Adult Independence Living Measurement Scale: Psychometric validation of a scale to estimate personal skills for independent living in people with intellectual and developmental disabilities.

BACKGROUND: The United Nations has declared that people with disabilities should be enabled to live as independently as possible, since independence is correlated with a better quality of life. Consequently, services need to have common and validated measurement tools for the evaluation of the different levels of personal support needs in order to promote independent living skills. We aimed to create and validate the Adult Independence Living Measurement Scale (AILMS) to estimate personal skills considered tantamount for independent living in adult persons with intellectual and developmental disabilities. METHODS: AILMS is a short informant-rated assessment tool consisting of 19 items (goals) regarding the most important skills related to independent living. AILMS total score is directly proportional to the degree of independence, with scores ranging from 19 to 76. Our validation is a multicentre study attended by 243 subjects, 110 female and 123 males, with a median age of 37 years and with an interquartile range (IQR) of 18 (25th percentile [Q1] 29 years to 75th percentile [Q3] 47 years). All subjects had a diagnosis of intellectual disability associated with various neurodevelopmental disorders or syndromic conditions. RESULTS: The AILMS shows a wide range of scores with a minimum score of 21 and a maximum of 72. We found no floor or ceiling effects for the total score on the AILMS. Cronbach's α coefficient (= 0.95), based on the 19 AILMS items, indicated high internal consistency. The tool demonstrates a very good agreement even when comparing the results submitted by two different interviewers. It also shows an excellent temporal stability of 1 week, with intraclass correlation coefficients both of 0.97. AILMS total scores do not differ by sex or age, while statistically significant differences are observed between people with different levels of severity of ID. Convergent validity of AILMS was analysed by correlating its total scores with the Italian validated versions of the Support Intensity Scale (SIS-I) and the Alzheimer's Functional Assessment Tool (AFAST-I) scores. Strong inverse Spearman correlations coefficients (rs ) were found both for the Support Need Index of the SIS-I (rs  = -0.66; P < 0.001) and AFAST-I (rs  = -0.73; P < 0.001). Scores of support needs in exceptional health disorders of the SIS-I appear unrelated to AILMS total scores (rs  = -0.01; P = 0.05), confirming the divergent validity of the new scale. Exploratory factor analysis reveals three underlying factors within the AILMS, with factor 1 explaining 51.2% of the total variance (Cronbach's α = 0.92) composed of predominantly nine advanced daily activities. CONCLUSIONS: The AILMS has good psychometric properties and user friendliness and may therefore be a valuable addition to the current informant-rated tools for screening and assessment of independent living skills of individuals with intellectual and developmental disabilities.

Short forms of Prudhoe Cognitive Function Test in adults and aging people with intellectual disabilities: Italian validation study.

BACKGROUND: We aimed to validate the Italian version of the two parallel short forms of the Prudhoe Cognitive Function Test (s-PCFT-I) in adults and seniors with intellectual disabilities (ID) of any aetiology and level of severity. METHODS: Our validation is a multicentre study attended by 211 subjects with ID, 125 male and 86 female, aged 40 years and above for people with Down syndrome and aged 50 years for people with other forms of disabilities. RESULTS: The s-PCFT-I shows a wide range of scores in the absence of floor effects with minimal ceiling effects. A Cronbach's α coefficient of 0.85 and a mean inter-item correlation of 0.21 indicate high internal consistency. The tool demonstrates good agreement between testers and near excellent temporal stability with intraclass correlation coefficients respectively of 0.85 and 0.90. s-PCFT-I total scores do not differ by sex or age, while statistically significant differences are observed between people with different levels of severity of ID. Moderate to good and highly significant correlations (-0.40 to -0.66) among the s-PCFT-I total scores and subscores and the Sum of Cognitive Score of the informant-based Dementia Questionnaire for Persons with Intellectual Disabilities suggest an acceptable level of concurrent criterion validity. Cognitive decliners according to Prasher's Dementia Questionnaire for Persons with Intellectual Disabilities cut-off scores perform significantly lower on s-PCFT-I than non-decliners. CONCLUSIONS: The s-PCFT-I has good psychometric properties and user friendliness and may therefore be a valuable addition to the current informant-rated tools for screening and assessment of cognition in aging people with ID.

Functional abilities and cognitive decline in adult and aging intellectual disabilities. Psychometric validation of an Italian version of the Alzheimer's Functional Assessment Tool (AFAST): analysis of its clinical significance with linear statistics and artificial neural networks.

