Predictors of instrumental activities of daily living in community-dwelling older adults.

Psychiatric mental health clinicians often rely on proxy and self-report evaluations to determine the cognitive function of older adults however, performance measures have greater accuracy and predictive ability for everyday function. This study tested physical and cognitive predictors of functional abilities in fifty-one community residing older adults. We administered a computerized battery of executive function tasks, a performance-based measure of instrumental activities of daily living (IADL), and three physical function measures (grip strength, 30-second Chair Stand Test, and 8-foot Up and Go). Regression models assessed the associations of three components of executive function (updating, shifting, and inhibition) with IADLs and physical functions. Updating was a significant predictor of the Medications and Financial DAFS scores and of grip strength. Shifting also predicted grip strength. In conclusion, different executive functions predict different domains of IADL functioning. Working memory was a robust predictor of IADL functioning in older adults, especially medication management skills.

PTSD and cognitive symptoms relate to inhibition-related prefrontal activation and functional connectivity.

BACKGROUND: Posttraumatic stress disorder (PTSD) is associated with reduced executive functioning and verbal memory performance, as well as abnormal task-specific activity in prefrontal cortex (PFC) and anterior cingulate cortices (ACC). The current study examined how PTSD symptoms and neuropsychological performance in combat veterans relates to (1) medial PFC and ACC activity during cognitive inhibition, and (2) task-independent PFC functional connectivity. METHODS: Thirty-nine male combat veterans with varying levels of PTSD symptoms completed the multisource interference task during functional magnetic resonance imaging. Robust regression analyses were used to assess relationships between percent signal change (PSC: incongruent-congruent) and both PTSD severity and neuropsychological performance. Analyses were conducted voxel-wise and for PSC extracted from medial PFC and ACC regions of interest. Resting-state scans were available for veterans with PTSD. Regions identified via task-based analyses were used as seeds for resting-state connectivity analyses. RESULTS: Worse PTSD severity and neuropsychological performance related to less medial PFC and rostral ACC activity during interference processing, driven partly by increased activation to congruent trials. Worse PTSD severity related to reduced functional connectivity between these regions and bilateral, lateral PFC (Brodmann area 10). Worse neuropsychological performance related to reduced functional connectivity between these regions and the inferior frontal gyrus. CONCLUSIONS: PTSD and associated neuropsychological deficits may result from difficulties regulating medial PFC regions associated with "default mode," or self-referential processing. Further clarification of functional coupling deficits between default mode and executive control networks in PTSD may enhance understanding of neuropsychological and emotional symptoms and provide novel treatment targets.

Adults with diabetic peripheral neuropathy exhibit impairments in multitasking and other executive functions.

BACKGROUND AND PURPOSE: Diabetic peripheral neuropathy (DPN) contributes to functional impairment, and there is growing evidence that neuropsychological factors also influence physical function. We compared cognitive and executive function in adults with DPN with an age-matched comparison group, and examined the relationships between DPN, executive function, and physical function. METHODS: Twenty subjects with DPN and 20 comparison subjects were assessed. Diabetic peripheral neuropathy was quantified via the Michigan Neuropathy Screening Instrument and nerve conduction velocity testing. Subjects were administered Beck's Depression Inventory, the Mini-Mental Status Examination, and the Timed Up and Go (TUG) test. Each participant also completed a battery of 7 executive function tasks, including the Cognitive Timed Up and Go (cTUG) test, in which a concurrent mental subtraction task was added to the standard TUG test. RESULTS: The DPN group demonstrated poorer letter fluency (34.2 ± 11.6 words vs 46.2 ± 12.2 words; P = 0.001), category fluency (47.0 ± 8.1 words vs 56.3 ± 8.5 words; P = 0.003), and Rey-Osterrieth scores (25.9 ± 4.3 points vs 31.7 ± 2.4 points; P < 0.001), and took longer to complete both the TUG (10.3 ± 2.8 seconds vs 5.9 ± 1.0 seconds; P < 0.001) and cTUG (13.0 ± 5.8 seconds vs 6.9 ± 1.6 seconds; P < 0.001). Poorer global cognitive performance and greater depression symptoms were significantly related to each other (r = -0.46; P = 0.04) and to slower TUG times (r = -0.53; P = 0.02; and r = 0.54; P = 0.02, respectively). DISCUSSION AND CONCLUSIONS: Verbal, visuospatial, and multitasking measures of executive function may be impaired in adults with DPN. Future research should examine how these and other cognitive and psychological factors, such as depression, affect physical function in this population.

