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Ashendorf L, Alosco ML, Bing-Canar H, Chapman KR, Martin B, Chaisson CE, Dixon D, Steinberg EG, Tripodis Y, Kowall NW, Stern RA. Clinical Utility of Select Neuropsychological Assessment Battery Tests in Predicting Functional Abilities in Dementia. Arch Clin Neuropsychol 2018; 33:530-540. [PMID: 29126099 PMCID: PMC6116785 DOI: 10.1093/arclin/acx100] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 08/21/2017] [Accepted: 10/02/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Neuropsychological test performance can provide insight into functional abilities in patients with dementia, particularly in the absence of an informant. The relationship between neuropsychological measures and instrumental activities of daily living (IADLs) is unclear due to hetereogeneity in cognitive domains assessed and neuropsychological tests administered. Practical and ecologically valid performance-based measures of IADLs are also limited. The Neuropsychological Assessment Battery (NAB) is uniquely positioned to provide a dual-purpose assessment of cognitive and IADL function, as it includes Daily Living tests that simulate real-world functional tasks. We examined the utility of select NAB tests in predicting informant-reported IADLs in mild cognitive impairment and dementia. METHODS The sample of 327 participants included 128 normal controls, 97 individuals with mild cognitive impairment, and 102 individuals with Alzheimer's disease dementia from the Boston University Alzheimer's Disease Center research registry. Informants completed the Lawton Brody Instrumental Activities of Daily Living Scale, and study participants were administered selected NAB tests that were complementary to the existing protocol. RESULTS ROC curves showed strongest prediction of IADL (AUC > 0.90) for memory measures (List Learning delayed recall and Daily Living Memory delayed recall) and Daily Living Driving Scenes. At a predetermined level of specificity (95%), List Learning delayed recall (71%) and Daily Living Memory delayed recall (88%) were the most sensitive. The Daily Living Memory and Driving Scenes tests strongly predicted IADL status, and the other Daily Living tests contributed unique variance. CONCLUSIONS NAB memory measures and Daily Living Tests may have clinical utility in detecting informant-rated functional impairment in dementia.
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Affiliation(s)
- Lee Ashendorf
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA
| | - Michael L Alosco
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Hanaan Bing-Canar
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kimberly R Chapman
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Brett Martin
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Christine E Chaisson
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Diane Dixon
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Eric G Steinberg
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Yorghos Tripodis
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Neil W Kowall
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Pathology, Boston University School of Medicine, Boston, Massachusetts, USA
- Neurology Service, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Robert A Stern
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
- Departments of Neurosurgery, and Anatomy & Neurobiology, Boston University School of Medicine, Boston, Massachusetts, USA
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Gomersall T, Smith SK, Blewett C, Astell A. 'It's definitely not Alzheimer's': Perceived benefits and drawbacks of a mild cognitive impairment diagnosis. Br J Health Psychol 2017. [PMID: 28628736 DOI: 10.1111/bjhp.12255] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To understand the perceived benefits and drawbacks of a mild cognitive impairment (MCI) diagnosis from the perspective of those living with the label. METHODS Participants were included if they had recently (within 6 months) received a MCI diagnosis. We also recruited close family members to gain their perspectives. Each was interviewed separately with a semi-structured topic guide covering three areas: (1) experience of cognitive impairments and changes in the individual; (2) impact of cognitive impairment(s) on daily activities and social relationships; and (3) experience of the diagnosis process and living with the label. Transcribed interviews were stored in Nvivo® . Grounded theory procedures of memo writing, open coding, constant comparison, and focused coding were used to derive conceptual themes. RESULTS Eighteen dyads were interviewed. The overarching themes surrounding diagnosis benefits and drawbacks were as follows: (1) emotional impact of the diagnosis; (2) practical benefits and limitations of the diagnosis, in terms of (a) understanding one's symptoms and (b) access to clinical support. Although participants were glad to have clinical support in place, they expressed frustration at the lack of clarity, and the lack of available treatments for MCI. Consequently, living with MCI can be characterized as an ambivalent experience. CONCLUSION As a clinical label, MCI appears to have little explanatory power for people living with cognitive difficulties. Work is needed to clarify how clinicians and patients communicate about MCI, and how people can be helped to live well with the label. Despite an emerging body of prognostic studies, people with MCI are likely to continue living with significant uncertainty. Statement of contribution What is already known on this subject? Mild cognitive impairment is a state of cognitive decline between normal cognitive ageing and dementia. This clinical category has been an important domain of academic debate over recent years. From a clinical perspective, diagnosing MCI is a helpful way to enable communication between health professionals, and a diagnosis can be important for patients in need of support and education. However, diagnosis can be fraught with difficulties, while patients have reported significant uncertainty about the label. This study aimed to examine the perceived benefits and drawbacks of receiving a MCI diagnosis. What does this study add? The emotional impact of a MCI diagnosis is complex and raised conflicting and fluctuating emotions in our participants' accounts - most notably worry and relief. Participants were glad to have clinical support available to call on; however, they were frustrated at the lack of 'treatments' available for MCI and were often anxious to slow any cognitive decline down Health psychologists will have an important role to play in understanding and improving clinical communication about MCI.
