Instrumental Activities Of Daily Living Performance Research Articles

Predictive Utility of Four Instrumental Activities of Daily Living Assessments and Cognitive Status Changes Among Cognitively In-Tact Older Adults.

To examine the factor structure and predictive utility of four instrumental activities of daily living (IADL) measures to identify cognitive status changes among older adults enrolled in the ACTIVE Trial. Extracted factors represented IADL instruments. Baseline performance on the Everyday Problems Test (EPT) predicted 5-year MMSE scores (est. = .08, p < .001), adjusting for demographic and health covariates, baseline MMSE, self-reported IADL function, and the performance-based Observed Tasks of Daily Living and Timed Instrumental Activities of Daily Living assessments. For each 1-point increase in baseline EPT financial performance, the odds of cognitive impairment decreased by 26%. IADL functional domains were not interchangeable across instruments. The EPT demonstrated better predictive utility compared to other instruments for detecting subsequent cognitive decline/impairment. This is a useful step in developing effective tools to detect early functional deficits indicating subsequent clinical impairment. Advanced Cognitive Training for Independent and Vital Elderly Trial (ACTIVE), NCT00298558, https://clinicaltrials.gov/study/NCT00298558.

Long COVID Brain Fog Treatment: Findings from a Pilot Randomized Controlled Trial of Constraint-Induced Cognitive Therapy.

Long COVID brain fog is often disabling. Yet, no empirically-supported treatments exist. This study's objectives were to evaluate feasibility and efficacy, provisionally, of a new rehabilitation approach, Constraint-Induced Cognitive Therapy (CICT), for post-COVID-19 cognitive sequelae. Sixteen community-residents ≥ 3-months post-COVID-19 infection with mild cognitive impairment and dysfunction in instrumental activities of daily living (IADL) were enrolled. Participants were randomized to Immediate-CICT or treatment-as-usual (TAU) with crossover to CICT. CICT combined behavior change techniques modified from Constraint-Induced Movement Therapy with Speed of Processing Training, a computerized cognitive-training program. CICT was deemed feasible if (a) ≥80% of participants completed treatment, (b) the same found treatment highly satisfying and at most moderately difficult, and (c) <2 study-related, serious adverse-events occurred. The primary outcome was IADL performance in daily life (Canadian Occupational Performance Measure). Employment status and brain fog (Mental Clutter Scale) were also assessed. Fourteen completed Immediate-CICT (n=7) or TAU (n=7); two withdrew from TAU before their second testing session. Completers were [M (SD)]: 10 (7) months post-COVID; 51 (13) years old; 10 females, 4 males; 1 African American, 13 European American. All the feasibility benchmarks were met. Immediate-CICT, relative to TAU, produced very large improvements in IADL performance (M=3.7 points, p<.001, d=2.6) and brain fog (M=-4 points, p<.001, d=-2.9). Four of five non-retired Immediate-CICT participants returned-to-work post-treatment; no TAU participants did, p=.048. CICT has promise for reducing brain fog, improving IADL, and promoting returning-to-work in adults with Long COVID. Findings warrant a large-scale RCT with an active-comparison group.

An immersive virtual reality shopping task detects declines in instrumental activities of daily living in individuals with Parkinson's disease

IntroductionDeclines in instrumental activities of daily living (IADLs) have been proposed as a prodromal marker of Parkinson's disease (PD). The Cleveland Clinic Virtual Reality Shopping (CC-VRS) platform combines an omnidirectional treadmill with a virtual reality headset to create a virtual grocery store that a user physically walks through and completes a shopping task. The primary aim of this project was to determine the known-group validity of the CC-VRS platform in discriminating IADL performance and to characterize specific motor and cognitive declines responsible for PD-related IADL impairments. MethodsSixteen individuals with PD and 15 healthy adults completed traditional motor, cognitive, and IADL assessments and the CC-VRS task. Group differences were evaluated using Welch's t-test. ResultsThere were no between-group differences in traditional performance measures of motor, cognitive, or IADL function. Regarding CC-VRS performance, participants in the PD group completed the task significantly slower than controls (690 vs. 523 sec, respectively). Participants with PD spent 25 % more time walking and turning and were stopped 46 % longer than controls. Average gait speed when viewing the shopping list, a measure of dual-task performance, was significantly slower in the PD group compared to controls (0.26 vs. 0.17 m/s, respectively). ConclusionUnlike traditional performance measures of motor, cognitive, and IADL function, the CC-VRS discriminated participants with PD from healthy older adults. For the PD group, motor and dual-task declines contributed to diminished CC-VRS performance. Identifying underlying contributors to IADL declines supports using ecological assessments, such as the CC-VRS, for the routine clinical evaluation of IADLs.

