Assessment Of Functional Skills Research Articles

Novel measures of cognition and function for the AD spectrum in the Novel Measures for Alzheimer's Disease Prevention Trials (NoMAD) project: Psychometric properties, convergent validation, and contrasts with established measures.

This study derived composite scores for two novel cognitive measures, the No Practice Effect (NPE) battery and the Miami Computerized Functional Skills Assessment and Training system for use in early-stage Alzheimer's disease (AD) clinical trials. Their psychometric properties and associations with AD risk markers were compared to those of well-established measures. For 291 older adults with healthy cognition or early mild cognitive impairment, Exploratory factor analyses were used to identify the factor structure of the NPE. Factor and total scores were examined for their psychometric properties and associations with AD risk biomarkers. Composite scores from the novel cognitive and functional measures demonstrated better psychometric properties (distribution and test-retest reliability) and stronger associations with AD-related demographic, genetic, and brain risk markers than well-established measures, DISCUSSION: These novel measures have potential for use as primary cognitive and functional outcomes in early-stage AD clinical trials. Well-established cognitive tests may not accurately detect subtle cognitive changes. No Practice Effect (NPE) and Computerized Functional Skills Assessment and Training are novel measures designed to have improved psychometric properties. NPE had Executive Function, Cognitive Control/Speed, and Episodic Memory domains. Novel measures had better psychometric properties compared to established measures. Significant associations with Alzheimer's disease biomarkers were found with novel measures.

The Efficacy of a Home-Based Functional Skills Training Program for Older Adults With and Without a Cognitive Impairment.

The performance of everyday technology-based tasks, such as online banking or shopping, can be challenging for older adults, especially those with a cognitive impairment. Technology-based tasks are cognitively demanding and require learning new skills. This study explored the efficacy of a technology-based functional skills assessment and training program (FUNSAT) among aging adults with and without mild cognitive impairment (MCI) in home settings. One hundred and eighty-four racially/ethnically diverse male and female adults aged 65+ participated in the study. The sample included 75 noncognitively impaired (NC) older adults and 109 older adults with MCI. The FUNSAT program includes medication and money management, transportation, and shopping tasks. The MCI participants were randomized to the FUNSAT training or FUNSAT training combined with computer-based cognitive training (FUNSAT/CCT). The nonimpaired adults received the FUNSAT training only. Using alternative forms of the assessment component of the FUNSAT program, assessments occurred at baseline, post-training, and 1- and 3-month post-training. This paper reports the post-training results. The findings indicated that the performance of both the nonimpaired and MCI participants improved significantly for all 6 tasks post-training. Specifically, training resulted in improvements in task completion time and task errors. Participants also reported greater confidence when performing the tasks in the real world. Nonimpaired aging adults and those with MCI can learn to perform technology-based everyday tasks. Further, home-based technology training protocols are feasible for aging adults with and without a cognitive impairment. NCT0467944 1.

FUNSAT: A FUNCTIONAL SKILLS TRAINING PROGRAM

Abstract Performance of everyday activities is often challenging for older adults, especially for aging adults with a cognitive impairment (CI), which threatens independence and quality of life. We developed a novel computer-based functional skills assessment and training (FUNSAT) program, which includes simulations of everyday technology-based tasks (e.g., online banking, prescription refill, online shopping) important to everyday living. This presentation will present preliminary findings from our study that is evaluating the FUNSAT program with aging adults with and without a cognitive impairment. The sample includes 153 adults (83 with a CI, 130 females and 23 males) ranging in age from 60-92 yrs. Initially, participants completed the FUNSAT assessment and then engaged in the FUNSAT training program for up to 24 hours over 12 weeks at home after an initial in-person training. The non-cognitively impaired participants completed the FUNSAT training alone. The participants with a cognitive impairment were randomized into one of two conditions; FUNSAT training alone, or Cognitive Training (3 weeks) followed by FUNSAT training. We also evaluated transfer of training using ecological momentary assessment (EMA). Our preliminary findings indicate that participants irrespective of cognitive status are demonstrating significant gains in performance following training on the training tasks. Further, they are reporting an increase in confidence with respect to performing the tasks in daily living and the EMA data suggest transfer of training to other technology-based tasks. We will also discuss adherence to the home training protocol, which has important implications for implementation of the program beyond the research setting.

