The Combined Effect of Neuropsychological and Neuropathological Deficits on Instrumental Activities of Daily Living in Older Adults: a Systematic Review

To date, studies have consistently demonstrated associations between either neuropsychological deficits or neuroanatomical changes and instrumental activities of daily living (IADL) in aging. Only a limited number of studies have evaluated morphological brain changes and neuropsychological test performance concurrently in relation to IADL in this population. As a result, it remains largely unknown whether these factors independently predict functional outcome. The current systematic review intended to address this lack of information by reviewing the literature on older adults, incorporating studies that examined e.g., normal aging, but also stroke or dementia patients. A comprehensive search of databases (Pubmed, Embase, Medline, Web of Science, PsycINFO) and reference lists was performed, focusing on papers in the English language that examined the combined effect of neuropsychological and neuroanatomical factors on IADL in samples of adults with an average age above 50. In total, 58 potential articles were identified; 20 were included in the review. The results show that especially neuropsychological variables (primarily memory and executive functions) independently predict IADL. Although some unique predictive value of brain morphological changes, such as hippocampal atrophy, was found, support for the importance of white matter changes was limited. However, the results of the studies reviewed are diverse, and appear to be at least partially determined by the variables included. For example, studies were less likely to find an independent effect of cognition if they solely employed a cognitive screening instrument. This indicates that a structured examination of neuroanatomical and neuropsychological correlates of IADL in different patient populations is warranted.     

Factors Associated with Functional Dependence in Alzheimer's Disease

The purpose of this study was to determine whether common geriatric conditions, family function, and nutritional problems have independent associations with functional dependence beyond the effect of cognitive impairment in patients with Alzheimer's disease. It was found that some common geriatric conditions affecting patients with Alzheimer's disease appear to have multiple and differential relationships with specific instrumental activities of daily living (IADLs) dependency. These results have implications for medical care. Preventing one condition may not be sufficient to prevent further IADL dependences because the conditions are independently related to individual outcome variables. Thus, multiple conditions may need to be managed concurrently if further functional dependence is to be expected.     

Phenomenological Aspects of Complementarity and Entanglement in Exceptional Human Experiences (ExE)

The mental system of an individual usually generates a reality-model that includes a self-model and a world-model as fundamental components. Exceptional experiences (ExE) can be classified as subjectively experienced anomalies in the self-model or the world-model or in the relation of both. Empirical studies show significant correlations between specific patterns of ExE and socially and clinically relevant variables. In order to examine the ontological status of anomalous phenomena a psychophysical approach is presented in which the principle of complementarity is of fundamental importance. Applying a generalized quantum theory to psychosocial and psychophysical systems, complementary aspects such as autonomy versus reliability or novelty versus confirmation are identified as possible local and global variables. The findings indicate that entanglement correlations could play a role in the occurrence of ExE and that specific psychological interventions can dissolve them.     

Memory rehabilitation for older adults: preserving independent living / Rehabilitación de la memoria para adultos mayores: preservación de la autonomía de vida

Abstract

Episodic memory problems are the hallmark of cognitive ageing in normal elderly people. Learning of new material is worse in pathological cognitive ageing, such as dementia and its preliminary states (mild cognitive impairment). Because episodic learning is crucial to preserve independent living in the elderly, rehabilitation programmes for everyday memory problems are welcomed. The scope of scientific interest has switched from treatment to prevention. We claim that lifestyle interventions are the most direct way to preserve cognition. We summarize evidence for changes in nutrition and exercise. In addition, psychological interventions for elderly people with normal or pathological cognitive ageing are available. Recent meta-analyses found lacking evidence of transfer to everyday life and long-term effects. We critically assess these meta-analyses. We propose theoretically derived experimental interventions relying on spared learning mechanisms. As an example we report visual-imagery training showing positive effects in a randomized control trial, using individual memory diaries on memory improvement.     

Does prospective memory influence quality of life in community-dwelling older adults?

