Conscientiousness Is Associated with Lower Risk of Dementia among Black and White Older Adults.

BACKGROUND: While some personality traits may reduce risk of dementia, this is controversial and has not been studied as much among diverse populations. We examined associations between 2 traits - Conscientiousness and Openness to Experience - and risk of dementia among black and white older adults. METHODS: We studied 875 older adults (ages 71-82, 47% black) without prevalent dementia from the Health, Aging and Body Composition study, who completed the NEO Five-Factor Inventory for Conscientiousness and Openness to Experience. Incident dementia over 8 years (mean = 6.9 years) was determined by hospital records, medications, or ≥1.5 SD race-specific decline on the Modified Mini-Mental State Examination. In adjusted models, we investigated associations between each trait and risk of dementia, including for race interactions. RESULTS: Associations between personality traits and dementia risk did not differ by race (interactions: p > 0.7). Higher Conscientiousness was associated with lower dementia risk (adjusted HR per 1SD = 0.78; 95% CI 0.65-0.94). There was no association for Openness to Experience (adjusted HR per 1SD = 0.88; 95% CI 0.71-1.08). CONCLUSIONS: Higher Conscientiousness is associated with lower dementia risk, even among diverse populations. Higher Conscientiousness may be protective, or lower Conscientiousness may be an early symptom of neurodegenerative disease.

Multimedia Aided Consent for Alzheimer's Disease Research.

OBJECTIVES: Optimizing the research consent process simultaneously fosters respect for autonomy and protection of those with diminished capacity for autonomy. This study evaluated the effectiveness of an enhanced research consent procedure, employing multimedia disclosure and corrective feedback, in improving decisional capacity among 114 people with mild-to-moderate Alzheimer's disease (AD) and 134 non-psychiatric comparison (NC) subjects. METHODS: Participants were randomized to consent type (routine versus enhanced) and protocol type (lower versus higher risk). Outcomes included a 5-item questionnaire assessing immediate comprehension, MacArthur Competence Assessment Tool for Clinical Research assessing four components of decision-making capacity, and categorical decisional capacity (based on a cut-score established in reference to expert judgments for a subset of participants). RESULTS: There was no significant effect of the enhanced consent procedure, relative to routine consent, on immediate comprehension or decisional capacity. CONCLUSIONS: Multimedia tools do not appear to be the solution to better consent for AD research. CLINICAL IMPLICATIONS: Given the ethical primacy of informed consent and issues of justice for impaired populations who might be harmed by an absence of research-based treatment advances, continued search for ways to more meaningfully engage people with AD in the consent or assent process is warranted.

Neurocognitive and functional correlates of mobile phone use in middle-aged and older patients with schizophrenia.

OBJECTIVES: Our objective was to examine the association of mobile phone use and ownership with psychopathology, cognitive functioning, and functional outcome in 196 outpatients aged 40 years and older who were diagnosed with schizophrenia. METHOD: Participants reported their past and current mobile phone use on a standardized self-report scale and they were administered tests of global cognition, functional capacity, and informant-rated functional outcome. RESULTS: The great majority of subjects had used a mobile phone (78%) but few currently owned one (27%). After adjusting for age (mean age 51), any past mobile phone use was associated with less severe negative symptoms, and higher global cognitive performance, functional capacity, and functional outcome. A total of 60% of participants reported being comfortable with mobile phones, but comfort was not associated with any cognitive or functional outcomes. CONCLUSION: Most of the older patients with schizophrenia have used mobile phones and lifetime mobile phone use is a positive indicator of cognitive and functional status.

Longitudinal study of sustained attention in outpatients with bipolar disorder.

Individuals with bipolar disorder (BD) may exhibit attentional deficits, however, the extent of impairment and long-term fluctuations in performance in attention are relatively unknown. We investigated the relationship between sustained attention and affective symptoms over time among BD patients. We also examined whether global differences in attentional capacity differed among BD versus normal comparison (NC) subjects. Participants included 106 outpatients with BD and 66 NC subjects who were administered symptom rating scales and a measure of sustained attention (Continuous Performance Test- Identical Pairs). Measures were repeated 6, 12, and 26 weeks post-baseline. Compared to NC subjects, participants with BD showed impairment in sustained attention across time. Within patient increases in manic symptoms were associated with increased false alarms; both manic and depressive symptoms were associated with worse discrimination. Neither manic nor depressive symptoms were related to hit rates. Our results indicate that the ability to inhibit a response to near miss stimuli (i.e., those that are close to but not identical to the target) is globally impaired among BD patients relative to NC subjects, as well as state-dependent, covarying with affective symptoms. Psychosocial interventions requiring high levels of attentional capacity may need to be adapted according to patients' current symptomatology.

