Different Levels Of Impairment Research Articles

The 12-Item Buschke Memory Test: Appropriate for Use Across Levels of Impairment

Monitoring cognitive functions as older adults move from independent to assisted living is of utmost importance with respect to care planning. To this end, we examined the utility of a 12-item, free and cued recall, selective reminding, memory task for assessing persons across levels of functioning. Using cross-sectional data from the Canadian Study of Health and Aging, it was observed that the 12-item Buschke memory test was well tolerated by participants regardless of their level of impairment. Further, various measures from the memory task differentiated among participants with different levels of impairment: Individuals living in the community performed better than those in institutions; individuals with no or mild functional impairment performed better than individuals with moderate or severe functional impairments; individuals with mild dementia performed better than those with moderate to severe dementia. Normative data are provided for this easily administered and well-tolerated memory measure.

Modelling the decline pattern in functional measures from a prevalent cohort study

In studying decline among cognitively impaired people, a prevalent cohort study design is commonly used to account for entry into the study at different levels of impairment. The data set typically consists of many short series of repeated measurements collected over time. However, the time origin, such as time of disease/impairment onset, is often uncertain. In order to model non-linear decline patterns in functional test scores and associated risk factors with such data, we propose two approaches as alternatives to Liu et al. One approach models change over adjacent visits with varying time intervals. The second models the change since baseline using a random effect for heterogeneity of change. We used these two approaches to examine the decline in cognitive test scores among special care unit (SCU) and non-SCU residents at the New York sites of the National Institute on Aging (NIA) collaborative studies of special dementia care. The analyses suggest that, controlling for several covariates, SCU residents experienced more rapid cognitive decline than did non-SCU residents. The relative advantages and disadvantages of the two models are discussed. Copyright © 2000 John Wiley & Sons, Ltd.

Modelling the decline pattern in functional measures from a prevalent cohort study.

In studying decline among cognitively impaired people, a prevalent cohort study design is commonly used to account for entry into the study at different levels of impairment. The data set typically consists of many short series of repeated measurements collected over time. However, the time origin, such as time of disease/impairment onset, is often uncertain. In order to model non-linear decline patterns in functional test scores and associated risk factors with such data, we propose two approaches as alternatives to Liu et al. One approach models change over adjacent visits with varying time intervals. The second models the change since baseline using a random effect for heterogeneity of change. We used these two approaches to examine the decline in cognitive test scores among special care unit (SCU) and non-SCU residents at the New York sites of the National Institute on Aging (NIA) collaborative studies of special dementia care. The analyses suggest that, controlling for several covariates, SCU residents experienced more rapid cognitive decline than did non-SCU residents. The relative advantages and disadvantages of the two models are discussed.

Assessing head and neck cancer patient outcome domains.

The purpose of this study was to assess the relative importance on patients' lives of multiple outcomes resulting from the management of head and neck cancer (HNC). HNC patients filled out a disease-specific quality of life (QOL) survey covering 5 domains (speech, eating, aesthetics, pain/discomfort, and social/role functioning). Logistic regression was used to determine which of these domains best predicted the patients' response to a single, overall QOL assessment. In univariate analyses, all 5 domains were significantly correlated to QOL (p<.0001), with correlation coefficients ranging from.48 for eating to.64 for social/role functioning. Logistic regression indicated that speech and eating best predicted QOL (R(2) =.4647), with odds-ratios of 2. 96 for speech and 2.49 for eating. These data demonstrated that, for this group of patients, speech has the most impact on well-being, whereas eating has a substantial, unrelated influence. This is important information in counseling patients about treatment plans that have different levels of impairment.