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Affiliation(s)
- Tim Gomersall
- Department of Behavioural & Social Sciences, University of Huddersfield, UK
| | - Sarah Kate Smith
- School of Health & Related Research, University of Sheffield, UK
| | | | - Arlene Astell
- School of Health & Related Research, University of Sheffield, UK
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Wesson J, Clemson L, Crawford JD, Kochan NA, Brodaty H, Reppermund S. Measurement of Functional Cognition and Complex Everyday Activities in Older Adults with Mild Cognitive Impairment and Mild Dementia: Validity of the Large Allen's Cognitive Level Screen. Am J Geriatr Psychiatry 2017; 25:471-482. [PMID: 28238815 DOI: 10.1016/j.jagp.2016.11.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/20/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To explore the validity of the Large Allen's Cognitive Level Screen-5 (LACLS-5) as a performance-based measure of functional cognition, representing an ability to perform complex everyday activities in older adults with mild cognitive impairment (MCI) and mild dementia living in the community. METHODS Using cross-sectional data from the Sydney Memory and Ageing Study, 160 community-dwelling older adults with normal cognition (CN; N = 87), MCI (N = 43), or dementia (N = 30) were studied. Functional cognition (LACLS-5), complex everyday activities (Disability Assessment for Dementia [DAD]), Assessment of Motor and Process Skills [AMPS]), and neuropsychological measures were used. RESULTS Participants with dementia performed worse than CN on all clinical measures, and MCI participants were intermediate. Correlational analyses showed that LACLS-5 was most strongly related to AMPS Process scores, DAD instrumental activities of daily living subscale, Mini-Mental State Exam, Block Design, Logical Memory, and Trail Making Test B. Multiple regression analysis indicated that both cognitive (Block Design) and functional measures (AMPS Process score) and sex predicted LACLS-5 performance. Finally, LACLS-5 was able to adequately discriminate between CN and dementia and between MCI and dementia but was unable to reliably distinguish between CN and MCI. CONCLUSION Construct validity, including convergent and discriminative validity, was supported. LACLS-5 is a valid performance-based measure for evaluating functional cognition. Discriminativevalidity is acceptable for identifying mild dementia but requires further refinement for detecting MCI.
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Affiliation(s)
- Jacqueline Wesson
- Ageing Work & Health Research Unit, Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia.
| | - Lindy Clemson
- Ageing Work & Health Research Unit, Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing, UNSW, Sydney, New South Wales, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing, UNSW, Sydney, New South Wales, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, UNSW, Sydney, New South Wales, Australia; School of Psychiatry, Faculty of Medicine, Dementia Collaborative Research Centre, School of Psychiatry, Australian Graduate School of Management, UNSW, Sydney, New South Wales, Australia; Aged Care Psychiatry and Memory Disorders Clinic, Euroa Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Simone Reppermund
- Centre for Healthy Brain Ageing, UNSW, Sydney, New South Wales, Australia; Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW, Sydney, New South Wales, Australia
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Wesson J, Clemson L, Brodaty H, Reppermund S. Estimating functional cognition in older adults using observational assessments of task performance in complex everyday activities: A systematic review and evaluation of measurement properties. Neurosci Biobehav Rev 2016; 68:335-360. [DOI: 10.1016/j.neubiorev.2016.05.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 04/19/2016] [Accepted: 05/23/2016] [Indexed: 12/01/2022]
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Lindbergh CA, Dishman RK, Miller LS. Functional Disability in Mild Cognitive Impairment: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2016; 26:129-59. [PMID: 27393566 DOI: 10.1007/s11065-016-9321-5] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 05/12/2016] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Cutter A Lindbergh
- Department of Psychology, University of Georgia, Athens, GA, 30602, USA.
| | - Rodney K Dishman
- Department of Kinesiology, University of Georgia, Athens, GA, 30602, USA
| | - L Stephen Miller
- Department of Psychology, University of Georgia, Athens, GA, 30602, USA.,Bio-Imaging Research Center, Paul D. Coverdell Center, University of Georgia, Athens, GA, 30602, USA
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Avila J, Flowers A, Scott TM, Quilici J, Apostolova LG, Woo E, Ringman J, Razani J. Daily Activity Abilities in MCI, Alzheimer's Disease, and Healthy Controls. GEROPSYCH 2015; 28:191-200. [PMID: 27366145 PMCID: PMC4922896 DOI: 10.1024/1662-9647/a000136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Mild cognitive impairment (MCI) is a risk state for dementia. The present study assessed daily functioning in MCI individuals (amnestic [aMCI] and nonamnestic [naMCI]) relative to those with Alzheimer's disease (AD) and healthy controls (NC). Twenty AD participants, 14 aMCI, 12 naMCI, and 30 healthy controls were administered the Direct Assessment of Functional Status (DAFS). The AD group performed poorer than all groups on all DAFS subscales. The aMCI group performed poorer than controls on the shopping subtests, while the naMCI group performed poorer than controls on only the free recall shopping. Finally, DAFS subscales discriminated the AD and aMCI groups well, but only recognition shopping discriminated between naMCI and aMCI individuals. These findings suggest that circumscribed ADL deficits distinguish subtypes of MCI and AD.
