Multidomain Assessment Research Articles

PREDICTING CLINICAL DIAGNOSIS FROM PATTERNS OF IMPAIRED PERFORMANCE ON COMPUTERISED COGNITIVE TESTING IN A MIXED NEUROLOGICAL SAMPLE

Neurodegenerative and neurological diseases affect distinct, though overlapping neural systems. These patterns of pathology result in impairments in specific cognitive domains. The aim of this study was to evaluate the performance of an automated 20-minute touchscreen-based cognitive test battery assessing multiple cognitive domains in predicting clinical diagnosis. 249 (mean age =52.7) patients presenting to a tertiary referral centre were assessed using Cantab Insight: an automated computerised battery which measures episodic memory, working memory, attention, executive function and processing speed, alongside self-reported memory problems (20-point scale) and the Geriatric Depression Scale (GDS). Cognitive scores were adjusted for age, education and gender based on a large normative dataset. Patients were diagnosed according to consensus criteria following structured history, examination, and ancillary tests (MRI brain, HMPAO-SPECT and CSF examination). Diagnoses included a range of neurological and neurodegenerative diseases (e.g. Alzheimer's disease (AD), fronto-temporal dementia (FTD), Parkinson's disease(PD)). Performance on Cantab Insight was not used to inform diagnosis. We constructed a series of logistic classification models using performance on single or multiple cognitive domains, GDS and self-reported memory to predict diagnosis. Model performance was verified using k-fold cross-validation, and ROC curves and confusion matrices were used to assess the accuracy of the models. We focused on diagnosis of AD, PD, FTD as well as participants with subjective cognitive complaints, but no clinical diagnosis. As predicted, different diagnostic groups showed distinct patterns of impaired performance. Logistic regression and classification modelling showed that performance on these tests was able to predict diagnostic group membership with high accuracy (area under the curve > 0.8). For all diagnostic groups, the inclusion of multiple measures of cognition significantly and substantially increased classification accuracy. Cantab Insight is a brief, well-tolerated assessment of different cognitive domains. Logistic classifiers based on performance in these different domains were able to discriminate diagnostic groups with a high degree of accuracy, in an unselected, heterogeneous group patients presenting to a tertiary referral centre. These data support the use of multi-domain assessments of cognition in a clinical setting.

Prediction of conversion to psychosis in individuals with an at-risk mental state: a brief update on recent developments.

So far, only little more than one-third of individuals classified as being at-risk for psychosis have been shown to actually convert to frank psychosis during follow-up. There have therefore been enormous efforts to improve the accuracy of predicting this transition. We reviewed the most recent studies in the field with the aim to clarify whether accuracy of prediction has been improved by the different research endeavors and what could be done to further improve it, and/or what alternative goals research should pursue. A total of 56 studies published between May 2015 and December 2016 were included, of which eight were meta-analyses. New meta-analytical evidence confirms that established instruments for checking clinical risk criteria have an excellent clinical utility in individuals referred to high-risk services. Within a such identified group of ultra-high-risk (UHR) individuals, especially Brief Limited Intermittent Psychotic Symptoms and Attenuated Psychotic Symptoms seem to predict transition. Further assessments should be performed within the UHR individuals, as risk of transition seems particularly high in those with an even higher severity of certain symptoms such as suspiciousness or anhedonia, in those with lower global or social functioning, poor neurocognitive performance or cannabis abuse. Also, electroencephalography, neuroimaging and blood biomarkers might contribute to improving individual prediction. The most promising approach certainly is a staged multidomain assessment. Risk calculators to integrate all data for an individualized prediction are being developed. Prediction of psychosis is already possible with an excellent prognostic performance based on clinical assessments. Recent studies show that this accuracy can be further improved by using multidomain approaches and modern statistics for individualized prediction. The challenge now is the translation into the clinic with a broad clinical implementation.