PURPOSE: (a) A psychometric validation of an Italian version of the Alzheimer's Functional Assessment Tool scale (AFAST-I), designed for informant-based assessment of the degree of impairment and of assistance required in seven basic daily activities in adult/elderly people with intellectual disabilities (ID) and (suspected) dementia; (b) a pilot analysis of its clinical significance with traditional statistical procedures and with an artificial neural network. METHODS: AFAST-I was administered to the professional caregivers of 61 adults/seniors with ID with a mean age (± SD) of 53.4 (± 7.7) years (36% with Down syndrome). Internal consistency (Cronbach's α coefficient), inter/intra-rater reliabilities (intra-class coefficients, ICC) and concurrent, convergent and discriminant validity (Pearson's r coefficients) were computed. Clinical significance was probed by analysing the relationships among AFAST-I scores and the Sum of Cognitive Scores (SCS) and the Sum of Social Scores (SOS) of the Dementia Questionnaire for Persons with Intellectual Disabilities (DMR-I) after standardisation of their raw scores in equivalent scores (ES). An adaptive artificial system (AutoContractive Maps, AutoCM) was applied to all the variables recorded in the study sample, aimed at uncovering which variable occupies a central position and supports the entire network made up of the remaining variables interconnected among themselves with different weights. RESULTS: AFAST-I shows a high level of internal homogeneity with a Cronbach's α coefficient of 0.92. Inter-rater and intra-rater reliabilities were also excellent with ICC correlations of 0.96 and 0.93, respectively. The results of the analyses of the different AFAST-I validities all go in the expected direction: concurrent validity (r=-0.87 with ADL); convergent validity (r=0.63 with SCS; r=0.61 with SOS); discriminant validity (r=0.21 with the frequency of occurrence of dementia-related Behavioral Excesses of the Assessment for Adults with Developmental Disabilities, AADS-I). In our sample age and gender do not correlate with the scale and comparing the distribution of the AFAST-I and DMR-SCS and DMR-SOS expressed as ES, it appears that memory disorders and temporal and spatial disorientation (SCS) precede the loss of functional abilities, whereas changes in social behaviour (SOS) are less specific in detecting cognitive deterioration sufficient to provoke functional disability and vice versa. The results of AutoCM analysis reveal that the hub (core) of the entire network is represented by the functional domain 'personal/oral hygiene' in the entire study sample and 'use of toilet' in a subgroup of subjects who obtained an ES equal to 0 at DMR-SCS. CONCLUSIONS: These results confirm the reliability and validity of AFAST-I and emphasise the complexity of the relationship among functional status, cognitive functioning and behaviour also in adults/seniors with ID.

An electronic memory aid to support prospective memory in patients in the early stages of Alzheimer's disease: a pilot study.

The use of an electronic memory aid (EMA) for patients with mild-to-moderate probable Alzheimer disease is examined in five outpatients aged 58-79 years. The ability to remember to carry out seven tasks at a particular time was evaluated in three experimental conditions: recall without an external memory aid, recall with a written list and recall with support available from an EMA. The use of an EMA significantly improved patients' prospective memory, while the written list and free recall were not useful. Future research that examines the value of using an EMA to help with tasks that are associated with prospective memory with a larger sample of patients within their own home context is suggested.

Memory rehabilitation in Alzheimer's disease: a review of progress.

BACKGROUND: Memory rehabilitation is a sadly misrepresented area of applied research in Alzheimer's disease. OBJECTIVES: To gather and evaluate recent evidence for the clinical effectiveness or ecologically validity of memory rehabilitation for mild to moderate Alzheimer's patients. METHODS: Computerised searches and some handsearching were conducted spanning the last five years, from 1995 to 2000, inclusively. Criteria for inclusion in this overview involved the use of a precise memory rehabilitation technique within an experimental study design applied to Alzheimer's patients with pre- and post-treatment evaluation. FINDINGS: Three potential levels of memory rehabilitation procedures with proven clinical or pragmatic efficacy were identified. The first level bears on the facilitation of residual explicit memory with structured support both at encoding and at subsequent recall; the second level of memory rehabilitation exploits the relatively intact implicit memory system (priming and procedural memory); the last deals with finding ways of coping with the patient's limited explicit memory capacities through the use of external memory aids. A proposal of suggestions for good practice and future research in memory rehabilitation is also offered with the hope to spur further development in this rapidly expanding area of applied research. CONCLUSION: The available evidence shows that alternative and innovative ways of memory rehabilitation for Alzheimer's patients can indeed be clinically effective or pragmatically useful with a great potential for use within the new culture of a more graded and proactive type of Alzheimer's disease care.