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Affiliation(s)
- Justina Avila
- Department of Psychology, California State University, Northridge, CA, USA; Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Amina Flowers
- Department of Psychology, California State University, Northridge, CA, USA
| | - Travis M Scott
- Department of Psychology, California State University, Northridge, CA, USA; Department of Psychology, Fordham University, Bronx, NY, USA
| | - Jill Quilici
- Department of Psychology, California State University, Northridge, CA, USA
| | | | - Ellen Woo
- Department of Neurology, University of California, Los Angeles, CA, USA
| | - John Ringman
- Department of Neurology, University of California, Los Angeles, CA, USA; Department of Neurology, University of Southern California, Los Angeles, CA, USA
| | - Jill Razani
- Department of Psychology, California State University, Northridge, CA, USA
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Gomersall T, Astell A, Nygård L, Sixsmith A, Mihailidis A, Hwang A. Living With Ambiguity: A Metasynthesis of Qualitative Research on Mild Cognitive Impairment. THE GERONTOLOGIST 2015; 55:892-912. [PMID: 26315317 PMCID: PMC4580312 DOI: 10.1093/geront/gnv067] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/17/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose of the study: Mild Cognitive Impairment (MCI) is a diagnosis proposed to describe an intermediate state between normal cognitive aging and dementia. MCI has been criticised for its conceptual fuzziness, its ambiguous relationship to dementia, and the tension it creates between medical and sociological understandings of “normal aging”. Design and Methods: We examined the published qualitative literature on experiences of being diagnosed and living with MCI using metasynthesis as the methodological framework. Results: Two overarching conceptual themes were developed. The first, MCI and myself-in-time, showed that a diagnosis of MCI could profoundly affect a person’s understanding of their place in the world. This impact appears to be mediated by multiple factors including a person’s social support networks, which daily activities are affected, and subjective interpretations of the meaning of MCI. The second theme, Living with Ambiguity, describes the difficulties people experienced in making sense of their diagnosis. Uncertainty arose, in part, from lack of clarity and consistency in the information received by people with MCI, including whether they are even told MCI is the diagnosis. Implications: We conclude by suggesting an ethical tension is always at play when a MCI diagnosis is made. Specifically, earlier support and services afforded by a diagnosis may come at the expense of a person’s anxiety about the future, with continued uncertainty about how his or her concerns and needs can be addressed.
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Affiliation(s)
- Tim Gomersall
- School of Health & Related Research, University of Sheffield, Sheffield, UK.
| | - Arlene Astell
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Louise Nygård
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Andrew Sixsmith
- Department of Gerontology, Simon Fraser University, Vancouver, Canada
| | - Alex Mihailidis
- Toronto Rehabilitation Institute, University of Toronto, Toronto, Canada
| | - Amy Hwang
- Toronto Rehabilitation Institute, University of Toronto, Toronto, Canada
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Jekel K, Damian M, Wattmo C, Hausner L, Bullock R, Connelly PJ, Dubois B, Eriksdotter M, Ewers M, Graessel E, Kramberger MG, Law E, Mecocci P, Molinuevo JL, Nygård L, Olde-Rikkert MG, Orgogozo JM, Pasquier F, Peres K, Salmon E, Sikkes SA, Sobow T, Spiegel R, Tsolaki M, Winblad B, Frölich L. Mild cognitive impairment and deficits in instrumental activities of daily living: a systematic review. ALZHEIMERS RESEARCH & THERAPY 2015; 7:17. [PMID: 25815063 PMCID: PMC4374414 DOI: 10.1186/s13195-015-0099-0] [Citation(s) in RCA: 350] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 01/21/2015] [Indexed: 01/11/2023]
Abstract
INTRODUCTION There is a growing body of evidence that subtle deficits in instrumental activities of daily living (IADL) may be present in mild cognitive impairment (MCI). However, it is not clear if there are IADL domains that are consistently affected across patients with MCI. In this systematic review, therefore, we aimed to summarize research results regarding the performance of MCI patients in specific IADL (sub)domains compared with persons who are cognitively normal and/or patients with dementia. METHODS The databases PsycINFO, PubMed and Web of Science were searched for relevant literature in December 2013. Publications from 1999 onward were considered for inclusion. Altogether, 497 articles were retrieved. Reference lists of selected articles were searched for potentially relevant articles. After screening the abstracts of these 497 articles, 37 articles were included in this review. RESULTS In 35 studies, IADL deficits (such as problems with medication intake, telephone use, keeping appointments, finding things at home and using everyday technology) were documented in patients with MCI. Financial capacity in patients with MCI was affected in the majority of studies. Effect sizes for group differences between patients with MCI and healthy controls were predominantly moderate to large. Performance-based instruments showed slight advantages (in terms of effect sizes) in detecting group differences in IADL functioning between patients with MCI, patients with Alzheimer's disease and healthy controls. CONCLUSION IADL requiring higher neuropsychological functioning seem to be most severely affected in patients with MCI. A reliable identification of such deficits is necessary, as patients with MCI with IADL deficits seem to have a higher risk of converting to dementia than patients with MCI without IADL deficits. The use of assessment tools specifically designed and validated for patients with MCI is therefore strongly recommended. Furthermore, the development of performance-based assessment instruments should be intensified, as they allow a valid and reliable assessment of subtle IADL deficits in MCI, even if a proxy is not available. Another important point to consider when designing new scales is the inclusion of technology-associated IADL. Novel instruments for clinical practice should be time-efficient and easy to administer.
