The Cleveland Scale for Activities of Daily Living (CSADL): Its Reliability and Validity

This study evaluated the reliability and validity of the Cleveland Scale for Activities of Daily Living (CSADL), a scale designed to measure in detail specific activities of daily living in individuals with dementia. Administered to knowledgeable informants by trained examiners, the CSADL demonstrated good reliability in terms of interrater agreement and internal consistency. The validity of CSADL total scores was shown by its sensitivity to degree of cognitive impairment: All comparisons between means of the healthy elderly group and three groups of AD patients differing in severity were statistically significant. The CSADL was highly correlated with the Blessed–Roth Dementia Scale (DS-ADL) and more highly correlated with Mini-Mental State Exam scores than was the DS-ADL.     

Sex Differences in Cognitive Performance Among the Very Old--Mini-Mental State Examination in a Population Aged 85 Years and Over

We examined 553 persons aged 85 years or more, who comprised 92% of all 601 citizens of a Finnish city Vantaa. The Mini-Mental State Examination (MMSE), Index of Activities of Daily Living (ADL), and the Instrumental Activities of Daily Living (IADL) scale were completed. Diagnoses of dementia and depression were made according to the DSM-III-R criteria. Mean MMSE score for men was 20.1 and for women was 16.8 (difference = 3.3 points). When demented subjects (N = 210) were excluded, the difference reduced to 2.2 points. When depressed subjects were also excluded, the difference further reduced to 1.9 points. Education and institutionalization explained some of this difference, but sex also had an independent effect on the MMSE score. The home-dwelling women had lower functional capacity compared with respective men, as measured by the ADL scale. No differences were found in the IADL scale. It seems that men over 85 years of age represent a very select population. Men probably die earlier in the course of any deteriorating illness. It is also possible that our measurements of cognitive capacity favor men among very old people.     

Cognition and daily activities in a general population sample aged +55

ABSTRACT

Objective: We tested the association of individual cognitive domains measured with the Mini-Mental State Examination (MMSE) and disability.

Method: Cross-sectional study in a population-based cohort aged ≥55 years (n = 4,803). Sample was divided into two groups: individuals with cognition within the normal range (CNR) (n = 4,057) and those with cognitive impairment (CI) (n = 746). Main outcome measures: The MMSE, the Katz Index (Basic Activities of Daily Living, bADL), the Lawton and Brody Scale (Instrumental Activities of Daily Living, iADL), and the Geriatric Mental State (GMS-AGECAT).

Results: MMSE-orientation was associated with disability in bADL, iADL and a decrease in social participation, regardless of cognitive status. MMSE-attention was associated with disability in iADL, but only in CNR. MMSE-language was associated with disability in bADL, iADL and with reduced social participation, but only in CI. Conclusions: The associations observed between disability and orientation may have clinical and public health implications.     

Personality features and cognitive level in patients at an early stage of Alzheimer’s disease

In this cross-sectional study, we explored the relationship between premorbid personality and its changes over 5 years, and cognitive deterioration in patients with mild Alzheimer’s disease. The cognitive level of 54 patients was compared with that of 64 control subjects using the Mini Mental State (MMSE). Family members completed the NEO-PI-R (form R) twice, once to evaluate the participants’ current personality and again to assess personality traits as they were remembered to be 5 years earlier. Furthermore, the family filled in the Informant Questionnaire on Cognitive Decline (IQCODE), the Activities of Daily Living (ADL), and the Instrumental Activities of Daily Living (IADL) scales to assess their proxies’ cognitive level and daily living functioning. Regarding the relationship between personality characteristics and cognitive status, we observed trends for premorbid personality and significant links for personality changes in the clinical group. Thus, changes in neuroticism and conscientiousness were associated with cognitive deterioration, whereas decreased openness to experience and conscientiousness over time predicted loss of independence in daily functioning in the clinical group. Our study suggests that premorbid features can be considered as latent traits linked to the neuropathology underlying the disease process, while personality changes are probably the consequences of the pathological process.     

