Everyday Functioning Of People Research Articles

74 Adherence to Behavioral Interventions is Associated with a Change in Participant Adjustment in a Sample of aMCI Patients

Objective:Behavioral interventions are a non-pharmacological treatment that shows improvement in the everyday functioning of people with Mild Cognitive Impairment (MCI). Multiple studies have focused on examining factors that can reduce or enhance adherence to behavioral interventions. However, few studies use adherence as a predictor of functional changes. The goal of this study was to analyze the association between adherence, age, and education in factor score changes of participant impairment, participant adjustment, and partner adjustment in a sample of participants with amnestic MCI (aMCI) and their study partners.Participants and Methods:We included fifty-two dyads of a person with aMCI and their study partner with intervention data at baseline and 24-week follow-up from the Physical Exercise and Cognitive Engagement Outcomes for Mild Neurocognitive Disorder (PEACEOFMND) study. At baseline, participants were randomized to one of three behavioral interventions: computerized cognitive training (BrainHQ; n=19), yoga (n=15), or wellness education (n=18). Factors were established from a larger clinical sample that used the same measures as PEACEOFMND. The three-factor latent structure was constructed as the following: 1) participant adjustment combined scores of the Center for Epidemiologic Studies Depression Scale (CES-D), Quality of Life in Alzheimer’s Disease (QoL-AD), and Self-Efficacy for managing MCI scales; 2) partner adjustment included study partner’s scores in CES-D, QoLAD and Caregiving Competence and Mastery Components (CCMC) of the Pearlin scales; 3) participant impairment included participant’s scores in E-Cog memory domain, and study partner’s scores in the Functional Activity Questionnaire (FAQ) and Zarit Burden Interview. We calculated factor changes by obtaining the difference between factor scores at follow-up and baseline. Bayesian correlation analysis was performed to investigate the association between age, education, adherence to the combined behavioral interventions, participant adjustment, participant impairment, and partner adjustment.Results:The Bayesian correlation results showed moderate evidence (BF10=6.8, Pearson’s r=0.38) supporting a positive correlation between adherence and change in participant adjustment. Additionally, there was moderate evidence (BF10=2.18, Pearson’s r=0.32) supporting a positive correlation between change in participant impairment and participant level of education as well as participant age and change in partner adjustment (BF10=2.8, Pearson’s r=0.33).Conclusions:Bayesian correlations replicated results from previous analysis using a traditional method, showing that increased adherence to combined behavioral interventions is associated with an increase in participant’s quality of life, self-efficacy, and better mood. Thus, commitment to behavioral intervention completion in aMCI participants is related to overall participant adjustment.

Hearing and Functioning in Everyday Life Questionnaire: Development and Validation of an ICF-Based Instrument.

Self-assessment instruments are commonly used in audiological rehabilitation. However, several studies highlight the lack of multidimensionality in existing outcome measures, with the consequence that they only partially capture aspects of functioning in everyday life for people living with hearing loss. This study aimed to develop and investigate the content validity of a self-assessment instrument based on the validated Brief International Classification of Functioning, Disability, and Health Core Set for Hearing Loss. The design was a two-part instrument development study. The first part focused on the item-generation process of the instrument, named the Hearing and Functioning in Everyday Life Questionnaire (HFEQ) during an experts' workshop. The second part focused on international content validation of the instrument using group interviews. Strategic sampling was used and 30 adults with hearing loss from India, South Africa, and the United States participated in the group interviews. The expert's workshop resulted in the first version of the HFEQ containing 30 items. The results from group interviews show that the content of the HFEQ was considered to be valid concerning its relevance, comprehensiveness, and comprehensibility. A majority (73%) of the HFEQ items were perceived by the participants as relevant and easy to comprehend. For the remaining 27% of the items, the content was perceived to be relevant in all countries, but some terms and expressions were reported to require rewording or clearer examples. These modifications will be made in the next step of the development process. Content validation of the HFEQ demonstrates promising results, with participants perceiving the content as relevant and comprehensible. Further psychometric validation is required to investigate other psychometric properties, such as construct validity and reliability. The HFEQ has the potential to become a valuable new instrument for assessing everyday functioning in people with hearing loss in audiological rehabilitation and in research.