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Affiliation(s)
- Katrin Jekel
- Network Aging Research, Heidelberg University, Bergheimer Str. 20, 69115 Heidelberg, Germany ; Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Square J 5, 68159 Mannheim, Germany
| | - Marinella Damian
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Square J 5, 68159 Mannheim, Germany
| | - Carina Wattmo
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, 20502 Malmö, Sweden
| | - Lucrezia Hausner
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Square J 5, 68159 Mannheim, Germany
| | - Roger Bullock
- Kingshill Research Centre, Victoria Hospital, 53 Downs Way, Swindon, SN3 6BW UK
| | - Peter J Connelly
- Hon Senior Lecturer in Psychiatry at the University of Dundee, Murray Royal Hospital, Perth, PH2 7BH UK
| | - Bruno Dubois
- Centre des Maladies Cognitives et Comportementales (IM2A), Institut du Cerveau et de la Moelle épinière (ICM), UMR-S975, Université Pierre et Marie Curie- Paris6, AP-HP, Hôpital de la Salpêtrière, 47 boulevard de l'Hôpital, 75013 Paris, France
| | - Maria Eriksdotter
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Alfred Nobels allé 23, 14183 Huddinge, Sweden
| | - Michael Ewers
- Institute of Health and Nursing Science, Charité Center 1 for Health and Human Sciences, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Elmar Graessel
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Milica G Kramberger
- Department of Neurology, Centre for Cognitive Impairments, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
| | - Emma Law
- Scottish Dementia Clinical Research Network, Murray Royal Hospital, Perth, PH2 7BH UK
| | - Patrizia Mecocci
- Institute of Gerontology and Geriatrics, University of Perugia, via Brunamonti 51, 06122 Perugia, Italy
| | - José L Molinuevo
- Alzheimer's Disease and Other Cognitive Disorders Unit, ICN, Hospital Clínic i Universitari, IDIBAPS, Villarroel 170, Barcelona, 08036 Spain
| | - Louise Nygård
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Fack 23200, 14183 Huddinge, Sweden
| | - Marcel Gm Olde-Rikkert
- Department of Geriatrics, Radboud University Nijmegen Medical Centre, Reinier Postlaan 4, 6525 GC Nijmegen, the Netherlands
| | - Jean-Marc Orgogozo
- Department of Clinical Neurosciences, University Hospital Pellegrin, Place Amélie Raba-Léon, 33000 Bordeaux, France
| | - Florence Pasquier
- INSERM U1171, CHU, Memory Clinic, University of Lille, rue Emile Laine, 59037 Lille, France
| | - Karine Peres
- University of Bordeaux, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, 33000 Bordeaux, France ; INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, 33000 Bordeaux, France
| | - Eric Salmon
- Memory Clinic, Department of Neurology, University of Liège, allée du 6 Août 8, 4000 Liège, Belgium
| | - Sietske Am Sikkes
- Alzheimer Center and Department of Epidemiology and Biostatistics, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Tomasz Sobow
- Department of Medical Psychology, Medical University of Lodz, 5 Sterling St, 90-425 Lodz, Poland
| | - René Spiegel
- Memory Clinic, University Center for Medicine of Aging Basel, Felix Platter Hospital, Schanzenstr. 55, CH-4031 Basel, Switzerland
| | - Magda Tsolaki
- 3rd Department of Neurology, Aristotle University, Despere 3, Thessaloniki, 54621 Greece
| | - Bengt Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Center for Alzheimer Research, Karolinska Institutet, 14157 Huddinge, Sweden
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Square J 5, 68159 Mannheim, Germany
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Koskas P, Henry-Feugeas MC, Feugeas JP, Poissonnet A, Pons-Peyneau C, Wolmark Y, Drunat O. The Lawton Instrumental Activities Daily Living/Activities Daily Living Scales: A Sensitive Test to Alzheimer Disease in Community-Dwelling Elderly People? J Geriatr Psychiatry Neurol 2014; 27:85-93. [PMID: 24578460 DOI: 10.1177/0891988714522694] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 10/09/2013] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine the diagnostic ability of the Lawton Instrumental Activities Daily Living (IADLs) scale and the Activities Daily Living (ADLs) scale as a sensitive tool to Alzheimer's disease (AD) in community-dwelling elderly people. DESIGN In an old age memory outpatient center, among patients with a clinical diagnosis of AD dementia or no dementia supported by at least 6 months of follow-up, we looked back at the baseline Lawton IADL scale (short version IADL-4 item), ADL scale, Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MOCA) values. RESULTS There were 109 patients with AD and 53 nondemented individuals (81.4 ± 4.6 years). The sensitivity of ADL scale or IADL-4 item or the MMSE was low (52%-57%). The most efficient AD classification used both the IADLs-4 item and the MOCA with a threshold score of 20. Besides age and memory scores, the main correlates of IADLs scale or ADLs scale were executive, neuropsychiatric, vascular, and extrapyramidal scores. CONCLUSION Our results suggest that the Lawton IADLs-4 item scale and ADLs scale lack sensitivity to AD dementia in elderly people and support a better sensitivity of MOCA rather than MMSE and IADLs-4 item/ADLs at the expense of specificity.