Prediction and mediation analysis for treatment responses to combined cognitive and physical training for older adults

Diminished cognitive and physical functions negatively affect the daily functions of individuals. Although combined cognitive and physical training prevents instrumental activities of daily living (IADL) disability in older adults, no predictive model or mediation analysis of IADL after combined training exists. This study aims to employ prediction and mediation analysis to identify the predictors of IADL performance and to elucidate the mediators of the association between baseline global cognition and subsequent IADL performance following combined cognitive and physical training. This study involved 177 participants aged 60 years and older who underwent combined training. Cognitive function was measured with the Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSST), Color Trails Test, Word List, and a dual task; physical function with the Timed Up and Go (TUG) test; daily function with the Lawton IADL Scale. We conducted regression analyses to identify the predictors of IADL performance, and mediation analysis to examine whether DSST and TUG mediate the relationship between MoCA and IADL. The pre-intervention DSST and TUG were significant independent predictors of post-intervention IADL. The association between the pre-intervention MoCA and post-intervention IADL was mediated by pre-intervention DSST and TUG. This study highlighted the importance of measuring and improving processing speed and functional mobility before and during interventions to enhance IADL outcomes.Trial registration: NCT03619577, 23/07/2018; NCT04689776, 29/12/2020.

Instrumental activities of daily living function and cognitive status among Chinese older adults: a serial multiple mediation model.

This study aimed to develop and validate a serial multiple mediation model to investigate the association between instrumental activities of daily living (IADL) function and cognitive status among older adults while exploring the underlying mechanisms. This cross-sectional study involved 3,665 individuals aged 60 years and older who participated in the China Health and Retirement Longitudinal Survey (CHARLS). A serial multiple mediation model was utilized to explore the direct and indirect relationship between IADL function and cognitive status and whether sleep duration, social engagement, and depressive symptoms mediated this relationship. Decreased IADL function was associated with worse cognitive status [effect = -0.620, 95% CI: (-0.692, -0.540)]. Sleep duration, social participation (SP), and depressive symptoms all acted as mediators in the relationship between IADL function and cognitive status. This study found both direct and indirect associations between IADL function and cognitive status, providing new insights into the effective prevention and intervention of cognitive decline among older adults.

Using Objective and Subjective Measures of Cognition to Predict Instrumental Activities of Daily Living Abilities in Multiple Sclerosis.

Cognitive impairment, difficulty performing basic activities of daily living (ADLs) and instrumental ADLs (IADLs), depression, and fatigue are common among individuals with multiple sclerosis (MS). Some associations between these symptoms are known; however, many of their relationships remain unclear. This study investigated the contributions of subjective and objective cognition, depressive symptom severity, and fatigue on ADLs and IADLs. Participants (N = 217) were individuals with MS from a comprehensive MS center, participating in a larger study characterizing upper extremity function in MS. Outcome measures of ADL and IADL abilities were the Functional Status Index-Assistance (FSI-A) and Functional Status Index-Difficulty (FSI-D) and the Test D'évaluation Des Membres Supérieurs de Personnes Âgées (TEMPA). Predictors were objective cognition (Symbol Digit Modalities Test; SDMT), subjective cognition (Performance Scales©-Cognition; PS-C), depressive symptom severity (Center for Epidemiologic Studies Depression Scale; CES-D-10), and fatigue (Modified Fatigue Impact Scale; MFIS-5). Correlations were conducted, followed by hierarchal linear regressions. The SDMT and PS-C were entered into separate models. After controlling for demographics, the SDMT significantly predicted the TEMPA and FSI-A, while the PS-C predicted only the FSI-D. The CES-D-10 predicted the FSI-D even after accounting for PS-C and SDMT, while the MFIS-5 only predicted the FSI-D when the SDMT was included. Neither the CES-D-10 nor MFIS-5 significantly predicted the FSI-A or TEMPA. The way an individual with MS perceived their symptoms significantly contributed to their reported difficulty with functional tasks, while only their objective cognitive functioning predicted ADL and IADL performance and the level of assistance they would require.