Self – Advocacy Significance in Work Placement Adjustment of PwID

Self – Advocacy of differently abled adults living in Urban cities, Suburban and Rural areas were examined with respect to self - advocacy of their technical training, life skill development programs and social support systems. In the present situation based on applicability of scientific knowledge helping the Intellectual disabled adult children from positive psychology frameworks and from the strengths-based approach through which they can learn natural language and understanding language is currently focused by special education and vocational training centres for differently abled adult students. Under this framework, Self-determined, Self – advocacy action is including and able to implement practically by two following essential criteria’s: 1. Vocational training action, 2. Self - governing action. Vocational action refers to the extent to which a person makes intentional, conscious choices based on differently abled adult choice and interests. Self - governing action involves self-directing and managing actions in service of a chosen work area and implies identifying different ways and methods to solve their disable problem. This study paper focusing on the dedicated services of Vocational training centres rendering multiple roles in promoting technical skills and life skills based on identifying different abilities and preparing the differently abled adults to enter into suitable work places for self-earning with intellectual disabilities. The study was conducted with the purpose to identifying the role of Vocational instructors in development of assessment tool, need assessment of functional skills, programming, implementation, and evaluation of training program by involving even parents in all stages. Differently abled adults in DAIL section identified male and female students and their parents who showed their commitment to participate in the program were involved in the Work Placement Adjustment of PwID program. Need assessment of functional skills of each adult was done through technical and functional skills training programs were developed by implementing and evaluated with the support of parents. Data showed that Instructors played multiple roles were observed in the whole study; their teaching style, use of different behaviour modification technique and other were come forth and performance of differently abled adults was increased.

Computerized Cognitive and Skills Training in Older People With Mild Cognitive Impairment: Using Ecological Momentary Assessment to Index Treatment-Related Changes in Real-World Performance of Technology-Dependent Functional Tasks

ObjectivesCognitive and functional skills training improves skills and cognitive test performance, but the true test of efficacy is real-world transfer. We trained participants with mild cognitive impairment (MCI) or normal cognition (NC) for up to 12 weeks on six technology-related skills using remote computerized functional skills assessment and training (FUNSAT) software. Using ecological momentary assessment (EMA), we measured real-world performance of the technology-related skills over 6 months and related EMA-identified changes in performance to training gains. DesignRandomized clinical trial with post-training follow-up. SettingA total of 14 Community centers in New York City and Miami. ParticipantsOlder adults with normal cognition (n = 72) or well-defined MCI (n = 92), ranging in age from 60 to 90, primarily female, and racially and ethnically diverse. InterventionComputerized cognitive and skills training. MeasurementsEMA surveys measuring trained and untrained functional skills 3 or more days per week for 6 months and training gains from baseline to end of training. ResultsTraining gains in completion times across all 6 tasks were significant (p <0.001) for both samples, with effect sizes more than 1.0 SD for all tasks. EMA surveys detected increases in performance for both trained (p <0.03) and untrained (p <0.001) technology-related skills for both samples. Training gains in completion times predicted increases in performance of both trained and untrained technology-related skills (all p <0.001). ConclusionsComputerized training produces increases in real-world performance of important technology-related skills. These gains continued after the end of training, with greater gains in MCI participants.

Piloting a Novel Daily Living Skills Assessment in Autistic Adolescents and Young Adults.