A virtual reality program to assess cognitive function in multiple sclerosis: A pilot study.

Introduction: Cognitive impairment is a debilitating symptom in people with multiple sclerosis (MS). Most of the neuropsychological tasks have little resemblance to everyday life. There is a need for ecologically valid tools for assessing cognition in real-life functional contexts in MS. One potential solution would involve the use of virtual reality (VR) to exert finer control over the task presentation environment; however, VR studies in the MS population are scarce. Objectives: To explore the utility and feasibility of a VR program for cognitive assessment in MS. Methods: A VR classroom embedded with a continuous performance task (CPT) was assessed in 10 non-MS adults and 10 people with MS with low cognitive functioning. Participants performed the CPT with distractors (i.e., WD) and without distractors (i.e., ND). The Symbol Digit Modalities Test (SDMT), California Verbal Learning Test-II (CVLT-II), and a feedback survey on the VR program was administered. Results: People with MS exhibited greater reaction time variability (RTV) compared to non-MS participants, and greater RTV in both WD and ND conditions was associated with lower SDMT. Conclusions: VR tools warrant further research to determine their value as an ecologically valid platform for assessing cognition and everyday functioning in people with MS.

A Cross-Sectional Study on Associations Between BDNF, CRP, IL-6 and Clinical Symptoms, Cognitive and Personal Performance in Patients With Paranoid Schizophrenia

BackgroundCognitive impairment is among the core dimensions in schizophrenia and is a significant predictor of everyday functioning in people with schizophrenia. Given the enormous burden of schizophrenia, the search for its clinically relevant biomarkers is essential. Researchers have been trying to elucidate factors of cognitive impairment as well as personal performance, but the search is still ongoing. The aim of the study was to search for associations between BDNF, CRP, IL-6 and clinical symptoms, cognitive and personal performance in patients with paranoid schizophrenia.MethodsA total of 86 patients (53.5% women, mean age 31.1 ± 6.5) with paranoid schizophrenia (F20.0; ICD-10) in remission were examined. Clinical and neuropsychological examination included the Positive and Negative Syndrome Scale, Personal and Social Performance Scale, Calgary Depression Scale for Schizophrenia and the Brief Assessment of Cognitive Function in Schizophrenia. IL-6, BDNF, CRP levels were determined in the patients' blood serum.ResultsCognitive impairment was revealed in 79.1% of patients and was more profound in patients with higher number of hospitalizations (p = 0.006). The average BDNF levels were 13.38 ± 15.84 ng/ml, CRP concentration was 2.09 ± 2.54 mg/l, and IL-6 levels were 12.14 ± 5.88 pg/ml. There were no differences in biomarker levels or BACS results in patients that had different antipsychotic therapy or differed in the presence of anticholinergic therapy. CRP levels were higher in patients with longer disease duration, lower age of onset, more impaired personal social performance and processing speed. IL-6 was higher in individuals with lower working memory scores. PANSS negative subscale score negatively correlated and PSP score positively correlated with most cognitive domains. A linear regression established that the first episode vs. multiple episodes of schizophrenia could statistically significantly predict personal and social performance and cognition, including speech fluency and planning, as well as CRP levels.ConclusionsThis study continues the search for biomarkers of schizophrenia and cognitive impairment in schizophrenia to improve the reliability of diagnosing the disorder and find new treatment approaches. The role of the number of psychoses experienced (first episode vs. multiple episodes of schizophrenia) in cognition, personal and social performance and inflammation is shown.