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Affiliation(s)
- Pierre Koskas
- Memory Center, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie Cécile Henry-Feugeas
- Department of Radiology, Bichat Claude Bernard University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean Paul Feugeas
- UMR U722 INSERM Faculté de Médecine Xavier Bichat, Paris Diderot University, Paris, France
| | - Aurore Poissonnet
- Department of Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cécile Pons-Peyneau
- Department of Psycho-Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yves Wolmark
- Department of Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Drunat
- Department of Psycho-Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Kottorp A, Nygård L. Development of a short-form assessment for detection of subtle activity limitations: can use of everyday technology distinguish between MCI and Alzheimer’s disease? Expert Rev Neurother 2014; 11:647-55. [DOI: 10.1586/ern.11.55] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Tarnanas I, Schlee W, Tsolaki M, Müri R, Mosimann U, Nef T. Ecological validity of virtual reality daily living activities screening for early dementia: longitudinal study. JMIR Serious Games 2013; 1:e1. [PMID: 25658491 PMCID: PMC4307822 DOI: 10.2196/games.2778] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 07/22/2013] [Accepted: 07/22/2013] [Indexed: 11/13/2022] Open
Abstract
Background Dementia is a multifaceted disorder that impairs cognitive functions, such as memory, language, and executive functions necessary to plan, organize, and prioritize tasks required for goal-directed behaviors. In most cases, individuals with dementia experience difficulties interacting with physical and social environments. The purpose of this study was to establish ecological validity and initial construct validity of a fire evacuation Virtual Reality Day-Out Task (VR-DOT) environment based on performance profiles as a screening tool for early dementia. Objective The objectives were (1) to examine the relationships among the performances of 3 groups of participants in the VR-DOT and traditional neuropsychological tests employed to assess executive functions, and (2) to compare the performance of participants with mild Alzheimer’s-type dementia (AD) to those with amnestic single-domain mild cognitive impairment (MCI) and healthy controls in the VR-DOT and traditional neuropsychological tests used to assess executive functions. We hypothesized that the 2 cognitively impaired groups would have distinct performance profiles and show significantly impaired independent functioning in ADL compared to the healthy controls. Methods The study population included 3 groups: 72 healthy control elderly participants, 65 amnestic MCI participants, and 68 mild AD participants. A natural user interface framework based on a fire evacuation VR-DOT environment was used for assessing physical and cognitive abilities of seniors over 3 years. VR-DOT focuses on the subtle errors and patterns in performing everyday activities and has the advantage of not depending on a subjective rating of an individual person. We further assessed functional capacity by both neuropsychological tests (including measures of attention, memory, working memory, executive functions, language, and depression). We also evaluated performance in finger tapping, grip strength, stride length, gait speed, and chair stands separately and while performing VR-DOTs in order to correlate performance in these measures with VR-DOTs because performance while navigating a virtual environment is a valid and reliable indicator of cognitive decline in elderly persons. Results The mild AD group was more impaired than the amnestic MCI group, and both were more impaired than healthy controls. The novel VR-DOT functional index correlated strongly with standard cognitive and functional measurements, such as mini-mental state examination (MMSE; rho=0.26, P=.01) and Bristol Activities of Daily Living (ADL) scale scores (rho=0.32, P=.001). Conclusions Functional impairment is a defining characteristic of predementia and is partly dependent on the degree of cognitive impairment. The novel virtual reality measures of functional ability seem more sensitive to functional impairment than qualitative measures in predementia, thus accurately differentiating from healthy controls. We conclude that VR-DOT is an effective tool for discriminating predementia and mild AD from controls by detecting differences in terms of errors, omissions, and perseverations while measuring ADL functional ability.