The Behavioral Dyscontrol Scale and Functional Status Among Elderly Medical and Surgical Rehabilitation Patients

This research was conducted in a sample of 150 older adults (mean age = 78.0) who were inpatients receiving rehabilitation services for a variety of medical and postsurgical conditions. The purpose of the study was to test the hypothesis that the Behavioral Dyscontrol Scale (BDS), a measure of the ability to use intentions to guide purposeful activity, would be strongly associated with concurrent functional status after controlling for age, sex, education, severity of pain, medical comorbidity, depression (Geriatric Depression Scale), and general mental status (Mini Mental State Exam [MMSE]). Functional status was assessed by rehabilitaion nurses' ratings of patients on 11 individual Activities of Daily Living (ADL) items and the Barthel Index. The hypothesis, tested by means of multiple regression analysis, was supported by the results. The BDS was the independent variable most strongly associated with all 11 ADL items and the Barthel Index. The MMSE contributed significantly to none of the models. Other covariates made minimal contributions to the variance shared with functional ability. Consistent with prior results in other samples, the ability to use intentions to guide purposeful behavior appears to be an important contributor to everyday functioning among older adults.     

Expanding the ecological validity of WAIS-IV and WMS-IV with the Texas functional living scale

Assessment of functional status is an important aspect of clinical evaluation. As part of the standardization of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) and Wechsler Memory Scale-Fourth Edition (WMS-IV), participants completed the Texas Functional Living Scale (TFLS), a measure of Instrumental Activities of Daily Living. The relationships between TFLS and WAIS-IV and WMS-IV were examined in both normally developing and clinical samples. In general, the highest correlations were between TFLS and measures of general cognitive ability (WAIS-IV FSIQ [Full Scale IQ] and GAI [General Ability Index]) and working memory (WAIS-IV WMI [Working Memory Index] and WMS-IV VWMI [Visual Working Memory Index]). Across the clinical populations, working memory subtests were generally strongly related to TFLS performance, although this relationship was more consistent with WAIS-IV than WMS-IV. Contrast scaled scores are presented for the TFLS based on WAIS-IV or WMS-IV performance. These scores allow the evaluation of functional abilities within the context of cognitive and memory ability, enhancing and expanding the utility of the WAIS-IV and WMS-IV.     

进行中任务变化对轻度认知功能障碍者基于事件前瞻记忆的影响

本实验采用2被试组别(MCI组、正常老年组) × 3进行中任务变化(无变化、顺序变化、随机变化)被试间设计探究进行中任务变化对轻度认知功能障碍者基于事件前瞻记忆的影响。结果表明：(1)轻度认知功能障碍者的前瞻记忆成绩显著低于正常老年人的前瞻记忆成绩; (2)进行中任务变化对两组被试前瞻记忆和进行中任务的反应时影响存在显著差异。进行中任务变化越大, 轻度认知功能障碍者完成前瞻记忆和进行中任务的反应速度越慢; 而正常老年被试则不受影响。研究支持前瞻记忆策略加工的理论观点, 认为执行功能损伤可能是导致轻度认知功能障碍者前瞻记忆失败的主要原因。     

The Hong Kong version of the Oxford Cognitive Screen (HK-OCS): validation study for Cantonese-speaking chronic stroke survivors

This study reports the validation of the Hong Kong version of Oxford Cognitive Screen (HK-OCS). Seventy Cantonese-speaking healthy individuals participated to establish normative data and 46 chronic stroke survivors were assessed using the HK-OCS, Albert’s Test of Visual Neglect, short test of gestural production, and Hong Kong version of the following assessments: Western Aphasia Battery, MMSE, MoCA, Modified Barthel Index, and Lawton Instrumental Activities of Daily Living scale. The validity of the HK-OCS was appraised by the difference between the two participant groups. Neurologically unimpaired individuals performed significantly better than stroke survivors on the HK-OCS. Positive and significant correlations found between cognitive subtests in the HK-OCS and related assessments indicated good concurrent validity. Excellent intra-rater and inter-rater reliabilities, fair test–retest reliability, and acceptable internal consistency suggested that the HK-OCS had good reliability. Specific HK-OCS subtests including semantics, episodic memory, number writing, and orientation were the best predictors of functional outcomes.     

