Domains Of Everyday Functioning Research Articles

The cognitive and behavioral correlates of functional status in patients with frontotemporal dementia: A pilot study.

Objective: Frontotemporal dementia (FTD) impinges significantly on cognition, behavior, and everyday functioning. Goal of the present study is the detailed description of behavioral disturbances and functional limitations, as well as the investigation of associations between cognition, behavior, and functional impairment among FTD patients. Given the importance of maintaining a satisfying functional status as long as possible, this study also aims to identify the cognitive correlates of compensatory strategy use in this clinical group. Methods: A total of 13 patients diagnosed with FTD (behavioral variant FTD = 9, non-fluent variant primary progressive aphasia = 3, semantic dementia = 1) were administrated a broad range of neuropsychological tests for the assessment of different cognitive abilities. Behavioral symptomatology and performance on everyday activities were rated with informant-based measures. Descriptive statistics were used for the delineation of behavioral and functional patterns, whereas stepwise multiple regression analyses were performed to identify associations between cognition, behavior, and functional status. Results: Negative symptoms, especially apathy, were found to predominate in the behavior of FTD patients. Instrumental tasks, such as housework and leisure activities, appeared to be the most impaired functional domains. Working memory was the strongest cognitive correlate of performance across various domains of everyday functioning, whereas working memory along with short-term verbal memory accounted for a great proportion of variance in compensatory strategy use. Behavioral disturbances and especially negative symptoms were also found to contribute significantly to functional impairment in FTD. Conclusions: Executive dysfunction, as well as behavioral disturbances contribute significantly to functional disability in FTD. Early interventions tailored at these domains may have the potential to improve functional outcomes and delay the rate of functional decline among FTD patients.

Longitudinal Predictors of Informant-Rated Everyday Function in Mild Cognitive Impairment.

To examine predictors of informant-reported everyday functioning in mild cognitive impairment (MCI) and relations between everyday function and conversion to dementia. Informants of participants (n = 2614) with mild cognitive impairment (MCI) were administered the Functional Activities Questionnaire (FAQ). Changes in dimensions of functional ability as determined by an exploratory factor analysis (EFA) were examined over 3years and participant predictors of change were examined using multilevel modeling (MLM). The FAQ consisted of 3 factors, multistep, finance, and memory/orientation daily tasks. Impairment in memory/orientation tasks was significantly higher than impairment in multistep tasks. Worse functioning was associated with greater depression, worse memory, worse speed/EF, higher years of education and identifying as White. There was variability in some of these associations with different FAQ factors. Impairments in financial and memory/orientation daily tasks predicted follow-up conversion to dementia. Depression, speed/EF, and memory are consistently associated with domains of everyday functioning. Race, education, and age may be more variability associated with everyday functioning. Specific attention should be paid to subtle declines in the financial and memory/orientation domains as they may uniquely predict future dementia development. Depression may be a modifiable risk factor associated with functional impairment over time.

Daily Ecological Momentary Assessments of happy and sad moods in people with schizophrenia and bipolar disorders: What do participants who are never sad think about their activities and abilities?

ObjectivesPeople with schizophrenia have challenges in their self-assessments of everyday functioning and those who report no sadness also tend to overestimate their everyday functional abilities. While previous studies were cross-sectional, this study related longitudinal assessments of sadness to self-reports of abilities in domains of everyday functioning and cognitive abilities. Methods71 people with bipolar illness (BPI) were compared to 102 people with schizophrenia (SCZ). Participants were sampled 3 times per day for 30 days with a smartphone-based Ecological Momentary Assessment (EMA) survey. Each survey asked where they were, with whom they were, what they were doing, and if they were sad. Performance based assessments of executive functioning, social competence, and everyday activities were collected after the EMA period, at which time the participants and observers were asked to provide ratings of three different domains of everyday functioning and neurocognitive ability. Results18% of participants with SCZ reported that they were never sad on any one of the 90 EMA surveys. Reports of never being sad were associated with overestimated functioning compared to observers and SCZ participants who reported that they were never sad were more commonly home and alone than both SCZ participants who reported occasional sadness and participants with BPI. These participants reported being significantly happier than all people in the study. ImplicationsReporting that you were never sad was associated with overestimation of everyday functioning and cognitive abilities. Although participants who were never sad did not perform more poorly on objective measures than those were occasionally sad, their self-assessed functioning was significantly elevated. These data suggest that negative symptoms constructs such as reduced emotional experience need to consider reduced ability to subjectively evaluate emotional experience as a feature of negative symptoms.