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Affiliation(s)
- Ioannis Tarnanas
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland.
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Kaye J, Mattek N, Dodge HH, Campbell I, Hayes T, Austin D, Hatt W, Wild K, Jimison H, Pavel M. Unobtrusive measurement of daily computer use to detect mild cognitive impairment. Alzheimers Dement 2013; 10:10-7. [PMID: 23688576 DOI: 10.1016/j.jalz.2013.01.011] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 01/08/2013] [Accepted: 01/11/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mild disturbances of higher order activities of daily living are present in people diagnosed with mild cognitive impairment (MCI). These deficits may be difficult to detect among those still living independently. Unobtrusive continuous assessment of a complex activity such as home computer use may detect mild functional changes and identify MCI. We sought to determine whether long-term changes in remotely monitored computer use differ in persons with MCI in comparison with cognitively intact volunteers. METHODS Participants enrolled in a longitudinal cohort study of unobtrusive in-home technologies to detect cognitive and motor decline in independently living seniors were assessed for computer use (number of days with use, mean daily use, and coefficient of variation of use) measured by remotely monitoring computer session start and end times. RESULTS More than 230,000 computer sessions from 113 computer users (mean age, 85 years; 38 with MCI) were acquired during a mean of 36 months. In mixed-effects models, there was no difference in computer use at baseline between MCI and intact participants controlling for age, sex, education, race, and computer experience. However, over time, between MCI and intact participants, there was a significant decrease in number of days with use (P = .01), mean daily use (∼1% greater decrease/month; P = .009), and an increase in day-to-day use variability (P = .002). CONCLUSIONS Computer use change can be monitored unobtrusively and indicates individuals with MCI. With 79% of those 55 to 64 years old now online, this may be an ecologically valid and efficient approach to track subtle, clinically meaningful change with aging.
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Affiliation(s)
- Jeffrey Kaye
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA; Department of Neurology, Oregon Health & Science University, Portland, OR, USA; Neurology Service, Portland Veteran Affairs Medical Center, Portland, OR, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.
| | - Nora Mattek
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA; Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Hiroko H Dodge
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA; Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Ian Campbell
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Tamara Hayes
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Daniel Austin
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - William Hatt
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA; Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Katherine Wild
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA; Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Holly Jimison
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA; Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Michael Pavel
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
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Rosenberg L, Nygård L. Learning and using technology in intertwined processes: A study of people with mild cognitive impairment or Alzheimer’s disease. DEMENTIA 2013; 13:662-77. [DOI: 10.1177/1471301213481224] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
People with mild cognitive impairment and Alzheimer’s disease are likely to be challenged by the multitude of everyday technology in today’s society. The aim of this study was to explore how they try to prohibit, avoid or solve problems in everyday technology use, maintain skills, and learn to use new technology. To explore how the participants applied and reasoned about using everyday technology in real-life situations interviews were conducted while the participants used their own technology in their homes. Interviews were conducted with 20 participants with mild cognitive impairment ( n = 10) or Alzheimer’s disease ( n = 10). The analyses were inspired from grounded theory and resulted in one core category and three sub-categories that represent sub-processes in the core. The core finding presents a continuous, intertwined process of learning and using everyday technology, highlighting how the context was interwoven in the processes. The participants used a rich variety of management strategies when approaching technology, including communication with the everyday technologies on different levels. The findings underscore that it is important to support continued use of everyday technology as long as it is valued and relevant to the person with mild cognitive impairment or Alzheimer’s disease. The intertwined process of learning and using everyday technology suggests how support could target different sub-processes.