Reliability of physical performance tests in four different randomized clinical trials

Objectives: (1) To assess the test-retest reliability of physical performance tests in subject groups with different levels of impairment and disability, and (2) to assess the stability of these tests over different time intervals. Design: Test-retest, repeated measures reliability design. Setting: (1) A university's center for aging and research center, (2) a continuing care retirement community, and (3) an extended care and rehabilitation center at a Veterans Affairs medical center. Subjects: Twenty-four community-dwelling elders, 15 community-dwelling elders with Parkinson disease, 12 older women with vertebral osteoporosis and compression fractures, and 14 elderly nursing home residents. Measures: Lower extremity isometric strength (ankle dorsiflexion, hip abduction), spinal configuration (thoracic kyphosis, lumbar lordosis), lumbosacral motion (flexion, extension), and timed measures of the ability to get in and to get out of bed at a usual pace. Results: Most of the within-group intraclass correlation coefficients (ICCs) were good to excellent (.70 to .97). Overall, ICCs for all groups combined were between .70 and .96, and no decrement in reliability was noted after controlling for group membership. In addition, no decrement in the ICC was observed for short (1 day) vs longer (1 week) intervals of testing. Conclusions: These performance-based measures may be used reliably across a wider range of testing environments and elderly populations than has been reported.

The relationship between the uncomfortable loudness level and the acoustic reflex threshold for pure tones in normally-hearing and impaired listeners--a meta-analysis.

The objective of this study was to determine the potential of the acoustic reflex threshold (ART) as a predictor of the uncomfortable level (ULL) and to identify related areas for investigations in the future. Eleven studies reporting data from 141 normally-hearing and 240 impaired hearing subjects have been reviewed, focusing on methods, test conditions and subjects. Results and conclusions are discussed and new calculations have been performed on the reported data. The median difference between ART and ULL across studies and frequencies was 5 dB both in normally-hearing and impaired subjects. Some authors argue, that although a close relationship of mean values of the two measurements may exist, prediction of the ULL based on ART measurement will be inaccurate because of high inter-subject variability. A statistically significant correlation exists between the mean HTL, the mean ART and the mean ULL in impaired hearing, while a relationship between the mean ART and the mean ULL does not exist in normal hearing. Based on pooled data across frequencies from the reviewed studies the mean ULL= (0.64 x mean ART+38) dB HL. The discrepancies between the results found in the reviewed studies may be explained by different instructions and stimulus presentation orders when assessing the ULL, difficulty in assessing the sound pressure level in the ear canal, influence of varying background noise levels and different admission criteria. It is recommended that the relationship between different loudness levels and the ART be investigated in normally-hearing subjects and in subjects with different levels of impairment, using standardized instructions. To further provide uniformity of the test material groups should be selected according to history of middle ear diseases and the use of hearing aids.

Assessment of 'subcortical dementia' in patients with Huntington's disease, Parkinson's disease, multiple sclerosis and AIDS by a neuropsychological screening battery.

Four diagnostic groups categorized as 'subcortical dementia' were studied using a neuropsychological screening battery. The specificity of the battery in disclosing characteristic patterns of impairment in subgroups within the category, and the correspondence between natural subgroups generated by an unsupervised statistical classification technique and the diagnostic labels were investigated. All cognitive affected subgroups demonstrated impairment on tests of sensomotor function, cognitive efficiency and/or memory, and were characterized in terms of severity of impairment as well as a progressive involvement of functional areas. The diagnostic groups were not evenly represented in all natural subgroups. Affected AIDS-patients seemed to resemble patients with Huntington's disease more than the other diagnostic groups. The screening battery could give a general characterization of the pattern of 'subcortical dementia' and different levels of impairment, but more specific process-oriented tasks are needed to contrast diagnostic groups within the concept of 'subcortical dementia'.

The consortium to establish a registry for Alzheimer's disease (CERAD). Part IV. Rates of cognitive change in the longitudinal assessment of probable Alzheimer's disease.