Health-related quality of life and physical, mental, and cognitive disabilities among nursing home residents in Jordan.

PURPOSE: To describe the physical, cognitive, psychological, and medical status of nursing home residents in Jordan. We also investigated the perceived health-related quality of life of this population. METHODS: A sample of 221 nursing home residents in Jordan was recruited to participate in this study. Demographic variables and medical history were collected. In addition, all participants were assessed using health-related quality of life items (HRQOL), mini-mental state examination (MMSE), Geriatric Depression Scale (GDS), Tinetti assessment battery for gait and balance (TAB), and disability of arm, shoulder, and hand assessment (DASH). RESULTS: TAB and DASH scores were related to the following HRQOL items: self-reported general health status, the need for personal care, the need for help from others in handling routine needs, the number of days of pain, feeling sad, depressed, worried, and not getting enough sleep, and the number of days feeling very healthy and full of energy. MMSE scores were related to self-reported need for personal care, the need for help from others in handling daily routine needs, and the number of days feeling pain, sad, worried, and depressed. GDS scores were related to self-reported general health status, the need for personal care, the need for help from others for handling daily routine needs, the number of pain, sad, worried, and not getting enough sleep days, and the number of days feeling healthy and full of energy. CONCLUSIONS: This study revealed a substantial impact of physical, cognitive, and psychological disabilities on HRQOL of nursing home residents in Jordan.

"Black Women Don't Always Put Our Healthcare First": Facilitators and Barriers to Cervical Cancer Screening and Perceptions of Human Papillomavirus Self-Testing Among Church-Affiliated African American Women.

Background: African American women are at greater risk for cervical cancer incidence and mortality than White women. Up to 90% of cervical cancers are caused by human papillomavirus (HPVs) infections. The National Institutes of Health (NIH) co-developed HPV self-test kits to increase access to screening, which may be critical for underserved populations. Purpose/Research Design: This mixed methods study used the Theory of Planned Behavior to examine attitudes, barriers, facilitators, and intentions related to receipt of cervical cancer screening and perceptions of HPV self-testing among church-affiliated African American women. Study Sample/Data Collection: Participants (N = 35) aged 25-53 participated in focus groups and completed a survey. Results: Seventy-four percent of participants reported receipt of cervical cancer screening in the past 3 years. Healthcare providers and the church were supportive referents of screening. Past trauma and prioritizing children's healthcare needs were screening barriers. Concerns about HPV self-testing included proper test administration and result accuracy. Conclusions: Strategies to mitigate these concerns (e.g., delivering HPV self-test kits to the health department) are discussed.

The association between verbal memory, processing speed, negative symptoms and functional capacity in schizophrenia.

The aim of this paper is to explore the links among verbal memory, processing speed, negative symptoms, and functional capacity, using structural equation modeling techniques. Model A is a multiple regression model with cognitive and symptom variables as predictors and functional capacity as the latent outcome variable. Model B consists of three two mediator models that assess the ability of each variable to mediate the effect of the other variable on outcome conditional on the inclusion of the other mediator in the model. Ninety-eight community-dwelling patients with schizophrenia (mean age=35.8years, S.D.=10.1) participated in the study. Results indicate that verbal memory, processing speed and negative symptoms significantly contributed to functional status. Verbal memory was at least partially mediated by processing speed in its effect on outcome, while the impact of processing speed on outcome was mediated by both verbal memory and negative symptoms. The influence of negative symptoms on functional capacity was partially mediated by processing speed. These findings enrich our understanding of the direct and indirect effects of these three interrelated variables and provide a basis for the development of intervention strategies.

Cognitive predictors of a performance-based measure of instrumental activities of daily living following stroke.

BACKGROUND: To inform cognitive interventions that target functional capacity for individuals who have survived stroke, an evaluation of predictors of daily functioning is necessary. The current literature is limited regarding identifying the associations between objective cognitive functioning and objective performance of Instrumental Activities of Daily Living (IADLs). OBJECTIVES: To investigate the relationship between objectively measured cognitive domains/executive functions and performance on an objective measure of IADLs following a stroke. METHODS: Cross-sectional examination of 52 participants who have survived strokes and completed assessments of immediate memory, visuospatial/constructional skills, language, attention, delayed memory, executive functions (i.e., inhibition and flexibility, concept-formation and problem-solving, abstract thinking, deductive thinking, and verbal abstraction), and a performance-based measure of IADLs (UCSD Performance-based Skills Assessment; UPSA). RESULTS: Results indicated significant correlations between the UPSA and immediate memory, visuospatial/constructional skills, language, delayed memory, and executive functions (i.e., concept formation and problem-solving, flexibility of thinking, and verbal abstraction). A hierarchical multiple regression, controlling for age, severity of stroke, side of stroke, and depressive symptoms and including the cognitive measures individually significantly associated with the UPSA, explained approximately 62% of the variance in overall UPSA performance. This regression demonstrated that only language significantly predicted UPSA total score, in the context of multiple variables. CONCLUSIONS: Cognitive functioning is significantly associated with IADL functioning post-stroke, and considering multiple domains of cognitive functioning together largely explains the performance of IADLs.