Learning disabilities among extremely preterm children without neurosensory impairment: Comorbidity, neuropsychological profiles and scholastic outcomes

BackgroundChildren born extremely preterm are at high risk for intellectual disability, learning disabilities, executive dysfunction and special educational needs, but little is understood about the comorbidity of intellectual and learning disabilities in this population. AimsThis study explored comorbidity in intellectual disability (ID) and learning disabilities (LD) in children born extremely preterm (EP; <26+0weeks' gestation). Subjects and study designA UK national cohort of 161 EP children and 153 term-born controls without neurosensory impairments was assessed at 11years of age (the EPICure Study). Outcome measuresIQ, mathematics and reading attainment, executive function, visuospatial processing and sensorimotor skills were assessed using standardised tests, and curriculum-based attainment and special educational needs (SEN) using teacher reports. ResultsOverall, 75 (47%) EP children and 7 (4.6%) controls had ID or LD (RR 10.12; 95% CI 4.81, 21.27). Comorbidity in ID/LD was more common among EP children than controls (24% vs. 0%). EP children with comorbid ID/LD had significantly poorer neuropsychological abilities and curriculum-based attainment than EP children with an isolated disability or no disabilities. LD were associated with a 3 times increased risk for SEN. However, EP children with ID alone had poorer neuropsychological abilities and curriculum-based attainment than children with no disabilities, yet there was no increase in SEN provision among this group. ConclusionsEP children are at high risk for comorbid intellectual and learning disabilities. Education professionals should be aware of the complex nature of EP children's difficulties and the need for multi-domain assessments to guide intervention.

"Peaks, Slumps, and Bumps": Individual Differences in the Development of Creativity in Children and Adolescents.

This article reviews developmental studies of creativity in children and adolescents with a focus on "peaks" and "slumps" that have often been described in the literature. The irregularity of the development of creativity is interpreted in light of conceptual and measurement issues and with regard to the interaction between individual-level resources, task-specific demands, and environmental influences, resulting in apparent individual differences in the development of creativity. The need for longitudinal designs, multidimensional and multi-domain assessment of creative potential limiting the contribution of task-specific factors is outlined and discussed as an important direction for developmental research on creativity.

The utility of a multidomain assessment of steroid response for predicting clinical response to omalizumab

The utility of a multidomain assessment of steroid response for predicting clinical response to omalizumab

Impact of Frailty on Hematopoietic Cell on Early Transplant Outcomes in Older Recipients

▪Introduction: With improvements in transplant strategy and supportive care, hematopoietic cell transplantation (HCT) is increasingly being used to treat older patients (60-80 years). Frailty is a well-accepted phenomenon in the geriatric population characterized by diminished physiological reserve and increased vulnerability to stress, with strong associations with falls, disability, hospitalization and mortality. Since HCT is a substantial stressor, we hypothesized that the prevalence of frailty and pre-frailty will increase in the immediate post-transplant period, and that frailty will be associated with early (1y) post-transplant non-relapse mortality (NRM).Methods: We conducted a prospective, longitudinal study of 96 patients undergoing HCT at age 40y or older between February 2014 and April 2015, and serially performed a multi-domain geriatric assessment (incorporating function, comorbidity, cognition, psychological state, social activity/support, and nutritional status) in additional to demographic, transplant and disease related variables. Frailty was defined by presence of 3 or more of the following criteria: unintentional weight loss, exhaustion, weakness, slow walking speed and low physical activity; pre-frailty was defined by presence of 1 or 2 of the criteria. Geriatric assessments were performed pre-HCT and at 100 days, 6 months and 1 year post HCT. The prevalence of frailty and pre-frailty was evaluated at each time point in older (60-74y, n=48) vs. younger (40-59y, n=48) recipients. Longitudinal assessments (baseline, 100 days, 6 months, 1 year) of ordinal frailty measures were assessed using random effects and non-linear mixed logistic regression models. Impact of frailty on 1 year NRM was estimated using cumulative incidence estimates.Results: Older patients were more likely to undergo reduced intensity conditioning, and less likely to be employed at HCT. The prevalence of frailty increased with time since HCT: The prevalence of frailty was 8% at baseline and increased to 39% by 6 months (<0.01). The prevalence of pre-frailty was 44% at baseline and remained at 45% by 6 months. The prevalence of frailty and pre-frailty did not differ in the younger vs. older age groups at any time point and was independent of the baseline HCT-comorbidity index (HCT-CI).In the random effects model for frailty, increasing time from transplant was associated with a 3.7 times higher odds of frailty (OR: 3.7, 95% CI: 1.9-7.2, p< 0.01). Other variables associated with a higher odds of frailty were pre-transplant employment status (retired: OR: 7.3, 95% CI: 1.2-46.2, p= 0.03); patients on medical leave or disabled (OR: 11.2, 95% 1.8-67.7, p=0.01), limitations in social activities (OR: 1.04, 95% CI: 1.01-1.07, p< 0.01), and type of HCT (allogeneic vs. autologous: OR: 3.1, 95% CI: 0.9-10.2, P=0.06). Baseline pre-frailty was associated with a 3.1 times odds of subsequently developing frailty (OR: 3.1, 95% CI: 2.3-45.5, P< 0.01)Despite only limited follow up to date in this recent cohort, we identified a trend towards increasing non-relapse mortality (NRM) in frail patients. The cumulative incidence of NRM at one year was 7% (95% CI: 0-14%) in the non-frail group, 23% (95% CI: 8-38%) in the pre-frail group and 28% (95% CI: 0-57%) in the frail group (p-value for trend= 0.07).Conclusion: Independent of specific medical co-morbidities or the HCT-CI, frailty was noted in 8%, and pre-frailty in 44% of our HCT population prior to HCT, and was not dependent on age. Frailty is a transitional state and appears to reflect a dynamic progression from robustness to functional decline with time since HCT. It is associated with a higher mortality, indicating a need to identify vulnerable populations and define their need for specific interventions. DisclosuresNo relevant conflicts of interest to declare.

