The relationship among performance of instrumental activities of daily living, self-report of quality of life, and self-awareness of functional status in individuals with multiple sclerosis.

Objective: To investigate the relationship between self-awareness of functional status and performance of Instrumental Activities of Daily Living (IADL), and self-reports of quality of life (QOL) in persons with multiple sclerosis (MS). Design: A between-groups design, using a correlational approach to examine the relationship between self-awareness of functional status, IADL and QOL. Participants: We studied 47 individuals with clinically definite MS and 26 healthy controls (HCs). Measures: The Functional Behavior Profile was completed by both participants and their informants. Participants' scores were subtracted from those of their informants', and the absolute value was used as the self-awareness/concordance score. The Executive Function Performance Test measured IADL performance; QOL was measured with the Functional Assessment of Multiple Sclerosis. Results: MS participants showed lower levels of self-awareness relative to HCs. Significant correlations were observed between performance of IADL, reports of QOL and self-awareness levels of functional status. However, reports of QOL were not significantly correlated with performance of IADL. Conclusions: The positive association between self-awareness of functional status with IADL performance and QOL reports provides support for the role of awareness in rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use it or lose it: Engaged lifestyle as a buffer of cognitive decline in aging?

Data from the Victoria Longitudinal Study were used to examine the hypothesis that maintaining intellectual engagement through participation in everyday activities buffers individuals against cognitive decline in later life. The sample consisted of 250 middle-aged and older adults tested 3 times over 6 years. Structural equation modeling techniques were used to examine the relationships among changes in lifestyle variables and an array of cognitive variables. There was a relationship between changes in intellectually related activities and changes in cognitive functioning. These results are consistent with the hypothesis that intellectually engaging activities serve to buffer individuals against decline. However, an alternative model suggested the findings were also consistent with the hypothesis that high-ability individuals lead intellectually active lives until cognitive decline in old age limits their activities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Everyday cognition: Age and intellectual ability correlates.

The primary aim of this study was to examine the relationship between a new battery of everyday cognition measures, which assessed 4 cognitive abilities within 3 familiar real-world domains, and traditional psychometric tests of the same basic cognitive abilities. Several theoreticians have argued that everyday cognition measures are somewhat distinct from traditional cognitive assessment approaches, and the authors investigated this assertion correlationally in the present study. The sample consisted of 174 community-dwelling older adults from the Detroit metropolitan area, who had an average age of 73 years. Major results of the study showed that (a) each everyday cognitive test was strongly correlated with the basic cognitive abilities; (b) several basic abilities, as well as measures of domain-specific knowledge, predicted everyday cognitive performance; and (c) everyday and basic measures were similarly related to age. The results suggest that everyday cognition is not unrelated to traditional measures, nor is it less sensitive to age-related differences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disability and cognitive impairment in the elderly

Disability and cognitive impairment show similar patterns of increasing frequency with ageing. A review of the published literature shows that there is a cross-sectional relationship between cognitive impairment and disability, independent of demographic, medical, and lifestyle factors. Some instrumental activities of daily living (IADL) items appear more specifically related to cognitive impairment, but cognition and functional impairment are distinct concepts requiring separate assessments. Subjects with low cognitive performances are at higher risk of functional impairment in the following years. Cognitive impairment as well as disability increase the risk of death and institutionalization. Preventive strategies could be directed against the risk factors of cognitive impairment and disability, and would aim to delay the onset of dementia. Prevention of disability associated with cognitive impairment needs further assessment in elderly community-dwellers. Further research is needed to better identify the specific areas cognition involved in the disablement process.     

