Montreal Cognitive Assessment and Mini-Mental Status Examination compared as cognitive screening tools in heart failure.

BACKGROUND: Heart failure (HF) patients run four times the risk of developing cognitive impairment than does the general population, yet cognitive screening is not routinely performed. METHODS: This cross-sectional study enrolled 90 community-dwelling adults with HF aged 50 years and above. Participants took the Mini Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA), to measure cognitive function in persons with HF. Participants were predominately men (66%) and Caucasian (78%), aged 50-89 years (62 SD, 9 years), and 77% had an ejection fraction <40%. RESULTS: Fifty-four percent of participants scored ≤26 on the MoCA, suggesting mild cognitive impairment (MCI), and 17% scored ≤22, suggesting moderate cognitive impairment, compared with 2.2% on the MMSE. The MoCA scores were lowest for visuospatial/executive domain, short-term memory, and delayed recall. These findings were similar to those in published reports. CONCLUSION: These preliminary findings support the use of MoCA for cognitive screening in stable HF.

Detecting navigational deficits in cognitive aging and Alzheimer disease using virtual reality.

BACKGROUND: Older adults get lost, in many cases because of recognized or incipient Alzheimer disease (AD). In either case, getting lost can be a threat to individual and public safety, as well as to personal autonomy and quality of life. Here we compare our previously described real-world navigation test with a virtual reality (VR) version simulating the same navigational environment. METHODS: Quantifying real-world navigational performance is difficult and time-consuming. VR testing is a promising alternative, but it has not been compared with closely corresponding real-world testing in aging and AD. We have studied navigation using both real-world and virtual environments in the same subjects: young normal controls (YNCs, n = 35), older normal controls (ONCs, n = 26), patients with mild cognitive impairment (MCI, n = 12), and patients with early AD (EAD, n = 14). RESULTS: We found close correlations between real-world and virtual navigational deficits that increased across groups from YNC to ONC, to MCI, and to EAD. Analyses of subtest performance showed similar profiles of impairment in real-world and virtual testing in all four subject groups. The ONC, MCI, and EAD subjects all showed greatest difficulty in self-orientation and scene localization tests. MCI and EAD patients also showed impaired verbal recall about both test environments. CONCLUSIONS: Virtual environment testing provides a valid assessment of navigational skills. Aging and Alzheimer disease (AD) share the same patterns of difficulty in associating visual scenes and locations, which is complicated in AD by the accompanying loss of verbally mediated navigational capacities. We conclude that virtual navigation testing reveals deficits in aging and AD that are associated with potentially grave risks to our patients and the community.

The sex specificity of navigational strategies in Alzheimer disease.

Alzheimer disease (AD) is associated with navigational impairments that limit functional independence. We have now examined the role of cognitive and perceptual mechanisms in the navigational impairment of AD to test the hypothesis that men and women with AD may focus on different navigational cues. We conducted navigational, neuropsychologic, and psychophysical testing in men and women from 3 groups: older normal controls, patients with mild cognitive impairment, and patients with AD. Men and women showed parallel declines in navigational capacities from the older normal control, to the mild cognitive impairment, to the AD groups with men and women making similar numbers of errors but different types of errors. There were small sex differences in neuropsychologic and psychophysical performance but large sex differences in how those measures related to navigational capacity: men showed strong links between visual motion processing and navigation. Women showed strong links between verbal capacities and navigation. The findings of these cross-sectional comparisons suggest that there may be sex differences in the progressive navigational decline of AD: men and women who are impaired to the same degree may suffer somewhat different patterns of decline with men relying more on visuospatial processing and women relying more on verbal mediation.

Predictors of assistive technology use: the importance of personal and psychosocial factors.