The association between functional disability and depressive symptoms among older adults: Findings from the China Health and Retirement Longitudinal Study (CHARLS)

BackgroundPrevious research has shown that depressive symptoms in older adults was associated with functional disability, including basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs). However, little is known about the impact of different patterns of functional disability and new-onset functional disability on subsequent depressive symptoms. ObjectiveTo determine the effect of various patterns of functional disability and new-onset functional disability on depressive symptoms among Chinese older adults aged 60 years and above. MethodThe study included 3242 older adults from the China Health and Retirement Longitudinal Study (CHARLS), which was conducted from 2011 to 2018. Cox proportional hazards models were used to investigate the associations between patterns of functional disability and depressive symptoms. The associations were also examined in the population with new-onset functional disability. ResultDuring 15,321 person-years of follow-up, 946 depressive symptoms occurred. The hazard ratios (HRs) of depressive symptoms were 1.29 (95 % confidence intervals [CI]: 1.05–1.58) for IADLs disability, 1.22 (95 % CI: 0.75–1.55) for BADLs disability, and 1.78 (95 % CI: 1.41–2.22) for both IADLs and BADLs disabilities. In the analysis of new-onset functional disability, the HRs were 1.50 (95 % CI: 1.06–2.13) for onset IADLs disability, 1.28 (95 % CI: 0.85–1.91) for onset BADLs disability, and 1.69 (95 % CI: 1.03–2.76) for both onset BADLs and IADLs disabilities. LimitationsDepressive symptoms were assessed using the Centre for Epidemiological Studies Depression Scale, which has limitations in diagnosing clinical depression. ConclusionFunctional disability increases the risk of depressive symptoms, particularly impaired IADLs function. Psychological care for older adults with functional disability should be strengthened.

Attentional Resources and Independence in Basic and Instrumental Activities of Daily Living in Individuals with Intellectual Disabilities.

The relationship between attentional resources and functionality in individuals with intellectual disabilities (IDs) is clinically relevant. This study aimed to examine the possible relationship between the degree of ID and attentional resources, and to evaluate whether attentional resources predict the performance of basic and instrumental activities of daily living (ADL) in individuals with mild and moderate ID. This study, which employed a descriptive, cross-sectional, observational design, was conducted between July 2019 and May 2020. The sample consisted of 166 individuals divided into three groups: moderate ID, mild ID, and those without ID. These groups were compared for attentional functions (p < 0.001), obtaining an effect size ranging from medium to large. The results indicated that 40% of the variance in basic ADL performance was explained by the age of the participants, degree of disability, and sustained attention in individuals with ID. Additionally, 64% of the variance in instrumental ADL performance was explained by sustained, divided, and executive attention. Therefore, attentional resources appear to be associated with the performance of basic and instrumental ADL in individuals with mild and moderate ID.

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.

DOES CRIMINAL VICTIMIZATION RAISE THE RISK OF IADL LIMITATIONS AMONG OLDER ADULTS?

Abstract Many studies have analyzed the effect of victimization on children and young adults, but relatively few have explored its impact on older adults’ well-being. Drawing from cumulative inequality theory, this study analyzed a sample of 11,860 respondents aged 50 and older from the Health and Retirement Study (HRS) to examine whether victimization experiences, measured by physical attack/assault, robbery/home burglary, and fraud, raise the risk of limitations in performing instrumental activities of daily living (IADLs). The analysis, which used zero-inflated negative binomial models to examine the onset and severity of IADL limitations, revealed that criminal victimization was associated with a higher likelihood of IADL limitations (IRR=0.735, p&amp;lt; 0.01), even after adjusting for demographic and health-related factors. Additional analyses examining the influence of each type of victimization showed that the experiences of a physical attack and robbery were related to IADL limitations. These findings demonstrate that criminal victimization experiences are associated with compromised IADL function, especially when the encounter involves an intentional act of immediate harm. There is a need for (a) additional research on the consequences of criminal victimization on the health and well-being of older adults and (b) interventions to help older adults who experience a personal or property crime.

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.