The effects of personality and aging attitudes on well-being in different life domains

Objectives Personality plays a major role in determining the way people adjust to life experiences, ultimately affecting life satisfaction. Aging attitudes also impact well-being, but there is little research on whether these personality and attitudinal effects reflect the same mechanism. The purpose of this study was to examine whether aging attitudes mediate the relationship between personality and well-being across seven different domains of everyday functioning, and whether this effect depends on age. Methods Data from 563 adults ranging in age from 30 to 89 were used. Sociodemographic information as well as the Big Five Inventory, aging attitudes, and well-being (i.e. current self-views and life satisfaction) in seven different life domains was assessed. Results The mediating effect of aging attitudes in the relationship between personality and well-being was strong for neuroticism, conscientiousness, and agreeableness and varied across domains. Significant mediation effects were limited for openness and extraversion. Significant moderated mediations were rather limited but the effects were stronger in later life. Discussion These results suggest that personality influences aging attitudes, which in turn affect well-being. Further, our results indicate that such relationships are context-specific, suggesting that the global assessments of attitudes and well-being may not fully characterize significant aging outcomes.

Clinical Practice Guidelines for the Assessment and Management of Attention-Deficit/Hyperactivity Disorder.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders. ADHD affects around 5%–7% of school-aged children. It is a neurodevelopmental disorder that runs a chronic course and causes significant impairments across various domains of everyday functioning, such as peer and social functioning, academic functioning, and occupational functioning across the lifespan. Besides the patient, ADHD also has significant negative impact on the caregivers. This guideline seeks to lay out guidelines for effective and comprehensive assessment, diagnosis, and management of ADHD. It attempts to update the previous guidelines taking into account the current state of evidence that can inform clinical practice. These guidelines ought to be read in conjunction with the earlier version of the treatment guidelines on ADHD as developed and published by the Indian Psychiatric Society in 2007.

Context influences on the relationship between views of aging and subjective age: The moderating role of culture and domain of functioning.

Subjective age has been shown to reliably predict a variety of psychological and physical health outcomes, yet our understanding of its determinants is still quite limited. Using data from the Aging as Future project, the authors examined the degree to which views of aging influence subjective age and how this influence varies across cultures and domains of everyday functioning. Using data from 1,877 adults aged from 30 to 95 years of age collected in China, Germany, and the United States, they assessed how general attitudes about aging and perceptions of oneself as an older adult influenced subjective age estimates in 8 different domains of functioning. More positive attitudes about aging were associated with older subjective ages, whereas more positive views of self in old age were associated with younger subjective age. It is hypothesized that these effects are reflective of social-comparison processes and self-protective mechanisms. These influences varied considerably over contexts, with views of aging having a greater impact in domains associated with stronger negative stereotypes of aging (e.g., health) compared to those with more positive ones (e.g., family). Culture also moderated the impact of aging views in terms of the strength of prediction, direction of effect, and age of greatest influence, presumably due to cultural differences in the salience and strength of aging-related belief systems across contexts. The results illustrate the contextual sensitivity of subjective age and highlight the role played by an individual's views of old age-both in general and regarding oneself-in determining their own experience of aging. (PsycINFO Database Record

Everyday functional ability in HIV and methamphetamine dependence

BackgroundMethamphetamine (METH) use is a risk factor for the transmission of HIV. Each is associated with neurocognitive impairment and subsequent problems in everyday functioning, yet additive effects of HIV and METH are not consistently observed. This study used the UCSD Performance-Based Skills Assessment (UPSA-2) to assess whether METH use disorder and HIV together resulted in poorer functional outcome than either condition alone. MethodParticipants in the Translational Methamphetamine AIDS Research Center (TMARC) cohort were stratified based upon HIV infection and METH use disorder: HIV-/METH- (n=49), HIV-/METH+ (n=48), HIV+/METH- (n=37), and HIV+/METH+ (n=38). They were administered the UPSA-2 which measures abilities in six domains of everyday functioning. Main effects and interactions of HIV and METH were examined, as were relationships between UPSA-2 scores and disease characteristics. ResultsSignificant HIV-by-METH interactions were observed for the UPSA-2 total score and Comprehension/Planning and Financial subscales such that METH was associated with lower scores in HIV- participants but not HIV+ participants. METH was associated with lower scores on the Communications subscale. All three risk groups had lower scores than HIV-/METH- participants. Recency and frequency of METH use were associated with lower scores. Lower Medication Management scores were related to lower nadir CD4 counts. ConclusionsMETH use disorder and HIV each impair functional performance, but there is no additive effect when the two conditions occur together. The neurocognitive sequelae of combined HIV infection and METH use are complex and warrant further study, as do the potential effects of compensatory strategies and other factors.

