Instrumental Activities Of Daily Living Tasks Research Articles

Six elements test vs D-KEFS: what does "Ecological Validity" tell us?

Extensive research shows that tests of executive functioning (EF) predict instrumental activities of daily living (IADLs) but are nevertheless often criticized for having poor ecological validity. The Modified Six Elements Test (MSET) is a pencil-and-paper test that was developed to mimic the demands of daily life, with the assumption that this would result in a more ecologically valid test. Although the MSET has been extensively validated in its ability to capture cognitive deficits in various populations, support for its ability to predict functioning in daily life is mixed. This study aimed to examine the MSET's ability to predict IADLs assessed via three different modalities relative to traditional EF measures. Participants (93 adults aged 60 - 85) completed the MSET, traditional measures of EF (Delis-Kaplan Executive Function System; D-KEFS), and self-reported and performance-based IADLs in the lab. Participants then completed three weeks of IADL tasks at home, using the Daily Assessment of Independent Living and Executive Skills (DAILIES) protocol. The MSET predicted only IADLs completed at home, while the D-KEFS predicted IADLs across all three modalities. Further, the D-KEFS predicted home-based IADLs beyond the MSET when pitted against each other, whereas the MSET did not contribute beyond the D-KEFS. Traditional EF tests (D-KEFS) appear to be superior to the MSET in predicting IADLs in community-dwelling older adults. The present results argue against replacing traditional measures with the MSET when addressing functional independence of generally high-functioning and cognitive healthy older adult patients.

SUPPORTING OLDER ADULTS WHO LIVE ALONE: UNDERSTANDING THEIR UNMET NEEDS USING NHATS SURVEY DATA

Abstract Research suggests that older adults living alone in the community are at higher risk for poor health-related outcomes due to lack of cohabitants to support their health needs. Using National Health and Aging Trends Study (NHATS) data, we identified community-residing older adults (≥65 years) with assistance needs for Instrumental Activities of Daily Living (IADLs), Activities of Daily Living (ADLs), or mobility. We used bivariate analyses to compare the unmet needs related to IADL, ADL, and mobility tasks between those living alone and those living with others. Of the 3,458 individuals identified, 28.9% (n=1001) lived alone. Those living alone were more likely to be women, unpartnered, and lacking informal caregivers. There was no difference in perceived overall health scores between the groups. Individuals living alone experienced more mobility and IADL-related unmet needs. In the month prior to survey completion, those living alone were more likely to forgo getting out of bed (p=0.031), grocery shopping (p< 0.001), cooking (p< 0.001), and paying bills (p=0.025) due to lack of available assistance. Our findings suggest that older adults living alone may need higher levels of formal assistance with IADLs to remain living in the community. Given the key role IADLs play in promoting quality of life and a person’s ability to remain independent and engaged in the community, it is important to consider IADLs in addition to ADLs when assessing formal care needs for those living alone. Policy makers should prioritize the specific needs of those living alone when developing national aging strategies.

DEVELOPMENT AND ACCEPTABILITY OF A MOBILE APP FOR MONITORING EVERYDAY FUNCTIONAL ABILITIES

Abstract Subtle changes in instrumental activities of daily living (IADL), also termed everyday functional abilities, may be early markers of dementia. However, there are no widely available tools for tracking IADL function, and it is unclear whether such a tool would be used by older adults. The present study investigates older adults’ adherence to a novel mobile app designed to conveniently and cost-effectively monitor IADL function. We also examine participants’ acceptability of the app, including their overall satisfaction, perceived ease of use, benefits and limitations, and suggestions for improvement. Community-dwelling older adults (n=24; Mage=71.63 years) were randomly assigned three different simulated IADL tasks, to complete at specified times, each day for two weeks. Adherence was assessed using app usage data. App perceptions were assessed via survey and individual interview at the end of the two-week study period. Results indicate high adherence, with an average total task completion of 94.2%. Results from follow-up interviews revealed the app was generally perceived as “easy to use” and the assigned tasks could be completed quickly. Participants expressed frustration over app glitches that prevented them from successfully completing tasks and noted the assigned tasks and associated steps to complete were too simplified to be realistic. High adherence rates and general acceptance indicate the app’s potential usefulness. Further research should assess long-term effectiveness and user experience, especially among a more diverse sample. If reliable and valid, such apps could enable early dementia detection, but only if their use is feasible and accepted.