Learning from trials: LIVE@Home.Path, a stepped-wedge cluster randomized controlled trial of care coordination and implementation for home-dwelling people with dementia.

Background:Dementia is not an unavoidable consequence of aging, but for most home-dwelling people with dementia (PwD) a result of complex chronic health conditions. About 95% of PwD have multimorbidity, which requires a multicomponent approach and interdisciplinary collaboration to support patients and relatives, and to implement welfare technology and smart solutions.Method:The LIVE@Home.Path study is a 2-year, mixed-method, stepped-wedged, cluster randomized controlled trial, including home-dwelling PwD and their informal caregivers (N=320 dyads) in Norway (May 2019 – December 2021), to investigate the efficacy of the multicomponent LIVE intervention (LIVE is the acronym for Learning, Innovation, Volunteerism, and Empowerment) on resource utilization and use of welfare technology. The intervention was implemented by a skilled coordinator from the municipality with high focus on use, usefulness, and experiences in welfare technology, both at baseline and during the implementation period.Results:At baseline, we found that most participants had traditional equipment such as stove guards (43.3%), social alarms (39.5%) or everyday technology (45.3%) (e.g., calendar, door locks). A social alarm was more often available for alone-living elderly women, while tracking devices (14.9%) were associated with lower age. Everyday technology was more often available for women at increased age, higher comorbidity, and poor instrumental activities of daily living (IADL). In people with severe dementia, welfare technology was associated with poor IADL function, children as the main caregiver (61.3%), and having caregivers who contributed 81–100% to their care (49.5%).Discussion:We describe unmet potential for communication, tracking, and sensing technology and especially, for devices not offered by the municipalities. In our symposium, we will present early findings on the implementation effect of welfare technology and participants experiences related to usage and awareness.

Older adults exhibit declines in instrumental activities of daily living during a virtual grocery shopping task

Introduction: The successful performance of instrumental activities of daily living (IADLs) is critical in maintaining independence for older adults. Traditional IADL questionnaires and performance-based assessments are time consuming, potentially unreliable, and fail to adequately consider the interplay between cognitive and motor performance in completing IADLs. The Cleveland Clinic Virtual Reality Shopping (CC-VRS) platform was developed to objectively quantify IADL performance through the characterization of cognitive, motor, and cognitive-motor function. The CC-VRS combines an immersive virtual grocery store with an omnidirectional treadmill to create a scenario in which the user physically navigates through a virtual environment. The primary aim of this project was to determine the known-group validity of the CC-VRS platform to characterize IADL performance in healthy older adults and young adults.Methods: Twenty healthy young (n = 10) and older (n = 10) adults completed the Basic and Complex CC-VRS scenarios. Position data from VR trackers on the hands, waist, and feet were used to quantify motor performance. Cognitive and dual-task performance were automatically calculated by the application during specific shopping sub-tasks.Results: Older adults exhibited significantly worse performance on multiple cognitive, motor, and dual-task outcomes of the CC-VRS (e. g., average walking speed, number of list activations, and stopping frequency).Discussion: The CC-VRS successfully discriminated IADL performance between young and healthy older adults. The complex realistic environment of the CC-VRS, combined with simultaneous evaluation of motor and cognitive performance, has the potential to more accurately characterize IADL performance by identifying subtle functional deficits that may precede neurological disease.

Relationship Between Non-Cognitive Intrinsic Capacity and Activities of Daily Living According to Alzheimer's Disease Stage.

Few studies have examined the relationship between non-cognitive factors and activities of daily living (ADL) according to Alzheimer's disease (AD) stage. We aimed to identify the differences in non-cognitive factors according to AD stages and their involvement in basic and instrumental ADL performance by using intrinsic capacity (IC) in groups with cognition ranging from normal to moderate or severe AD. We enrolled 6397 patients aged≥65 years who visited our memory clinic. Non-cognitive IC was assessed using the locomotion, sensory, vitality, and psychological domains. Multiple logistic regression was performed to identify how non-cognitive IC declines over the AD course and examine the correlation between non-cognitive IC and basic and instrumental ADL performance. Non-cognitive IC declined from the initial AD stage and was significantly correlated with both basic and instrumental ADL performance from the aMCI stage through all AD stages. In particular, the relationship between IC and basic ADL was stronger in mild and moderate to severe AD than in the aMCI stage. On the other hand, the relationship between IC and instrumental ADL was stronger in aMCI than in later AD stages. The results show non-cognitive factors, which decline from the aMCI stage, are correlated with ADL performance from the aMCI stage to almost all AD stages. Considering that the relationship strength varied by ADL type and AD stage, an approach tailored to ADL type and AD stage targeting multiple risk factors is likely needed for effectively preventing ADL performance declines.