Adaptation to stroke using a model of successful aging

The process of adaptation to the physical and psychosocial consequences after stroke is a major challenge for many individuals affected. The aim of this study was to examine if stroke patients within 1 month of admission (n = 153) and followed up at 1 year (n = 107) engage in selection, optimization, and compensation (SOC) adaptive strategies and the relationship of these strategies with functional ability, health-related quality of life (HRQOL) and depression 1 year later. Adaptive strategies were measured using a 15-item SOC questionnaire. Internal and external resources were assessed including recovery locus of control, stroke severity, and socio-demographics. Outcome measures were the Stroke Specific Quality of Life Questionnaire (SS-QoL), the Nottingham Extended Activities of Daily Living Scale and the Depression Subscale of the Hospital Anxiety and Depression Scale. Findings indicated that stroke patients engaged in the use of SOC strategies but the use of these strategies were not predictive of HRQOL, functional ability or depression 1 year after stroke. The use of SOC strategies were not age specific and were consistent over time, with the exception of the compensation subscale. Results indicate that SOC strategies may potentially be used in response to loss regulation after stroke and that an individual's initial HRQOL functional ability, levels of depression and socio-economic status that are important factors in determining outcome 1 year after stroke. A stroke-specific measure of SOC may be warranted in order to detect significant differences in determining outcomes for a stroke population.     

Depression: Psychological Referrals in Nursing Homes

Studies in nursing homes have consistently shown the presence of mental health disorders. We assessed 300 nursing home residents (referred for psychological testing) to provide preliminary data on referral patterns, assess the cognitive and affective patterns of residents with different diagnoses, and present psychometric data on depression measures, including the Beck Depression Scale (BDI) (as a bivariate index) and the Mood Scale (a shortened version of the Geriatric Depression Scale). Results show that the referrals involved a compromised group of residents, both cognitively and affectively. Despite obvious mean differences, a MANOVA revealed that Major Depressive Disorder did not differ significantly from the Adjustment Disorder and Dementia groups on the bivariate BDI and Mood Scale; the dementia group was lower than the depression and adjustment groups on the MMSE. Patterns on depression inventories also identified a correct classification score of 4 on the BDI (89%) and 3 on the Mood Scale (79%). Discussion endorsed use of the bivariate BDI and addressed depression in these facilities.     

Cognitive testing in non‐demented Turkish immigrants ‐ comparison of the RUDAS and the MMSE

Nielsen, T. R. Vogel, A., Gade, A. & Waldemar, G. (2012). Cognitive testing in healthy Turkish immigrants ‐ comparison of the RUDAS and the MMSE. Scandinavian Journal of Psychology 53, 455–460. Methods for culturally and linguistically appropriate cognitive testing of elderly minority populations are lacking in Europe. The aim of this study was to compare performance on the Rowland Universal Dementia Assessment Scale (RUDAS) and the Mini Mental State Examination (MMSE) in Turkish immigrants in Denmark and determine the impact of demographic and health‐related variables on test performance. A sample of non‐demented community‐dwelling Turkish immigrants was recruited from the greater Copenhagen area. All participants completed a structured interview regarding demographic, physical and mental health status, as well as measures of depression and acculturation, and cognitive testing with the RUDAS and the MMSE. A total of 76 non‐demented participants aged 50 or more were included in the study. The mean performance on the RUDAS and the MMSE was 26.8 (SD 2.4) and 23.7 (SD 4.3), respectively. In group comparisons, correlation analyses and regression analyses, level of schooling represented a more significant variable for RUDAS and MMSE performance than any other variable. However, the impact of schooling was considerably more pronounced on the MMSE and the test was not found to be a valid measure of general cognitive function in subjects with less than five years of schooling. Although not entirely free of educational bias, the RUDAS can be a valuable supplement to the MMSE for assessment of general cognitive function in Turkish minority populations.     