Test of Practical Judgment (TOP-J): Construct, Criterion, and Incremental Validity in a Community Sample of Older Adults.

The Test of Practical Judgment (TOP-J) is a stand-alone judgment measure that is considered to tap into aspects of executive functioning (EF) and inform clinical predictions of daily functioning in older adults. Past validation research is variable and has some limitations. The present study sought to examine the reliability and construct, criterion, and incremental validities of scores on TOP-J 9-item version (TOP-J/9). Participants were 95 community-dwelling older adults aged 60 to 85. Participants completed TOP-J/9, measures of EF and global cognition, and three different modalities of instrumental activities of daily living (IADLs) (self-report, performance-based tasks conducted in the laboratory, and performance-based tasks completed at home over 3weeks). TOP-J/9 scores showed adequate internal consistency (α = 0.73) after correcting for the low number of items. TOP-J/9 was correlated with global cognition and EF, although EF did not survive correction for lower-order processes. Finally, although TOP-J/9 scores were associated with home-based IADL tasks (but not with self-report and laboratory-based IADLs), providing some evidence of criterion validity, they did not incrementally contribute to home-based IADL performance beyond other cognitive measures. However, when two items pertaining to social/ethical judgment were removed, this modified version of TOP-J did relate to EF beyond lower-order processes and contributed uniquely to prediction of home-based IADLs beyond other measures. Results suggest that TOP-J/9 taps into global cognitive status (but not necessarily EF) and predicts "real-world" functioning (but not above and beyond other cognitive measures). TOP-J psychometrics may be improved by removing two social/ethical items.

P61: The use of the errorless learning method in the rehabilitation of activities of daily living and instrumental activities of daily living

Objective:The aim of this review was to describe the usage and effectiveness of errorless learning in activities of daily living (ADL) and instrumental activities of daily living (IADL) rehabilitation methods reported in the literature over the past 10 years.Methods:Two databases were searched (PubMed, EMBASE) using the key words “errorless learning and ADL and IADL”. Articles published in the last 10 years in English were considered.Results:4 studies were identified that included 94 people with Alzheimer's disease (AD) and 129 people with stroke (104 with amnesia and 25 with ideational apraxia ).One study on AD patients showed that it is possible for them to re-learn relevant IADL activities using the errorless learning (EL) and spaced retrieval (SR) techniques and to maintain these gains for at least 3 months (t =2.811; df =22.246; p=0.010).In another study on AD patients, participants with AD had to re-learn three IADLs. All three learning methods (including EL) had similar efficiency (F(2,94)=21,99). However, the intervention resulted in greater improvement in actual IADL task performance than in explicit knowledge.In another study, structured ADL re-training in stroke survivors with amnesia significantly increased functional independence (MD: 4.90, SE=1.4, 95% confidence interval) and shortened time of hospitalisation (mean difference: 5.22, SE= 1.4, 95% CI: 1.8, 8.7).The fourth study presented a model in which patients with post-stroke ideational apraxia attended tea making training sessions during which progress was monitored and feedback was provided via a computer system. A qualitative analysis of errors was conducted before training, and the most common errors observed were those related to kettlebell and continuous perseveration. After training, the frequency of errors decreased for all error types except for skipping a step.Conclusion:The results of the studies discussed demonstrate the wide range of applications of error-free learning protocols in both AD patients and post-stroke patients. A clearly specified but flexible training protocol, together with information on error distribution, provide pointers for further refinement of task model approaches in ADL and IADL rehabilitation.

Are Friendly Robots Trusted More? An Analysis of Robot Sociability and Trust

Older individuals prefer to maintain their autonomy while maintaining social connection and engagement with their family, peers, and community. Though individuals can encounter barriers to these goals, socially assistive robots (SARs) hold the potential for promoting aging in place and independence. Such domestic robots must be trusted, easy to use, and capable of behaving within the scope of accepted social norms for successful adoption to scale. We investigated perceived associations between robot sociability and trust in domestic robot support for instrumental activities of daily living (IADLs). In our multi-study approach, we collected responses from adults aged 65 years and older using two separate online surveys (Study 1, N = 51; Study 2, N = 43). We assessed the relationship between perceived robot sociability and robot trust. Our results consistently demonstrated a strong positive relationship between perceived robot sociability and robot trust for IADL tasks. These data have design implications for promoting robot trust and acceptance of SARs for use in the home by older adults.