Older adults commonly experience declines in prospective memory, which describes one’s ability to “remember to remember,” and can adversely affect instrumental activities of daily living and healthcare compliance. However, the extent to which prospective memory failures may influence quality of life in typically aging older adults is not well understood. One-hundred and four community-dwelling older Australians (aged 50 to 82 years) were administered a comprehensive, neuropsychological battery that included the Memory for Intentions Screening Test (MIST), Prospective and Retrospective Memory Questionnaire (PRMQ), Instrumental Activities of Daily Living Questionnaire (IADLQ), and World Health Organization Quality of Life-8 (WHOQOL-8). Multiple regressions controlling for negative affect, medical comorbidities, and other neurocognitive functions revealed an interaction between prospective memory and instrumental activities of daily living in the concurrent prediction of quality of life. Among the 39 older adults who reported multiple problems on the IADLQ, lower performance-based prospective memory (MIST) and higher self-reported prospective memory failures in daily life (PRMQ) were significantly associated with lower quality of life (WHOQOL-8). Conversely, no significant associations were observed between prospective memory and quality of life in the 65 participants without IADL problems. Prospective memory difficulties adversely impact quality of life in community-dwelling older adults who experience problems independently managing their instrumental activities of daily living. These findings extend prior literature showing that prospective memory plays a unique role in the real-world outcomes of older adults and clinical populations and highlight the need to develop effective strategies to enhance prospective memory functioning in these vulnerable groups.     

Strategic sequence planning and prospective memory impairments in frontally lesioned head trauma patients performing activities of daily living

The aim of this research was to study strategic sequence planning and prospective memory in activities of daily living (ADL) in 10 patients with frontal lobe lesions after a mild to moderate closed head injury (CHI). The lesions were documented radiologically. The CHI patients were compared to 12 normal controls with a neuropsychological test battery and a realistic simulation of complex multitask ADL (planning and preparing a meal). Though the CHI patients were significantly slow on one test and subject to interference on an attention test, they manifested no basic executive or memory deficit on the paper-pencil tests. However, the CHI patients manifested marked anomalies in the organization of behavior in the meal preparation task. While small sequences of actions were easily produced, large action sets could not be correctly executed. An outstanding difficulty in strategic planning and prospective memory, particularly time-based more than event-based, appears to be an important underpinning of the impairment of ADL observed in the CHI patients with frontal lobe lesions.     

Reversed dimensional analysis in psychophysics

It is argued that dimensional analysis (from physics) can be applied in psychophysics in the same manner as in physics, provided that the dimensions of sensations are interpreted in the sense of reversed dimensional analysis, which allows for extracting dimensions from data. A dimension obtained by this method, referred to as phenomenological dimension, is similar to a fractal dimension. The examples discussed show that, if the dimension of sensation in Stevens' psychophysical law for time duration (psi = Cphin, n approximately 1.15) is interpreted as a phenomenological dimension, such a dimension can be traced even in short-term memory data. It is suggested that dimensions obtained via reversed dimensional analysis may serve as a link between physical and psychological variables and as a basis for developing the notion of dimension in psychology.     

Religiosity, psychological resources, and physical health

Various explanations have been given for the positive association between religiosity and physical health. Using data from two waves of the National Survey of Midlife in the United States (1995, 2005) and retrospective data on the importance of religion in the home in which respondents were raised we find that psychological resources, operationalized by measures of emotional and psychological well-being, mediate the effect of this early exposure to religion but only on self-rated health and physical symptomatology; chronic illnesses and health limitations on activities of daily living are unaffected.     

Word list memory predicts everyday function and problem-solving in the elderly: results from the ACTIVE cognitive intervention trial

Data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial (N = 2,802) were analyzed to examine whether word list learning predicts future everyday functioning. Using stepwise random effects modeling, measures from the modified administrations of the Hopkins Verbal Learning Test (HVLT) and the Auditory Verbal Learning Test (AVLT) were independently predictive of everyday IADL functioning, problem-solving, and psychomotor speed. Associations between memory scores and everyday functioning outcomes remained significant across follow-up intervals spanning 5 years. HVLT total recall score was consistently the strongest predictor of each functional outcome. Results suggest that verbal memory measures are uniquely associated with both current and future functioning and that specific verbal memory tests like the HVLT and AVLT have important clinical utility in predicting future functional ability among older adults.     

Effects of environment on psychological well-being of elderly persons

This study reports an investigation of the psychological well-being of 90 elderly persons living in independent, retirement, and nursing homes. In previous studies elderly persons have not been matched on high levels of social and physical functioning across these living environments. Analyses indicated significantly that elderly persons living in their own homes or retirement homes reported greater well-being than their matched cohorts in nursing homes.     