There are a few ecologically valid measurements of Daily Living Skills (DLS)-a critical component of adaptive functioning (AF)-for autistic adolescents and young adults. This is particularly important given that DLS predict outcomes as autistic adolescents transition to adulthood. We pilot-tested the assessment section of two modules of the Computerized Functional Skills Assessment and Training program (CFSAT) in 25 autistic (n = 4 female) and 25 non-autistic (n = 6 female) adolescents and young adults to evaluate preliminary feasibility in an autistic sample. Tasks involved using an ATM and ticket-buying machine. We also assessed AF and DLS with a well-validated self-report questionnaire. We examined group differences in performance and relationships between performance on CFSAT and an existing measure of AF and DLS. We also conducted regression analyses to investigate the associations between age, IQ, executive functioning (EF), and CFSAT task performance. All but one autistic participant were able to complete the CFSAT tasks. Autistic participants made more errors, but did not take longer to complete the task, than non-autistic participants. Performance correlated strongly with self-reported AF generally and DLS specifically. The regression analyses revealed that task performance was associated with EF in the autistic group, but not the non-autistic group. These results provide preliminary support for the use of a new performance-based ecologically valid assessment of DLS in an autistic population. Two CFSAT modules were well-tolerated and detected differences in DLS ability. Strong correlations with an existing measure of AF suggest evidence of construct validity. The EF was associated with CFSAT task performance in autistic individuals. Such a tool could help identify individuals who would benefit from a DLS intervention.

Improvements in Cognitive Performance With Computerized Training in Older People With and Without Cognitive Impairment: Synergistic Effects of Skills-Focused and Cognitive-Focused Strategies

ObjectivesBoth cognitively impaired (CI) and nonimpaired (NC) older people have challenges in performing everyday tasks. Previous skills training efforts in NC individuals have led to improvements in both functional skills and cognitive functioning. We evaluated the cognitive benefits of combining computerized cognitive training (CCT) with a computer-based functional skills assessment and training (CFSAT) program in a sample of CI and NC older adults. DesignRandomized parallel clinical trial with two treatment conditions: up to 24 sessions of CFSAT training alone or CFSAT plus speed focused CCT. ParticipantsNC (n = 62) and CI (n = 55) older adults, ranging in age from 60–86 years (M = 73.12), primarily female (90%), and ethnically diverse (21% Hispanic, 52% African American). Participants were divided based on Montreal Cognitive Assessment scores and cognitive complaints. SettingThree different community centers in Miami, FL. MeasurementsThe Brief Assessment of Cognition, app version, was used to measure cognitive performance across six different cognitive domains before and after training. ResultsAll six cognitive domains improved from baseline. Multivariate analyses found the effects of the combined CFSAT and CCT to be superior. The interaction of training condition and cognitive status was not statistically significant, indicating no global impact of cognitive status on improvements in cognition across training conditions. ConclusionsCFSAT training was associated with cognitive benefits, particularly in CI participants. The combined intervention led to greater improvements. Consistent with results of previous studies, there is considerable evidence of cognitive plasticity in older adults, including those with CI.

Life Expectancy of 1-Year Survivors of Traumatic Brain Injury, 1988-2019: Updated Results From the TBI Model Systems

ObjectiveTo update the life expectancy estimates according to age, sex, mobility, and feeding skills reported in the 2015 study of Brooks et al. To examine trends in survival over the past decade. DesignObservational cohort study. SettingPoisson regression and life table analysis applied to long-term follow-up data on United States (US) Traumatic Brain Injury (TBI) Model Systems patients recorded in the national database. Functional mobility and feeding skills were assessed with FIM. ParticipantsA total of 14,803 persons with TBI during the years 1988-2019 who underwent inpatient rehabilitation and provided at least 1 long-term assessment of functional skills 1 year or more postinjury (N=14,803). InterventionsNot applicable. Main Outcome MeasuresSurvival, mortality rates, and life expectancy. ResultsLife expectancy was lower than that of the age- and sex-matched general population. Older age and severity of functional impairments were risk factors for mortality (both P<.0001 in regression models). Among ambulatory individuals, mortality was 51% (95% confidence interval, 35%-69%) higher in men than women. Life expectancy of 20-year-old women who walked well (FIM ambulation score 7) was 55 (SE=0.8) additional years to age 75, representing a reduction of 6.9 years from the normal general population figure. For 20-year-old men who walked well, the life expectancy was 49 (SE=0.5) additional years, representing a reduction of 8.1 years from normal. Life expectancies for men and women who did not walk and were fed by others were much lower. There was no significant change in mortality rates during the study period (hazard ratio, 1.008; P=.07). ConclusionsThere has been no significant change in the long-term survival of persons with TBI in the US since the late 1980s. The life expectancies reported here are similar to those reported in the 2015 study of Brooks et al, although they are more precise because of the larger sample size and longer follow-up.