48 Variable Sleep Hours and Restfulness Ratings Across Days Predict Daily Functioning in Community-Dwelling Older Adults

Objective:Certain contextual factors, including non-restorative sleep (Niermeyer & Suchy, 2020), sleep deprivation (Lim & Dinges, 2010), burdensome emotion regulation (Franchow & Suchy, 2017), and pain interference (Boselie, Vancleef, & Peters, 2016) have been shown to contribute to temporary declines in executive functioning (EF). Contextually-induced decrements in EF in turn have been associated with temporary decrements in performance of instrumental activities of daily living (IADLs) among healthy older adults (Brothers & Suchy, 2021; Suchy et al., 2020; Niermeyer & Suchy 2020). Furthermore, some evidence suggests that higher variability in levels of contextual factors across days (i.e., deviations from routine) may contribute to IADL lapses above and beyond average, albeit high, levels of these contextual burdens (Bielak, Mogle, & Sliwinksi, 2019; Brothers & Suchy, 2021). Taken together, these findings highlight the importance of accounting for transient contextual burdens when assessing EF and IADL abilities in older adults.Poor sleep quality has been associated with poor IADL performance (Fung et al., 2012; Holfeld & Ruthing, 2012) when assessed in a single visit. However, the potential contributions of variable sleep quantity and quality on IADL performance have not been assessed in healthy older adults using longitudinal methods. Accordingly, the aim of this study was to examine the impact of fluctuations in sleep quantity and quality, assessed daily, above and beyond average levels, on at-home IADL performance across 18 days in a group of community-dwelling older adults.Participants and Methods:Fifty-two non-demented community-dwelling older adults (M age = 69 years, 65% female) completed 18 days of at-home IADL tasks, as well as daily ecological momentary assessment (EMA) measures of EF, sleep hours, and restfulness questions. An 18-day mean EMA EF score was computed controlling for practice effects. Mean levels of and variability in EMA sleep hours and EMA restfulness ratings were computed. IADL scores were computed for timeliness and accuracy across the 18 days.Results:A series of hierarchical linear regressions were run using separate IADL timeliness and accuracy as the dependent variable. In the first step, demographics (age, sex, education) were entered. Then, EMA EF was entered, followed by mean EMA sleep hours and EMA mean restfulness, and lastly, variability in EMA sleep hours and EMA restfulness. EMA EF was found to significantly predict both IADL accuracy (B = .46, p = .001) and timeliness (B = .45, p = .005). Variability in EMA sleep hours (B = .40, p = .008) and restfulness (B = -.29, p = .043) both predicted IADL accuracy beyond other variables, while mean levels did not. Additionally, variability in sleep hours and restfulness substantially improved the prediction of IADL accuracy above and beyond other variables in the model, accounting for an additional 16% of variance (F (2) = 3.80, ∆ R2 = .16, p = .006). Neither mean levels of or variability in sleep hours or restfulness predicted IADL timeliness.Conclusions:Results suggest that greater fluctuations in the amount and quality of sleep across days may render healthy older adults more susceptible to lapses in daily functioning abilities, particularly the accuracy with which IADL tasks are completed.

Effect of the cognitive strategy training protocol on task mastery and cognitive performance during the instrumental activity of daily living in stroke patients

Background: Stroke leads to decrease in physical, emotional, social function, and activities in daily living. Cognitive functions, either basic or higher-level, are fundamental factors in performing tasks and functional activities in daily life. Therefore, cognitive training to enhance functions in stroke patients is necessary. This study developed a cognitive strategy training protocol using the Perceive, Recall, Plan & Perform (PRPP) System of Intervention and the Multicontext Approach to improve cognitive function during performance in instrumental activities of daily living (IADL) tasks. Objectives: This study aimed to examine the task mastery of stroke patients during the performance of IADL tasks and to examine the effects of the cognitive strategy training protocol on cognitive performance in stroke patients. Materials and methods: The study was a quasi-experimental, one-group, pretestposttest research design. Eight stroke patients with cognitive impairment aged between 18-70 years old participated in the study. The intervention called “cognitive strategy training protocol” included 12 sessions, 3 times a week across 4 consecutive weeks. Each session took approximately 60 minutes. An outcome measure was the PRPP System of Task Analysis-Thai version. Descriptive data obtained from Stage One of the PRPP System-Thai version were analyzed to determine for task mastery, and pre-and post-scores of Stage Two of the PRPP System-Thai version were computed using the Wilcoxon signed-rank test. Results: After the cognitive strategy training protocol, all participants had higher percentage scores obtained from Stage One of the PRPP System-Thai version for at least 1 activity. Five out of eight participants showed higher percentage scores in both activities. Comparing the pre- and post-test scores from Stage Two of the PRPP System-Thai version using the Wilcoxon signed-rank test revealed no significant difference in all activities (p>0.05). However, the descriptive results of the posttest percentage scores of Stage Two of the PRPP System-Thai version showed that 4 out of 8 participants had higher scores for at least 1 activity and 2 participants showed higher scores in both activities. Conclusion: The cognitive strategy training protocol was likely to be possible to improve task mastery and cognitive performance during the IADLs tasks in the participants despite no statistically significant difference.

