The Influence of Processing Speed, Attention, and Inhibition on Texas Functional Living Scale Performance.

OBJECTIVE: Attention, inhibition, and processing speed are related to functional decline among older adults. This study attempts to clarify the relationships between these cognitive factors and adaptive functioning. METHOD: We examined relationships between attention, inhibition, and processing speed, with scores on the Texas Functional Living Scale (TFLS), a performance-based measure of daily functioning, in a mixed clinical sample of 530 older adults who were referred for an outpatient neuropsychological evaluation. RESULTS: The current study used a confirmatory factor analysis (CFA) to derive a three-factor cognitive model consisting of attention, inhibition, and processing speed. Results from a hierarchical regression, which included factor scores from the CFA, revealed that processing speed was the only significant predictor of TFLS performance when all three cognitive factors were included within a single model. CONCLUSION: These results highlight the influence of processing speed as an important indicator of functional decline among a clinical population of older adults.

Contribution of executive functioning to instrumental activities of daily living in older adults.

The Texas Functional Living Scale (TFLS) is a performance-based measure of instrumental activities of daily living (IADLs). Executive dysfunction has been linked to impairment on other IADL measures but has not been thoroughly investigated with the TFLS. This study examined the contribution of executive functioning to IADLs on the TFLS among 228 older adults (M age =76.0 +/- 6.5 years; 59% females) who completed the TFLS as part of comprehensive assessment at an outpatient neuropsychology clinic. Executive functioning measures included the Trail Making Test (TMT) Part B, the Controlled Oral Word Association Test, and the Wechsler Abbreviated Scale of Intelligence-II (WASI-II) Matrix Reasoning and Similarities subtests. Results from a hierarchical regression model revealed that only TMT Part B (ß = -.23, p = .023) and WASI-II Similarities (ß = .32, p = .002) scores significantly predicted TFLS Total scores after controlling for the contributions of demographics (i.e., age, education, and gender), and intellectual functioning and capabilities in other neurocognitive domains (i.e., WASI-II Vocabulary and Block Design subtests, TMT Part A, and Repeatable Battery for the Assessment of Neuropsychological Status Coding subtest, and the Immediate Memory, Delayed Memory, and Visuospatial/Construction Indices).

Factor Analysis of the Texas Functional Living Scale in an Outpatient Clinical Sample.

OBJECTIVE: Prior factor analysis of the Texas Functional Living Scale (TFLS), a performance-based measure of functional abilities, in a military veteran sample supported four factors discrepant from the published subscales. This study analyzed TFLS factor structure in a non-veteran clinical sample. METHOD: Two hundred seventy adult outpatients completed the TFLS during neuropsychological evaluation. Principal axis factor analysis with oblique promax rotation was conducted with age and education effects partialed out. RESULTS: Parallel analysis indicated five factors for extraction that accounted for a combined 48% of the variance. The first factor independently explained 26% of the total variance. Inspection of factor loadings suggested the following factor interpretations: complex calculations/time, complex visual search, praxis, memory, and basic calculations/math concepts. Five items did not significantly load onto any of the factors. CONCLUSIONS: Current results did not entirely correspond to the published subscales or prior results in a veteran sample. Further clarification of the TFLS factor structure is warranted.

Relative Utility of Performance and Symptom Validity Tests.

This investigation adds to the burgeoning body of research concerned with discriminating performance and symptom validity tests (SVTs) through examination of their differential relationships with cognitive performance and symptom self-report measures. To the authors' current knowledge, prior studies have not assessed differences between participants who fail either a performance validity test (PVT) or an SVT but not both. As part of their neuropsychological evaluations at four Veterans Affairs medical centers across the United States, participants were administered a fixed, standardized battery that consisted of performance validity, symptom validity, cognitive performance, and symptom self-report measures. Compared with participants who failed a PVT and an SVT, participants who passed both and participants who only passed a PVT demonstrated better cognitive performance and self-reported fewer symptoms. Results support differential clinical utility of performance validity and SVTs when assessing cognitive performance and symptom self-report.