Measures Of Everyday Functioning Research Articles

Cognitive and everyday functioning after bacterial brain abscess: a prospective study of functional recovery from 8 weeks to 1 year post-treatment

ABSTRACT Objective A bacterial brain abscess may damage surrounding brain tissue by mass effect, inflammatory processes, and bacterial toxins. The aim of this study was to examine cognitive and functional outcomes at 8 weeks and 1 year following acute treatment. Methods Prospective study of 20 patients with bacterial brain abscess (aged 17–73 years; 45% females) with neuropsychological assessment at 8 weeks and 1 year post-treatment. Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) and Patient Competence Rating Scale (PCRS) were used to assess everyday functioning and administered to patients and informants. Results Cognitive impairment was found in 30% of patients at 8 weeks and 22% at 1 year. Significant improvements were seen on tests of perceptual reasoning, attention, verbal fluency, and motor abilities (p < 0.05). At 1 year, 45% had returned to full-time employment. Nevertheless, patients and their informants obtained scores within the normal range on measures of everyday functioning (PCRS and BRIEF-A) at 8 weeks and 1 year. No significant improvements on these measures emerged over time. Conclusion Residual long-term cognitive impairment and diminished work ability affected 22% and 45% of patients one year after BA. Persistent cognitive impairment emphasizes the importance of prompt acute treatment and cognitive rehabilitation.

Relationship between a novel virtual reality test of mild functional difficulties and cerebrovascular disease

AbstractBackgroundIt is well known that mild cognitive impairment (MCI) is associated with subtle functional decline. However, standardized and cost‐effective methods for the objective quantification of mild functional difficulties are lacking. Here we report preliminary validity data for a novel, non‐immersive virtual‐reality task (Virtual Kitchen Challenge [VKC]) against brain markers of cerebrovascular disease and in contrast to a conventional, self‐report measure of function.MethodTwenty (n = 14 healthy control, n = 6 MCI) community‐dwelling older adults aged 60+ completed neuropsychological testing, including the Functional Activities Questionnaire (FAQ), and the VKC, which requires completion of simulated breakfast and lunch tasks on a touch‐screen computer. White matter hyperintensity (WMH) volumes from Fluid Attenuation Inversion Recovery (FLAIR) MRI sequences were derived using the UBO detector, a cluster‐based WMH extraction pipeline based on k‐nearest neighbors (k‐NN) algorithm. WMH volumes were calculated in SPM’s DARTEL space, precluding the need to adjust for intracranial volume (ICV).ResultMCI participants reported significantly more functional difficulties than healthy controls (FAQ U = 76.50 p = .002) and obtained marginally slower completion times on the VKC (U = 60.00, p = .138). VKC completion time was moderately associated with age (r = .441, p = .059) but relations with sex, race, and IQ were weak and not significant (all rs&lt;.195). VKC completion time significantly and strongly correlated with all WMH measures, even after controlling for age, sex, race, and IQ (total WMH r = .649, p = .031; deep WMH r = .615, p = .044; periventricular WMH r = .623, p = .041). By contrast, FAQ was not associated with WMH (rs&lt;.2, p&gt;.05 for all) or VKC completion time (r&lt;.1, p&gt;05) after controlling for age, sex, race, and IQ.ConclusionOur naturalistic, performance‐based measure of function (VKC) was not associated with race, sex, or premorbid IQ, but was strongly associated with neuroimaging markers of cerebrovascular disease (WMH). By contrast, a conventional self‐report measure of everyday functioning (FAQ) was not associated with neuroimaging measures (WMH). These results offer preliminary support for the VKC as a valid measure of early, subtle functional difficulties associated with cerebrovascular pathology that is not vulnerable to bias associated with race, sex, or premorbid IQ.