Desperately Seeking Sustainability: Urban Shrinkage, Land Consumption and Regional Planning in a Mediterranean Metropolitan Area

Land degradation has expanded in the Mediterranean region as a result of a variety of factors, including economic and population growth, land-use changes and climate variations. The level of land vulnerability to degradation and its growth over time are distributed heterogeneously over space, concentrating on landscapes exposed to high human pressure. The present study investigates the level of land vulnerability to degradation in a shrinking urban area (Rome, Italy) at four points in time (1960, 1990, 2000 and 2010) and it identifies relevant factors negatively impacting the quality of land and the level of landscape fragmentation. A multi-domain assessment of land vulnerability incorporating indicators of climate quality, soil quality, vegetation quality and land management quality was carried out based on the Environmentally Sensitive Area (ESA) framework. The highest rate of growth in the level of land vulnerability was observed in low-density suburban areas. The peri-urban mosaic formed by coastal woodlands and traditional cropland preserved high-quality land with a stable degree of vulnerability over time. Evidence suggests that the agro-forest mosaic surrounding Mediterranean cities act as a “buffer zone” mitigating on-site and off-site land degradation. The conservation of relict natural landscapes is a crucial target for multi-scale policies combating land degradation in suburban dry regions.

32 * SINGLE SCREENING QUESTIONS FOR COGNITIVE IMPAIRMENT IN OLDER PEOPLE; A SYSTEMATIC REVIEW

Scope: Single item screening questions may be a practical first step in screening for cognitive problems in older people. A form of single item cognitive assessment is proposed in the NHS England and Wales dementia strategy. Our objective was to provide a review and synthesis of the evidence regarding the performance of single item tests for detection of cognitive impairment. Search methods: We performed a systematic review using Cochrane diagnostic test accuracy procedures. Two independent researchers searched for relevant papers across multiple, cross disciplinary electronic databases using previously validated search strings. Our index test of interest was any single screening question for cognitive impairment, including single items derived from factor analysis of multi-item tools. Our reference standards included clinical diagnosis (dementia, delirium and mild cognitive impairment) and accepted cut-offs on multi-domain cognitive assessments. We assessed risk of bias and external validity using the QUADAS-2 tool. Results: From 884 initial titles 11 studies were identified as eligible for inclusion in this review. Four studies were graded low risk of bias and recruited a representative patient sample. Clinical heterogeneity precluded formal meta-analysis. Five papers described a single screening question for cognitive impairment, each used a differing single question. Sensitivity ranged from 96% to 26%; specificity 45% to 100% depending on setting and question used. Six papers described component analysis of multiple item tools, in general broadly worded single questions around “decline in memory function”; “changes in ability to think and reason” or “learning new things” performed well. Conclusions: Informant based single item screening questions show promise for detection of cognitive impairment. However, there was substantial heterogeneity in format / application of single item screening tools and several papers had methodological or generalizability issues. Without further high quality test accuracy studies, we would not recommend large scale screening using a single item approach.

A resting state functional magnetic resonance imaging study of concussion in collegiate athletes.