A Novel Method for Assessing and Training Everyday Functional Skills

Older adults, especially those with cognitive impairments often experience difficulty performing everyday tasks such as medication management, which threatens independence. Thus, there is an interest in developing treatment approaches for those who are experiencing or at risk for cognitive problems. Cognitive remediation training (CRT) programs have shown to be effective in improving cognitive abilities, but there is limited evidence to suggest that CRT results in everyday task performance gains. This presentation will discuss findings from a trial evaluating an innovative computer -based functional skills assessment and skills training program (CFSAT), which includes ecologically valid simulations of everyday tasks (e.g., shopping, money and medication management). The sample includes non-cognitively impaired (NC) older adults (n=50) and those with mild cognitive impairment (MCI) (n = 40), ranging in age from 60 -86 years (M= 73.10; SD = 6.06), is primarily female (90%), and ethnically diverse (69% minority). Participants were randomized into the CFSAT condition or a CFSAT + CRT condition. Performance data includes real time measures of accuracy, response time and efficiency. The findings indicate that the assessment component of the CFSAT program differentiated between the NC and MCI groups at the baseline assessment. Both NC and MCI participants demonstrated improvements in performance following training across all tasks; though the MCI participants required more training. Participants who received CFSAT + CRT training demonstrated increased efficiency in skill acquisition. The results indicate that the CFSAT program is an efficacious tool for assessing and training functional performance in both non-cognitively and cognitively impaired older adults.

Evaluation of a Novel Technology-Based Program Designed to Assess and Train Everyday Skills in Older Adults.

Background and ObjectivesPerformance of everyday activities is often challenging for older adults. We evaluated a novel computer-based functional skills assessment and training (CFSAT) program, which includes simulations of everyday tasks (e.g., money and medication management).Research Design and MethodsThe sample included noncognitively impaired (NC) older adults (n = 51) and cognitively impaired (CI) older adults (n = 43), who ranged in age from 60 to 86 years (M = 73.12; SD = 6.06), were primarily female (90%), and ethnically diverse (23% Hispanic, 51% African American). Participants (stratified by cognitive status) were randomized to 1 of the 2 conditions training alone (CFSAT) or CFSAT with computerized cognitive training and trained up to 24 training sessions. Task performance, using measures of completion time and efficiency (accuracy/completion time), was evaluated at baseline, the final training session, and immediately posttraining with an alternate form of the CFSAT assessment.ResultsBoth NC and CI participants demonstrated significant performance improvements across all tasks following training (all ps < .001). The CI participants demonstrated reduced training gains compared to the NC participants (all ps < .001). Training gains did not vary as a function of training conditions.Discussion and ImplicationsThe findings suggest that CFSAT is an efficacious program for assessing and training everyday task performance. CFSAT can ultimately be used as an intervention strategy to enhance functional independence for aging adults with and without cognitive impairments.

The Computerized Functional Skills Assessment and Training Program: Sensitivity to Global Cognitive Impairment, Correlations With Cognitive Abilities, and Factor Structure