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Characterizing mild cognitive disorders in the young‐old over 8 years: Prevalence, estimated incidence, stability of diagnosis, and impact on IADLs. Alzheimers Dement 2013; 9:640-8. [DOI: 10.1016/j.jalz.2012.11.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 11/08/2012] [Accepted: 11/21/2012] [Indexed: 11/18/2022]
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Galambos C, Skubic M, Wang S, Rantz M. Management of Dementia and Depression Utilizing In- Home Passive Sensor Data. GERONTECHNOLOGY : INTERNATIONAL JOURNAL ON THE FUNDAMENTAL ASPECTS OF TECHNOLOGY TO SERVE THE AGEING SOCIETY 2013; 11:457-468. [PMID: 24049513 PMCID: PMC3773874 DOI: 10.4017/gt.2013.11.3.004.00] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE This study investigates whether motion density maps based on passive infrared (PIR) motion sensors and the average time out and average density per hour measures of the density map are sensitive enough to detect changes in mental health over time. METHOD Within the sensor network, data are logged from PIR motion sensors which capture motion events as people move around the home. If there is continuous motion, the sensor will generate events at 7 second intervals. If the resident is less active, events will be generated less frequently. A web application displays the data as activity density maps showing events per hour with hours on the vertical axis and progressive days on the horizontal axis. Color and intensity provide textural indications of time spent away from home and activity level. Texture features from the co-occurrence matrix are used to capture the periodicity pattern of the activity (including homogeneity, local variation, and entropy) and are combined with the average motion density per hour and the average time away from home. The similarity of two different density maps is represented by a number that is computed in feature space as the distance from one map to the other, or a measure of dis-similarity. Employing a retrospective approach, density maps were compared with health assessment information (Geriatric Depression Scale, Mini Mental State Exam, and Short Form Health Survey -12) to determine congruence between activity pattern changes and the health information20. A case by case study method, analyzed the density maps of 5 individuals with identified mental health issues. These density maps were reviewed along with the averages of time out of apartment per day per hour and average density per hour for hours at home and mental health assessment scores to determine if there were activity changes and if activity patterns reflected changes in mental health conditions. RESULTS & DISCUSSION The motion density maps show visual changes in the client's activity, including circadian rhythm, time away from home, and general activity level (sedentary vs. puttering). The measures are sensitive enough, yielding averages of time out of apartment and average density per hour for hours at home that indicate significant change. There is evidence of congruence with health assessment scores. This pilot study demonstrates that density maps can be used as a tool for early illness detection. The results indicate that sensor technology has the potential to augment traditional health care assessments and care coordination.
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Nygård L, Pantzar M, Uppgard B, Kottorp A. Detection of activity limitations in older adults with MCI or Alzheimer's disease through evaluation of perceived difficulty in use of everyday technology: a replication study. Aging Ment Health 2012; 16:361-71. [PMID: 21895555 DOI: 10.1080/13607863.2011.605055] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES AND METHODS Earlier research indicates that the ability to use everyday technology (ET) may be sensitive to subtle functional change. People with mild cognitive impairment (MCI) have been identified as significantly more disabled in ET use compared to controls, albeit less disabled than people with dementia. The aim of this study was to investigate the replicability of these findings using an improved version of the Everyday Technology Use Questionnaire (ETUQ) to compare perceptions of relevance and difficulty in ET use in participants with MCI or Alzheimer's disease (AD) and controls. Additional aims were to explore the validity of ETUQ, and the relationships between perceived difficulty in ET use and cognitive status, mood state, and involvement in everyday life activities. In total, 118 participants were included, 37 with AD, 37 with MCI, and 44 controls. RESULTS Analyses confirmed that the rating scale of the ETUQ functioned well. The three groups overlapped but differed significantly in their perceptions of ETs relevance (p < 0.05) as well as of difficulties in ET use (p < 0.001). Moderate correlations were also found between ETUQ measures and cognitive status, mood, and involvement in activities, the strongest being that between ETUQ measures and involvement in activities (r = 0.563). CONCLUSION Taken together, the findings underscore the plausibility of disability already in people with MCI, as the use of ET strongly correlates to involvement in activities. It is therefore important that professionals who meet older adults with cognitive impairment take this aspect of function into account in assessments and targeted interventions.
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Affiliation(s)
- Louise Nygård
- Division of Occupational Therapy, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden.
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Rodríguez-Sánchez E, Mora-Simón S, Patino-Alonso MC, García-García R, Escribano-Hernández A, García-Ortiz L, Perea-Bartolomé MV, Gómez-Marcos MA. Prevalence of cognitive impairment in individuals aged over 65 in an urban area: DERIVA study. BMC Neurol 2011; 11:147. [PMID: 22093337 PMCID: PMC3226440 DOI: 10.1186/1471-2377-11-147] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 11/17/2011] [Indexed: 11/27/2022] Open
Abstract
Background Few data are available on the prevalence of cognitive impairment (CI) in Spain, and the existing information shows important variations depending on the geographical setting and the methodology employed. The aim of this study was to determine the prevalence of CI in individuals aged over 65 in an urban area, and to analyze its associated risk factors. Methods Design: A descriptive, cross-sectional, home questionnaire-based study; Setting: Populational, urban setting. Participants: The reference population comprised over-65s living in the city of Salamanca (Spain) in 2009. Randomized sampling stratified according to health district was carried out, and a total of 480 people were selected. In all, 327 patients were interviewed (68.10%), with a mean age of 76.35 years (SD: 7.33). Women accounted for 64.5% of the total. Measurements: A home health questionnaire was used to obtain the following data: age, sex, educational level, family structure, morbidity and functionality. All participants completed a neuropsychological test battery. The prevalence data were compared with those of the European population, with direct adjustment for age and sex. Diagnoses were divided into three general categories: normal cognitive function, cognitive impairment - no dementia (CIND), and dementia. Results The prevalence of CI among these over-65s was 19% (14.7% CIND and 4.3% dementia). The age-and sex-adjusted global prevalence of CI was 14.9%. CI increased with age (p < 0.001) and decreased with increasing educational level (p < 0.001). Significant risk factors were found with the multivariate analyses: age (OR = 1.08, 95%CI: 1.03-1.12), anxiety-depression (OR = 3.47, 95%CI: 1.61-7.51) and diabetes (OR = 2.07, 95%CI: 1.02-4.18). In turn, years of education was found to be a protective factor (OR = 0.79, 95%CI: 0.70-0.90). Although CI was more frequent among women and in people living without a partner, these characteristics were not significantly associated with CI risk. Conclusions The observed raw prevalence of CI was 19% (14.9% after adjusting for age and sex). Older age and the presence of diabetes and anxiety-depression increased the risk of CI, while higher educational level reduced the risk.