Sports-related concussions are currently diagnosed through multi-domain assessment by a medical professional and may utilize neurocognitive testing as an aid. However, these tests have only been able to detect differences in the days to week post-concussion. Here, we investigate a measure of brain function, namely resting state functional connectivity, which may detect residual brain differences in the weeks to months after concussion. Twenty-one student athletes (9 concussed within 6months of enrollment; 12 non-concussed; between ages 18 and 22years) were recruited for this study. All participants completed the Wisconsin Card Sorting Task and the Color-Word Interference Test. Neuroimaging data, specifically resting state functional Magnetic Resonance Imaging data, were acquired to examine resting state functional connectivity. Two sample t-tests were used to compare the neurocognitive scores and resting state functional connectivity patterns among concussed and non-concussed participants. Correlations between neurocognitive scores and resting state functional connectivity measures were also determined across all subjects. There were no significant differences in neurocognitive performance between concussed and non-concussed groups. Concussed subjects had significantly increased connections between areas of the brain that underlie executive function. Across all subjects, better neurocognitive performance corresponded to stronger brain connectivity. Even at rest, brains of concussed athletes may have to 'work harder' than their healthy peers to achieve similar neurocognitive results. Resting state brain connectivity may be able to detect prolonged brain differences in concussed athletes in a more quantitative manner than neurocognitive test scores.

Older adults have diminished awareness of errors in the laboratory and daily life.

Poor recognition of the degree or scope of one's own cognitive deficits is a common feature of many neurological conditions, including diseases of aging, but little is known about the impact the natural aging process has on this aspect of self-awareness (SA). Here, a group of 45 healthy older adults and a comparison group of 45 young adults completed a multidomain assessment of SA. Awareness of daily functioning was evaluated based on discrepancies between self- and informant ratings on questionnaire measures of attentional control, memory functioning, and socioemotional functioning. Online error awareness was also assessed using a variant of the Go/No-Go Error Awareness Task (EAT) in which participants are required to signal commission errors via a separate manual response. Whereas younger participants tended to underestimate their attentional control and memory functioning relative to informant reports, older adults significantly overestimated their abilities. The older adults also exhibited substantially poorer online error awareness compared with young adults, despite the fact that the two groups were matched for overall accuracy. Levels of online error awareness were significantly correlated with discrepancy scores for daily attentional and memory functioning, and with performance of a sustained attention task. These novel findings suggest that an important aspect of the neuropsychology of healthy aging has hitherto been overlooked.

A Proposed Multisite Double-Blind Randomized Clinical Trial of Neurofeedback for ADHD

Objective: Additional treatments with persisting benefit are needed for ADHD. Because ADHD often shows excessive theta electroencephalogram (EEG) power, low beta, and excessive theta-beta ratio (TBR), a promising treatment is neurofeedback (NF) downtraining TBR. Although several nonblind randomized clinical trials (RCTs) show a medium-large benefit for NF, a well-blinded, sham-controlled RCT is needed to differentiate specific from nonspecific effects. Method: Experts in NF, ADHD, clinical trials, and statistics collaborated to design a double-blind multisite RCT. Results/Conclusion: At four sites, 180 children aged 7 to 10 years with rigorously diagnosed ADHD and TBR ≥ 5 will be randomized to active TBR-NF versus sham NF of equal duration, intensity, and appearance. Sham, utilizing prerecorded EEGs with participant artifacts superimposed, will keep participants and staff blind. Treatment fidelity will be trained/monitored by acknowledged NF leaders. Multidomain assessments before, during, and after treatment (follow-up to 2 years) will also include tests of blinding and sham inertness.

How poorer quality of life in adolescence predicts subsequent type 1 diabetes management and control

ObjectiveDetriments in quality of life (QOL) may contribute to the common, costly decline in adolescents’ type 1 diabetes management and control, yet we know little about how this might happen. MethodsParticipants were 150 adolescents (age 13–18) with type 1 diabetes and their parents. We constructed a latent QOL variable from a multi-informant, multi-domain assessment when participants entered the study. The QOL variable was examined in relation to prospective assessments of diabetes management (blood glucose monitoring frequency; BGM) and control (hemoglobin A1c). We used an indirect path model to test the links among these variables, using bias-corrected bootstrapping. ResultsPoorer QOL at baseline was indirectly linked with higher A1c at 12 months via less frequent BGM obtained at 6 months (b=−0.01, 95% CI=−0.025, −0.004, p<0.05). Older age (b=−0.32), longer diabetes duration (b=−0.07), and insulin delivery via injections versus the insulin pump (b=0.67) were covariates of less frequent BGM, and unmarried caregiver status was associated with higher A1c (b=−0.76), all ps<0.05. ConclusionsIn this study, poorer QOL acted as a barrier to effective diabetes management, subsequently altering diabetes control. Practice implicationsEfforts to monitor and enhance QOL may hold promise for improving adolescents’ diabetes outcomes in the future.

