CB, Naik AD. Convergent validation of the Kohlman Evaluation of Living Skills as a screening tool of older adults' ability to live safely and independently in the community. Arch Phys Med Rehabil 2009; 90:1948-52. [PMID: 19887222 PMCID: PMC2855551 DOI: 10.1016/j.apmr.2009.05.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 05/26/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the convergent validity of the Kohlman Evaluation of Living Skills (KELS) to screen older adults' ability to live safely and independently. DESIGN Cross-sectional study correlating KELS with components of a Comprehensive Geriatric Assessment. SETTING Participants' homes. PARTICIPANTS Community-dwelling older adults (N=200) 65 years and older including 100 persons referred by Adult Protective Services (APS) and 100 ambulatory patients matched on age, race, sex, and socioeconomic status. INTERVENTIONS In-home comprehensive assessment. MAIN OUTCOME MEASURES KELS, Geriatric Depression Scale (GDS), modified Physical Performance Test (mPPT), Mini-Mental State Examination (MMSE), Knee Extensor Break Test, Executive Cognitive Test (EXIT25), executive clock-drawing test (CLOX) 1 and 2, and an 8-foot walk test. RESULTS Older adults with abnormal KELS scores performed significantly worse on all tests except for the Knee Extensor Break Test. Accordingly, among the entire group, the KELS correlated with measures of executive function (EXIT25, r=.705, P<.001; CLOX 1, r=-.629, P<.001), cognitive function (MMSE, r=-.508, P<.001), affect (GDS, r=.318, P<.001), and physical function (mPPT, r=-.472, P<.001) but did not correlate with the Knee Extensor Break Test (r=-.068, P=.456). Among those referred by APS, the KELS failed to correlate with only the 8-foot walk test (r=.175, P=.153) and GDS (r=.080, P=.450). CONCLUSIONS This study demonstrated the convergent validity of KELS with a battery of cognitive, affective, executive, and functional measures often used to determine older adults' ability to live safely and independently in the community. KELS may be a valid and pragmatic alternative to screen for the capacity to live safely and independently among older adults.
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Affiliation(s)
- Jason Burnett
- The University of Texas Health Science Center at Houston, Department of Internal Medicine, Division of Geriatric and Palliative Medicine
- The Consortium for Research in Elder Self-Neglect of Texas (CREST)
- The Harris County Hospital District (HCHD)
| | - Carmel B. Dyer
- The University of Texas Health Science Center at Houston, Department of Internal Medicine, Division of Geriatric and Palliative Medicine
- The Consortium for Research in Elder Self-Neglect of Texas (CREST)
- The Harris County Hospital District (HCHD)
| | - Aanand D. Naik
- The Consortium for Research in Elder Self-Neglect of Texas (CREST)
- The Harris County Hospital District (HCHD)
- Houston Center for Quality of Care & Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Alkek Department of Medicine, Baylor College of Medicine, Houston, TX
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Kochunov P, Robin DA, Royall DR, Coyle T, Lancaster J, Kochunov V, Schlosser AE, Fox PT. Can structural MRI indices of cerebral integrity track cognitive trends in executive control function during normal maturation and adulthood? Hum Brain Mapp 2009; 30:2581-94. [PMID: 19067326 DOI: 10.1002/hbm.20689] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We explored the relationship between structural neuroimaging-based indices of cerebral integrity and executive control function (ECF) in two groups of healthy subjects: A maturing group (33 subjects; 19-29 years) and a senescing group (38 adults; 30-90 years). ECF was assessed using the Executive Interview (EXIT) battery. Cortical indices of cerebral integrity included GM thickness, intergyral span, and sulcal span, each measured for five cortical regions per hemisphere. Subcortical indices included fractional anisotropy (FA), measured using track-based-spatial-statistics (TBSS), and the volume of T2-hyperintense WM (HWM). In the maturing group, no significant relationships between neuroanatomical changes and ECF were found; however, there were hints that late-term maturation of cerebral WM influenced variability in ECF. In the senescing group, the decline in ECF corresponded to atrophic changes in cerebral WM (sulcal and intergyral span) primarily in the superior frontal and anterior cingulate regions. A large fraction of the variability in ECF (62%) can be explained by variability in the structural indices from these two regions.
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Affiliation(s)
- Peter Kochunov
- Research Imaging Center, University of Texas Health Science Center at San Antonio, Texas 78284, USA.