Relationship between a novel virtual reality test of mild functional difficulties and cerebrovascular disease

AbstractBackgroundIt is well known that mild cognitive impairment (MCI) is associated with subtle functional decline. However, standardized and cost‐effective methods for the objective quantification of mild functional difficulties are lacking. Here we report preliminary validity data for a novel, non‐immersive virtual‐reality task (Virtual Kitchen Challenge [VKC]) against brain markers of cerebrovascular disease and in contrast to a conventional, self‐report measure of function.MethodTwenty (n = 14 healthy control, n = 6 MCI) community‐dwelling older adults aged 60+ completed neuropsychological testing, including the Functional Activities Questionnaire (FAQ), and the VKC, which requires completion of simulated breakfast and lunch tasks on a touch‐screen computer. White matter hyperintensity (WMH) volumes from Fluid Attenuation Inversion Recovery (FLAIR) MRI sequences were derived using the UBO detector, a cluster‐based WMH extraction pipeline based on k‐nearest neighbors (k‐NN) algorithm. WMH volumes were calculated in SPM’s DARTEL space, precluding the need to adjust for intracranial volume (ICV).ResultMCI participants reported significantly more functional difficulties than healthy controls (FAQ U = 76.50 p = .002) and obtained marginally slower completion times on the VKC (U = 60.00, p = .138). VKC completion time was moderately associated with age (r = .441, p = .059) but relations with sex, race, and IQ were weak and not significant (all rs&lt;.195). VKC completion time significantly and strongly correlated with all WMH measures, even after controlling for age, sex, race, and IQ (total WMH r = .649, p = .031; deep WMH r = .615, p = .044; periventricular WMH r = .623, p = .041). By contrast, FAQ was not associated with WMH (rs&lt;.2, p&gt;.05 for all) or VKC completion time (r&lt;.1, p&gt;05) after controlling for age, sex, race, and IQ.ConclusionOur naturalistic, performance‐based measure of function (VKC) was not associated with race, sex, or premorbid IQ, but was strongly associated with neuroimaging markers of cerebrovascular disease (WMH). By contrast, a conventional self‐report measure of everyday functioning (FAQ) was not associated with neuroimaging measures (WMH). These results offer preliminary support for the VKC as a valid measure of early, subtle functional difficulties associated with cerebrovascular pathology that is not vulnerable to bias associated with race, sex, or premorbid IQ.

Self-reported eye contact sensitivity and face processing in chromosome 22q11.2 deletion syndrome

ABSTRACT Introduction 22q11.2 deletion syndrome (22qDS) has been associated with varying levels of social impairments, and with atypical visual scanning of faces. The present study explored whether self-reported sensitivity to eye contact might be related to these phenomena. Method Individuals with confirmed 22qDS were interviewed about their experience and possible discomfort with eye contact. In cases where individuals expresesed discomfort, they were subsequently asked about coping mechanisms used to deal with this discomfort. In addition to self-reported eye contact discomfort, gaze to emotional faces was examined using eye tracking. Results In the subgroup of individuals who reported discomfort during eye contact, eye tracking results revealed a lower amount of gaze in the eyes of neutral faces, as well as the absence of the typical left visual field (LVF) bias, indicative of alterations in hemispheric lateralization. This subgroup also scored lower on a measure of everyday functioning. Conclusions Our results show that, by simply asking individuals with this social and communicative disorder about eye gaze discomfort, we may better understand the specific challenges that they experience. Moreover, information gained from such first-person reports together with eye-tracking measures further informs about the integrity of their face processing system, as well as about the nature and degree of impairment in this population.