The Post-Pandemic Development of the Green Circular Economy and the Declarations Made During the UN Climate Change Conference (COP26) as Security Determinants

Purpose: The aim of this article is to describe the important security determinants of post-pandemic development of the green circular economy in the context of the latest report of the Intergovernmental Panel on Change (IPCC) I IPCC Working Group, Climate Change 2021: the Physical Science Basis and declarations made during the UN Change Conference (COP26) in Glasgow in early November 2021. Approach/Methodology/Design: The main research methodology was based on the analysis of the results of scientific research and a synthetic description of the key conclusions drawn from the review of the literature describing various aspects of the analyzed issues concerning the determinants of the climate change process, the issue of green economy development, the implementation of the principles of sustainable economic development, reduction of greenhouse gas emissions and how they impact security aspects etc. Research methods used in the study included critical literature review, comparative analysis, and analysis of available data. Findings: The analysis of scientific data shows that the process of climate change has entered a strong upward trend and perhaps humanity has little effect on reversing this process in this century. The transformation of the environment into the economy should include, first of all, the energy sector through the development of renewable energy sources, the development of electromobility, ecological agriculture, improvement of waste segregation techniques, recycling, etc. A key issue in this process is the pursuit of sustainability. The factual implementation of the aforementioned shall enable to address the security threats that are largely intensified by climate change and lack of efficient level of sustainable development. The aforementioned shall be helpful in providing the necessary level of security and address the threats. Practical Implications: In order to slow down the progressing global warming process, and tame global security threats related to climate change it absolutely is necessary to reduce all or most of greenhouse gas emissions in the shortest possible time, reform the energy sector with the respect to energy security, implement eco-innovations and carry out other pro-environmental reforms as well as to increase the scale of achieving sustainable development goals implemented in accordance with the principles of a sustainable, green circular economy. The global socio-economic crisis caused by the development of the SARS-CoV-2 (Covid-19) coronavirus pandemic should significantly change the pro-ecological awareness of people and the need to implement sustainable development in economic processes and everyday functioning of people. The need to continue the policy of reducing greenhouse gas emissions was discussed during the UN Conference COP26 in early November 2021. Originality/Value: For the purposes of this article, a multifaceted, synthetic and critical analysis of data available in the source literature was carried out. The proposed solutions are to contribute to a significant reduction in greenhouse gas emissions and slow down the process of global warming, and to reduce the scale of the drastic effects of climate change over the next several decades. This shall also lead to decrease of conflicts that otherwise would resource from global instabilities caused by climate change consequences.

A cross-diagnostic study of adherence to ecological momentary assessment: Comparisons across study length and daily survey frequency find that early adherence is a potent predictor of study-long adherence

BackgroundEcological momentary assessment (EMA) offers a highly valid strategy to assess everyday functioning in people with severe mental illness. Adherence is generally good, but several questions regarding the impact of study length, daily density of sampling, and symptom severity on adherence remain. MethodsEMA adherence in two separate studies was examined. One sampled participants with schizophrenia (n = 106) and healthy controls (n = 76) 7 times per day for 7 days and the other sampled participants with schizophrenia (n = 104) and participants with bipolar illness (n = 76) 3 times per day for 30 days. Participants were asked where they were, who they were with, what they were doing and how they were feeling in both studies. The impact of rates of very early adherence on eventual adherence was investigated across the samples, and adherence rates were examined for associations with mood state and most common location when answering surveys. ResultsMedian levels of adherence were over 80% across the samples, and the 10th percentile for adherence was approximately 45% of surveys answered. Early adherence predicted study-long adherence quite substantially in every sample. Mood states did not correlate with adherence in the patient samples and being home correlated with adherence in only the bipolar sample.Implications: Adherence was quite high and was not correlated with the length of the study or the density of sampling per study day. There was a tendency for bipolar participants who were more commonly away from home to answer fewer surveys but overall adherence for the bipolar patients was quite high. These data suggest that early nonadherence is a potential predictor of eventual nonadherence and study noncompletion.

The Ritual of Cooperation and the Routine as a Tool for Shaping Social and Civic Competences – Based on the Thoughts of Richard Sennett

The subject of the article is the problem of the discrepancy between the actual educational practice in schools and the official policy and declarations regarding shaping social and civic competences, characterized, inter alia, by the ability to cooperate. The aim of the article is to try to answer the question about the causes of weakening the ability to cooperate in the everyday functioning of people and institutions. The answer to this question is analyzed on the basis of the source texts of Richard Sennett, an American sociologist who devoted a lot of space to this problem in his works. In the first part of the article, the author describes the problem of the condition of modern man. In the second part, she presents the problems of changes taking place in today's world that cause the "corrosion of character" of human. In the third part, she discusses the issue of cooperation ritual and routine, which have the power to educate. The last part of the article, she presents an attempt to answer the question about what one needs / what one can to be changed in contemporary education, so that the development of competencies important from the point of view of functioning in the contemporary world has become an essential tool for education and upbringing.