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 &amp; Suchy, 2020), sleep deprivation (Lim &amp; Dinges, 2010), burdensome emotion regulation (Franchow &amp; Suchy, 2017), and pain interference (Boselie, Vancleef, &amp; 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 &amp; Suchy, 2021; Suchy et al., 2020; Niermeyer &amp; 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, &amp; Sliwinksi, 2019; Brothers &amp; 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 &amp; 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.

4 Initial Application of Constraint-Induced Cognitive Therapy to Long COVID Brain Fog

Objective:Persistent brain fog is common in adults with Post-Acute Sequelae of SARS-CoV-2 infection (PASC), in whom it causes distress and in many cases interferes with performance of instrumental activities of daily living (IADL) and return-to-work. There are no interventions with rigorous evidence of efficacy for this new, often disabling condition. The purpose of this pilot is to evaluate the efficacy, on a preliminary basis, of a new intervention for this condition termed Constraint-Induced Cognitive therapy (CICT). CICT combines features of two established therapeutic approaches: cognitive speed of processing training (SOPT) developed by the laboratory of K. Ball and the Transfer Package and task-oriented training components of Constraint-Induced Movement therapy developed by the laboratory of E. Taub and G. Uswatte.Participants and Methods:Participants were &gt; 3 months after recovery from acute COVID symptoms and had substantial brain fog and impairment in IADL. Participants were randomized to CICT immediately or after a 3-month delay. CICT involved 36 hours of outpatient therapy distributed over 4-6 weeks. Sessions had three components: (a) videogamelike training designed to improve how quickly participants process sensory input (SOPT), (b) training on IADLs following shaping principles, and (c) a set of behavioral techniques designed to transfer gains from the treatment setting to daily life, i.e., the Transfer Package. The Transfer Package included (a) negotiating a behavioral contract with participants and one or more family members about the responsibilities of the participants, family members, and treatment team; (b) assigning homework during and after the treatment period; (c) monitoring participants’ out-of-session behavior; (d) supporting problem-solving by participants and family members about barriers to performance of IADL; and (e) making follow-up phone calls. IADL performance, brain fog severity, and cognitive impairment were assessed using validated, trans-diagnostic measures before and after treatment and three months afterwards in the immediate-CICT group and on parallel occasions in the delayed-CICT group (aka waitlist controls).Results:To date, five were enrolled in the immediate-CICT group; four were enrolled in the wait-list group. All had mild cognitive impairment, except for one with moderate impairment in the immediate-CICT group. Immediate-CICT participants, on average, had large reductions in brain fog severity on the Mental Clutter Scale (MCS, range = 0 to 10 points, mean change = -3.7, SD = 2.0); wait-list participants had small increases (mean change = 1.0, SD = 1.4). Notably, all five in the immediate-CICT group had clinically meaningful improvements (i.e., changes &gt; 2 points) in performance of IADL outside the treatment setting as measured by the Canadian Occupational Performance Measure (COPM) Performance scale; only one did in the wait-list group. The advantage for the immediate-CICT group was very large on both the MCS and COPM (d’s = 1.7, p’s &lt; .05). In follow-up, immediate-CICT group gains were retained or built-upon.Conclusions:These preliminary findings warrant confirmation by a large-scale randomized controlled trial. To date, CICT shows high promise as an efficacious therapy for brain fog due to PASC. CICT participants had large, meaningful improvements in IADL performance outside the treatment setting, in addition to large reductions in brain fog severity.