ObjectivesWe evaluated a novel computer-based functional skills assessment and training (CFSAT) program, which includes ecologically valid simulations of six everyday technology-related tasks. In this report, we describe the psychometric properties of the assessment in terms of sensitivity to impairment, factor structure and correlations with cognitive performance. DesignCross-sectional baseline assessment prior to a treatment study. ParticipantsNoncognitively impaired older adults (n = 62) and cognitively impaired older adults (n = 55), that ranged in age from 60 to 86 years (M = 73.12), was primarily female (90%), and ethnically diverse (21% Hispanic, 52% African American). Participants were divided at baseline on the basis of MOCA scores and cognitive complaints. MeasurementsThe Brief Assessment of Cognition (BAC), app version, was used to measure cognitive performance and completion times on the six subtasks of the CFAST constituted the functional capacity measures. ResultsPerformance on the CFSAT and BAC discriminated the two cognitive status groups. All of the cognitive domains on the BAC correlated significantly with all six CFSAT subtasks (all p < .01). Factor analyses suggested that the CFSAT and the BAC loaded on separate factors and regression analyses indicated that executive functioning and processing speed had the largest independent association with performance on the CFSAT. ConclusionThe CFSAT is sensitive to functional impairments seen in cognitively impaired older adults. Cognitive performance and CFSAT scores were related but nonredundant. Thus, the CFSAT appears to identify functional deficits that could be targeted with skills training interventions, likely augmented by pharmacological or computerized cognitive training interventions.

A Computerized Functional Skills Assessment and Training Program Targeting Technology Based Everyday Functional Skills.

Today, many functional skills are technology-based, so development of a technology-based training program has broad importance. Here we present a computerized functional skills training program that was paired in half of the participants with a commercially available cognitive training (CCT) program. Non-impaired older individuals (NC) aged 60+ (n=45) and similarly aged individuals with mild cognitive impairment (MCI; n=50) were randomized to receive 12 weeks of twice-weekly computerized functional skills training (CFST) or 12 weeks of twice-weekly sessions split between CCT and CFST. Skills trained were use of an ATM; internet banking; ticket kiosk; telephone and internet prescription refill; medication management; and internet shopping. As with previous functional capacity assessments, we focus on completion time for each simulation. 51 participants completed the training program, either by mastering all 6 tasks (34) or completing 12 weeks of training. 44 more participants completed 4 or more training sessions so they were also analyzed for improvement up to their last training session. Completion time for all 6 tests significantly improved from the baseline assessment to the final training session in both groups of participants (all p<0.001 with an average improvement in task completion time of 45%). Further, there was no differential improvement in MCI and NC in the 6 tests from baseline to end of training (all t<1.66, all p>0.12). Finally, combined CCT plus CFST did not differ from CSFT alone on any of the percent-change score measures (all t<1.64, all p>0.11). Both NC and MCI groups evidenced substantial improvements in performance. CCT supplementation led to similar functional gains with half as many training sessions. The NC participants proceeded through the training fairly rapidly even without CCT supplementation; MCI participants required more training but learned equivalently. These findings suggest that even in cases with memory impairments, functional skills can be efficiently learned with training.

A Computerized Functional Skills Assessment and Training Program Targeting Technology Based Everyday Functional Skills

A Computerized Functional Skills Assessment and Training Program Targeting Technology Based Everyday Functional Skills

283 Does a Pen and Paper Assessment of Executive Skills Correlate with Functional Decline Identified Through Specialised Occupational Therapy Assessment?

Abstract Background Executive skills refer to a set of cognitive skills that allow individuals to engage in goal directed behavior. They encompass planning, initiation, inhibition, monitoring and flexibility in approach to tasks, and are necessary for functional competence. Executive skills are vulnerable to disruption with damage to the brain, as occurs with dementia. Methods Participants were recruited from a tertiary memory assessment and support Service. The Assessment of Motor &amp; Process Skills (AMPS), a standardised observational assessment of occupational performance (1Fischer, 2003) was administered by trained Occupational Therapists. In addition, the EXIT-25, a pen &amp; paper based assessment of executive skills (2Royall et al, 1992) was administered. Process scores from the AMPS, and overall score from the EXIT 25 were utilised for correlation analysis. Results 22 participants, 12 male and 10 females, age range 60-91 (mean 75.5 years), was analysed using Spearman’s Rho correlation (-.2). Results did not identify a strong correlation Conclusion Dementia is commonly regarded as a disorder of memory. However, diagnosis is dependent on functional decline related to cognitive decline. The AMPS provides a formal assessment of functional skills, in terms of motor &amp; process skills with cut off scores regarding safe independent living. The results of this study indicate that the AMPS is not associated with executive scores on formal cognitive assessments, highlighting the value of an extensive multi-component MDT approach (also incorporating history taking, imaging, bio marker testing etc.) in assessing and diagnosing a dementia.