Two-year clinical trial examining the effects of speed of processing training on everyday functioning in adults with human immunodeficiency virus-associated neurocognitive disorder (HAND) and borderline HAND in the U.S. Deep South: Findings of the Think Fast Study

Many people living with human immunodeficiency virus (HIV) (PLWH) experience cognitive decline that impairs everyday functioning. Cognitive training approaches, such as speed of processing (SOP) training, may reduce the impact of HIV-Associated Neurocognitive Disorder (HAND) on everyday functioning. In this experimental design study called the Think Fast Study, 216 participants age 40 and older with HAND or borderline HAND were randomized to one of three groups: (1) 10 h of SOP training (n = 70); (2) 20 h of SOP training (n = 73); or (3) 10 h of Internet Navigation Control Training (a contact control group; n = 73). Participants completed several everyday functioning measures at baseline, posttest, and year 1 and year 2 follow ups, which included: (a) Modified Lawton and Brody Activities of Daily Living (ADL) Questionnaire; (b) Timed Instrumental Activities of Daily Living (TIADL) Test; (c) Patient’s Assessment of Own Functioning (PAOFI); (d) Medication Adherence Questionnaire (MAQ); and (e) Medication Adherence Visual Analog Scale (VAS). Linear mixed-effect models and generalized estimating equation models were fitted to estimate between group differences at all follow-up time points. At follow-up timepoints, those in the 10-h and 20-h training groups had better scores on medication adherence measures (MAQ and VAS) than those in the control group, with effects (Cohen’s d) ranging 0.13–0.41 for MAQ and 0.02–0.43 for VAS. In conclusion, SOP training improved some indicators of everyday functioning, specifically medication adherence; however, the therapeutic effects diminished over time. Implications for practice and research are posited.

Baseline Differences in Driving Frequency as a Predictor of Cognitive Decline and Alzheimer's Disease.

To extend prior research by examining daily driving frequency as a predictor of cognitive decline and later diagnosis of Alzheimer's disease. 1,426 older adults completed batteries of questionnaires and neuropsychological tests at baseline and yearly follow-ups (M = 6.8, SD = 4.9). Linear mixed effects models were estimated to examine whether daily driving frequency at baseline was predictive of cognitive decline while accounting for IADLs, mobility, depression, and demographics. Cox regression was used to examine driving frequency as a predictor of Alzheimer's disease diagnosis. Less daily driving frequency was associated with greater decline in all cognitive domains over time except for working memory. Although driving frequency was associated with these changes in cognition, it did not uniquely predict the development of Alzheimer's disease when accounting for other factors (eg, other IADLs). Our findings extend prior research linking driving cessation to greater levels of cognitive decline. Future work might benefit from examining the utility of driving habits (especially changes in driving) as measures of everyday functioning in older adult evaluations.

Correlating continuously captured home-based digital biomarkers of daily function with postmortem neurodegenerative neuropathology.

Outcome measures available for use in Alzheimer's disease (AD) clinical trials are limited in ability to detect gradual changes. Measures of everyday function and cognition assessed unobtrusively at home using embedded sensing and computing generated "digital biomarkers" (DBs) have been shown to be ecologically valid and to improve efficiency of clinical trials. However, DBs have not been assessed for their relationship to AD neuropathology. The goal of the current study is to perform an exploratory examination of possible associations between DBs and AD neuropathology in an initially cognitively intact community-based cohort. Participants included in this study were ≥65 years of age, living independently, of average health for age, and followed until death. Algorithms, run on the continuously-collected passive sensor data, generated daily metrics for each DB: cognitive function, mobility, socialization, and sleep. Fixed postmortem brains were evaluated for neurofibrillary tangles (NFTs) and neuritic plaque (NP) pathology and staged by Braak and CERAD systems in the context of the "ABC" assessment of AD-associated changes. The analysis included a total of 41 participants (M±SD age at death = 92.2±5.1 years). The four DBs showed consistent patterns relative to both Braak stage and NP score severity. Greater NP severity was correlated with the DB composite and reduced walking speed. Braak stage was associated with reduced computer use time and increased total time in bed. This study provides the first data showing correlations between DBs and neuropathological markers in an aging cohort. The findings suggest continuous, home-based DBs may hold potential to serve as behavioral proxies that index neurodegenerative processes.

A pilot study of cognition and creativity among persons with HIV disease referred for neuropsychological evaluation.