Influence of clinical variables on neuropsychological performance in multiple sclerosis

The effects of age, educational level, duration and course of the disease, physical disability and mood status on several cognitive functions (short- and long-term memory, frontal functions, attention, language and visuospatial skills) have been evaluated in 42 multiple sclerosis (MS) patients. The Hamilton Depression Rating Scale (HDRS) scores and a secondary progressive disease course significantly influenced neuropsychological performance. Factorial analysis revealed that indexes of (1) frontal function impairment, (2) long-term verbal memory and language function impairment, and (3) visuospatial short- and long-term memory and visuoperceptive function impairment accounted for 85% of the variance in neuropsychological performance. Only the first factor was significantly related to the presence of depressive symptomatology, as assessed by the HDRS. These results indicate that both the course of the disease and the presence of affective disorders must be taken into account when evaluating the natural history of cognitive impairment in MS and suggest that depressive symptomatology and cognitive dysfunction in MS are related to the involvement of at least partially overlapping anatomofunctional circuits.     

Hearing loss and cognition in the Baltimore Longitudinal Study of Aging.

Objective: To determine the relationship between hearing loss and cognitive function as assessed with a standardized neurocognitive battery. We hypothesized a priori that greater hearing loss is associated with lower cognitive test scores on tests of memory and executive function. Method: A cross-sectional cohort of 347 participants ≥55 years in the Baltimore Longitudinal Study of Aging without mild cognitive impairment or dementia had audiometric and cognitive testing performed in 1990–1994. Hearing loss was defined by an average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better-hearing ear. Cognitive testing consisted of a standardized neurocognitive battery incorporating tests of mental status, memory, executive function, processing speed, and verbal function. Regression models were used to examine the association between hearing loss and cognition while adjusting for confounders. Results: Greater hearing loss was significantly associated with lower scores on measures of mental status (Mini-Mental State Exam), memory (Free Recall), and executive function (Stroop Mixed, Trail Making B). These results were robust to analyses accounting for potential confounders, nonlinear effects of age, and exclusion of individuals with severe hearing loss. The reduction in cognitive performance associated with a 25 dB hearing loss was equivalent to the reduction associated with an age difference of 6.8 years. Conclusion: Hearing loss is independently associated with lower scores on tests of memory and executive function. Further research examining the longitudinal association of hearing loss with cognitive functioning is needed to confirm these cross-sectional findings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The measurement of everyday cognition (ECog): Scale development and psychometric properties.

This article describes the development and validation of an instrument to assess cognitively mediated functional abilities in older adults, Everyday Cognition (ECog). The ECog is an informant-rated questionnaire comprised of multiple subscales. Confirmatory factor analysis (CFA) was used to examine its factor structure. Convergent validity was evaluated by comparing it to established measures of everyday function. External validity was evaluated by comparing ECog results across different clinical groups [cognitively normal, mild cognitive impairment (MCI), dementia]. CFA supported a seven-factor model including one global factor and six domain-specific factors (Everyday Memory, Language, Visuospatial Abilities, Planning, Organization, and Divided attention). The ECog correlated with established measures of functional status and global cognition, but only weakly with age and education. The clinical groups performed differently in each domain. In addition to the global factor, the Everyday Memory factor independently differentiated MCI from Normal, while the Everyday Language domain differentiated Dementia from MCI. Different subtypes of MCI also showed different patterns. Results suggest the ECog shows promise as a useful tool for the measurement of general and domain-specific everyday functions in the elderly. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coffee with jelly or unbuttered toast: Commissions and omissions are dissociable aspects of everyday action impairment in Alzheimer's disease.

Relative to our understanding of the memory and language deficits associated with Alzheimer's disease (AD), little is known about problems with everyday action performance (i.e., meal preparation, grooming). The resource theory proposes that everyday action problems are best explained by a unitary deficit in general cognitive resources. However, recent research suggests that omission and commission errors may reflect dissociable aspects of action impairment, with only omissions associated with resource limitations. This study examined everyday action performance in 70 participants with AD who also underwent a neuropsychological evaluation. First, correlation and principal component analyses were performed to examine the construct(s) that might explain everyday action impairment. Second, relations between everyday task component(s) and neuropsychological tests were examined by using correlation and regression analyses. Third, differences in everyday action error patterns were examined among participants of comparable overall impairment levels. Results showed omission and commission errors were uncorrelated and distinct components of everyday action performance, predicted by different neuropsychological tests, and differentially distributed even among participants with comparable overall impairment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

SMS text messages as a prosthetic aid in the cognitive rehabilitation of schizophrenia.