What eye-tracking methods can reveal about the role of information format in decision-aid processing: an exploratory study.

OBJECTIVE: Decision tools can assist patients and families in making informed choices about treatment options. However, information format can influence understanding of treatment options and subsequent treatment decisions, so it is critical to identify formats that support clear and accurate communication. METHOD: Forty-five older adults made a hypothetical treatment decision about rt-PA therapy for stroke while viewing risk information presented in one of three graph formats (bar, stacked bar, or iconic array). We investigated decisional uncertainty, study time and memory accuracy as a function of graph format. Eye tracking methods explored format-related differences in graph processing. RESULTS: Decisional uncertainty was higher after studying the bar graph, compared to the stacked bar or iconic graph. The bar graph was also associated with poorer memory and longer overall study time. Eye-tracking indicated that graph information was processed in a different order and to a different extent for the three graph types. CONCLUSION: Understanding how people process information in decision aids is critical for clear communication with decision-makers. PATIENT IMPLICATIONS: Format has been shown to impact information processing, and eye-tracking may be a useful tool to understand these format differences and their implications, and to guide the design of decision aids to optimize communication.

Computer-Based Executive Function Training for Combat Veterans With PTSD: A Pilot Clinical Trial Assessing Feasibility and Predictors of Dropout.

Background: While evidence-based PTSD treatments are often efficacious, 20-50% of individuals continue to experience significant symptoms following treatment. Further, these treatments do not directly target associated neuropsychological deficits. Here, we describe the methods and feasibility for computer-based executive function training (EFT), a potential alternative or adjunctive PTSD treatment. Methods: Male combat veterans with full or partial PTSD (n = 20) and combat-exposed controls (used for normative comparison; n = 20) completed clinical, neuropsychological and functional neuroimaging assessments. Those with PTSD were assigned to EFT (n = 13) or placebo training (word games; n = 7) at home for 6 weeks, followed by repeat assessment. Baseline predictors of treatment completion were explored using logistic regressions. Individual feedback and changes in clinical symptoms, neuropsychological function, and neural activation patterns are described. Results: Dropout rates for EFT and placebo training were 38.5 and 57.1%, respectively. Baseline clinical severity and brain activation (i.e., prefrontal-insula-amygdala networks) during an emotional anticipation task were predictive of treatment completion. Decreases in clinical symptoms were observed following treatment in both groups. EFT participants improved on training tasks but not on traditional neuropsychological assessments. All training completers indicated liking EFT, and indicated they would engage in EFT (alone or as adjunctive treatment) if offered. Conclusion: Results provide an initial framework to explore the feasibility of placebo-controlled, computerized, home-based executive function training (EFT) on psychological and neuropsychological function and brain activation in combat veterans with PTSD. Clinical severity and neural reactivity to emotional stimuli may indicate which veterans will complete home-based computerized interventions. While EFT may serve as a potential alternative or adjunctive PTSD treatment, further research is warranted to address compliance and determine whether EFT may benefit functioning above and beyond placebo interventions.

Task switching after stroke.

BACKGROUND AND PURPOSE: Task switching is a cognitive skill that may be compromised after brain damage. The purposes of this study were to examine task-switching abilities in the subacute phase after stroke, to determine whether a switching task under endogenous or internal control is more difficult than a switching task under exogenous or cued control, and to determine whether deficits in switching attenuate in the first few months after stroke. SUBJECTS: The participants in this study were 46 adults with stroke and 38 adults without stroke. METHODS: Subjects performed 2 computer-based switching tasks, an alternating task that relied on endogenous control and a cued task that relied on exogenous control. Testing was done in subjects' homes at 1 and 3 months after stroke and at a 2-month interval for control subjects. Switch costs, or the difference between the no-switch condition and the switch condition, were calculated for accuracy and response time. RESULTS: Subjects in the stroke group had higher switch costs for accuracy than did subjects in the control group. The alternating task was more difficult than the cued task, with higher switch costs for accuracy and response time. The alternating task was particularly difficult for subjects in the stroke group, with high switch costs for accuracy. Both groups showed decreased response time switch costs at the second testing session. DISCUSSION AND CONCLUSION: Task switching, particularly if under endogenous control, is impaired in adults in the subacute phase after stroke. Clinicians should be aware of performance deficits that may relate to task switching.