Creativity can help people to innovate, overcome obstacles, and successfully navigate challenges in daily life. Some aspects of creativity rely on the prefrontostriatal loops and executive functions, which can be compromised in persons with HIV (PWH). This pilot study examined whether neuropsychological functioning plays a role in creativity in PWH. A consecutive series of 41 PWH who were referred to an urban neuropsychology clinic in southeastern Texas were enrolled. Participants completed the Abbreviated Torrance Test for Adults (ATTA) to measure creativity, from which standardized creativity scores of fluency, originality, elaboration, and flexibility were derived. Participants also completed several measures of everyday functioning and a brief clinical neuropsychological battery measuring executive functions, motor skills, memory, and visuoconstruction. Global neuropsychological functioning showed a large, positive association with ATTA creativity performance that did not vary meaningfully by creativity domain and was independent of premorbid IQ. ATTA creativity scores were not associated with any measure of everyday functioning. Findings from this pilot study suggest that higher levels of neuropsychological functioning may support multiple dimensions of creativity in adults with HIV disease. Future studies might examine whether creativity moderates the association between HIV-associated neurocognitive impairment and various health behaviors (e.g., adherence, appointment attendance).

Error relationship to an everyday monitoring in mild cognitive impairment: Cognitive correlates and task

AbstractBackgroundAccurate error monitoring is important for successful completion of everyday tasks and use of compensatory strategies. This work examined error monitoring in individuals with amnestic MCI (aMCI) as compared to healthy older adults (HOA) using a computerized task. We also examined cognitive domains associated with error monitoring and the contribution of error monitoring to objective and self‐reported measurement of everyday functioning.MethodsTwenty‐four individuals with aMCI and 24 HOAs were administered a battery of neuropsychological tests (domains assessed: attention, working memory, executive functioning, memory, language, visuospatial abilities); a sustained attention task that included an error‐monitoring score (Sustained Attention to Response Task; SART); a naturalistic, performance‐based measure of everyday functioning (Day Out Task; DOT); and self‐ and informant‐report measures that captured everyday dysexecutive difficulties (DEX).Results T‐test comparisons revealed the aMCI group (M = 0.48; SD = 0.22) exhibited poorer error monitoring (measured by the number of accurately self‐corrected errors on the SART divided by total errors) compared to the HOA group (M = 0.71; SD = 0.23), d = 1.02. Partial correlation analyses with age as a covariate revealed significant correlations between the error monitoring score and the cognitive domains of working memory and executive functioning for both the aMCI group and the HOA group. Hierarchical regression analyses revealed that after accounting for age and global cognitive status, the SART error monitoring score significantly predicted DOT total time, but not accuracy, as well as both self‐ and informant DEX scores.ConclusionThis study revealed that the ability to recognize errors was significantly poorer in individuals with aMCI compared to HOAs and most associated with the cognitive domains of executive functioning and working memory. After controlling for age and general cognitive status, error monitoring predicted performance in everyday functioning as assessed by a naturalistic, performance‐based test and questionnaires assessing everyday dysexecutive difficulties. This suggests that if individuals with aMCI do not recognize performance inaccuracies, they will not be able to correct errors, leading to mistakes in everyday task completion and reduction in implementation of appropriate compensatory strategies. These results implicate error monitoring as a potential target for early interventions with individuals with aMCI.

Can individualized-targeted computerized cognitive training improve everyday functioning in adults with HIV-associated neurocognitive disorder?