66 Association of Executive Functions and Instrumental Activities of Daily Living in Parkinson’s Disease

Objective:Executive function (EF) abilities tend to decline with age, and disproportionately so for people with neurodegenerative disorders such as Parkinson’s Disease (PD), where EF deficits are commonly seen in the early stages of the disease. Due to their nature, EF are essential for performing tasks of daily life, particularly for the more complex instrumental activities of daily living (IADL), and deficits can impair the ability to execute IADL in PD participants. The aim of this study was to examine how EF impairments relate to IADL deficits in both healthy elderly controls and PD participants.Participants and Methods:Seventy-four participants with idiopathic PD and 66 elderly controls were recruited. All participants were non-demented. A comprehensive neuropsychological assessment was administered including the following measures of EF: Hayling Sentence Completion, Brixton Spatial Anticipation, Trail Making Test A and B, Stroop Color-Word Test, Symbol Span (Wechsler Memory Scale-III), Digit Span (Wechsler Adult Intelligence Scale-III), F-A-S test, and Semantic Fluency (Animals and Actions). Z scores were calculated from respective test manuals. Independence was measured using the 8-item Lawton IADL Scale where items are coded from 0 (dependent) to 1 (independent) and the total score ranges from 0 to 8. Motor impairments were assessed using Part III of the Movement Disorder Society Unified Parkinson’s Disease Rating Scale. Regression models were run with each cognitive measure as the dependent variable, with group (control vs. PD), age, sex, education, and motor severity as predictors, to examine the effect of group on each cognitive variable. Correlations were then run between the total IADL score, demographic variables, and cognitive variables for each participant group separately to identify the relationship between IADL and EF measures.Results:PD participants were predominantly males (n=51, 68.9%), with an average age of 70.64±6.03 and 15.22±2.78 education years. Controls were predominantly female (n=34, 51.5%) and had an average age of 71.19±7.75 and 15.85±2.82 education years. Regarding IADL function, all participants were relatively independent in their IADLs (PD: 7.72±0.69, range 4-8, Controls: 7.98±0.13, range 7-8). The most difficult IADL items for PD participants were shopping (8.2% dependent) and food preparation (12.2% dependent). When correcting for age, education, sex, and motor severity, only the Stroop Interference z-score was significant for participant group (b=0.44, t=2.14, p=0.034), where controls had slightly lower scores (-0.33±0.77) than PD participants (-0.31±0.91). Correlations in controls were significant between IADL total score and Hayling trials 1 (r=0.35, p=0.005) and 2 (r=0.33, p=0.008), and semantic fluency actions trial (r=0.34, p=0.006). In PD participants, IADL total score was only correlated with semantic fluency (animals trial, r=0.26, p=0.028).Conclusions:There were only weak associations between EF abilities and IADL in both healthy controls and PD participants, suggesting that impairments in EF do not necessarily translate into worse ability to execute IADL in PD. More correlations were found in the control group, which may be confounded by the inclusion (in both groups) of participants who already had cognitive impairment. This highlights a further need to examine whether EF impairments in people with PD influence IADL functioning above and beyond normal aging and whether specific deficits have more real-life consequences not attainable through IADL questionnaires.