It's complicated: Executive functioning moderates impacts of daily busyness on everyday functioning in community-dwelling older adults.

Research shows that cognitively healthy older adults with mild executive function (EF) weaknesses are vulnerable to the negative impacts of life complexity (or daily busyness) when performing instrumental activities of daily living (IADLs). However, past research assessed life complexity only at one timepoint, not capturing daily fluctuations. Importantly, fluctuations in busyness can themselves have deleterious impacts on functioning. This study extended past research by examining whether (1) variability in daily busyness would be more detrimental than level of busyness to performance of IADLs, and (2) EF assessed at home would moderate deleterious impact of busyness on IADLs. Fifty-two community-dwelling older adults aged 60 to 95 completed daily IADL tasks and daily measures of EF and busyness via ecological momentary assessment, independently at home for 18 days. (1) In a subset of participants with mild EF weaknesses, high variability in busyness across days was associated with fewer tasks completed correctly; and (2) across all participants (regardless of EF), high levels of daily busyness were associated with fewer tasks completed on time. Findings indicate that high variability in daily busyness, potentially reflecting a lack of daily routine, was associated with IADL errors among cognitively healthy older adults with mild EF weaknesses. Additionally, consistently high levels of busyness were associated with failures to complete tasks, or failures to complete them on time, regardless of EF. These results further support the Contextually Valid Executive Assessment (ConVExA) model, which posits that EF and contextual factors interact to predict functional outcomes.

Know thyself: Executive functioning and sex predict self-appraisal of functional abilities in community-dwelling older adults

Objective: The capacity for accurate self-appraisals of age-related changes in cognitive and functional abilities is integral to the maintenance of independence in later life, yet there is little understanding of the factors that place nondemented older adults at risk for poor self-awareness. This study examined the potential contributions of executive functioning (EF), crystallized intelligence (IQ-Cr), and sex in predicting congruence between performance and self-appraisals of instrumental activities of daily living (IADL) in a group of community-dwelling older adults. Method: A group of 150 nondemented, community-dwelling older adults (White and majority highly educated) completed measures of EF and IQ-Cr. Participants also completed five timed IADL tasks and self-appraised their performance relative to others of similar age. Results: Sex [F(1,148) = 7.75, p = .006, ηp 2 = .05] and EF [(F(1,147) = 5.30, p = .02, ηp 2 = .04)], but not IQ-Cr, predicted the relationship between performance and self-appraisals, such that those with lower EF and those of male sex overestimated their performance more than those with higher EF and females. Conclusions: Findings indicate that having average to below average EF abilities and being of male sex are risk factors for less accurate self-report of IADL abilities and as such might represent important considerations when assessing IADL abilities via self-report among largely independent, community-dwelling older adults.

Functional profiles of older adults from the dementia continuum: Analyzing critical errors that occurred during an IADL ecological evaluation