Half of people with human immunodeficiency virus (HIV) have HIV-associated neurocognitive disorder (HAND). Fortunately, cognitive training programs can improve function across cognitive domains, which may translate to everyday functioning. The Training on Purpose (TOPS) Study was designed to reverse HAND by targeting cognitive training to specific cognitive impairments that contributed to the diagnosis. A secondary aim of TOPS was to determine whether such cognitive training improved subjective and objective everyday functioning. In this two-group pre–post experimental design study, 109 adults with HAND were randomized to either: (1) a no-contact control group (no training) or (2) the Individualized-Targeted Cognitive Training group. Each participant received approximately 10 hours of cognitive training in two selected cognitive domains based on her/his individual baseline cognitive performance. Thus, 20 hours of individualized training on these two cognitive domains occurred over a course of 12 weeks in 1–2 hour sessions. Specific to the secondary aim of TOPS, measures of everyday functioning were administered before and after cognitive training to examine transfer effects. The analyses revealed that in general, speed of processing training produced benefits in everyday functioning as measured by the medication adherence visual analogue scale and the Timed Instrumental Activities of Daily Living test. Inconsistent findings were found for the other seven cognitive training protocols in either improving everyday functioning or reducing perceived everyday functioning; however, there may be other contributing factors that obscured such effects needing further research. This study demonstrated that some training protocols vary in efficacy in altering both objective and subjective everyday functioning ability.

Cognitive phenotypes in Parkinson's disease: A latent profile analysis.

Neurocognitive disorders in Parkinson's disease (PD) are common and heterogeneous. The aim of this study was to use a data-driven method to describe different cognitive phenotypes in PD and to explore anxiety, depression, and motor disturbances across the different cognitive profiles. Latent profile analysis was applied to the neuropsychological performances of 65 patients with idiopathic PD assessed by means of a battery of tests that encompass measures of attention, memory, executive functions, social cognition, language, and visuospatial abilities. A three-cluster model produced the best solution: Cluster A (21.54%) included patients with intact cognition or with a relatively slight cognitive impairment in memory and executive functioning; Cluster B (53.85%) included patients with an intermediate level of cognitive impairment; and Cluster C (24.61%) included patients with the most severe cognitive impairment, with greater deficit compared to Cluster B in executive functioning, and, notably, in tasks with a predominantly posterior cortical basis (naming and visuospatial abilities). The three subgroups did not differ in terms of age, gender, disease duration, motor symptom severity or side of onset, levodopa equivalent daily dose, level of anxiety, or depression; however, patients from Cluster C showed greater impairment than patients from Cluster A in measures of everyday functioning. We presented a qualitative description of three distinct cognitive phenotypes emerging from a sample of 65 PD patients. The three clusters seem to be related to daily functioning but are independent from the stage of disease, motor functioning, anxiety, and depression. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Cultural Adaptation of the Everyday Problems Test-Greek Version: An Instrument to Examine Everyday Functioning.

Assessing cognitive decline and everyday functioning (EvF) in older age is valuable in detecting age-related neurological disorders. In Greece, there is a lack of sensitive instruments that capture fluctuations in EvF among older persons who are cognitively healthy or have subtle cognitive impairments. The EPT 28-items test, a widely used paper-and-pencil EvF measure, was translated in Greek and adapted to the Greek culture in this study. A multi-step methodology using a sample of 139 older Greek persons was employed. The results indicate that the Greek version of the EPT 28-items (i.e., the EPT-G) was well adapted, representing everyday tasks in Greece within a good range of task difficulty. The psychometric properties of the EPT-G replicate those of the original instrument, capturing EvF fluctuations among older persons with mild cognitive impairments. It was concluded that the EPT-G is a useful measure of EvF among Greek older persons.

Multidisciplinary goal attainment measure (MGAM): A review of stroke client goal-based outcomes within a community rehabilitation setting in Brisbane, Queensland, Australia