The validity of informant reports in assessing the severity of dementia: evidence from the CAMDEX interview.

The evaluation of a patient's mental state, overall clinical profile and behavioural disturbance in the process of diagnosing dementia requires at least two sources of information: the patient and the informant. Since the severity of the dementia may interfere with the subjective perception of these disorders, it is important to evaluate the consistency between these two sources of information and the clinical and psychometric evaluation made by the physician. Accordingly, in this study five behavioural areas, derived from the semi-structured interview schedule provided by the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX, i.e., Sleep, Depressed Mood, Everyday Activity, Memory and Global Mental Functioning) have been tested on the patient and his/her informant. Eighty dementia patients (mean age = 74 years) and their informants participated in the study. The dementia group was subdivided into two levels of severity according to DSM-IIIR criteria: 41 with mild dementia and 39 with moderate dementia, respectively, matched for age and schooling. The rating of impairment was found to increase along with the severity of dementia in all the above-mentioned areas, except for sleep. However, the source of information per se significantly influenced the evaluation of memory functioning. Moreover, the significant interaction between the two factors considered indicates that memory functioning is evaluated quite differently by the patients and the informants, as only in the assessment made by the latter group did the impairment increase in parallel with severity of dementia. Finally, whereas none of the subjective measures recorded in the patients were significantly correlated with their test scores, the correlations between the informant memory appraisals and patient test results proved to be significant. The present findings confirm the validity of informant reports in assessing cognitive and memory disorders in early-stage dementia, as well as in distinguishing patients with mild from those with moderate dementia.

The influence of depression on memory and metamemory in the elderly.

This study aimed to assess the relationships among depression level, memory and metamemory scores on a large sample of elderly subjects (139 men and 147 women). Preliminary examination showed that none of the sampled subjects had intellectual impairment (as assessed by means of the Mini-Mental State Examination) or neuropsychiatric symptoms. Each subject was administered the Randt Memory Test (RMT), the Sehulster Memory Scale (SMS) and the Geriatric Depression Scale (GDS). A Multivariate Analysis of Covariance revealed a negative influence of depression on the two RMT measures (Acquisition-Recall: AR; Delayed Memory: DM) and on the three SMS measures (Set1: self-comparison; Set2: memory complaints; Set3: peer comparison), and of age on AR and DM, and Set1 and Set2. A Multivariate Regression Analysis showed that DM scores were positively correlated with Set2 in men and women, and with Set1 in women and Set3 in men, whereas AR scores related to Set2 and Set3 in men and Set1 in women. In addition, depression influenced negatively Set1, Set2 and AR scores in both men and women and DM scores only in men. On the whole, the results suggest that depression, memory and metamemory are rather closely related in non-severely depressed older individuals, albeit with slightly different patterns in men and women, and that some areas of metamemory are congruent with objective functioning regardless of the level of depressive symptoms.

1995 IPA/Bayer Research Awards in Psychogeriatrics. Bihemispheric language disorders in early-stage dementia of the Alzheimer type: evidence from a novel metalinguistic task.

Because dementia of the Alzheimer type (DAT) is commonly characterized by bilateral cerebral atrophy, we examined the issue of higher linguistic abilities lateralized to the right cerebral hemisphere (RH) in earlystage DAT. A modified version of an insertion task was administered to 14 patients with probable DAT, 8 right-hemisphere brain-damaged (RHD) patients, 8 left-hemisphere brain-damaged (LHD) patients, and 28 normal elderly (control, CTR) right-handed subjects. The task consisted of presenting the subjects with 53 well-formed sentences; in each a word or syntagm had to be inserted grammatically. Twenty-eight word/syntagm insertions required grammatical role reassignment of a lexical item in the stimulus sentence (shift, sensitive to RHD); 25 insertions implied only semantic reinterpretation of the target sentence (nonshift, sensitive to LHD). The three pathological groups were relatively and similarly impaired on standard aphasia assessment. The performances of the DAT patients, controlled for global cognitive verbal proficiency, verbal cognitive skills, and mood, were found to be significantly worse than the performances of the CTR group on both insertion subtests, whereas there were no significant differences between the DAT and RHD subjects on the shift items or between the DAT and LHD subjects on the nonshift items. Similarly, no differences were noted between the RHD and CTR nonshift scores, or between the LHD and CTR shift scores. On the other hand, the LHD group outscored the RHD group on the shift insertions. A comparison between the two insertion subtests revealed that only the RHD and DAT groups performed significantly worse on the shift than on the nonshift items. Results are consistent with other anecdotally reported RH-specific language-related disorders in early DAT and replicate previous findings of bihemispheric extralinguistic disturbances in these patients.