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26
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Radiation dose, driving performance, and cognitive function in patients with head and neck cancer. Radiother Oncol 2008; 87:304-7. [DOI: 10.1016/j.radonc.2008.03.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Accepted: 03/31/2008] [Indexed: 11/21/2022]
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Milan G, Lamenza F, Iavarone A, Galeone F, Lorè E, de Falco C, Sorrentino P, Postiglione A. Frontal Behavioural Inventory in the differential diagnosis of dementia. Acta Neurol Scand 2008; 117:260-5. [PMID: 17922889 DOI: 10.1111/j.1600-0404.2007.00934.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate diagnostic properties of the Frontal Behavioural Inventory (FBI) in patients suffering from different forms of dementia. METHODS The FBI was administered with other psychometric tests investigating cognitive performances and behavioral scales to the caregivers of 35 patients with the frontal variant of frontotemporal dementia (fv-FTD), 22 patients with Alzheimer's disease (AD) and 15 with vascular dementia (VaD). All patients were comparable for degree of dementia severity and level of executive impairment. RESULTS The FBI showed high concurrent validity, internal consistency and good inter-rater and test-retest reliability. The discriminant validity was also very high. A new FBI cut-off score of 23 gave 97% sensitivity and 95% specificity in distinguishing fv-FTD from non-FTD patients. Conversely, the Neuropsychiatic Inventory (NPI) score was unable to differentiate fv-FTD from AD. CONCLUSIONS The FBI is a neurobehavioral tool suitable to distinguish fv-FTD from other forms of dementia also when data from cognitive testing or other behavioral scales fail to support the differential diagnosis.
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Affiliation(s)
- G Milan
- Department of Clinical and Experimental Medicine, University Federico II, Naples, Italy
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Error detection and correction patterns in dementia: a breakdown of error monitoring processes and their neuropsychological correlates. J Int Neuropsychol Soc 2008; 14:199-208. [PMID: 18282318 DOI: 10.1017/s1355617708080193] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 09/07/2007] [Accepted: 09/07/2007] [Indexed: 11/05/2022]
Abstract
Error monitoring is critical to an individual's ability to function autonomously. This study characterized error detection and correction behaviors within the service of everyday tasks in individuals with dementia. Also, the impact of neuropsychological functioning on error detection and correction was examined. Fifty-three participants diagnosed with Alzheimer's disease (AD) or vascular dementia (VaD) were administered a neuropsychological protocol and the Naturalistic Action Test, which requires performance of three everyday tasks. Error detection, correction, and the point at which correction occurred (i.e., microslip--before the error was completed, immediate--just after the error was made, delayed--after performing other task steps) was coded. Dementia participants detected 32.7% of their errors and corrected 75.8% of detected errors. Participants were more likely to engage in microslips than delayed corrections. Tests of executive control and language predicted detection and correction variables; moreover, detection and correction were each related to different aspects of executive functioning. Microslips were related to naming ability. AD and VaD patients did not differ on detection/correction variables, and regression analyses indicated that dementia severity and memory abilities were unrelated to detection/correction. The results specify the error monitoring deficits in AD and VaD and have implications for improving functional abilities in dementia.
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Abstract
The Cognitive section of the Alzheimer's Disease Assessment Scale (ADAS-Cog) remains the most widely used cognitive measure in dementia trials although it does not assess attention, executive function, or agnosia. Designed for use in Alzheimer's disease (AD), it may not be ideal in assessing patients with other diagnoses. The ADAS-Cog differentiates between AD patients, patients with Mild Cognitive Impairment, and normal controls. It has been used in trials of drugs for vascular and mixed dementia and dementia with Lewy bodies. It is not clear that the ADAS-Cog is adequate for assessing cognition in frontotemporal dementia. Well-validated aphasia batteries, such as the Western Aphasia Battery, can be used to assess language. Brief tests of frontal function such as the Frontal Assessment Battery or the Executive Interview might be useful additions in frontotemporal dementia trials. The most widely used assessment tool for patients with advanced dementia is the Severe Impairment Battery. The domains tested are analogous to those assessed by the ADAS-Cog. The Mini-Mental State Exam and the Modified Mini-Mental State Examination are useful in stratifying patients for trial entry. Cognitive measures better tailored to the diseases in question are needed for non-Alzheimer dementias.
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Affiliation(s)
- Andrew Kirk
- Division of Neurology, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada
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Meschia JF, Rush BK. Vascular dementia may be easier to treat than diagnose. Expert Rev Neurother 2006; 6:123-7. [PMID: 16466291 DOI: 10.1586/14737175.6.2.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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