Assessing Motor-Cognition Interaction of Patients with Cognitive Disorders: Clinical Aspects

Difficulties of walking and deficits of cognitive functions appear to be associated in the elderly. Thus, clinical assessment in geriatry and neurology should focus on: (1) diagnostic approaches covering both domains of everyday functioning; (2) therapeutic interventions that take into account possible interactions and synergies of both domains. In order to assess the capability for motor-cognitive interactions in the elderly it is recommended to investigate walking patterns during dual-tasks (e.g. walking and counting backwards, walking and naming words) and to examine clinical tests of everyday mobility tasks, such as the Timed-up-and-go-Test and spatial navigation tasks. Patients with cognitive disorders often perform inferior with a reduction of walking speed and an increase of stepping variability. Dual-task performance appears to be a reliable parameter for long-term observations of the course of the disease. Moreover, it might improve the quality of the gait examination during diagnostic or therapeutic interventions (e.g. the spinal tap test in patients with NPH). Several studies further highlight gait deficits during dual-task walking as a marker for the everyday functioning and the quality of life in elderly persons and patients with cognitive disorders.Therapeutic approaches in this context comprise complex motor-cognitive interventions, such as Thai Chi and Dalcroze rhythmic exercises. These interventions appear to act synergistically in motor and cognitive domains. First evidence for the efficacy for improving executive functions and reducing the fall risk of patients with cognitive impairments is given, thought randomized, controlled trials are rare.

Evaluating domains of everyday functioning in people with developmental disabilities

Objective: To examine the relationship among (a) quality of activities of daily living (ADL) task performance, (b) quality of social interaction, and (c) the extent of discrepancy between the person’s and the occupational therapist’s perspectives; and explore patterns of strengths and challenges among people with developmental disabilities (DD). Methods: Fifty-eight adults with different types of DD, living in northern Sweden, were evaluated using the Assessment of Motor and Process Skills (AMPS), the Evaluation of Social Interaction (ESI) and the Assessment of Compared Qualities – Occupational Performance (ACQ-OP) and Assessment of Compared Qualities – Social Interaction (ACQ-SI). The relationships among assessments were analysed using Pearson correlation analyses. Cluster analysis was used to group participants based on their evaluation results. Results The quality of ADL task performance and the quality of social interaction demonstrated weak to moderate positive relationships while the ACQ-OP and ACQ-SI demonstrated a strong positive relationship. The cluster analysis resulted in identifying three distinct groups that differed significantly from one another. Conclusion: The findings support the clinical use of multiple assessment tools, including observation and self-report, to evaluate different aspects of occupational performance. Comprehensive and relevant evaluation supports collaborative goal setting and intervention planning.

The influence of demographic factors on functional capacity and everyday functional outcomes in schizophrenia

Patients with schizophrenia have impaired everyday living and social outcomes. Performance-based measures, including neuropsychological (NP) performance and functional capacity (FC) measures have demonstrated usefulness in predicting these outcomes. We examined the correlation of demographic factors (race, age, and education) and FC measures, and the relative ability of NP performance, FC, and demographic factors to predict real-world outcomes in social, vocational, and residential domains in 194 outpatients with schizophrenia. Age, education, sex, and racial status were significantly, but modestly, associated with performance-based measures of everyday functioning, while, in addition, age and education had a similar modest relationship with social competence. Age, but none of the other demographic variables, contributed to the prediction of all three domains of everyday functioning. Functional capacity variables predicted everyday outcomes even when demographic variables were entered into a predictive equation first. These data suggest a similar and modest but detectable effect of demographic factors on performance-based measures of functional capacity as seen with NP performance in schizophrenia populations. Older age contributed to poorer everyday functioning even after consideration of functional capacity, which seems similar to findings in healthy populations without clinically notable cognitive decline.

Anticipated Benefits of Care (ABC): psychometrics and predictive value in psychiatric disorders