Strategies for successful aging: a research update.

Population aging is an enormous public health issue and there is clear need for strategies to maximize opportunities for successful aging. Many psychiatric illnesses are increasingly thought to be associated with accelerated aging, therefore emerging data on individual and policy level interventions that alter typical aging trajectories are relevant to mental health practitioners. Although the determinants and definition of successful aging remain controversial, increasing data indicate that psychiatric illnesses directly impact biological aging trajectories and diminish lifestyle, psychological, and socio-environmental factors that seem to reduce risk of morbidity and mortality. Many interventions designed to enhance the normal course of aging may be adjunctive approaches to management of psychiatric illnesses. We highlight recent data on interventions seeking to promote healthy aging, such as cognitive remediation, physical activity, nutrition, and complementary and alternative treatments for older people with and without psychiatric illnesses.

Using the repeatable battery for the assessment of neuropsychological status (RBANS) effort index to predict treatment group attendance in patients with schizophrenia.

In a psychosocial treatment study, knowing which participants are likely to put forth adequate effort to maximize their treatment, such as attending group sessions and completing homework assignments, and knowing which participants need additional motivation before engagement in treatment is a crucial component to treatment success. This study examined the ability of the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) Effort Index (EI), a newly developed measure of suboptimal effort that is embedded within the RBANS, to predict group attendance in a sample of 128 middle-aged and older adults with schizophrenia. This study was the first to evaluate the EI with a schizophrenia sample. While the EI literature recommends a cutoff score of >3 to be considered indicative of poor effort, a cutoff of >4 was identified as the optimal cutoff for this sample. Receiver Operating Characteristics curve analyses were conducted to determine if the EI could predict participants who had high versus low attendance. Results indicated that the EI was successfully able to discriminate between group attendance, and this measure of effort appears to be most valuable as a tool to identify participants who will have high attendance. Of interest, overall cognitive functioning and symptoms of psychopathology were not predictive of group attendance.

Relationship between chronic stress and carotid intima-media thickness (IMT) in elderly Alzheimer's disease caregivers.

The stress associated with providing care for a spouse diagnosed with Alzheimer's disease can have adverse effects on cardiovascular health. One potential explanation is that chronic caregiving stress may contribute to the development of atherosclerosis. The purpose of this study was to determine whether the duration that one has provided care is associated with the degree of atherosclerotic burden, as measured by carotid artery intima-media thickness (IMT). One hundred and ten Alzheimer caregivers [mean age 74 ± 8 (SD) years, 69% female] underwent in-home assessment of carotid artery IMT via B-mode ultrasonography. Data regarding medical history, blood pressure, and multiple indicators of caregiving stress were also collected. Multiple regression indicated that duration of care was positively associated with IMT measured in the internal/bifurcation segments of the carotid artery (ß = 0.202, p = 0.044) independent of risk factors such as age, gender, body mass index, smoking history, sleep quality, hypertension status, and caregiving stressors. Duration of care was positively associated with IMT in the common carotid artery, but the relationship was not significant. These findings provide more evidence of the link between chronic caregiving stress and cardiovascular disease and indicate that enduring the experience of caregiving over a period of years might be associated with atherosclerotic burden.

Meta-analysis of the association between cognitive abilities and everyday functioning in bipolar disorder.

OBJECTIVES: Neurocognitive deficits are common in bipolar disorder and contribute to functional disability. However, the degree to which general and specific cognitive deficits affect everyday functioning in bipolar disorder is unknown. The goal of this meta-analysis was to examine the magnitude of the effect of specific neurocognitive abilities on everyday functioning in bipolar disorder. METHODS: We conducted a comprehensive meta-analysis of studies that reported associations between performance on objective neuropsychological tasks and everyday functioning among individuals with bipolar disorder. From an initial pool of 486 papers, 22 studies met inclusion criteria, comprising a total of 1344 participants. Correlation coefficients were calculated for 11 cognitive domains and four measurement modalities for functioning. We also examined effect moderators, such as sample age, clinical state, and study design. RESULTS: The mean Pearson correlation between neurocognitive ability and functioning was 0.27, and was significant for all cognitive domains and varied little by cognitive domain. Correlations varied by methods of everyday functioning assessment, being lower for clinician and self-report than performance-based tasks and real-world milestones such as employment. None of the moderator analyses were significant. CONCLUSIONS: Overall, the strength of association between cognitive ability and everyday functioning in bipolar disorder is strikingly similar to that seen in schizophrenia, with little evidence for differences across cognitive domains. The strength of association differed to a greater extent according to functional measurement approach.