AbstractBackgroundOlder adults with Alzheimer disease (AD) or mild cognitive impairment (MCI) experience challenges that affect their independence. Instrumental activities of daily living (IADLs) are critical in assessing the independence. Single errors can have considerable impact, as they can lead to institutionalization. Thus, optimal recommendations regarding independence depends on an accurate analysis of IADL, including a fine grain analysis of the type of critical errors. Our study aim to describe the errors produced by older adults from the dementia continuum (AD, MCI and older adults living in the community with no dementia) when performing IADL. More specifically, our objectives are to understand: (1) What are the main types of errors occurring during IADL and (2) When are these errors more likely to occur.MethodWe conducted a performance based IADL assessment with older adults (n = 24), including 7 with AD, 8 with MCI, and 9 without dementia. We used the IADL Profile[1], which is a standardized assessment based on ecological observation of 8 IADL tasks. For each task, observations of performance are grouped into 4 operations: (1) formulate a goal, (2) plan, (3) execute, and (4) achieve the goal. Based on video recordings of the sessions, participants performances were transcribed into verbatim reports of all the errors that occurred. Deductive qualitative analysis and descriptive statistical analysis (standard deviation and correlation) were used to categorize/count the main type of errors for each task.ResultOur results highlighted that (1) older adults make several errors while performing IADLs, with a higher occurrence according to the advancement along the dementia continuum and some of which may be crucial to the person’s independence; (2) the most frequent errors for all participants were in formulating a goal and in planning a task and (3) these errors are likely to occur during grocery shopping and meal preparation.ConclusionThe fine grain analysis of errors during the performance of IADL allows us to better identify the needs of older adults from the dementia continuum that can service to guide the selection of effective strategies that can optimize their safety and functional independence.[1] Bottari et al. (2009)

Ecological validity reconsidered: the Night Out Task versus the D-KEFS

ABSTRACT Introduction Although executive functioning (EF) correlates with execution of instrumental activities of daily living (IADLs), tests of EF have been criticized for having poor ecological validity. Attempts have been made to develop new tests that approximate naturalistic daily tasks. However, the incremental utility of such tests has not been convincingly demonstrated. The Night Out Task (NOT) is a novel measure designed to increase ecological validity. This study examined whether the NOT correlates with traditional lab- and home-based measures of EF and IADLs, and whether it outperforms traditional measures of EF in predicting IADLs. Method Participants (50 adults aged 60 to 95) completed (1) the Delis Kaplan Executive Function System (D-KEFS) and IADLs in the laboratory, and (2) ecological momentary assessment of EF and daily IADL tasks at home across three weeks (using the Daily Assessment of Independent Living and Executive Skills protocol; DAILIES). Results The NOT correlated with a lab-based measure of EF beyond covariates, and lab-based IADLs beyond covariates and beyond the D-KEFS. However, it was unrelated to at-home variables beyond covariates. In contrast, the D-KEFS was a significant predictor of at-home IADLs, and this association was mediated by at-home EF performance. Conclusion This study provides a preliminary validation of the NOT as a correlate of office-based performances in a primarily college educated white sample. Despite its high face validity, the NOT does not appear to sufficiently tap EF processes needed for home-based IADLs as measured by the DAILIES, although small sample size limits the interpretability of this negative finding.

Latent Classes of First Incident Difficulty in Instrumental Activities of Daily Living

Ability to perform instrumental activities of daily living (IADLs) deteriorates during prodromal Alzheimer’s disease (AD), eventually leading to impaired everyday functioning and dementia. Ordering and timing of IADL difficulty onset may identify individuals at greater risk of cognitive impairment, but most studies only consider total number of difficult tasks. Leveraging longitudinal data from the Advanced Cognitive Training in Independent and Vital Elderly (ACTIVE) Study who entered free of any IADL difficulty (N=1266), we hypothesized that a latent class analysis based on timing of first reported IADL task difficulty would reveal class differences in cognitive functioning . Participants were followed until they self-reported at least one IADL difficulty, study completion (10 years), or loss to follow-up. Discrete-time multiple event process survival mixture (MEPSUM) models were used to simultaneously estimate hazards of incident IADL task difficulty across 7 task groups. Two, 3, 4, and 5 latent class models were fit to the data. Both unadjusted and covariate-adjusted models (adjusted for age, sex, race, education, marital status, and general health rating) were fit. Using the 2-class solution as the most parsimonious model, model entropy was 0.855. The model was able to distinguish a class of participants with lower global cognitive factor scores at baseline (Cohen’s D = 0.23, P = 0.04). We conclude that first incident IADL difficulty may be a useful measure in identifying individuals with worse cognitive functioning.

Daily Assessment of Executive Functioning and Expressive Suppression Predict Daily Functioning among Community-Dwelling Older Adults.