Adaptation to stroke using a model of successful aging

ABSTRACT

The process of adaptation to the physical and psychosocial consequences after stroke is a major challenge for many individuals affected. The aim of this study was to examine if stroke patients within 1 month of admission (n?=?153) and followed up at 1 year (n?=?107) engage in selection, optimization, and compensation (SOC) adaptive strategies and the relationship of these strategies with functional ability, health-related quality of life (HRQOL) and depression 1 year later. Adaptive strategies were measured using a 15-item SOC questionnaire. Internal and external resources were assessed including recovery locus of control, stroke severity, and socio-demographics. Outcome measures were the Stroke Specific Quality of Life Questionnaire (SS-QoL), the Nottingham Extended Activities of Daily Living Scale and the Depression Subscale of the Hospital Anxiety and Depression Scale. Findings indicated that stroke patients engaged in the use of SOC strategies but the use of these strategies were not predictive of HRQOL, functional ability or depression 1 year after stroke. The use of SOC strategies were not age specific and were consistent over time, with the exception of the compensation subscale. Results indicate that SOC strategies may potentially be used in response to loss regulation after stroke and that an individual's initial HRQOL functional ability, levels of depression and socio-economic status that are important factors in determining outcome 1 year after stroke. A stroke-specific measure of SOC may be warranted in order to detect significant differences in determining outcomes for a stroke population.     

Relationship between hemispatial inattention and performance of activities of daily living in patients with schizophrenia

This study investigated the relation of hemispatial inattention to the performance of daily functions in 32 patients with schizophrenia or schizoaffective disorder and in 31 healthy controls. They were tested on the relationship between a target cancellation task and the Activities of Daily Living Rating Scale-II (ADLRS-II). According to the results of the hemispatial inattention test, the patients with schizophrenia made more omissions in the cancellation test than the controls. In addition, the results showed a significant correlation between number of omissions on the cancellation test and the ADLRS-II score in the study participants. A statistically significant relationship was observed between hemispatial inattention and the functional status of patients with schizophrenia, and suggests the need to incorporate measures of visual attention into psychiatric rehabilitation assessments.     

Relation of the Repeatable Battery for Assessment of Neuropsychological Status to measures of daily functioning in dementia

In the present study were examined relations of scores on the Repeatable Battery for the Assessment of Neuropsychological Status (Randolph, 1998) with measures of daily functioning in a sample with dementia. Participants (N=66) with various forms of dementia were seen at a dementia diagnostic clinic. All participants were administered the battery as part of a larger battery of neuropsychological measures. The participants' functional status was assessed by their primary caregivers, who completed the Physical Self-maintenance Scale and the Instrumental Activities of Daily Living scale (Lawton & Brody, 1969) as part of a social work interview. Analysis indicated that the Repeatable Battery for Assessment of Neuropsychological Status, particularly the Attention, Visuospatial/Constructional, and Immediate Memory indices, strongly correlated with measures of daily functioning. These results were supported by multiple regression analyses showing the RBANS Attention and Immediate Memory indices as significant predictors of functional abilities. One may conclude the RBANS should be favorably considered in understanding the functional problems of probable dementing patients.     

An Evaluation of Change Over Time in Everyday Cognitive Competence Among Alzheimer’s Patients

This short-term longitudinal study was designed to examine the pattern of change in everyday cognitive competence as assessed by an objective measure (i.e. the Test of Everyday Problem Solving for Cognitively Challenged Elderly; EPCCE; Willis, 1993) and by self- and caregiver reports (i.e. Instrumental Activities of Daily Living; IADL; Lawton & Brody, 1969). Patient and caregiver characteristics and clinical assessments were explored as predictors. Participants included 100 Alzheimer’s disease (AD) patients and their caregivers who were part of the Stanford Longitudinal Study. Four waves of data were examined via hierarchical linear modeling. Major findings revealed that the EPCCE and the patient IADL formed a linear pattern of decline while the caregiver IADL demonstrated a curvilinear form. Second, different sets of predictors explained the variance in the competence measures at initial status. Finally, the predictors did not account for a significant amount of variance in the instantaneous rate of change on any of the measures; however, a portion of the variance in the acceleration in the caregiver IADL was explained.     