Memory training and drug therapy act differently on memory and metamemory functioning: evidence from a pilot study.

The aim of this study was to assess the influence of drug therapy (DT) with pramiracetam and memory training (MT), each alone, and in combination (DTMT), on both the objective memory and metamemory performance. Thirty-five non-depressed, non-demented healthy elderly (mean age: 64.8 years) with objective (story recall) and/or subjective (cognitive difficulties scale) memory loss were randomly included in four open-label conditions: an MT condition (n = 10), a DT condition (n = 8), a DTMT condition (n = 10), and a control (CTR) condition (n = 7). MT and DTMT subjects participated in 12 real-life tutor-guided MT sessions, once weekly, each lasting 1.5 hrs. The subjects were tested for objective (Randt memory test) and subjective (Sehulster metamemory scale; memory functioning questionnaire) memory proficiency prior to (t(0)) and shortly after treatment (t(1)). Results showed that objective memory gains of the two groups receiving pramiracetam were significantly larger than that of the MT and CTR groups. The ranking order in terms of decreasing score improvements was DTMT - DT - MT - CTR. Metamemory, on the other hand, displayed only a trend to between-group differences with opposite patterns for the DT and DTMT groups. In the DT group, the level of depression, negatively interfered with metamemory but not with actual memory performance. The present findings stress, once again, the complex relationships between memory, metamemory and affective status, which may be differently modified by DT and MT.

Transient global amnesia: memory and metamemory.

Twenty patients (mean age 64 years) with a previous episode of transient global amnesia (TGA) were examined to assess the functioning of objective memory (by using the Randt Memory Test), the metamemory capacities (Sehulster Memory Scale), the residual level of retrograde amnesia (Questionnaire of Remote Events), and the level of depression (Geriatric Depression Scale). Patients with residual retrograde amnesia scored significantly lower than non-amnesic ones on indices of both short-term and long-term memory, and for one of three main metamemory components, namely self-rating of memory functioning through comparison with memory functioning of peers (Set3). Age, time interval from TGA attack and TGA duration did not prove to influence memory and metamemory scores. Retrograde amnesia and depression were rather substantially associated (1/5), and this association was found to negatively influence nearly all memory and metamemory scores. Depression level showed a positive correlation with short-term memory functioning in non-amnesics. The different pattern and strength of the relationships between metamemory components and objective memory dimensions observed in amnesics and non-amnesics indicate that metamemory evaluations are more closely related to memory functioning in amnesics than in non-amnesics.

Two systems for colour-naming defects: verbal disconnection vs colour imagery disorder.

Two subjects affected by pure alexia and showing no central dyschromatopsia or generalized aphasia, performed poorly on traditional tasks with visually-presented colour stimuli and on tasks with objects presented verbally. Three experiments were conducted to evaluate the possible role of mental colour imagery in recalling the colours of objects from memory. It was concluded that Case I, with left occipital lobe softening, had preserved imagery systems, but failed to recode the colours of mentally generated colour images, just as he failed to name visually presented colours, suggesting a language-imagery disconnection. In contrast, Case II, with a bilateral occipital lesion, had sustained damage to her long-term visual memories for colours as chromatic attributes of objects. This content-specific imagery deficit was concomitant with colour agnosia. The present findings are discussed in terms of current cognitive theories on imagery deficits.

Category-specific versus modality-specific aphasia for colours: a review of the pioneer case studies.

This paper addresses the long-standing dichotomy between category-specific (colour-name aphasia) and modality-specific impaired colour-naming (optic aphasia for colours) in posteriorly brain injured patients with preserved colour vision and language abilities. The data gathered for this paper were obtained from a critical review of the pioneer case studies and the analysis of the author's research findings. A number of easily applicable colour tasks, especially the so-called "verbal-verbal" ones are recommended and are believed to be equipped to refine the clinical assessment of impaired visual and verbal knowledge of colours in the brain damaged as well as to pinpoint the functional defects underlying the varieties of colour-naming impairments.