Family Conflict, Emotional Security, and Child Development: Translating Research Findings into a Prevention Program for Community Families

The social problem posed by family conflict to the physical and psychological health and well-being of children, parents, and underlying family relationships is a cause for concern. Inter-parental and parent-child conflict are linked with children's behavioral, emotional, social, academic, and health problems, with children's risk particularly elevated in distressed marriages. Supported by the promise of brief psycho-educational programs (e.g., Halford et al. in Journal of Family Psychology 22:497-505, 2008; Sanders in Journal of Family Psychology 22:506-517, 2008), the present paper presents the development and evaluation of a prevention program for community families with children, concerned with family-wide conflict and relationships, and building on Emotional Security Theory (Davies and Cummings in Psychological Bulletin 116:387-411, 1994). This program uniquely focuses on translating research and theory in this area into brief, engaging programs for community families to improve conflict and emotional security for the sake of the children. Evaluation is based on multi-domain and multi-method assessments of family-wide and child outcomes in the context of a randomized control design. A series of studies are briefly described in the programmatic development of a prevention program for conflict and emotional security for community families, culminating in a program for family-wide conflict and emotional security for families with adolescents. With regard to this ongoing program, evidence is presented at the post-test for improvements in family-wide functioning, consideration of the relative benefits for different groups within the community, and preliminary support for the theoretical bases for program outcomes.

A Review of Neurofeedback Treatment for Pediatric ADHD

Objective: The aim of this paper was to review all randomized published trials and unpublished conference presentations on the neurofeedback (NF) treatment of pediatric ADHD, and their relevance, strengths, and limitations. Method: Via PsychInfo and Medline searches and contacts with NF researchers 14 studies were identified and reviewed. Results: The majority were conducted from 1994 to 2010, with 5- to 15-year-olds, usually male and White with the combined type of ADHD. Most studies used theta/beta NF with a unipolar-electrode placement at Cz and demonstrated, where reported, an overall ADHD mean effect size of d = 0.69, a medium effect. Main study strengths, within some studies, include use of randomization, treatment control conditions, Diagnostic and Statistical Manual of Mental Disorders criteria, evidence-based assessment of ADHD, standard treatment outcome measures, multidomain assessment, and, for some studies, moderate sample size, some type of blind and the identification of medication as a concomitant treatment. Main study limitations (and directions for future research) include the lack of adequate blinding of participants, raters and NF trainers, a sham-NF/blinded control treatment condition, posttreatment follow-up, generalizability, specific details about delivery of NF, identification and control of comorbidity, and the identification, measurement, and control of concomitant treatments and potential side effects. Conclusion: Based on the results and methodologies of published studies, this review concludes that NF for pediatric ADHD can be currently considered as “probably efficacious.”

Validation of the relevant outcome scale for Alzheimer's disease: a novel multidomain assessment for daily medical practice