Polyneuropathy in the elderly

The peripheral nervous system is subject to changes during the ageing process, e. g. deep tendon reflexes decrease, as does proprioception. Polyneuropathies, on the other hand, need to be distinguished from age-related changes as independent diseases with etiologies similar to those at younger ages. Etiologies includes metabolic disorders, primary inflammatory polyneuropathies, and systemic disorders. Neuropathies associated with diabetes, malignancy, and monoclonal gammopathies appear to be more common in older patients. Using a systematic approach, it is possible to establish a specific diagnosis in the majority of cases. Since polyneuropathies contribute to reduced mobility in the elderly, an assessment of functional skills is mandatory. Polyneuropathy therapy is primarily based on the treatment of underlying conditions and neuropathic pain management. Physiotherapy and rehabilitation target pain relief and maintaining activities of daily living.

218. Top-Down or Bottom-Up? Comparison of Two Computer-Assisted Modalities of Cognitive Remediation Therapy for Schizophrenia

Abstract Cognitive remediation (CRT) designed to improve cognitive function in patients with schizophrenia has shown significant efficacy. Our study was designed to compare 2 computerized CRT programs for improving memory and problem-solving skills in patients with schizophrenia. Each intervention uses a specific theoretical rationale: a top down approach (CogPack), training a broad range of cognitive features and a bottom up approach (PositScience), which targets the discrimination ability in perceptual systems. Goals of this study were (1) to perform a noninferiority comparison of the effects of the two programs in patients with chronic schizophrenia and (2) to examine whether the addition of a social cognition remediation intervention, Mind Reading, would further improve social function outcomes over each intervention alone. Both CRT treatments were administered during a 12-week training period. Stable patients with DSM 5 schizophrenia who received either inpatient or outpatient clinical services were recruited. Patients were evaluated on a standardized battery of neuropsychological assessments (MCCB), social emotion measures, auditory and visual discrimination tasks, and a brief assessment of functional skills (PSP) and clinical symptoms (PANSS) at screening and at end point. 64 subjects were randomized as follows: (1) COGPACK Alone (n = 17), (2) PositScience Brain Fitness Alone (n = 14), (3) COGPACK + Mind Reading (Social cognition program; n = 19), (4) PositScience Brain Fitness + Mind Reading (n = 14). For the initial comparison and due to the small sample size, all subjects receiving COGPACK (n = 36), and all subjects receiving PositScience (n = 28) were each combined. Significant improvements from baseline were found in the COGPACK-treated patients for working memory and attention/vigilance. PositScience-treated patients showed significant improvements from baseline in working memory ( = .046) and visual learning ( = .048). Comparison of differential treatment effects found that patients treated with COGPACK + Mind Reader were significantly more benefited than patients treated with PositScience or COGPACK alone ( = .044). Changes in total PANSS ( = .453, = .049) and PSP ( = .466, = .045) scores were correlated with improvement in the MindReader combined groups (PositScience + Mind Reader and COGPACK + Mind Reader). COGPACK or PositScience was associated with intervention specific improvements in working memory and attention/vigilance, and working memory and visual learning respectively. Cognitive improvement in the Mind Reader augmented groups was associated with changes in psychopathology and functional outcomes. Patients with deficits in specific cognitive domains may benefit differentially from a bottom up versus a top down approach and may therefore be assigned to a specific “deficit associated” program within a personalized therapeutic approach.