Multiple mediators of the relations between caregiving stress and depressive symptoms.

OBJECTIVE: This study tested a model for explaining how stress is associated with depressive symptoms in a sample of spouse caregivers of patients with Alzheimer's disease. It was hypothesized that more depressive symptoms would be significantly correlated with both 'primary' caregiver stressors (i.e., care recipient problem behaviors) and 'secondary' stress (i.e., role overload), but that this relationship would be significantly mediated by four variables: (1) personal mastery, (2) coping self-efficacy, (3) activity restriction, and (4) avoidance coping. METHOD: We used an asymptotic and resampling strategy for simultaneously testing multiple mediators of the stress-to-depressive symptoms pathway. RESULTS: Greater stress was significantly related to more depressive symptoms. Increased stress was also associated with reduced personal mastery and self-efficacy, as well as increased activity restriction and avoidance coping. Finally, these four mediators accounted for a significant amount of the relationship between stress and depressive symptoms. DISCUSSION: These results suggest multiple pathways by which both primary and secondary caregiver stresses may be associated with increased depressive symptoms, and may argue for multiple treatment targets for caregiver interventions.

Carotid plaque in Alzheimer caregivers and the role of sympathoadrenal arousal.

OBJECTIVES: To test the hypothesis that those who provide care for a spouse diagnosed with Alzheimer's disease would have increased prevalence of carotid artery plaque compared with noncaregiving controls and that prolonged sympathoadrenal arousal to acute stress would relate to this difference. Providing care for a spouse with Alzheimer's disease has been associated with an increased risk of coronary heart disease, potentially due to the impact of caregiving stress on the atherosclerotic disease process. METHODS: Participants were 111 spousal caregivers (74 ± 8 years of age; 69% women) to patients with Alzheimer's disease and 51 noncaregiving controls (75 ± 6 years of age; 69% women). Inhome assessment of carotid artery plaque via B-mode ultrasonography was conducted. Plasma catecholamine response to an acute speech stressor task was also measured. RESULTS: Logistic regression indicated that caregiving status (i.e., caregiver versus noncaregiver) was associated significantly with a 2.2 times greater odds for the presence of plaque independent of other risk factors of atherosclerosis (95% confidence interval, 1.01-4.73, p = .048). Decreased recovery to basal levels of epinephrine after a psychological stress task was associated significantly with the presence of plaque in caregivers, but not in noncaregivers. Norepinephrine recovery post stressor was not associated with plaque in either group. CONCLUSIONS: Caregivers had a higher frequency of carotid plaque compared with noncaregivers. Poorer epinephrine recovery after acute stress was associated with the presence of plaque in caregivers but not in noncaregivers. A prolonged sympathoadrenal response to acute stress might enhance the development of atherosclerosis in chronically stressed Alzheimer caregivers.

A review of the psychobiology of dementia caregiving: a focus on resilience factors.

The recent aging trend in the United States has resulted in exponential growth in the number of informal dementia caregivers. Caring for a family member with dementia has been associated with negative health outcomes that are likely related to physiologic changes resulting from stress. However, caregiving is not always associated with health morbidity. In this review, we highlight resilience factors that appear to have a beneficial relationship with health outcomes. Specifically, we highlight 11 studies that examined the relationship of one of three broad resilience domains (personal mastery, self-efficacy, and coping style) to caregiver health outcomes. Our main findings were that higher levels of personal mastery and self-efficacy, and increased use of positive coping strategies appear to have a protective effect on various health outcomes in dementia caregivers. Continued research is warranted to help guide prospective directions for caregiver interventions focusing on increasing caregiver resilience and the corresponding impact on caregiver health.

PEAR model and sleep outcomes in dementia caregivers: influence of activity restriction and pleasant events on sleep disturbances.