OBJECTIVE: To validate an assistive technology (AT) baseline and outcomes measure and to quantify the measure's value in determining the best match of consumer and AT considering consumer ratings of their subjective quality of life, mood, support from others, motivation for AT use, program/therapist reliance, and self-determination/self-esteem. DESIGN: Prospective multi-cohort study. SETTING: Vocational rehabilitation offices and community. PARTICIPANTS: Over 150 vocational rehabilitation counselors in 25 U.S. states with one consumer each receiving new AT. INTERVENTIONS: Counselor training in the Matching Person and Technology (MPT) Model and consumer completion of the MPT measure, Assistive Technology Device Predisposition Assessment (ATD PA). MAIN OUTCOME MEASURES: Total and subscale scores on the ATD PA as well as counselor-completed questionnaires. RESULTS: ATD PA items differentiated consumer predispositions to AT use as well as AT and user match. There were no significant differences due to gender, physical locality, or age within this sample of working-age adult consumers. Vocational rehabilitation counselors exposed to training in the MPT Model achieved enhanced AT service delivery outcomes. CONCLUSIONS: The ATD PA is a valid measure of predisposition to use an AT and the subsequent match of AT and user. Rehabilitation practitioners who use the ATD PA will achieve evidence-based practice and can expect to see enhanced AT service delivery outcomes.

Spatial disorientation in Alzheimer's disease: the remembrance of things passed.

BACKGROUND: Patients with Alzheimer's disease (AD) and many older adults become lost even in familiar surroundings. This is commonly attributed to memory impairment, but it may reflect impaired spatial cognition. METHODS: The authors examined the role of memory, perceptual, and cognitive mechanisms in spatial disorientation by comparing the performance of normal young (YN), middle-aged (MA), older adult (OA), and AD subjects on neuropsychological and spatial orientation tests. RESULTS: The tendency to become lost is shared by almost all patients with AD (93%) and some OA subjects (38%). This impairment is not related to memory impairment. Instead, it reflects an inability to link recognized scenes with locations in the environment. CONCLUSIONS: Spatial disorientation reflects the impaired linking of landmarks and routes that should be assessed in conjunction with routine memory testing in elderly patients.

A pilot study of perceived needs of persons with new spinal cord injury.

Persons with new spinal cord injury have varying perceptions of their own needs in multiple life domains such as readiness and need to use assistive technologies, but these are often not directly addressed. These areas were the focus of the present study. This descriptive study looked at subjective need in a variety of areas with a new measure and also assessed perceptions related to assistive technology and quality of life. Perceptions of various needs were compared at baseline and at 1- and 6-mo. follow-up. The Perceived Needs Inventory, the Assistive Technology Device Predisposition Assessment, and the Diener Satisfaction with Life Scale were the main outcome measures given 22 patients with new injuries in an inpatient service for acute spinal cord injury with community follow-up. As the Perceived Needs Inventory provided distinct information and showed good test-reliability and some evidence of construct validity, it may be a useful adjunctive tool with such patients.

Determining the content for an interactive training programme and interpretive guidelines for the Assistive Technology Device Predisposition Assessment.

PURPOSE: Develop the content for interpretive guidelines and an interactive training programme for professionals administering the Assistive Technology Device Predisposition Assessment (ATD PA) consumer form, a self-report assessment tool for consumers to identify their perceived functional capabilities and limitations, satisfaction with and priorities for quality of life achievement, psychosocial characteristics and device preferences. METHOD: Twenty-two professionals (with 1-2 consumers each) completed surveys on their use of the ATD PA and recommendations for interpretive guidelines and an interactive training programme. Participants represent eight US states and the country of Italy. Fourteen women and eight men (professionals) participated, and 20% of the sample was comprised of US consumers from Hispanic or African-American ethnic groups. Professionals represented the following disciplines: occupational therapy (n=1); physical therapy (n=1); rehabilitation engineering (n=4); and vocational rehabilitation counselling (n=16). Additionally, an advisory committee of 14 persons was formed, comprising consumers as well as international AT experts. The committee members prioritized content areas for the training programme and interpretive guidelines. RESULTS/CONCLUSIONS: Responses strongly support the need for and the continued development of the training programme and interpretive guidelines. Content areas have been identified and prioritized.