IntroductionThe Relevant Outcome Scale for Alzheimer's Disease (ROSA) is a new observer rating instrument recently developed for routine medical practice. The validity and reliability of ROSA as well as sensitivity to changes due to intervention were examined in an open-label, single-arm, multicenter clinical study in patients with Alzheimer's disease (AD).MethodsThe study enrolled 471 patients with a diagnosis of AD consistent with the criteria of the National Institute of Neurological and Communicative Disease and Stroke/Alzheimer's Disease and Related Disorders Association or with the Diagnostic and Statistical Manual Disorders criteria for dementia of Alzheimer's type. Following assessments of the ROSA and other standard assessments (Alzheimer's Disease Assessment Scale - cognitive subscale, Severe Impairment Battery, Neuropsychiatric Inventory, and Disability Assessment for Dementia), patients were treated with memantine for 12 weeks. Factor analysis of the baseline ROSA total scores was performed based on the principal components method using the varimax orthogonal rotational procedure. The psychometric analyses of the ROSA included internal consistency, test-retest reliability, inter-rater reliability, construct validity, and responsiveness to changes over time.ResultsAll items showed adequate factor loadings and were retained in the final ROSA as Factor 1 (all items related to cognition, communication, function, quality of life and caregiver burden) and Factor 2 (all behavior items). The ROSA demonstrated high internal consistency (Cronbach's α = 0.93), test-retest reliability (intraclass correlation coefficient = 0.93), and inter-rater reliability (intraclass correlation coefficient = 0.91). The correlation coefficients between the ROSA and each of the validated scales ranged between 0.4 and 0.7, confirming the ROSA construct validity. Nonsubstantial floor and ceiling effects were found in middle and late disease stages, whereas a small ceiling effect was observed in the early stage. The ROSA responsiveness to change was high (responsiveness index ≥0.8) for all severity stages.ConclusionsThe ROSA is a valid and reliable instrument to aid medical practitioners in sensitively assessing AD-relevant symptoms over time in their clinical practice.

Development of the language subtest in a developmental assessment scale to identify Chinese preschool children with special needs

This study reports on the development of the language subtest in the Preschool Developmental Assessment Scale (PDAS) for Cantonese-Chinese speaking children. A pilot pool of 158 items covering the two language modalities and the three language domains was developed. This initial item set was subsequently revised based on Rasch analyses of data from 324 multi-stage randomly selected children between 3 and 6 years of age. The revised 106-item set demonstrated adequate measurement properties, including targeting and uni-dimensionality. The revised 106-item set successfully discriminated preschool children in the three age groups, and between preschool children and their age peers with special education needs (SEN). Results from this study support the collection of normative data from a larger population sample of children to examine its accuracy in identifying language impairment in children with SEN. Test development procedures reported in this study provide insight for the development of language subtests in multi-domain developmental assessment tools for children speaking other varieties of Chinese.

Response to Letter by Quinn et al

HomeStrokeVol. 41, No. 12Response to Letter by Quinn et al Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse to Letter by Quinn et al Jeffrey L. Saver, MD, Bogdan Filip, MD, Scott Hamilton, PhD, Anna Yanes, RN, Sharon Craig, RN, Michelle Cho, BS, Robin Conwit, MD and Sidney Starkman, MD Jeffrey L. SaverJeffrey L. Saver For the FAST-MAG Investigators and Coordinators Search for more papers by this author , Bogdan FilipBogdan Filip For the FAST-MAG Investigators and Coordinators Search for more papers by this author , Scott HamiltonScott Hamilton For the FAST-MAG Investigators and Coordinators Search for more papers by this author , Anna YanesAnna Yanes For the FAST-MAG Investigators and Coordinators Search for more papers by this author , Sharon CraigSharon Craig For the FAST-MAG Investigators and Coordinators Search for more papers by this author , Michelle ChoMichelle Cho For the FAST-MAG Investigators and Coordinators Search for more papers by this author , Robin ConwitRobin Conwit For the FAST-MAG Investigators and Coordinators Search for more papers by this author and Sidney StarkmanSidney Starkman For the FAST-MAG Investigators and Coordinators Search for more papers by this author Originally published28 Oct 2010https://doi.org/10.1161/STROKEAHA.110.591214Stroke. 2010;41:e603Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: October 28, 2010: Previous Version 1 Response:We are grateful for the interest of Dr Quinn et al1 in our work and are pleased that none of the criticisms advanced in their letter apply to the Rankin focused assessment (RFA) that was the subject of our report.The RFA does not seek to reduce the time spent in deriving a Rankin score. By requiring formal assessment of several domains of function, the RFA actually precludes overly rapid, snap judgments that can occur with holistic assessments.The RFA is not inflexibly reductionist, although it is operationalized. For many patients, use of the RFA forces a multi-domain assessment that structurally counteracts overly reductionist tendencies that can occur in less ordered encounters.The design of the RFA recognizes that patients may occasionally struggle to answer a categorical question regarding their capacities and activities. In such instances, the RFA takes the approach recommended by Quinn et al,1 explicitly directing raters to obtain information from all available sources, including other informants and the medical record, to arrive at a final assessment regarding each line item.We concur with Quinn et al1 that additional studies comparing the RFA against traditional and alternative Rankin assessment techniques would be most welcome. We also agree that additional benefits may be gained by combining a focused assessment with central adjudicator panel scoring, but we emphasize the importance of making available to the central review committee not only the video of an interview with a single patient informant but also all other available salient data, including physician, nursing, and rehabilitation therapist assessments in the medical record, the concurrent neurological examination, and interviews with family and caretakers.DisclosureNone.1 Quinn TJ, McArthur K, Dawson J, Walters MR, Lees KR. Reliability of structured modified Rankin scale assessment. Stroke. 2010; 41: e602.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails December 2010Vol 41, Issue 12 Advertisement Article InformationMetrics https://doi.org/10.1161/STROKEAHA.110.591214 Originally publishedOctober 28, 2010 PDF download Advertisement