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Affiliation(s)
- Emiliano Rodríguez-Sánchez
- Primary care research unit of La Alamedilla Health Center, Castilla y León Health Service- SACYL, Salamanca, Spain.
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Development and cross-validation of the UPSA short form for the performance-based functional assessment of patients with mild cognitive impairment and Alzheimer disease. Am J Geriatr Psychiatry 2011; 19:915-22. [PMID: 22024615 DOI: 10.1097/jgp.0b013e3182011846] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Functional capacity includes basic and complex behaviors necessary to independently live in the community. It has been found that patients with cognitive impairment have daily living functional skills altered at very early stages of illness. OBJECTIVES 1) To develop and validate a brief scale derived from the University of California, San Diego, performance-based skills assessment (UPSA); 2) to cross-validate this new UPSA short form with an independent healthy elderly sample. METHOD Fifty-one healthy elderly subjects, 26 mild cognitive impairment (MCI) subjects defined per Petersen's criteria, and 22 probable Alzheimer Disease (AD) subjects according to National Institute of Neurological and Communicative Disorders and Stroke-AD and Related Disorders Association criteria were included. For cross-validation purpose, a comparison group of 108 older healthy subjects with Mini-Mental scores of 25 or greater was also recruited. A modified four-functional domain version of the UPSA was administered. RESULTS Communication and comprehension/planning domains accounted for almost 90% of the variance (R = 0.89) and in all models entered first and second, respectively. An UPSA short form using these two domains was significantly correlated with the full UPSA scale in all the groups examined: 0.86 for healthy controls; 0.87 for MCI; and 0.88 for AD. Acceptable sensitivity and specificity values for the UPSA short form were found in receiver operating characteristic (ROC) analysis. A correlation of 0.80 was found between the short and the full UPSA scales in the cross-validation sample. CONCLUSIONS The UPSA short form is a rapid, reliable, and efficient measure of functional capacity that is able to detect performance impairment in an ecologically valid setting in much less time compared with the extended form of the scale. Furthermore, it demonstrated adequate discriminative properties among healthy subjects, MCI patients, and AD patients.
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Zhao S, Guo C, Wang M, Chen W, Wu Y, Tang W, Zhao Y. A clinical memory battery for screening for amnestic mild cognitive impairment in an elderly chinese population. J Clin Neurosci 2011; 18:774-9. [DOI: 10.1016/j.jocn.2010.07.149] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 06/20/2010] [Accepted: 07/24/2010] [Indexed: 10/18/2022]
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Whipple Drozdick L, Munro Cullum C. Expanding the ecological validity of WAIS-IV and WMS-IV with the Texas functional living scale. Assessment 2010; 18:141-55. [PMID: 20921288 DOI: 10.1177/1073191110382843] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Assessment of functional status is an important aspect of clinical evaluation. As part of the standardization of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) and Wechsler Memory Scale-Fourth Edition (WMS-IV), participants completed the Texas Functional Living Scale (TFLS), a measure of Instrumental Activities of Daily Living. The relationships between TFLS and WAIS-IV and WMS-IV were examined in both normally developing and clinical samples. In general, the highest correlations were between TFLS and measures of general cognitive ability (WAIS-IV FSIQ [Full Scale IQ] and GAI [General Ability Index]) and working memory (WAIS-IV WMI [Working Memory Index] and WMS-IV VWMI [Visual Working Memory Index]). Across the clinical populations, working memory subtests were generally strongly related to TFLS performance, although this relationship was more consistent with WAIS-IV than WMS-IV. Contrast scaled scores are presented for the TFLS based on WAIS-IV or WMS-IV performance. These scores allow the evaluation of functional abilities within the context of cognitive and memory ability, enhancing and expanding the utility of the WAIS-IV and WMS-IV.
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