Executive functioning (EF) is known to be associated with performance of instrumental activities of daily living (IADLs). However, prior research has found that the degree to which EF fluctuates was more predictive of self-reported cognitive and IADL lapses than was average EF performance. One source of such EF fluctuations is engagement in an emotion regulation strategy known as expressive suppression (ES). Importantly, ES has also been shown to relate to IADL performance, presumably due to its impact on EF. However, past research is limited due to assessing IADLs only in the laboratory or via self-report. The present study examined (a) the association of daily EF and ES fluctuations with performance of actual IADL tasks in participants' homes, and (b) whether any significant association between ES fluctuations and daily IADLs would be mediated by daily EF variability. Participants were 52 older adults aged 60 to 95. Over the course of 18 days while at home, participants completed daily IADL tasks as well as daily measures of EF and ES via ecological momentary assessment. Contrary to our hypothesis, average EF across days predicted at-home IADLs above and beyond daily EF variability, which itself was also predictive. ES variability also predicted daily IADLs, and this association was fully mediated by average daily EF. Daily fluctuations in ES appear to have a deleterious impact on performance of IADLs at home, likely due to the impact of such fluctuations on EF, although the average level of EF capacity is also important.

A-150 Comparison of a Traditional and a Novel Measure of Executive Functioning in Predicting Daily Task Performance

Abstract Objective Executive functioning (EF) is known to be associated with performance of instrumental activities of daily living (IADLs). However, traditional EF assessment takes place in the lab under ideal circumstances, which does not take into account the complexity of daily life, such as the need to interleave tasks. The present study aimed to examine whether a novel ecologically valid measure of EF that requires interleaving of activities, the “Night Out Task” (NOT), better predicted daily at-home IADL performance than a traditional EF measure. Method Participants were 49 healthy, community-dwelling older adults aged 60–95 (Mage = 69.35, SD = 6.51, 63.3% female, 100% non-Hispanic White). Participants completed both a traditional (Delis Kaplan Executive Function System; D-KEFS) and a novel measure (Night Out Task; NOT) of EF. Over the course of the next 18 days, they completed IADL tasks at home daily as part of the Daily Assessment of Independent Living and Executive Skills (DAILIES) protocol. Results Planning time on the NOT predicted, above and beyond the D-KEFS (p = 0.007, CI = −0.053 to −0.009), whether the DAILIES tasks were completed at all and whether they were completed during a required time frame. NOT accuracy was predictive of how accurately daily tasks were completed, but not above and beyond the D-KEFS (p = 0.131, CI = −0.266 to 1.99). Conclusions The NOT is a novel ecologically valid measure of EF that demonstrated incremental utility beyond the D-KEFS. While the NOT and D-KEFS predicted task accuracy, only the NOT planning time predicted whether participants completed a task.

Cognitive Correlates of Instrumental Activities of Daily Living Performance in Parkinson Disease Without Dementia

ObjectiveTo investigate cognitive correlates of instrumental activities of daily living (IADL) performance among people with Parkinson disease (PD) without dementia. DesignCross-sectional. SettingAcademic medical center. ParticipantsVolunteer sample (N=161) comprising participants with PD without dementia (n=102) and healthy comparison (HC) participants (n=59). InterventionsNot applicable. Main Outcome MeasuresPerformance-based assessment of cognitively-demanding IADL (meal preparation, bill paying, shopping, medication management, small home repair), neuropsychological tests (attentional control/flexibility, planning, working memory, memory, crystallized intelligence), and measures of motor function and other characteristics (eg, depressive symptoms). ResultsThere were no group differences in neuropsychological test performance (P>.06). The PD group performed more poorly than the HC group on a number of cognitive IADL tasks (P<.04). After accounting for the effects of motor impairment and other disease-related characteristics, neuropsychological test performance accounted for a small but unique portion of the variance in performance of all cognitive IADL combined, meal preparation, shopping, and medication management in the PD group (R2=4%-13%; P≤.01). ConclusionsThe PD group had cognitive IADL performance limitations despite being unimpaired on neuropsychological tests. Within PD, neuropsychological test performance accounted for a small but significant portion of the variance in cognitive IADL performance over and above the effects of motor and other impairments. These results support the added value of using performance-based IADL assessments in functional evaluations of individuals with early and mild PD without dementia.

Performance-based IADL evaluation of older adults with cognitive impairment within a smart home: A feasibility study.

