Association between cognition and daily life functioning in dementia subtypes.

OBJECTIVE: To investigate the association between cognition and daily life functioning in dementia subtypes. METHODS: Cross-sectional data were used from 615 patients with dementia who were referred to the Maastricht Memory Clinic of the Maastricht University Medical Centre. Pearson correlation coefficients were calculated between the Mini-Mental State Examination (MMSE; to measure cognitive status) and the Blessed Dementia Scale (BDS; to measure daily life functioning) for the following types of dementia: Alzheimer's Disease (AD, n = 442); Vascular dementia (VaD, n = 113); frontotemporal dementia (FTD, n = 18); Parkinson's dementia (PD, n = 21); and primary progressive aphasia (PPA, n = 21). One-way ANOVA was used to test differences in age, MMSE scores and BDS scores across dementia subtypes. RESULTS: Scores on the MMSE showed strong correlation with BDS scores in cases of FTD (r = -0.80); moderate correlation in cases of AD, VaD, and PD (range r = -0.50-0.60); while no correlation was found in PPA cases. CONCLUSIONS: The association between cognition and daily life functioning varied among dementia subtypes for AD, VaD, FTD and PD. Furthermore, the overall scores on both domains differ between dementia subtypes, indicating that different types of dementia are characterized by a specific pattern of cognitive status and daily life functioning. These findings underline the need for multidomain assessment in patients with dementia.

Review of goal attainment scaling as a useful outcome measure in psychogeriatric patients with cognitive disorders.

BACKGROUND: Since evidence-based interventions are the standard, there is an urgent need for more information concerning individual ways of measuring clinically relevant outcomes of interventions in cognitive disorders such as dementia. Goal Attainment Scaling (GAS) seems to offer a meaningful outcome measure. AIM: To examine the applicability of GAS in psychogeriatric patients with cognitive disorders. METHODS: A systematic review was performed on the available literature on the clinimetric aspects and the feasibility of GAS when used as an outcome measure for psychogeriatric patients with cognitive disorders. Eight databases were screened. Two authors independently reviewed all the data. Ten studies were included. RESULTS: Mixed results were found for responsiveness, content validity, inter-rater reliability and construct/convergent validity. The involvement of patient and/or caregiver in the goal-setting procedure is possible and multiple domains can be implemented. The possibility to set at least 3 realistic goals per patient in less than 30 min is unclear and the need for involvement of a blinded assessor is not well established. CONCLUSION: GAS proved to be useful on important aspects of an outcome measure for psychogeriatric patients with cognitive disorders. Since other relevant aspects showed mixed results and the number of studies investigating the use of GAS in psychogeriatric patients with cognitive disorders is small, the evidence is not strong enough yet to state that GAS is an applicable outcome measure in this population.

Relationship between measures of dementia severity and observation of daily life functioning as measured with the Assessment of Motor and Process Skills (AMPS).

BACKGROUND: Cognitive impairment is mostly regarded as the core symptom of dementia, but several other domains (such as daily functioning) are equally relevant to assess the severity of dementia. The relationship between these domains is unclear. The Assessment of Motor and Process Skills (AMPS) is a relatively unexplored instrument in people with dementia, measuring severity by direct observation. OBJECTIVE: To study the relationship between the AMPS and scores on several commonly used outcome measures for the assessment of dementia severity, and to examine the possible influence of neuropsychiatric symptoms on these relationships in patients with cognitive disorders. METHODS: Cross-sectional data of 118 patients with cognitive disorders were used; data on cognition (Mini-Mental State Examination, MMSE; CAMCOG), global severity (Global Deterioration Scale, GDS), daily life functioning (Instrumental Activities of Daily Living, IADL), and neuropsychiatric symptoms (Neuropsychiatric Inventory, NPI) were collected and analyzed using correlation and regression analyses. Different combinations of the severity measures were tested for their ability to predict the AMPS process ability scores. RESULTS: Scores on the MMSE, CAMCOG and GDS were moderately associated with the AMPS process ability score. These measures explained between 27 and 44% of the variance in the AMPS score. The presence of apathy influenced the association between the cognitive measures and the AMPS score. CONCLUSION: Commonly used measures of dementia severity are only moderately associated with observation of performance on daily activities. This underlines the need for direct observation of daily activities in dementia patients. This relationship between several approaches of assessing dementia severity needs further study.

The practical use of goal attainment scaling for people with acquired brain injury who receive cognitive rehabilitation.

OBJECTIVE: To examine the feasibility of and clinical experiences with goal attainment scaling when used for the evaluation of cognitive rehabilitation in people with acquired brain injury. DESIGN: A prospective observational longitudinal study. SETTING: A 21-week cognitive rehabilitation programme and a cognitive programme with varying length in two different Dutch rehabilitation centres. SUBJECTS: Forty-eight consecutive patients with acquired brain injury enrolled during a 15-month period. INTERVENTIONS: Cognitive rehabilitation programme. MAIN MEASURE: Goal attainment scaling; the number of goals was counted; time to set goals was recorded; the number of different domains in which goals were set was counted; goal attainment scaling score was calculated at baseline, one week after the end of the cognitive rehabilitation programme and at six months follow-up; clinical experiences that could be useful for both clinical and research practice were recorded. RESULTS: The mean (SD) age of the patients was 46.1 (10.7) years; 29 (60%) were male; 186 goals were set with a mean (SD) number of 4 (1) goals per patient. It was possible to set at least three realistic goals per patient within 30 minutes. Most goals were set in the cognitive domain (i.e. memory and attention), followed by the behavioural domain (i.e. fatigue and aggression). CONCLUSION: It proved possible to set three goals within an acceptable time-frame, to involve patients in the goal-setting procedure, to set realistic goals, and to set goals within relevant domains. Based on clinical experiences, goal attainment scaling is less feasible for research when patients lack insight, or suffer from comorbidity or mood problems.