Objective: To evaluate the efficacy of short message service (SMS) text messages as a compensatory aid to improve independence in individuals diagnosed with schizophrenia and cognitive deficits. Design: An ABA withdrawal single-case experimental design was used. Eight men diagnosed with schizophrenia took part in the study; all demonstrated memory or planning problems in everyday life. Results: Five participants completed the entire trial. Four were more successful in carrying out daily activities when receiving prompts, whereas 1 did not profit from the intervention. Conclusion: SMS text messages can be effective in compensating for cognitive impairment in some but not all individuals with schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal analysis of cognitive dysfunction, coping, and depression in multiple sclerosis.

Using a longitudinal design, the authors examined coping and cognitive functioning in the development of depression in individuals with multiple sclerosis (MS). Coping style was evaluated in 2 conceptually distinct roles: as moderator and mediator of the impact of cognitive dysfunction on depression. Using indices derived from the COPE (C. S. Carver, M. F. Scheier, & J. K. Weintraub, 1989), the authors operationalized coping in 3 ways—as active, avoidant, and an index accounting for relative levels of both. Coping both moderated and partially mediated the relationship between cognitive dysfunction and depression. Moderation results suggest that the relationship between cognitive dysfunction and depression is dependent on coping style—adaptive coping protects individuals from experiencing depression related to their cognitive deficits; however, when individuals use maladaptive coping, cognitive dysfunction puts them at risk for depression. Mediational results suggest that cognitive dysfunction leads to depression partially due to cognitive dysfunction’s effects on coping. That is, cognitive deficits may impair individuals’ ability to use adaptive coping strategies, leaving them more likely to use maladaptive strategies. Clinical and theoretical implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychological impairment in Tardive dyskinesia.

Tardive dyskinesia (TD) is a movement disorder secondary to neuroleptic treatment. Whether TD is associated with neurocognitive dysfunction is a controversial issue. We reviewed 31 published studies evaluating neuropsychological (NP) test results in schizophrenic patients with and without TD and found that TD was generally reported to be associated with cognitive impairment. Numerous methodological limitations, however, restrict the conclusions made about the relationship between cognition and dyskinesia. We therefore undertook a study in which 143 schizophrenic patients were evaluated on a comprehensive NP test battery. On both global and learning deficit scores, TD patients demonstrated greater impairment than did a matched comparison group. Two aspects of TD (severity and topography) were related to severity of cognitive impairment. These findings suggest that dyskinesia and cognition may share some underlying mechanism in schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Binding ties: Closeness and conflict in adult children's caregiving relationships.

The authors used a path model to test the hypothesis that emotional closeness and conflict between adult–child caregivers (N?=?90) and their impaired parents mediated the impact of the parents' functional and cognitive impairment on the caregivers' subjective stress, subjective effectiveness, and depression. Closeness mediated the relationship between cognitive impairment and both stress and effectiveness, whereas conflict mediated cognitive impairment for all 3 outcomes and generally accounted for more variance. There was limited evidence that functional impairment was mediated by the quality of the relationship. Results highlight the importance of both positive and negative ties as intervening mechanisms influencing caregivers' well-being, especially in the presence of cognitive dysfunction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A replicated prospective investigation of life stress, coping, and depressive symptoms in multiple sclerosis

Life stress and coping responses jointly contribute to psychological adjustment in many chronic illness populations, but their significance in multiple sclerosis (MS) has not been extensively investigated. Physical disability, cognitive status, negative life stress, coping strategies, and depressive symptoms were prospectively assessed in 27 adults with definite or probable MS. Of the original subjects, 22 provided two additional assessments at 6-month intervals. After accounting for cognitive status and physical disability, life stress was positively correlated with current as well as future depressive symptoms; the prospective relationship was replicated within the second pair of prospective data waves. Escape avoidance was the only coping strategy that added to the prediction of future mood symptoms, but this was not replicated. Results suggest that MS-related depressive symptoms are a function of prior disease-related impairment, life stress, and possibly escape avoidance coping.     

