Predictors Of Functional Decline Research Articles

Executive Impairments Predict Functional Declines in Vascular Dementia

The purpose of this study was to examine the course and predictors of functional decline among patients with vascular dementia (VaD). Twenty-eight VaD patients completed three tests of executive functions and underwent MRI scanning to generate quantitative ratings of subcortical neuropathology at a baseline evaluation. The caregiver-rated Lawton and Brody Activities of Daily Living Questionnaire was used to estimate instrumental activities of daily living (IADLs) at the baseline evaluation and at a 1 year follow-up. We hypothesized that: (a) IADLs would decline significantly over the course of 1 year, and (b) baseline performance on executive tasks and subcortical neuropathology would predict IADL impairment at 1 year follow-up, even after accounting for global cognitive dysfunction. A paired samples t-test demonstrated that IADLs declined significantly over the course of 1 year, and regression analyses revealed that baseline performance on executive tasks was a significant predictor of IADLs at the 1 year follow-up, even after accounting for global cognitive dysfunction. Contrary to our expectation, subcortical neuropathology did not explain unique variance in IADLs after accounting for executive dysfunction. These findings demonstrate that baseline executive dysfunction is a significant and powerful predictor of future functional decline in individuals with VaD.

Predictors of functional decline in hospitalized elderly patients: a systematic review.

This article will systematically review the methodological characteristics and results of studies of variables and indices that predict functional decline in older hospitalized patients. We restricted this review to original longitudinal studies of predictors of either physical functional decline or nursing home admission among patients aged 60 and older. Two reviewers independently abstracted information on methodological characteristics and substantive results. Thirty articles were identified, derived from 27 different studies, reporting on 33 substudies. Substantial variability was found with respect to study design, outcomes measured, period of follow-up, predictors investigated, and analytic methods. Multivariable predictive indices were significantly associated with adverse outcomes in the majority of studies that investigated them, as were the following variables: age, diagnosis, activities of daily living, cognitive impairment (including delirium), and residence. The methodological heterogeneity of the studies identified limits quantitative synthesis of the results. Predictive indices for hospitalized elders appear to have moderate short-term predictive ability.

One-leg standing balance and functional status in an elderly community-dwelling population in northeast Italy.

Development of simple and accurate indicators of frailty is an important research goal in aging societies. One-leg standing balance (OLSB) has been proposed as a component of a clinical index of frailty. We analyzed relationships between results of OLSB testing and multiple health risk factors and impairment/disability indicators in a sample of elderly subjects (N=102) participating in the Anchyses Project. Subjects were aged >65, lived in a home for the aged in Rovigo, Italy, and had no ADL dependencies or recent acute illnesses. More than half (53%) failed the OLSB test while 36% were able to balance without difficulty. Significant differences were observed among OLSB performance groups in forced vital capacity (p=0.025), dynamometry (p=0.001), age, physical activity, and IADL dependency (all p<0.001). OLSB performance is a marker of frailty and thus a potentially useful predictor of functional decline.

Prediction of Functional Status from Neuropsychological Tests in Community-Dwelling Elderly Individuals

Age-related dysfunction of frontal systems can result in deficits in planning, organization, self-control, and awareness of problems, which are likely to affect the ability to care for one's self. The purpose of this study was to determine the relationship between age-related frontal/executive deficits and impairment in instrumental activities of daily living (IADLs) in elderly individuals. Twenty-seven community-dwelling individuals were administered a comprehensive battery of neuropsychological tests and a performance-based evaluation of IADLs. Multiple regression analyses indicated that executive function and depression severity accounted for a significant proportion of variance in IADLs, with executive function making the greatest contribution. Tests measuring other cognitive functions, such as memory, language, and spatial skills, did not contribute significantly to the prediction of functional status. Furthermore, executive measures accounted for more variance than other demographic characteristics such as general health status, age, and educational level. The results of this study indicate that executive dysfunction in normal aging may be the best predictor of functional decline. A better understanding of the mechanisms that underlie IADL skills will ultimately aid in the development of compensatory and intervention strategies designed to delay the onset of assisted living and nursing home placement.

108. Neurocognitive predictors of functional decline in poor-outcome schizophrenia

Although cognitive abilities have been shown to be directly related to social, occupational, and adaptive functioning in patients with schizophrenia, there is no evidence indicating that a specific neuropsychological index can predict decline in functional status. Impairments in verbal learning and memory, verbal skills, and executive functions correlate with functional impairments, and are predictive of functional ability over time. Yet, there is no evidence that impairment on a specific neurocognitive index is associated with functional decline, or whether these measures are all associated with functional impairments due to a global or specific cognitive deficit. In order to test whether any of these neuropsychological measures (Verbal Learning and Memory, Praxis, and Confrontational Naming) is most associated with functional decline, 68 subjects were chosen from a long-term study of the effects of aging in schizophrenia. Subjects were chosen specifically because they declined functionally from a mildly impaired level of functioning to a moderate or severely impaired level of functioning across two assessments (mean interval 5 1.89 years, sd 5 1.42 years), based on a global rating of functioning on the Clinical Dementia Rating Scale (CDR). Age and education corrected z-scores were derived for measures of verbal learning, delayed memory, praxic ability, and confrontational naming, based on performance of healthy controls on these measures as part of the Consortium to Establish a Registry of Alzheimer’s Disease (CERAD). Change in performance on these neuropsychological measures was calculated by subtracting the standardized z-score of each measure at the follow-up assessment from the standardized score obtained on each measure at the initial assessment. A repeated measures ANOVA was used to determine if any of these measures were specifically associated with functional decline. Whereas the overall ANOVA was significant (F(1, 67) 5 14.49, p , .001), no specific measure of neurocognitive functioning was able to account for the decline in functional ability (Rao’s R (3, 65) 5 1.19, p , .321). These data suggest that the cognitive decline seen in these patients is generalized, rather than selective. It may be that this functional decline is related to low levels of cortical decline in patients with poor premorbid functioning and a chronic clinical course of illness.

Predictors of Function Among the Old-Old: A 10-Year Follow-Up

A 10-year follow-up of 297 survivors from a community study of the aged found there was little or no decline in social and economic function and only moderate declines in mental, physical, and activities-of-daily-living function; demographic and socioeconomic characteristics were usually strong predictors of decline in function; and impairment in one type of function often predicted greater decline in other types of function. Mental impairment was an especially strong predictor of social decline, but not vice versa.