Aims: Community rehabilitation is a key component of health services within stroke care. Ongoing challenges exist as to how to best capture outcomes for these services, especially considering the multi-faceted service delivery and flexible focus on individual need. A goal setting tool, such as the multidisciplinary goal attainment measurement (MGAM), may be useful to objectively measure client outcomes that are meaningful and relevant to individuals within this complex environment. This study aims to review MGAM client outcomes within a stroke population in a community rehabilitation context. Methods: Pre and post goal outcome data was collected by multidisciplinary team members with stroke survivors, across the domains of impairment, activity/participation, and knowledge/information. These pre and post scores were compared with each other, as well as a measure of everyday functioning. Results: Clinically significant average change scores and statistically significant changes pre and post intervention were found across all domains on the MGAM. There were no correlations noted between MGAM and length of stay, quality of life and everyday functioning outcomes. Conclusion: As evidenced in the stroke population of this study, MGAM offers a unique outcome measure different to other clinical measures as it captures client outcomes that are relevant and meaningful to individual need across a range of domains within a multi-disciplinary setting. These formalized goal setting practices and outcomes, such as the MGAM, may assist in providing standardized outcome processes across various community rehabilitation settings.

Construct validity, ecological validity and acceptance of self-administered online neuropsychological assessment in adults

Objective: The goal of this project was to explore the initial psychometric properties (construct and ecological validity) of self-administered online (SAO) neuropsychological assessment (using the www.testmybrain.org platform), compared to traditional testing, in a clinical sample, as well as to evaluate participant acceptance. SAO assessment has the potential to expand the reach of in-person neuropsychological assessment approaches.Method: Counterbalanced, within-subjects design comparing SAO performance to in-person performance in adults with diabetes with and without Chronic Kidney Disease (CKD). Forty-nine participants completed both assessment modalities (type 1 diabetes N = 14, type 2 diabetes N = 35; CKD N = 18).Results: Associations between SAO and analogous in-person tests were adequate to good (r = 0.49-0.66). Association strength between divergent cognitive tests did not differ between SAO versus in-person tests. SAO testing was more strongly associated with age than in-person testing (age R2=0.54 versus 0.23), while prediction of education, HbA1c, and estimated glomerular filtration rate (eGFR) did not differ significantly between test modalities (education R2=0.37 versus 0.30; HbA1c R2=0.20 versus 0.12; eGFR R2 = 0.41 versus 0.33). Associations with measures of everyday functioning were also similar (Functional Activities Questionnaire R2=0.08 versus 0.07; Neuro-QoL R2=0.14 versus 0.16; Diabetes Self-Management Questionnaire R2=0.19 versus 0.19).Conclusions: The selected SAO neuropsychological tests had acceptable construct validity (including divergent, convergent, and criterion-related validity), and similar ecological validity to that of traditional testing. These SAO assessments were acceptable to participants and appear appropriate for use in research applications, although further research is needed to better understand the strengths and weaknesses in other clinical populations.

Role of cognitive resources on everyday functioning among oldest-old physically frail.

Everyday functioning becomes a challenge with aging, particularly among frail oldest-old adults. Several factors have been identified as influencing everyday activities realization, including physical and cognitive functioning. However, the influence of cognitive resources as a compensatory factor in the context of physical frailty deserves further consideration. This study aims to investigate in older adults physically frail the possible compensatory role of cognitive resources to perform everyday tasks. Two groups of community-dwelling old participants (n = 26 per group) matched for their age and cognitive resources, have been drawn according to their level of physical functioning. Two measures of everyday functioning have been assessed: one self-reported by the participant (the IADL scale) and one performance-based measure (the TIADL tasks). Participants performed equally the TIADL tasks irrespective of their physical condition. Contrariwise, participants with low physical functioning reported more everyday difficulties than their counterparts with a high level of physical functioning. Additionally, regressions analyses revealed differential influence of cognitive resources on performance and reported measures of everyday functioning. Our data suggests that cognitive resources are more strongly involved in the performance-based IADL measure in situation of physical frailty. Additionally, for participants with low physical functioning, lower cognitive resources are associated with more perceived difficulties in everyday life. These results highlight the compensatory role of cognitive resources in physically frail older adults, and suggest that an overestimation of everyday difficulties compared to performance on IADL tasks is an early indicator of physical decline and cognitive compensation.