Everyday functioning of people with Parkinson’s disease and impairments in executive function: a qualitative investigation

Purpose: Executive function is the key area of cognitive impairment in Parkinson’s disease. This study investigated how cognitive difficulties impact on everyday life of people with Parkinson’s disease and their carers, and whether they explicitly mention executive-type difficulties.Methods: Semistructured interviews with 11 people with Parkinson’s disease and six carers were analyzed thematically. People with Parkinson’s disease performed within the normal range on cognitive screening tests, but all had abnormal scores on tests of executive function.Results: Despite relatively mild executive deficits and no global cognitive impairment, participants described executive-type difficulties as well as a range of problems in other cognitive domains, such as memory, processing speed and apathy. Cognitive difficulties had a far-reaching impact on everyday life and their significance depended on personal circumstances, such as the level of responsibilities of the person with Parkinson’s disease and the extent of available support.Conclusions: By presenting subjective accounts of living with Parkinson’s disease and cognitive difficulties, this study improves our understanding of how the observed level of cognitive impairment translates into everyday functioning. The study results have implications for recognizing cognitive difficulties and for planning support for people with Parkinson’s disease and their families, and can help identify ways of promoting effective self-management.Implications for rehabilitationTreatment of Parkinson’s disease tends to focus on the movement disorder, meaning that cognitive difficulties and their impact can be overlooked.Participants in this study had only relatively mild executive deficits but described a range of cognitive problems, including executive-type difficulties.Cognitive difficulties have an emotional impact and can cause a range of challenges in everyday life, adding to the burden of physical symptoms of Parkinson’s disease.Results of this study provide insights into how executive functions impairments translate into everyday difficulties in Parkinson’s disease and have implications for planning support for people with Parkinson’s disease and their families.

354. Negative Symptoms and Cognitive Deficits Predict Different Elements of Everyday Functioning in People with Schizophrenia

354. Negative Symptoms and Cognitive Deficits Predict Different Elements of Everyday Functioning in People with Schizophrenia

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.

Self-assessment in schizophrenia: Accuracy of evaluation of cognition and everyday functioning.

Self-assessment deficits, often referred to as impaired insight or unawareness of illness, are well established in people with schizophrenia. There are multiple levels of awareness, including awareness of symptoms, functional deficits, cognitive impairments, and the ability to monitor cognitive and functional performance in an ongoing manner. The present study aimed to evaluate the comparative predictive value of each aspect of awareness on the levels of everyday functioning in people with schizophrenia. We examined multiple aspects of self-assessment of functioning in 214 people with schizophrenia. We also collected information on everyday functioning rated by high contact clinicians and examined the importance of self-assessment for the prediction of real-world functional outcomes. The relative impact of performance-based measures of cognition, functional capacity, and metacognitive performance on everyday functioning was also examined. Misestimation of ability emerged as the strongest predictor of real-world functioning and exceeded the influences of cognitive performance, functional capacity performance, and performance-based assessment of metacognitive monitoring. The relative contribution of the factors other than self-assessment varied according to which domain of everyday functioning was being examined, but, in all cases, accounted for less predictive variance. These results underscore the functional impact of misestimating one's current functioning and relative level of ability. These findings are consistent with the use of insight-focused treatments and compensatory strategies designed to increase self-awareness in multiple functional domains.