Reliable information on rate of progression of cognitive impairment in probable Alzheimer's disease (AD) is important for evaluating possible beneficial effects of therapeutic agents and in planning long-term care for patients with this chronic illness. However, wide variability exists in published rates of change for psychometric measures of the dementing process, and there is need for an accurate analysis of large numbers of persons with the disorder studied over long periods. Utilizing the large, well-characterized sample of the Consortium to Establish a Registry for Alzheimer's Disease and employing a least squares regression method to adjust for different levels of impairment and periods of observation, we report rates of change on the Short Blessed Test, Mini-Mental State Examination, Blessed Dementia Scale, Clinical Dementia Rating, and other cognitive measures in 430 patients with probable AD (mean age at entry = 70.9 +/- 8.0 SD years) studied for up to 4 years. We found that rate-of-change determinations are less reliable when the observation period is 1 year or less, that dementia progression may be nonlinear when described by certain measures, and that simple change scores do not accurately characterize the rate of decline. We also found that rate of progression in AD is determined by the severity of cognitive impairment: the less severe the dementia, the slower the rate of decline.

Variability in behavioral impairment involved in the rising and falling BAC curve.

The purpose of this pilot study was to measure variability in behavior impairment at specific levels of the rising and falling blood alcohol concentration (BAC) curve. Behavior impairment was measured for anticipation and reaction time in addition to a variety of visual skills. Also of interest was the variability in impairment involved at specific BAC levels under single-dose and double-dose conditions. The experimental design was a variation on a 2 x 2 factorial with repeated measures on the dose of alcohol. All subjects took part in two experimental sessions, single-dose and double-dose. Sixteen (8 male and 8 female) paid subjects ages 21-40 participated in the study. Testing procedures included repeated measures on reaction time, anticipation time, perceptual vision acuity and depth perception. Breath-alcohol measures were sampled continuously at 5-minute intervals and used to plot absorption time, peak BAC and elimination time. Results showed that the average peak BAC for the double-dose was significantly higher than that of the single-dose condition. However, there were no significant differences between the single-dose and double-dose condition in either absorption time or elimination time. The performance pattern for reaction time, anticipation time and depth perception showed more impairment in the rising BAC limb than in the falling BAC limb. It is noteworthy that specific individuals exhibited different levels of impairment at a given BAC level, depending on whether the session was single- or double-dose, suggesting that one's current BAC level is less a measure of impairment than is the total quantity of alcohol consumed. A follow-up procedure to examine practice effects was conducted on eight volunteer students. Identical testing procedures, using no alcohol, produced no significant practice effects after a 3-hour period.

Dissociations in auditory word comprehension; evidence from nine fluent aphasic patients

Abstract Traditional aphasia classifications do not allow for a detailed description of auditory comprehension impairments. A cognitive neuropsychological model of lexical processing allows us to distinguish at least 5 different levels of impairment in single word auditory comprehension. It also specifies a more complex relationship between impairments in repetition and auditory comprehension. Nine fluent aphasic patients, with auditory comprehension disorders, were assessed using tests of phoneme discrimination, lexical decision, synonym matching and word and non-word repetition. The results of these tests, as predicted, indicated that there were 5 dissociable levels of impairment, although there was some evidence for interaction between levels. The patients showed qualitative differences between auditory and written comprehension. Four of the patients had impairments in repetition despite having no impairment in phoneme discrimination tests. No two patients showed exactly the same pattern of impairment across all the tests administered.

The concurrent validity of the survey version of the Clifton Assessment Procedures for the Elderly (CAPE).

The concurrent validity of the survey version of the Clifton Assessment Procedures for the Elderly (CAPE) was assessed by comparing the performance of four groups of elderly women selected to represent different levels of impairment and dependency. It was found to discriminate significantly among patients with severe (n = 100), moderate (n = 40), mild (n = 50) and no (n = 20) dementia; it also significantly distinguished between patients with severe and moderate dementia and patients with physical disability (n = 100) and with signs of 'institutionalization' (n = 25). Patients in the severe, moderate, mild and no dementia groups had all been judged clinically to have been placed appropriately as, respectively, geriatric psychiatry in-patients, geriatric psychiatry day-patients or local authority home residents, or as being able to live independently in the community. However, although the survey version dependency grade is intended for use in allocating patients to health and social services facilities, overall agreement between grades and clinically determined placement was only 63 per cent. Thus while the survey version may be useful in discriminating among groups of elderly people of different levels of impairment for research or screening purposes, its clinical value with individual patients remains uncertain.