BACKGROUND: Sleep disturbance is a common consequence of providing care to a loved one with Alzheimer's disease (AD). We explored the usefulness of the Pleasant Events and Activity Restriction (PEAR) model for predicting multiple domains of sleep disturbance. METHODS: Our sample consisted of 125 spousal AD caregivers. Participants completed the Pittsburg Sleep Quality Index (PSQI) and were questioned regarding the frequency with which they engaged in pleasant events and the extent to which they felt restricted in engaging in social and recreational activities in the past month. Participants were classified into one of three groups: HPLR = High Pleasant Events + Low Activity Restriction (= reference group; N = 38); HPHR/LPLR = either High Pleasant Events + High Activity Restriction or Low Pleasant Events + Low Activity Restriction (N = 52); and LPHR: Low Pleasant Events + High Activity Restriction (N = 35). These three groups were compared on the seven subscales of the PSQI. RESULTS: Significant differences were found between the HPLR and LPHR groups on measures of subjective sleep quality, sleep latency, habitual sleep efficiency, sleep disturbance, and daytime dysfunction. Additionally, significant differences were found between the HPLR and HPHR/LPLR groups on subjective sleep quality, sleep latency, and habitual sleep efficiency, and between the HPHR/LPLR and LPHR groups on sleep disturbance and daytime dysfunction. CONCLUSIONS: This study provides broad support for the PEAR model and suggests that interventions focusing on behavioral activation may potentially provide benefits to non-affective domains including sleep.

The moderating role of personal mastery on the relationship between caregiving status and multiple dimensions of fatigue.

OBJECTIVE: A substantial proportion of chronically-stressed spousal dementia caregivers report fatigue. The objective of this study was to examine whether personal mastery moderates the relationship between caregiving status (caregiver/non-caregiver) and multiple dimensions of fatigue. METHODS: Seventy-three elderly Alzheimer's caregivers and 41 elderly non-caregivers completed the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) and questionnaires assessing mastery. RESULTS: Regression analyses indicated that global fatigue was significantly higher for caregivers (M = 38.0 +/- 21.0) compared to non-caregivers (M = 18.2 +/- 10.4). However, personal mastery moderated the relation between caregiving status and global fatigue (t = -2.03, df = 107, p = 0.045), such that for those with low mastery, caregivers' fatigue scores were 18.1 points higher than non-caregivers, and for those with high mastery, this difference was only 7.5 points. For specific dimensions of fatigue, mastery moderated the relations between caregiving status and both emotional (t = -2.01, df = 107, p = 0.047) and physical (t = -2.51, df = 107, p = 0.014) fatigue. Specifically, association between caregiving status and emotional fatigue was greater when mastery was low than when mastery was high. Caregiving status was significantly associated with physical fatigue when mastery was low, but not when mastery was high. Significant main effects were found between mastery and general fatigue and vigor. CONCLUSION: Given the proportion of fatigued caregivers and the impact fatigue has on health; these findings provide important information regarding mastery's relationship with fatigue and may inform interventions aiming to alleviate fatigue in caregivers.

Determinants of Capacity to Consent to Research on Alzheimer's disease.

OBJECTIVE: Investigators conducting Alzheimer's disease (AD) research need to consider participants' capacity to consent. Cognitive functioning is a significant predictor of decisional capacity, but there is a dearth of information on the influence of neuropsychiatric symptoms in AD on decisional capacity. We examined the rates of decisional capacity associated with two types of research protocols, and the association of capacity with neuropsychiatric symptoms and other participant characteristics. METHODS: We comprehensively evaluated decisional capacity among 64 patients with mild-to-moderate AD and 70 healthy comparison (HC) subjects randomized to consider either a medium risk or higher risk hypothetical research protocol. Additional measures included sociodemographics, cognitive deficits, and neuropsychiatric symptoms. RESULTS: Twenty AD patients (31.3%) and 67 HCs (95.7%) were deemed capable; 44 AD patients (68.8%) and 3 HCs (4.3%) incapable of consent. Age, education, and severity of cognitive deficits were associated with incapable status; there were no significant associations with severity of neuropsychiatric symptoms or protocol risk level. CONCLUSIONS: Findings highlight the importance of understanding of capacity and its assessment among people with AD, rather than treating AD diagnosis as synonymous with impaired capacity. As novel treatments move from bench to bedside, methods of assessing and addressing capacity impairment must similarly advance. CLINICAL IMPLICATIONS: In assessing research consent capacity, use structured assessments with population specific cut scores interpreted in the context of the person's background including education, culture, and language. Individuals should be encouraged to execute research proxy documents when able.