Attitudes and expectations about treatment have been associated with symptomatic outcomes, adherence and utilization in patients with psychiatric disorders. No measure of patients' anticipated benefits of treatment on domains of everyday functioning has previously been available. The Anticipated Benefits of Care (ABC) is a new, 10-item questionnaire used to measure patient expectations about the impact of treatment on domains of everyday functioning. The ABC was collected at baseline in adult out-patients with major depressive disorder (MDD) (n=528), bipolar disorder (n=395) and schizophrenia (n=447) in the Texas Medication Algorithm Project (TMAP). Psychometric properties of the ABC were assessed, and the association of ABC scores with treatment response at 3 months was evaluated. Evaluation of the ABC's internal consistency yielded Cronbach's alpha of 0.90-0.92 for patients across disorders. Factor analysis showed that the ABC was unidimensional for all patients and for patients with each disorder. For patients with MDD, lower anticipated benefits of treatment was associated with less symptom improvement and lower odds of treatment response [odds ratio (OR) 0.72, 95% confidence interval (CI) 0.57-0.87, p=0.0011]. There was no association between ABC and symptom improvement or treatment response for patients with bipolar disorder or schizophrenia, possibly because these patients had modest benefits with treatment. The ABC is the first self-report that measures patient expectations about the benefits of treatment on everyday functioning, filling an important gap in available assessments of attitudes and expectations about treatment. The ABC is simple, easy to use, and has acceptable psychometric properties for use in research or clinical settings.

Age Differences in Everyday Problem-Solving Effectiveness: Older Adults Select More Effective Strategies for Interpersonal Problems

Using the Everyday Problem Solving Inventory of Cornelius and Caspi, we examined differences in problem-solving strategy endorsement and effectiveness in two domains of everyday functioning (instrumental or interpersonal, and a mixture of the two domains) and for four strategies (avoidance-denial, passive dependence, planful problem solving, and cognitive analysis). Consistent with past research, our research showed that older adults were more problem focused than young adults in their approach to solving instrumental problems, whereas older adults selected more avoidant-denial strategies than young adults when solving interpersonal problems. Overall, older adults were also more effective than young adults when solving everyday problems, in particular for interpersonal problems.

Correlations of functional capacity and neuropsychological performance in older patients with schizophrenia: Evidence for specificity of relationships?

Background Neuropsychological (NP) performance is a consistent correlate of everyday functioning in schizophrenia, but it is unclear whether relationships between individual NP ability areas and domains of everyday functioning are general or specific. Assessments of real-world everyday functioning may be influenced by environmental and social factors (e.g., social security, disability status, opportunities and restrictions in living situations). This study examined the specificity of the relationships between different NP abilities and performance-based measures of social and living skills. Methods 181 ambulatory older (age> 50) patients with schizophrenia were examined with NP tests measuring episodic and working memory, executive functioning, verbal fluency, and processing speed. All subjects performed tasks examining social (Social Skills Performance Assessment: SSPA) and everyday living (UCSD Performance Based Skills Assessment: UPSA) skills. Results Using canonical analysis, the NP variables were used to predict the functional capacity measures. The analysis found that 37% of the variance in the functional capacity and NP measures was shared, X 2 (54) = 106.29, p < .001. Two canonical roots described the cognitive variables and the roots were differentially associated with everyday living and social skills. The root loading on processing speed, episodic memory, and executive functions were associated with UPSA scores, while the root loading on working and episodic memory and verbal fluency were associated most strongly with social competence. Implications Social and everyday living skills deficits in patients with schizophrenia may reflect generally independent domains of functional outcome, linked through cognitive performance. The data suggest that somewhat different cognitive processes are associated with these two domains of functional capacity, although there appears to be some overlap, which may be due to the nature of the NP tests employed.

III. Determining “cases” of mental health-related dysfunction from continuous scales of everyday functioning

The Colorado Social Health Survey (CSHS) was designed to generate need prevalence rates for alcohol, drug abuse, and mental health (ADM) services using three different measures of need—diagnosable disorders, dysfunction in everyday living, and demoralization. Only the first of these measures was dichotomous, allowing clear specification of which survey respondents qualified as “cases” of need. For the CES-D scale-based measure of demoralization, a widely accepted cutting score established by other researchers was used to determine “caseness.” For everyday dysfunction scales, three different methods of designating cases among respondents were studied—a clinical judgment approach, a statistical deviation approach, and a patient criterion groups approach. The clinical judgment approach used the respondent's endorsement of at least two “critical” dysfunction items previously judged by research clinicians to indicate reasonably clear need for ADM services. The statistical deviation approach involved a respondent scoring in the highest 10% of the general population sample on two or more scales assessing dysfunction in different domains of everyday functioning. The criterion groups approach was based on a respondent scoring at or above the median score for CSHS outpatient and inpatient comparison groups on at least two domain dysfunction scales. Results for all procedures were examined for validity, using criteria ranging from agreement with the epidemiological literature to comparisons with dysfunction ratings for samples of Colorado public mental health system outpatients and inpatients. On the basis of best performance against these criteria, the clinical judgment caseness-determination procedure was chosen as the primary method for designating respondents as dysfunctional in everyday living for all phases of this needs-assessment study. The statistical deviation criterion was used as a “backup” caseness-determining procedure.