3 CI Cognitive Therapy: Initial Application in a Pilot Study to Improve Cognitive Impairment in Chronic Stroke Survivors

Objective:CI Cognitive Therapy (CICT) is a combination of behavioral techniques derived from CI Movement Therapy (CIMT) modified to apply to the cognitive domain, and Speed of (Cognitive) Processing Training (SOPT). SOPT is effective in improving cognitive function in the treatment setting and driving ability in everyday situations. The data concerning the effect of SOPT on other cognition-based instrumental activities of daily living (IADL) in everyday situations is incomplete. The strengths of CIMT, based on its Transfer Package (TP), are to facilitate 1) transfer of improved function from the treatment setting to IADL in everyday settings, and 2) long-term retention of the improved performance of IADL. This study sought to determine in a preliminary case series whether the TP of CI Movement Therapy combined with SOPT would have the same effect on a wide range of impaired cognition-based ADL.Participants and Methods:Participants were 6 adults with chronic stroke: mean chronicity = 36.2 months, (range, 16-56 months); mean age = 59.7 years, (range, 47-55); 1 female; 3 African American and 3 European American. Five had mild cognitive impairment, while one had moderate impairment. Participants received 35 hours of outpatient treatment in 10-15 sessions distributed over 2-6 weeks, depending on the participants’ availability. Sessions began with 1 hour of SOPT training followed by training of cognition-based ADL by the process of shaping, a common method in the behavior analysis field. Other behavior analysis methods employed in the TP of CI Movement Therapy were used, including: 1) behavior contracting, daily assignment of homework, participation of a family member in the training and monitoring process, daily administration of a structured interview assessing amount and quality of performance of 30 IADL, problem solving to overcome perceived (or real) barriers to performance of IADL. Participants were given daily homework assignments in follow-up and were contacted in periodic, pre-arranged phone calls to determine status, compliance and problem-solve.Results:All six participants showed marked improvement on the SOPT test similar to that in the Ball et al studies. However, here transfer to IADL outside the treatment setting was substantial. On the main real-world outcome, the Canadian Occupational Performance Measure (COPM), there were increases of 2.7±1.3 and 2.1±1.6 on the two scales (d’s = 1.9 &amp; 1.3, respectively). (Changes on the COPM &gt; 2 points are considered clinically meaningful and changes in d’ &gt;.8 are considered large). On two other real-word measures, the Cognitive Task Activity Log (CTAL) and inventory of Improved and New Cognitive Activities (INCA), there was a marked increase during the acquisition phase of training. There was no loss in retention over the 6-16 months (mean = 12.2) of follow-up to date. Instead, the INCA showed strong further improvement after the end of treatment-setting training, especially in the New Activities Not Performed Since Before Stroke Onset category, going from a mean of 8.2 after training to 14.6 at the end of follow-up.Conclusions:These very preliminary results suggest that CICT may be an efficacious therapy for mild to moderate cognitive impairment in chronic stroke and possibly other disorders.

The Association between Executive Function and Performing Instrumental Daily Activities in People with Intellectual Disabilities.

Institutionalized individuals with intellectual disabilities have few opportunities to participate in instrumental activities of daily living (IADLs), which probably affects higher cognitive functions, or vice versa. The objectives of this study were to evaluate the possible difference in the ability to perform IADLs and executive functioning between individuals with and without intellectual disabilities and to determine if executive functions are associated with the performance of IADLs in people with intellectual disabilities. This was a multi-center cross-sectional study, conducted between July 2019 and May 2020. Participants with intellectual disabilities were recruited from four centers for people with intellectual disabilities. Adults without these disabilities were gathered from several community centers. The sample consisted of 90 individuals with moderate intellectual disabilities and 79 individuals with no intellectual disability. Executive functions were evaluated using the Wechsler Adult Intelligence Scale-WAIS-IV, the INECO Frontal Screening test, the Semantic Verbal Fluency Test, and the Behavioural Assessment of the Dysexecutive Syndrome-BADS-Scale. The performance of the IADLs was assessed by the Lawton and Brody Scale. The results showed that the higher the function in instrumental activities, the lower the impairment of executive functions. Executive functions accounted for 81% of the total variance in the ability to perform the IADLs. In conclusion, individuals with moderate intellectual disabilities demonstrated limitations in executing the IADLs, which were partially associated with low performance in executive functions. This information could help in the development of evidence-based intervention programs and facilitate the formulation of appropriate support strategies to enhance participation in these activities.

Decline of instrumental activities of daily living is a risk factor for nutritional deterioration in older adults: a prospective cohort study

BackgroundThe association between functional capacity and the subsequent risk of nutritional deterioration is yet to be understood. The purpose of this study was to elucidate the relationship between functional capacity, comprising instrumental activities of daily living (IADL), intellectual activity, and social function, and future decline in nutritional status.MethodsThe current study is a two-year prospective cohort study. A total of 468 community-dwelling older adults without nutritional risks were enrolled. We used the Mini Nutritional Assessment Screening Form. Functional capacity, including IADL, intellectual activity, and social function, was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence at baseline. The nutritional status was reassessed at a 2-year follow-up. Risk ratios (RR) of functional capacity for the incidence of nutritional decline were estimated.ResultsLow functional capacity was significantly associated with future deterioration of nutritional status (RR 1.12, 95% confidence interval [CI] 1.02–1.25). Of the subdomains of functional capacity, IADL decline (adjusted RR 2.21, 95% CI 1.18–4.13) was an independent risk factor for the incidence of nutritional risk. Intellectual and social activities were not significant.ConclusionDecline in functional capacity, especially IADL, is a risk factor for future deterioration in nutritional status. Further studies are required to elucidate the effect of interventions for IADL decline on maintaining nutritional status in older adults.