Perceived difficulty in the use of everyday technology: relationships with everyday functioning in people with acquired brain injury with a special focus on returning to work

Purpose: The aim was to explore the relationships between difficulties in the use of everyday technology (ET) and the ability to perform activities of daily life (ADL) in the home and in society and in the workplace in people with acquired brain injury (ABI). Method: The investigation comprises an explorative cross-sectional study of 74 people with ABI. The short version of the Everyday Technology Use Questionnaire (S-ETUQ) and a revised version of the ADL taxonomy were used to evaluate the participants. Rasch-generated person ability measures of ET use and ADL were used in correlation analyses, in group comparisons by ANOVA and in logistic regressions. Results: Difficulty in the use of ET was significantly correlated with ADL limitations. People who worked full- or part-time had significantly higher ability to use ET than those with some type of full-time, long-term sickness compensation. The ability to use ET, ADL ability and age were significantly related to return to work. Conclusion: The ability to use ET is related to all areas of everyday functioning in people with ABI. Therefore, a patient’s ability to use ET needs to be considered in rehabilitation strategies following an ABI to enhance the patient’s performance of activities in the home and in society and to support his or her likelihood of returning to work.Implications for RehabilitationAbility to use everyday technology (ET) needs to be considered in rehabilitation following an ABI as difficulty in ET use is significantly related to the abilities of people with acquired brain injury (ABI) in all areas of everyday functioning (P/I ADL, leisure and work).The assessment S-ETUQ can assist professionals in screening and identifying ET that clients perceive supporting or challenging their everyday functioning.With respect to the Information and communication society of today, the match between users abilities and ET is important knowledge in designing an e-accessible and e-inclusive society for people with disabilities.

Functional milestones and clinician ratings of everyday functioning in people with schizophrenia: Overlap between milestones and specificity of ratings

Everyday functioning is known to be impaired in people with schizophrenia, across multiple functional domains. It is not clear, however, how impairments across social, vocational, and residential domains overlap with each other, Further, although there are multiple ratings scales available to rate everyday functioning, it is also not clear how scores on these scales, particularly total scores, relate to milestone achievement. This is important, because efforts to reduce disability with pharmacological or rehabilitative interventions are ultimately evaluated in terms of their impact on everyday functioning, which is often indexed with total scores on rating scales. In this paper from the VALERO study, we report on 195 people with schizophrenia who were rated with a comprehensive process on 6 different functional status rating scales. Milestone achievements in social (ever married or equivalent), vocational (ever employed, currently employed), and residential (living independently, financially responsible) domains were examined for their overlap with each other and with ratings on the rating scales. Total scores on the 6 rating scales were minimally related to milestone achievements and milestone achievements were quite independent of each other. Subscales from two of the rating scales, specifically examining vocational and residential functioning, were specifically related to milestone achievements in their functional domains, but not other milestones. These data suggest that global scores on everyday functioning measures may not capture functional milestones and highlight the fact that functional milestones have multiple determinants other then the ability variables that these rating scales attempt to capture.

Predictors of the accuracy of self assessment of everyday functioning in people with schizophrenia

Despite multiple lines of evidence suggesting that people with schizophrenia have substantial problems in self-reporting everyday functioning and cognitive performance, self-report methods are still widely used to assess functioning. This study attempted to identify predictors of accuracy in self report, both in terms of accurate self-assessment and over-estimation of current functioning. As part of the larger Validating Assessments of Everyday Real-World Outcomes (VALERO) study, 195 patients with schizophrenia were asked to self report their everyday functioning with the Specific Levels of Functioning (SLOF) scale, which includes subscales assessing social functioning, everyday activities, and vocational functioning. They were also assessed with measures of neuropsychological (NP) performance and functional capacity (FC), and were assessed for psychiatric symptomatology. In addition, a friend, relative or clinician informant was interviewed with the SLOF, and an interviewer with access to all information provided by the patient and informant (exclusive of performance-based data) generated “best estimate” ratings of actual, everyday functioning. Patients significantly (p<.001) overestimated their vocational functioning and everyday activities compared to the interviewer judgments. Lower levels of NP and FC performance and everyday functioning on the part of patients were consistently associated with overestimation of their functioning. Patient self-reports were not correlated with any performance-based measures, while interviewer judgments were significantly correlated with patients' performance on NP and FC measures (p<.005). In regression analyses, adjusting for interviewer ratings of functioning, several predictors of the discrepancy between self and interviewer judgments emerged. Higher levels of depressive symptoms were associated with less overestimation in self-reports (p<.001). Delusions, suspiciousness, grandiosity and poor rapport were all significantly (p<.001) associated with over-estimation of functioning compared to interviewer judgments. Poorer NP and FC performance were also associated with over-estimation of everyday functioning, but these results were not statistically significant in multivariate regression models. Consistent with previous studies in schizophrenia, other neuropsychiatric conditions and non-clinical populations, higher levels of depression were associated with increased accuracy in self-assessment. Similarly, lower scores on performance-based measures and judgments of everyday functioning also predicted over-estimation of functioning. Thus, we identified bi-directional predictors of mis-estimation of everyday functioning, even when poor baseline scores were considered. These data suggest that it may be possible to screen patients for their ability to self-report their functioning, but that performance-based measures of functioning provide a less biased assessment.