Social cognition and functional capacity in bipolar disorder and schizophrenia

Social cognition is a functionally relevant predictor of capacity in schizophrenia (SZ), though research concerning its value for bipolar disorder (BD) is limited. The current investigation examined the relationship between two social cognitive factors and functional capacity in bipolar disorder. This study included 48 individuals with bipolar disorder (24 with psychotic features) and 30 patients with schizophrenia. Multiple regression controlling for estimated IQ scores was used to assess the predictive value of social cognitive factors on the UCSD Performance-Based Functional Skills Assessment (UPSA). Results found that for the bipolar with psychosis and schizophrenia groups, the social/emotion processing factor predicted the UPSA. The theory of mind factor only predicted the UPSA for the schizophrenia group.. Findings support the clinical utility of evaluating emotion processing in individuals with a history of psychosis. For BD, theory of mind may be better explained by a generalized cognitive deficit. In contrast, social/emotion processing may be linked to distinct neurobiological processes associated with psychosis.

Ecological Inventory: An approach for assessment of children with intellectual disability

Assessment of children with intellectual disability is necessary to determine their eligibility for special educational services. As cognitive and adaptive behaviors are essential parts of the definition of intellectual disability. The main purpose of this paper is to review of different major tests, scales and instruments which are used for assessment of these children. This paper also present critical arguments against using intelligence tests and adaptive scales developed in other technically advanced countries of the world and use in Pakistan. Ecological approach is discussed in detail as best approach for need assessment of functional skills and programming for children with intellectual disability.

Performance-based assessment of functional skills in severe mental illness: Results of a large-scale study in China

Performance-based assessments of everyday living skills have been shown to be highly correlated with cognitive functioning in schizophrenia and bipolar disorder, as well as being predictive of deficits in real-world outcomes such as independent living and employment. In this study, we expand our assessments of impairments in everyday living skills to China, evaluating people with schizophrenia, bipolar disorder, and major depression, and comparing their performance to that of healthy controls. Samples of people with schizophrenia (n = 272), bipolar disorder (n = 61), major depression (n = 50), and healthy controls (n = 284) were examined with the Chinese version of the UCSD performance-based assessment, brief version (UPSA-B). Performance was compared across the groups and the association between age, gender, educational attainment, marital status, and UPSA-B scores was evaluated. When the performance on the UPSA was compared across the groups, with education as a covariate, significant effects of both diagnosis (F = 86.3, p < .001) and education were found (F = 228.3, p < .001). Sex and age did not contribute significantly when age and education were considered. Post-hoc comparisons revealed that total UPSA-B scores were lowest in the schizophrenia patients, followed by the patients with major depression. Patients with bipolar disorder did not differ from the healthy comparison subjects on overall performance. Scores for all groups were lower than previously reported in western samples (e.g., HC mean = 64). While diagnostic differences in UPSA-B scores are similar to those previously seen in western samples, the education effect is considerably more substantial. These data suggest that in developing countries educational attainment may be strongly associated with levels of adaptive outcomes and the utilization and interpretation of functional capacity measures be adjusted accordingly.

Improvement in social competence in patients with schizophrenia: a pilot study using a performance‐based measure using virtual reality

The objective of this study was to explore the possibility of the use of Virtual Reality Functional Skills Assessment (VRFSA) in a future regular clinical trial, as well as to report a preliminary result about effectiveness of atypical antipsychotics to social competence in schizophrenia. We developed the VRFSA that measured subjects' performances automatically and used analogue scale rather than Likert scale. Twenty-four female patients with paranoid schizophrenia and 15 healthy females were recruited. This was a 6-week, randomized, open-label, and flexible dose study, and 2 treatments (baseline versus post-treatment) x 2 skills phases (receptive versus expressive) x 2 patient groups (aripiprazole versus risperidone) analysis of variance was used in the final analysis. There was a significant difference in the VRFAS between the patients and the healthy subjects (p < 0.05). Eighteen patients were included in the final analysis. We found larger treatment effect than those found in previous studies, and significant treatment x skills phase x group interaction effect on the VRFAS. Our results suggest that the VRFAS is strongly sensitive to changes in social competence and thus especially beneficial in short-term clinical trials. In addition, atypical antipsychotics can improve social competence and differentially improve receptive skills and expressive skills in schizophrenia.