Awareness of Functional Difficulties in Mild Cognitive Impairment: A Multidomain Assessment Approach

To determine whether patients with mild cognitive impairment (MCI) are fully aware of and provide reliable estimates of their functional status. Controlled, matched-samples, cross-sectional study. University medical and research centers. Fifty-seven persons with amnestic MCI and 68 normal controls. The study examined accuracy of self-report in MCI across five functional domains (driving, financial abilities, medication management, grocery shopping, and telephone use) by comparing patients' report of functioning with their performance on laboratory-based measures of function. The discrepancy between self-report and objective performance was significantly higher in patients with MCI than in their cognitively normal peers only on financial abilities. Patients with MCI overestimated their abilities on this functional domain. Patients with MCI also tended to overestimate their driving abilities, although this was not statistically significant. These findings provide evidence that awareness of functional difficulties is not a unitary construct; rather, it varies across functional domains. They also suggest that self-report of functional abilities in MCI may be, on the whole, as accurate as in cognitively intact older adults. Even so, the self-objective discrepancies noted for both study groups suggest that supplementing self-reported information with objective functional assessment might improve detection of older adults who have begun to experience more functional restriction than is normal for age. In turn, timely identification would permit the targeted implementation of interventions that delay or forestall further deterioration in function.

Sharing clinical information across care settings: the birth of an integrated assessment system

BackgroundPopulation ageing, the emergence of chronic illness, and the shift away from institutional care challenge conventional approaches to assessment systems which traditionally are problem and setting specific.MethodsFrom 2002, the interRAI research collaborative undertook development of a suite of assessment tools to support assessment and care planning of persons with chronic illness, frailty, disability, or mental health problems across care settings. The suite constitutes an early example of a "third generation" assessment system.ResultsThe rationale and development strategy for the suite is described, together with a description of potential applications. To date, ten instruments comprise the suite, each comprising "core" items shared among the majority of instruments and "optional" items that are specific to particular care settings or situations.ConclusionThis comprehensive suite offers the opportunity for integrated multi-domain assessment, enabling electronic clinical records, data transfer, ease of interpretation and streamlined training.

Association between cognition and daily life functioning in dementia subtypes

To investigate the association between cognition and daily life functioning in dementia subtypes. Cross-sectional data were used from 615 patients with dementia who were referred to the Maastricht Memory Clinic of the Maastricht University Medical Centre. Pearson correlation coefficients were calculated between the Mini-Mental State Examination (MMSE; to measure cognitive status) and the Blessed Dementia Scale (BDS; to measure daily life functioning) for the following types of dementia: Alzheimer's Disease (AD, n = 442); Vascular dementia (VaD, n = 113); frontotemporal dementia (FTD, n = 18); Parkinson's dementia (PD, n = 21); and primary progressive aphasia (PPA, n = 21). One-way ANOVA was used to test differences in age, MMSE scores and BDS scores across dementia subtypes. Scores on the MMSE showed strong correlation with BDS scores in cases of FTD (r = -0.80); moderate correlation in cases of AD, VaD, and PD (range r = -0.50-0.60); while no correlation was found in PPA cases. The association between cognition and daily life functioning varied among dementia subtypes for AD, VaD, FTD and PD. Furthermore, the overall scores on both domains differ between dementia subtypes, indicating that different types of dementia are characterized by a specific pattern of cognitive status and daily life functioning. These findings underline the need for multidomain assessment in patients with dementia.