Assessment of Healthcare Decision-making Capacity.

It is often necessary for neuropsychologists, clinical psychologists, and other healthcare professionals to assess an individual's capacity to consent to treatment related to healthcare. This task can be challenging and requires a delicate balance of both respect for individuals' autonomy, as well as the protection of individuals with diminished capacity to make an autonomous decision. The purpose of the present review is to provide an overview of the conceptual model of decisional capacity as well as a brief summary of some of the currently available instruments designed to help evaluate medical decision making. In addition, current empirical literature on the relationship between neuropsychological abilities and decision-making capacity is discussed and a brief set of recommendations is provided to further aid clinicians or consultants when they are required to complete the ethically important but difficult task of making determinations about healthcare decision-making capacity.

Obstructive Sleep Apnea and Cognition in Parkinson's disease.

OBJECTIVE: Obstructive sleep apnea (OSA) is very common in Parkinson's disease (PD). OSA is known to affect patients' cognition. The present study assessed whether PD patients with OSA (PD + OSA) score lower on cognitive measures than those without OSA (PD - OSA). In addition, this study evaluated whether treating the OSA with continuous positive airway pressure (CPAP) in PD + OSA patients results in an improved cognitive functioning. METHODS: Eighty-six patients with PD underwent an overnight polysomnography screen for OSA and were administered the Mini-Mental Status Exam (MMSE) and the Montreal Cognitive Assessment (MoCA). This resulted in 38 patients with PD + OSA who were randomly assigned to receive either therapeutic CPAP for 6 weeks (n = 19) or placebo CPAP for three weeks followed by therapeutic CPAP for three weeks (n = 19). Intervention participants completed a neurocognitive battery at baseline and 3- and 6-week time-points. RESULTS: Patients with PD + OSA scored significantly lower than PD - OSA on the MMSE and MoCA after controlling for age, education, and PD severity. OSA was a significant predictor of cognition (MMSE p <0.01; MoCA p = 0.028).There were no significant changes between groups in cognition when comparing three weeks of therapeutic CPAP with 3 weeks of placebo CPAP. Comparisons between pre-treatment and 3-week post-therapeutic CPAP for the entire sample also revealed no significant changes on overall neuropsychological (NP) scores. CONCLUSIONS: Findings suggest that PD patients with OSA show worse cognitive functioning on cognitive screening measures than those without OSA. However, OSA treatment after three or six weeks of CPAP may not result in overall cognitive improvement in patients with PD.

Improving the understanding of the link between cognition and functional capacity in schizophrenia and bipolar disorder.

OBJECTIVE: Deficits in cognitive functioning are related to functional disability in people with serious mental illness. Measures of functional capacity are commonly used as a proxy for functional disabilities for cognitive remediation programs, and robust linear relationships between functional capacity and cognitive deficits are frequently observed. This study aimed to determine whether a curvilinear relationship better approximates the association between cognitive functioning and functional capacity. METHOD: Two independent samples were studied. Study 1: participants with schizophrenia (n=435) and bipolar disorder (n=390) aged 18-83 completed a neuropsychological battery and a performance-based measure of functional capacity. Study 2: 205 participants with schizophrenia (age range=39-72) completed a brief neuropsychological screening battery and a performance-based measure of functional capacity. For both studies, linear and quadratic curve estimations were conducted with cognitive performance predicting functional capacity scores. RESULTS: Significant linear and quadratic trends were observed for both studies. Study 1: in both the schizophrenia and bipolar participants, when cognitive composite z-scores were >0 (indicating normal to above normal performance), cognition was not related to functional capacity. Study 2: when neuropsychological screening battery z-scores were >-1 (indicating low average to average performance), cognition was not related to functional capacity. CONCLUSIONS: These results illustrate that in cognitively normal adults with serious mental illness, the relationship between cognitive function and functional capacity is relatively weak. These findings may aid clinicians and researchers determine who may optimally benefit from cognitive remediation programs, with greater benefits possibly being achieved for individuals with cognitive deficits relative to individuals with normal cognition.

A prospective study of the trajectories of clinical insight, affective symptoms, and cognitive ability in bipolar disorder.