Measuring learning potential in people with schizophrenia: A comparison of two tasks.

Learning potential measures utilize dynamic assessment methods to capture performance changes following training on a cognitive task. Learning potential has been explored in schizophrenia research as a predictor of functional outcome and there have been calls for psychometric development in this area. Because the majority of learning potential studies have utilized the Wisconsin Card Sorting Test (WCST), we extended this work using a novel measure, the Rey Osterrieth Complex Figure Test (ROCFT). This study had the following aims: 1) to examine relationships among different learning potential indices for two dynamic assessment tasks, 2) to examine the association between WCST and ROCFT learning potential measures, and 3) to address concurrent validity with a performance-based measure of functioning (Test of Grocery Shopping Skills; TOGSS). Eighty-one adults with schizophrenia or schizoaffective disorder completed WCST and ROCFT learning measures and the TOGSS. Results indicated the various learning potential computational indices are intercorrelated and, similar to other studies, we found support for regression residuals and post-test scores as optimal indices. Further, we found modest relationships between the two learning potential measures and the TOGSS. These findings suggest learning potential includes both general and task-specific constructs but future research is needed to further explore this question.

Multitasking in older adults with type 2 diabetes: A cross-sectional analysis.

BACKGROUND AND PURPOSE: Deficits in the ability to multitask contribute to gait abnormalities and falls in many at-risk populations. However, it is unclear whether older adults with type 2 diabetes mellitus (DM) also demonstrate impairments in multitasking. The purpose of this study was to compare multitasking performance in cognitively intact older adults with and without DM and explore its relationship to measures of gait and functional ability. METHODS: We performed a cross-sectional analysis of 40 individuals aged 60 and older with type 2 DM and a matched group of 40 cognitively intact older adults without DM. Multitasking was examined via the ambulatory Walking and Remembering Test (WART) and seated Pursuit Rotor Test (PRT). Self-selected normal and fast walking speed and stride length variability were quantitatively measured, and self-reported functional ability was assessed via the Late Life Function and Disability Index (LLFDI). RESULTS: Participants with DM walked slower and took more steps off path when multitasking during the WART. No between-group differences in multitasking performance were observed on the PRT. Multitasking performance demonstrated little correlation with gait and functional ability in either group. DISCUSSION AND CONCLUSIONS: Older adults with DM appear to perform poorly on an ambulatory measure of multitasking. However, we analyzed a relatively small, homogenous sample of older adults with and without type 2 DM and factors such as peripheral neuropathy and the use of multiple comparisons complicate interpretation of the data. Future research should explore the interactions between multitasking and safety, fall risk, and function in this vulnerable population. Clinicians should recognize that an array of factors may contribute to gait and physical dysfunction in older adults with type 2 diabetes, and be prepared to assess and intervene appropriately.

Eye movements of young and older adults while reading with distraction.

The authors used eye-tracking technology to examine young and older adults' online performance in the reading in distraction paradigm. Participants read target sentences and answered comprehension questions following each sentence. In some sentences, single-word distracters were presented in either italic or red font. Distracters could be related or unrelated to the target text. Online measures, including probability of fixation, fixation duration, and number of fixations to distracting text, revealed no age differences in text processing. However, young adults did have an advantage over older adults in overall reading time and text comprehension. These results provide no support for an inhibition deficit account of age differences in the reading in distraction paradigm, but are consistent with J. Dywan and W. E. Murphy's (1996) suggestion that older adults are less able than the young to distinguish target and distracter information held in working memory.

Revealing language deficits following stroke: the cost of doing two things at once.

The costs of doing two things were assessed for a group of healthy older adults and older adults who were tested at least 6 months after a stroke. A baseline language sample was compared to language samples collected while the participants were performing concurrent motor tasks or selective ignoring tasks. Whereas the healthy older adults showed few costs due to the concurrent task demands, the language samples from the stroke survivors were disrupted by the demands of doing two things at once. The dual task measures reveal long-lasting effects of strokes that were not evident when stroke survivors were assessed using standard clinical tools.

Perspectives of People with Dementia About Meaningful Activities: A Synthesis.