Identifying risk for functional impairment using cognitive measures: An application of CART modeling.

The relationship between cognitive test performance and functional status was assessed in 289 persons with a cognitive impairment diagnosis and in 307 controls from the Alzheimer's Disease Registry at Mayo Clinic. Classification and regression tree (CART) procedures were used to create decision rules (using cutoff scores) to identify persons most at risk for functional impairment. The results suggest that scores from the Dementia Rating Scale, the Mini-Mental State Examination (MMSE), the Perceptual-Organizational factor of the Weschler Adult Intelligence Scale-Revised (WAIS-R), and age and education may be used in combination to identify persons at risk for functional disability. Decision rules to predict performance in specific functional domains are also presented. The researchers concluded that CART has several advantages relative to traditional linear methods in establishing cognitive-functional relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Everyday cognition and mortality: Performance differences and predictive utility of the Everyday Cognition Battery.

In this article, the authors examine the relationship between everyday cognition and mortality. Data were initially collected in 1996-1997 from 171 community-dwelling older people ranging in age from 60 to 92 years old (M = 74 years, SD = 7.38). Participants completed the Everyday Cognition Battery (ECB; J. C. Allaire & M. Marsiske, 1999, 2002) as well as basic cognitive ability tests. Results indicated that participants who died since testing (n = 56) had performed significantly worse than did still-living participants on all measures. Additionally, performance on the ECB Knowledge Test was a significant predictor of death even after controlling for basic cognitive abilities, demographics, and self-rated health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brain imaging and age-related changes in cognition

Although there is currently some debate as to the degree of structural changes in the brain that occur with age, there is little doubt that such changes occur. There also are physiological changes in many areas that could have implications for cognitive function in the elderly. One way to study the impact of these age-related changes in the brain on cognition is to use neuroimaging techniques to examine brain activity during the performance of various tasks, and determine how this activity differs between young and older individuals. This approach has been used to study functions such as memory, perception, and attention, and it has generally been found that older individuals utilize different areas of the brain than do young subjects when carrying out the same cognitive task. This has led some researchers to suggest that older persons utilize different functional brain networks, perhaps to compensate for reductions of efficiency in some brain areas. The areas of the brain most often found to be more active during cognitive tasks in the elderly are the frontal lobes. Studies that have directly examined the functional networks utilized during cognition have found that older people do indeed have different functional interactions involving the frontal lobes, and therefore, utilize different functional networks. In some cases this differential activity has been accompanied by cognitive performance in the older participants that is equivalent to that seen in the young, suggesting that greater reliance on this brain region is related in some way to the maintained ability of the older individuals to perform the task. However, data collected to date on this issue are still limited, so although the evidence is intriguing, the definitive interpretation of these findings must await further experiments.     

Stress and memory bias interact to predict depression in multiple sclerosis.

This study is an investigation of the moderating effect of cognitive schema on the relationship between stress and depression in individuals with multiple sclerosis (MS). In the study, the authors employed a performance-based measure of affective memory bias and a self-report measure of everyday stress to assess both direct and interactive effects of cognitive schema and stress on depression in individuals with MS. The specific hypotheses were that high stress would be more highly associated with depression if an individual also demonstrated a bias for negative information, but that a bias for positive information may buffer against the effects of stress on depression. Results supported the hypotheses, demonstrating a significant effect of the interaction and differential effects of stress based on the direction of memory bias. Implications for understanding depression in MS are discussed, as well as dominant theories of adult depression in the general population. The results are also discussed as a potential contradiction to A. T. Beck's (1967, 1976) developmental hypothesis of cognitive schemas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A neuropsychological investigation of multitasking in HIV infection: Implications for everyday functioning.