BACKGROUND: Clinical insight in bipolar disorder is associated with treatment adherence and psychosocial outcome. The short-term dynamics of clinical insight in relationship to symptoms and cognitive abilities are unknown. METHODS: In a prospective observational study, a total of 106 outpatients with bipolar disorder I or II were assessed at baseline, 6 weeks, 12 weeks, and 26 weeks. Participants were administered a comprehensive neuropsychological battery, clinical ratings of manic and depressive symptom severity, and self-reported clinical insight. Lagged correlations and linear mixed-effects models were used to determine the temporal associations between symptoms and insight, as well as the moderating influence of global cognitive abilities. RESULTS: At baseline, insight was modestly correlated with severity of manic symptoms, but not with depressive symptoms or cognitive abilities. Insight and depressive symptoms fluctuated to approximately the same extent over time. Both lagged correlations and mixed effects models with lagged effects indicated that the severity of manic symptoms predicted worse insight at later assessments, whereas the converse was not significant. There were no direct or moderating influences of global cognitive abilities. LIMITATIONS: Our sample size was modest, and included relatively psychiatrically stable outpatients, followed for a six month period. Our results may not generalize to acutely symptomatic patients followed over a longer period. CONCLUSIONS: Clinical insight varies substantially over time within patients with bipolar disorder. Impaired insight in bipolar disorder is more likely to follow than to precede manic symptoms.

Interactive effects of vascular risk burden and advanced age on cerebral blood flow.

Vascular risk factors and cerebral blood flow (CBF) reduction have been linked to increased risk of cognitive impairment and Alzheimer's disease (AD); however the possible moderating effects of age and vascular risk burden on CBF in late life remain understudied. We examined the relationships among elevated vascular risk burden, age, CBF, and cognition. Seventy-one non-demented older adults completed an arterial spin labeling MR scan, neuropsychological assessment, and medical history interview. Relationships among vascular risk burden, age, and CBF were examined in a priori regions of interest (ROIs) previously implicated in aging and AD. Interaction effects indicated that, among older adults with elevated vascular risk burden (i.e., multiple vascular risk factors), advancing age was significantly associated with reduced cortical CBF whereas there was no such relationship for those with low vascular risk burden (i.e., no or one vascular risk factor). This pattern was observed in cortical ROIs including medial temporal (hippocampus, parahippocampal gyrus, uncus), inferior parietal (supramarginal gyrus, inferior parietal lobule, angular gyrus), and frontal (anterior cingulate, middle frontal gyrus, medial frontal gyrus) cortices. Furthermore, among those with elevated vascular risk, reduced CBF was associated with poorer cognitive performance. Such findings suggest that older adults with elevated vascular risk burden may be particularly vulnerable to cognitive change as a function of CBF reductions. Findings support the use of CBF as a potential biomarker in preclinical AD and suggest that vascular risk burden and regionally-specific CBF changes may contribute to differential age-related cognitive declines.

Initial validation of a computerized version of the UCSD Performance-Based Skills Assessment (C-UPSA) for assessing functioning in schizophrenia.

OBJECTIVE: This study aimed to validate the Computerized UCSD Performance-Based Skills Assessment (C-UPSA), a newly developed scale for assessing functional capacity in patients with schizophrenia. METHODS: The C-UPSA was administered to 21 middle-aged and older adults with schizophrenia and 20 healthy comparison (HC) subjects. Schizophrenia participants also completed the original UPSA and a symptom inventory (during a separate visit), and cognitive functioning was assessed in both groups using a brief neuropsychological screening battery. RESULTS: The C-UPSA total score was significantly correlated with UPSA total scores, and the magnitude of the correlation was comparable to the test-retest reliability of the original UPSA. The C-UPSA was also significantly correlated with UPSA-Brief scores and neuropsychological status among schizophrenia participants. Furthermore, the schizophrenia group scored significantly lower than the HCs on the C-UPSA. ROC curves were generated to determine the optimal C-UPSA value for discriminating between the two groups, with results indicating an optimal cutoff of 75, which is consistent with the derived cutoff from the original UPSA. The C-UPSA identified persons with schizophrenia with 95% accuracy. CONCLUSIONS: The C-UPSA appears to be highly related to the original UPSA. It has several advantages over the standard version, including increased portability, decreased administration time, and minimized examiner impact on participant performance. Future research would benefit from establishing this test as a clinical and research tool to effectively assess functional capacity.