Comparing Web-Based and Classroom-Based Memory Training for Older Adults: The ACTIVE Memory Works™ Study.

To compare the efficacy of a web-based versus a classroom-based memory training program in enhancing cognition and everyday functioning in older adults, and program satisfaction and acceptability. Participants (N = 208; mean age = 71.1) were randomly assigned to a web-based or classroom-based training, or to a wait-list control condition. Cognitive and everyday functioning measures were administered at baseline, immediate, and 6 months post-training; both training groups evaluated program satisfaction and acceptability at immediate post-training. Repeated-measures analyses of variance assessed training effects on cognitive and functioning outcomes; independent-samples t tests assessed group differences in program satisfaction and acceptability. Compared to controls, neither training group showed a significant improvement on measures of memory or everyday functioning as assessed by dependence or difficulty on instrumental activities of daily living over time. Training effects did not transfer to non-trained cognitive abilities. The web-based group was as satisfied with the training as the classroom-based group (p > .05). Although no significant training effects were found, we demonstrated that a web-based platform is an acceptable and feasible mode to provide memory training to healthy older adults. Further studies are needed to investigate the potential of web-based memory training programs for improving cognition and function in cognitively healthy older adults.

Adaptive functioning in children with neurofibromatosis type 1: relationship to cognition, behavior, and magnetic resonance imaging.

To characterize the adaptive behavior profile of children with neurofibromatosis type 1 (NF1) and determine its relationship to neuropsychological functioning and non-neoplastic T2-weighted hyperintense brain lesions on brain magnetic resonance imaging (MRI). In this cross-sectional study, we retrospectively reviewed neuropsychological reports from 104 children with NF1 (56 males, 48 females; mean age 10y 4mo; standard deviation [SD] 3y 4mo; range 3y 5mo-17y 6mo), and extracted data from a range of cognitive and behavioral measures, including the Adaptive Behavior Assessment System (ABAS). Brain MRI was retrospectively reviewed in 42 individuals. Adaptive Behavior Assessment System scores were continuously distributed and pathologically shifted by 0.79 to 1.26SD across Conceptual, Social, and Practical domains, and 46.5% of individuals had a composite score in the borderline or impaired range. Impairment in adaptive functioning was correlated with deficits in executive function (r=-9.543, p<0.001), externalizing problems (r=-0.366, p<0.001), and attention (r=-9.467, p=0.001). Cluster analysis revealed three distinct phenotypic subgroups, one of which exhibited normal cognitive ability, but impaired adaptive functioning, with persistent deficits in executive function, behavioral problems, and attention-deficit/hyperactivity disorder symptomatology. There was no relationship between ABAS scores and the number or location of unidentified bright objects. Adaptive functioning deficits are common among children with NF1 and are associated with impairment in other cognitive/behavioral domains, independent of general cognitive ability. Deficits in adaptive behavior are common in children with neurofibromatosis type 1 (NF1). Poor adaptive functioning is associated with impairments in executive function, externalizing behaviors, and attention, regardless of cognitive ability. The presence or location of unidentified bright objects do not predict adaptive behavior skills in children with NF1.

Measuring instrumental activities of daily living in non-demented elderly: a comparison of the new performance-based Harvard Automated Phone Task with other functional assessments