Objective: A subset of individuals with HIV-associated neurocognitive impairment experience related deficits in “real world” functioning (i.e., independently performing instrumental activities of daily living [IADL]). While performance-based tests of everyday functioning are reasonably sensitive to HIV-associated IADL declines, questions remain regarding the extent to which these tests' highly structured nature fully captures the inherent complexities of daily life. The aim of this study was to assess the predictive and ecological validity of a novel multitasking measure in HIV infection. Method: Participants included 60 individuals with HIV infection (HIV+) and 25 demographically comparable seronegative adults (HIV?). Participants were administered a comprehensive neuropsychological battery, questionnaires assessing mood and everyday functioning, and a novel standardized test of multitasking, which involved balancing the demands of four interconnected performance-based functional tasks (i.e., financial management, cooking, medication management, and telephone communication). Results: HIV+ individuals demonstrated significantly worse overall performance, fewer simultaneous task attempts, and increased errors on the multitasking test as compared to the HIV? group. Within the HIV+ sample, multitasking impairments were modestly associated with deficits on standard neuropsychological measures of executive functions, episodic memory, attention/working memory, and information processing speed, providing preliminary evidence for convergent validity. More importantly, multivariate prediction models revealed that multitasking deficits were uniquely predictive of IADL dependence beyond the effects of depression and global neurocognitive impairment, with excellent sensitivity (86%), but modest specificity (57%). Conclusions: Taken together, these data indicate that multitasking ability may play an important role in successful everyday functioning in HIV+ individuals. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Everyday action in schizophrenia: Performance patterns and underlying cognitive mechanisms.

Everyday action is impaired among individuals with schizophrenia, yet few studies have characterized the nature of this deficit using performance-based measures. This study examined the performance of 20 individuals with schizophrenia or schizoaffective disorder on the Naturalistic Action Test (M. F. Schwartz, L. J. Buxbaum, M. Ferraro, T. Veramonti, & M. Segal, 2003). Performance was coded to examine overall impairment, task accomplishment, and error patterns and was compared with that of healthy controls (n = 28) and individuals with mild dementia (n = 23). Additionally, 2 competing accounts of everyday action deficits, the resource theory and an executive account, were evaluated. When compared with controls, the participants with schizophrenia demonstrated impaired performance. Relative to dementia patients, participants with schizophrenia obtained higher accomplishment scores but committed comparable rates of errors. Moreover, distributions of error types for the 2 groups differed, with the participants with schizophrenia demonstrating greater proportions of errors associated with executive dysfunction. This is the 1st study to show different Naturalistic Action Test performance patterns between 2 neurologically impaired populations. The distinct performance pattern demonstrated by individuals with schizophrenia reflects specific deficits in executive function. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motivational reserve: Lifetime motivational abilities contribute to cognitive and emotional health in old age.

The authors recently developed the concept of motivational reserve, which implies a set of motivational abilities that provide individuals with resilience to neuropathological damage. This study investigated how lifetime motivational abilities are associated with current cognitive status, mild cognitive impairment, and psychological well-being in old age. A community sample of 147 participants without dementia between 60 and 94 years of age, stratified for age group, sex, and education, completed motivation and well-being questionnaires and cognitive tests. A new procedure was used to estimate their midlife motivational and cognitive abilities on the basis of their main occupation using the Occupational Information Network (O*NET) system. O*NET-estimated motivational abilities predicted cognitive status, psychological well-being, and odds of mild cognitive impairment, even when age, sex, education, and cognitive ability were controlled. Although O*NET-estimated cognitive abilities were not significant predictors, scores on a measure of crystallized intelligence were associated with current cognitive status and odds of mild cognitive impairment. Findings suggest that motivational reserve acts as a protective factor against the manifestation of cognitive impairment and emotional problems in later life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)