The association between depression and thyroid disorders in a regionally representative Canadian sample

A subsample of six provinces (n = 67,621) from the 2005 Canadian Community Health Survey was used to determine the gender-specific prevalence of depression among those with and without thyroid disorders. Information was not available on the type of thyroid disorder. Logistic regression analyses were conducted to determine the odds and socio-demographic correlates of depression among those with and without thyroid disorders. Women had a significantly higher prevalence of thyroid disorders (9.3%) and depression (6.6%) than men (2.4% and 3.7%, respectively). Thyroid disorders were associated with 22% higher odds of depression in women after adjusting for socio-demographic factors, but no association was found in men. Among women with and without thyroid disorders, younger age, lower income, and limitations in Activities in Daily Living (ADL) were associated with higher odds of depression. Results suggest that women with thyroid disorders are more vulnerable to depression, and socio-demographic correlates of depression are similar among women with and without thyroid disorders.     

Cognitive complaints in elderly depressed and pseudodemented patients

The cognitive complaints of 11 patients with depressive pseudodementia were compared with those of 22 patients with depression alone. Pseudodemented subjects were defined as depressed inpatients showing reversible cognitive impairment as measured by the Mini-Mental State Examination (MMSE); subjects with depression alone had no such impairment. For each group, cognitive complaints were highly correlated with depressive symptoms and were not related to MMSE scores. The pseudodemented group had significantly higher cognitive complaint scores, complaining more of difficulties with concentration and recent memory. Groups did not differ significantly in complaints of difficulties with remote memory.     

Cross-Cultural Application of Occupational Therapy Assessments

The applicability and generalizability of the human occupation model beyond the United States was investigated in this study. An assessment bati.ery was utilized to evaluate components of the volition and habituation subsystems of 50 adult psychiatric inpatients and 30 matched controls. Results su est that interest pattern, especially in Activities of Daily Living (WL); balance among activities during the day; and some items from role performance differentiated the groups. The importance of further investigation and refinement of the assessment Instruments is emphasized.     

A Study of the Criterion Validity of the Mattis Dementia Rating Scale

Criterion validity of the Mattis Dementia Rating Scale (MDRS) was evaluated with a concurrent study to obtain a cut-off score for an Argentinean population. A battery of several neuropsychological tests, including MDRS and Mini-Mental State Examination (MMSE), was administered to 60 patients in a memory disorder clinic. The MDRS cut-off score was used as the criterion variable. A total score of 123 in MDRS was found to classify incorrectly only 8 of 60 patients. Sensitivity was 0.83, and specificity was 0.90. MDRS showed a high convergent validity with MMSE. Consistent with the cut-off scores suggested by Mattis in his manual, a total score of 123 was found to be the most appropriate for adoption in the local population.     

Fatigue Impact Scale: Its validation in patients with chronic obstructive pulmonary disease

The aim of this study was to investigate the reliability and validity of the Fatigue Impact Scale (FIS) among patients with chronic obstructive pulmonary disease (COPD) and shorten the questionnaire. The empirically developed FIS, which comprised three subscales (cognitive, physical and psychosocial), was tested originally on Pipers' theoretical framework of subjective manifestations of fatigue, including behavioural, physical, emotional and cognitive expressions. The data analysed here consisted of responses from 296 patients with COPD who reported fatigue. The dimensionality of the FIS was examined using confirmatory factor analysis. A reduction of 15 items from the original FIS was made based on theory, modification indices and factor loadings. The results indicate that a nested-factor model with one general behavioural factor and three specific factors, physical, emotional and cognitive, shows acceptable fit. A modified version of 25 items, FIS-25 was developed. The original FIS and the FIS-25 were able to discriminate between patients with differing duration of fatigue. Test - retest correlations ranged from .70 to .85 for items and .94 for the total scale. Due to modification, the FIS-25 needs to be validated on a new group of patients with COPD.