IntroductionMild cognitive impairment (MCI) is characterized by subtle deficits that functional assessment via informant‐report measures may not detect. Sensors can potentially detect deficits in everyday functioning in MCI. This study aims to establish feasibility and acceptability of using sensors in a smart home for performance‐based assessments of two instrumental activities of daily living (IADLs).MethodsThirty‐five older adults (>65 years) performed two IADL tasks in a smart home laboratory equipped with sensors and a web camera. Participants’ cognitive states were determined using published criteria including measures of global cognition and comprehensive neuropsychological test batteries. Selected subtasks of the IADL assessment were autonomously captured by the sensors. Total time taken for each task and subtask were computed. A point scoring system captured accuracy and number of attempts. Acceptability of the smart home setup was assessed.ResultsParticipants with MCI (n = 21) took longer to complete both tasks than participants with healthy cognition (HC; n = 14), with significant time differences observed only in "Cost calculation." Completion time for IADL tasks and scores correlated in the expected direction with global cognition. Over 95% of the participants found the smart home assessment acceptable and a positive experience.DiscussionWe demonstrated the feasibility and acceptability of the use of unobtrusive commercially available sensors in a smart home for facilitating parts of the objective assessment of IADL in older adults. Future studies need to identify more IADLs that are suitable for semi‐automated or automated assessments through the use of simple, low‐cost sensors.

Motor neuroprosthesis implanted with neurointerventional surgery improves capacity for activities of daily living tasks in severe paralysis: first in-human experience

BackgroundImplantable brain–computer interfaces (BCIs), functioning as motor neuroprostheses, have the potential to restore voluntary motor impulses to control digital devices and improve functional independence in patients with severe paralysis due...

Incident Instrumental Activities of Daily Living Difficulty in Older Adults: Which Comes First? Findings From the Advanced Cognitive Training for Independent and Vital Elderly Study.

Introduction: Instrumental activities of daily living (IADLs) are complex daily tasks important for independent living. Many older adults experience difficulty with IADLs as their physical and/or cognitive function begins to decline. However, it is unknown in what order IADLs become difficult.Methods: Participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study who were free of IADL difficulty at baseline (N = 1,277) were followed up to 10 years until first reported IADL difficulty. A total of 19 IADL tasks were grouped into seven task categories. A discrete-time multiple-event process survival mixture model (MEPSUM) was used to generate hazard estimates of incident IADL difficulty in seven groups from ages 65 to 80. Hazard estimates were compared in the three intervention groups (memory, inductive reasoning, and speed of information processing) vs. the no-contact control group.Results: A total of 887 (69.5%) participants reported incident difficulty in at least one IADL task category. Compared to individuals who remained free of IADL difficulty, those who reported incident difficulty were more likely to be older, female, and have lower Short Form 36 general health scores. The IADL task categories to first become difficult were housework, managing health care, and phone use. There were no differences by intervention group in the hazard estimates of incident IADL difficulty.Conclusion: Managing health care and phone use are more cognitively demanding IADLs, and individuals who experience difficulty in these tasks first may be more likely to experience cognitive decline. Recognizing early difficulty in managing health care may allow for implementation of compensation strategies to minimize unintentional medication misuse, increased adverse medical events, and unnecessary hospitalization. Training of a specific cognitive domain may not influence ordering of IADL difficulty because IADL tasks require proficiency in, and integration of, multiple cognitive domains.

A French-Greek Cross-Site Comparison Study of the Use of Automatic Video Analyses for the Assessment of Autonomy in Dementia Patients.

Background: At present, the assessment of autonomy in daily living activities, one of the key symptoms in Alzheimer’s disease (AD), involves clinical rating scales. Methods: In total, 109 participants were included. In particular, 11 participants during a pre-test in Nice, France, and 98 participants (27 AD, 38 mild cognitive impairment—MCI—and 33 healthy controls—HC) in Thessaloniki, Greece, carried out a standardized scenario consisting of several instrumental activities of daily living (IADLs), such as making a phone call or preparing a pillbox while being recorded. Data were processed by a platform of video signal analysis in order to extract kinematic parameters, detecting activities undertaken by the participant. Results: The video analysis data can be used to assess IADL task quality and provide clinicians with objective measurements of the patients’ performance. Furthermore, it reveals that the HC statistically significantly outperformed the MCI, which had better performance compared to the AD participants. Conclusions: Accurate activity recognition data for the analyses of the performance on IADL activities were obtained.