BackgroundImpairment in instrumental activities of daily living (IADL) may occur in the earliest stages of mild cognitive impairment (MCI). However, there are few reliable measures of IADL in MCI or that have a sufficient range of scores in clinically normal (CN) elderly. The objective of this pilot study was to examine the convergent validity of a phone performance-based IADL instrument, the Harvard Automated Phone Task (APT), designed to measure the earliest IADL changes in Alzheimer’s disease (AD), with other sensitive performance-based and subjective measures of everyday functional capacity among CN and MCI participants.MethodsTwenty-nine CN and 17 MCI participants were administered the Harvard APT, the computer performance-based Czaja Functional Assessment Battery (CFAB), and the AD Cooperative Study ADL prevention instrument (ADCS ADL-PI) participant and study partner versions; in addition, 52 different CN and 7 MCI participants were administered the Harvard APT and the Subjective Study Partner and Participant-reported (SSPP) IADL scale. The Harvard APT was compared with the three other IADL assessments.ResultsIn both CN and MCI, better performance on the Harvard APT was associated with better performance on the CFAB. In CN, better performance on the Harvard APT was associated with better ADCS ADL-PI participant-reported IADL, while in MCI better performance on the Harvard APT was associated with better ADCS ADL-PI study partner-reported IADL. Furthermore, in CN better performance on the Harvard APT was associated with better SSPP-IADL participant and study partner-reported IADL.ConclusionsIn this small pilot study, the Harvard APT, a brief, self-administered, objective measure of IADL performance, appears to correlate well with other sensitive measures of everyday functioning, providing good preliminary convergent validity for this new measure. Moreover, it appears to perform well across both CN and MCI participants, which suggests that it is a promising measure of early, clinically meaningful functional change. This may not be the case as suggested in our small sample for subjective IADL scales that may perform differentially depending on the reporter (self vs. study partner) across the clinical spectrum possibly due to diminishing awareness of IADL difficulties in individuals who become cognitively impaired. Secondary prevention trials in AD have a great need for such ecologically valid and reliable measures of early IADL changes.

Everyday Functioning Benefits from an Assisted Living Platform amongst Frail Older Adults and Their Caregivers.

Ambient assisted living technologies (AAL) are regarded as a promising solution to support aging in place. Yet, their efficacy has to be demonstrated in terms of benefits for independent living and for work conditions of caregivers. Hence, the purpose of this study was to assess the benefits of a multi-task AAL platform for both Frail older Individuals (FIs) and professional caregivers with respect to everyday functioning and caregiver burden. In this context, a 6-month field study involved 32 FIs living at home (half of them were equipped by the platform and the remaining half were not, as a control condition) and their caregivers. Everyday functioning measures were reported by frail participants and caregivers. Self-reported burden measures of caregiver were also collected. The main results showed that the caregiver's estimates of everyday functioning of equipped participants were unchanged across time, while they decreased for the control participants. Also, a reduction of self-reported objective burden was obtained after 6 months of AAL intervention for the equipped group, compared to the control group. Overall, these results highlighted the potential of AAL as a relevant environmental support for preventing both functional losses in FIs and objective burden professional caregiver.

Mild Cognitive Impairment and Changes in Everyday Function Over Time: The Importance of Evaluating Both Speed and Accuracy.

Research estimates that a significant percentage of individuals with mild cognitive impairment (MCI) experience functional difficulties. In addition to reduced accuracy on measures of everyday function, cross-sectional research has demonstrated that speed of performing instrumental activities of daily living (IADLs) is slowed in individuals with MCI. The present study investigated whether baseline and longitudinal changes in speed and accuracy of IADL performance differed between persons with MCI and cognitively normal peers. Linear mixed models were used to estimate the group differences in longitudinal performance on measures of IADLs. Assessments were conducted at university and medical research centers. The sample consisted of 80 participants with MCI and 80 control participants who were enrolled in the Alzheimer's Disease Research Center's Measuring Independent Living in the Elderly Study. Instrumental activities of daily living speed and accuracy were directly assessed using selected domains of the Financial Capacity Instrument, the Timed IADL assessment, and driving-related assessments (Useful Field of View, Road Sign Test). Individuals with MCI performed worse on speed and accuracy measures of IADLs in comparison to cognitively normal peers and demonstrated significantly steeper rates of decline over three years in either speed or accuracy in all domains assessed. Both speed and accuracy of performance on measures of IADL are valuable indices for early detection of functional change in MCI. The performance pattern may reflect a trade-off between speed and accuracy that can guide clinical recommendations for maintaining patient independence.