Everyday action planning in schizophrenia

Planning of everyday tasks was examined in 48 inpatients with schizophrenia and 26 healthy controls. Participants were administered the Naturalistic Action Test, which requires completion of three everyday tasks (e.g., make toast and coffee). Planning variables, including planning behaviours (e.g., gathering items before engaging in a subtask) and planning time (e.g., period between task instructions and first action) were coded to evaluate forward thinking in these tasks. Results showed that planning variables were reliably coded. Controls demonstrated more planning behaviours than participants with schizophrenia; however, this difference was accounted for by education. People with schizophrenia spent significantly less time planning when planning time was analysed as a proportion of the total time on tasks. Planning variables were related to the ability to accomplish everyday task steps and to perform everyday task steps accurately. Together these findings suggest that rehabilitation strategies that emphasise both planning time and planning behaviours may facilitate everyday functioning in people with schizophrenia.

Cognitive functions among Hong Kong Chinese people with schizophrenia

Persons with schizophrenia show deficits in a variety of cognitive domains including executive function, attention, memory and language. Similar interest in studying the impact of cognitive deficits on the everyday functioning of people with schizophrenia has been documented. This study examined the cognitive functioning among Hong Kong Chinese schizophrenic patients compared with other patient groups, and its relationship with functional outcome, especially in the social aspect. Results indicated that schizophrenic patients presented with mild cognitive problems compared with neurosurgical and demented patients. Initial support was found in relating cognitive functions, as measured by Neurobehavioral Cognitive Status Examination, with functional outcome as measured by Functional Independence Measures. The implication for community rehabilitation is also discussed.

The relations between cognition and the independent living skill of shopping in people with schizophrenia

A great deal of interest has developed regarding the impact of cognitive deficits on the everyday functioning of people with schizophrenia. This study examined the relationships between cognitive functioning and the performance of a specific independent living skill (grocery shopping) in a sample of 73 individuals with schizophrenia or schizoaffective disorder. Cognitive variables included tests of verbal memory, executive functioning, verbal fluency, sustained attention and visual motor skill. Functional outcome was measured with the Test of Grocery Shopping Skills, which is an ecologically based performance measure that requires participants to shop for 10 items within an actual grocery store. Accuracy on the shopping task was significantly associated with fewer perseverative responses on the Wisconsin Card Sorting Test, better verbal memory and faster processing speed. Shopping efficiency (i.e. less redundancy) was associated with better performance on several cognitive tasks, including verbal memory, verbal fluency, sustained attention and executive functioning. Results of this study extend previous research by examining the relation between cognition and the actual performance of daily living skills under natural circumstances.

Nicotinic treatment for degenerative neuropsychiatric disorders such as Alzheimer’s disease and Parkinson’s disease

Nicotinic systems play an important role in the neural basis of working memory and attention. Recent progress in understanding of the structure, function, and distribution of central nervous system (CNS) nicotinic receptors and their pharmacology has opened up new possibilities for novel CNS therapeutics with nicotinic agents. In this paper, we review the theoretical justification and the experimental evidence supporting these developments. We focus on the applications of nicotinic agonists in CNS disorders that are degenerative in nature, namely Parkinson’s disease and Alzheimer’s disease. We suggest that there is considerable potential for therapeutic applications in the near future. Clinically, two major issues remain: (a) the selectivity of effects, that is, developing compounds which are selective in producing improvement in cognition, motor function, attention, or pain without significant side-effects; and (b) the realistic likelihood of long-term improvements in everyday functioning in people who have degenerative diseases.