Qualitative studies were synthesized to describe perspectives of people with dementia regarding meaningful activities. Themes of connectedness were identified using a meta-ethnography approach. The theme of being connected with self encompasses engagement for continuity, health promotion, and personal time. The theme of being connected with others includes being with others not to feel alone, doing an activity with others, and meaningful relationships. The theme of being connected with the environment encompasses being connected to one's familiar environment, community, and nature. This synthesis suggests that connectedness is an important motivation for engagement in daily activities. Findings indicate that identifying the underlying motivation for an individual with dementia to engage in different activities is important for matching a person with activities that will be satisfying. This review may inform the development of interventions for engaging people with dementia in meaningful, daily activities and creating connectedness to self, others, and the environment.

The role of visual attention in predicting driving impairment in older adults.

This study evaluated the role of visual attention (as measured by the DriverScan change detection task and the Useful Field of View Test [UFOV]) in the prediction of driving impairment in 155 adults between the ages of 63 and 87. In contrast to previous research, participants were not oversampled for visual impairment or history of automobile accidents. Although a history of automobile accidents within the past 3 years could not be predicted using any variable, driving performance in a low-fidelity simulator could be significantly predicted by performance in the change detection task and by the divided and selection attention subtests of the UFOV in structural equation models. The sensitivity and specificity of each measure in identifying at-risk drivers were also evaluated with receiver operating characteristic curves.

Balance and gait of adults with very mild Alzheimer disease.

BACKGROUND AND PURPOSE: Studies have shown that adults with Alzheimer disease (AD) have gait and balance deficits; however, the focus has been on those with mild to severe disease. The purpose of this study was to determine whether balance and gait deficits are present in those with very mild AD. METHODS: Thirteen adults (72.9±4.7 years old) with very mild AD and 13 age-matched (72.6±4.6 years old) and sex-matched (10 males and 3 females) participants in a control group without AD performed balance and gait tests. All participants were living in the community and independent in community ambulation. RESULTS: Participants with very mild AD had shorter times in tandem stance with eyes open (P<0.001) and with eyes closed (P=0.007) compared with participants in the control group. Those with AD also took longer to complete the Timed "Up & Go" Test (P<0.001). Gait deficits were found for those with AD as demonstrated by slower velocities in the 10-m walk at a comfortable pace (P=0.029) and on an instrumented walkway (P<0.001). Stance times were longer for those with AD (P<0.001) and step length was shorter (P=0.001). There were no group differences in the 10-m walk at a fast pace. The gait velocity of participants in the control group was faster on the instrumented walkway than in the 10-m walk at a comfortable pace (P=0.031). In contrast, the gait velocity of those with AD was significantly slower on the instrumented walkway than in the 10-m walk at a comfortable pace (P=0.024). DISCUSSION: Balance and gait deficits may be present in those in the very early stages of AD. Novel surfaces may affect gait speed in those with very mild AD. Identifying mobility deficits early in the progression of AD may provide an opportunity for early physical therapy intervention, thus promoting continued functional independence. CONCLUSIONS: Adults in the very early stages of AD may show signs of balance and gait deficits. Recognition of these problems early with subsequent physical therapy may slow the progression of further balance and gait dysfunction.

Effects of aging and task difficulty on divided attention performance.

We report two experiments that compare the performance of young and older adults on perceptual-motor tasks involving division of attention. Previous studies have shown older people to be especially penalized by divided attention situations, but the generality of this finding was recently challenged by Somberg and Salthouse (1982). The present study was conducted to investigate the possibility that age differences in dual-task performance are amplified by an increase in the difficulty of the constituent tasks, where difficulty was manipulated by varying the central, cognitive nature of the tasks (Experiment 1) or the degree of choice involved (Experiment 2). With the present tasks, strong evidence was found for an age-related decrement in divided attention performance. Contrary to our original expectations, however, it does not seem that division of attention presents some especial difficulty to older people. Rather, division of attention is one of several equivalent ways to increase overall task complexity. In turn, age differences are exaggerated as tasks are made more complex.

Attentional abilities and functional outcomes following stroke.

Although stroke affects cognitive functioning as well as motor functioning, research on cognitive consequences has lagged behind that focused on motor function. The evidence that is accruing suggests that cognitive function is importantly related to successful rehabilitation. The present study examined two aspects of attentional functioning (divided attention and switching attention) in older adult stroke survivors and healthy older adults. In addition, the authors investigated the relation between attention and functional outcomes following stroke. Results revealed stroke-related deficits in both of the types of attention as well as significant associations between attentional functioning and both physical and social outcome measures. Poorer attentional performance was associated with a more negative impact of stroke on daily functioning. These findings suggest an important role for attention in post-stroke function and provide information that can contribute to improving outcomes following stroke.