Decision-making capacity in elderly, terminally ill patients with cancer

Despite the importance and complexity of evaluating decision-making capacity at the end of life, little research has focused on terminally ill patients' decision-making ability. The purpose of this study was to explore the decision-making capacity of elderly, terminally ill patients and the psychological and physical factors that affect decision making. Decision-making capacity and cognitive abilities were assessed using four measures: the Hopkins Competency Assessment Kit, the Bechara Gambling Task, the Concept Assessment Kit, and the Mini Mental Status Exam. In addition, symptoms of depression, level of physical functioning, and extent of physical symptoms were evaluated in order to identify correlates of decision-making ability. Two samples were compared: elderly, terminally ill patients with cancer (n = 43) and elderly, physically healthy adults living in supportive community residence (n = 35). Results revealed significantly poorer decision-making abilities among the terminal ill sample compared with healthy comparisons, but no association between demographic variables (e.g., age, race, or education) or clinical variables (depression or physical symptoms) and decision making. Implications for evaluating decision-making capacity are addressed.     

Cognition, daily living, and health-related quality of life in 85-year-olds in Sweden

This study investigates how cognition influences activities of daily living and health-related quality of life in 85-year-olds in Sweden (n = 373). Data collection included a postal questionnaire comprising demographics and health-related quality of life measured by the EQ-5D. The ability to perform personal activities of daily living (PADL) was assessed during a home visit that included administering the Mini Mental State Examination (MMSE). Cognitive impairment was shown in 108 individuals (29%). The majority were independent with respect to PADL. A larger number of participants with cognitive impairment reported that they needed assistance in instrumental activities of daily living (IADL) compared to the group without cognitive impairment. Impaired cognition was significantly related to problems with IADL. Significant but low correlations were found between cognition and health-related quality of life - higher ratings on perceived quality of life correlated with higher results on the MMSE.     

Extending the trans‐contextual model in physical education and leisure‐time contexts: Examining the role of basic psychological need satisfaction

Background. The trans‐contextual model (TCM) is an integrated model of motivation that aims to explain the processes by which agentic support for autonomous motivation in physical education promotes autonomous motivation and physical activity in a leisure‐time context. It is proposed that perceived support for autonomous motivation in physical education is related to autonomous motivation in physical education and leisure‐time contexts. Furthermore, relations between autonomous motivation and the immediate antecedents of intentions to engage in physical activity behaviour and actual behaviour are hypothesized. Aims. The purpose of the present study was to incorporate the constructs of basic psychological need satisfaction in the TCM to provide a more comprehensive explanation of motivation and demonstrate the robustness of the findings of previous tests of the model that have not incorporated these constructs. Sample. Students (N=274) from Greek secondary schools. Method. Participants completed self‐report measures of perceived autonomy support, autonomous motivation, and basic psychological need satisfaction in physical education. Follow‐up measures of these variables were taken in a leisure‐time context along with measures of attitudes, subjective norms, perceived behavioural control (PBC), and intentions from the theory of planned behaviour 1 week later. Self‐reported physical activity behaviour was measured 4 weeks later. Results. Results supported TCM hypotheses. Basic psychological need satisfaction variables uniquely predicted autonomous motivation in physical education and leisure time as well as the antecedents of intention, namely, attitudes, and PBC. The basic psychological need satisfaction variables also mediated the effects of perceived autonomy support on autonomous motivation in physical education. Conclusions. Findings support the TCM and provide further information of the mechanisms in the model and integrated theories of motivation in physical education and leisure time.     

The Role of Existential Beliefs Within the Relation of Centenarians’ Health and Well-Being

The purpose of this study was to explore the role of existential beliefs in mediating the influence of health on centenarians’ well-being. A total of 80 centenarians (mean age 101.1; SD = 1.3; 81.3 % women) with no/minor cognitive impairment were included. The OARS questionnaire for diseases and functional capacity (ADL, IADL), the Satisfaction with Life Scale, and the existential beliefs subscale were used for data collection. The findings suggest that existential resources are a crucial element for mitigating the impact of health constraints in subjective well-being in this population. Appropriate models of intervention for very old age that recognize the importance of religion, spirituality, and meaning of life are to be considered.     

N-of-1 study of weight loss maintenance assessing predictors of physical activity,adherence to weight loss plan and weight change

Objective: Behaviour change interventions are effective in supporting individuals to achieve clinically significant weight loss, but weight loss maintenance (WLM) is less often attained. This study examined predictive variables associated with WLM.

Design: N-of-1 study with daily ecological momentary assessment combined with objective measurement of weight and physical activity, collected with wireless devices (Fitbit?) for six months. Eight previously obese adults who had lost over 5% of their body weight in the past year took part. Data were analysed using time series methods.

Main outcomes measures: Predictor variables were based on five theoretical themes: maintenance motives, self-regulation, personal resources, habits, and environmental influences. Dependent variables were: objectively estimated step count and weight, and self-reported WLM plan adherence.

Results: For all participants, daily fluctuations in self-reported adherence to their WLM plan were significantly associated with most of the explanatory variables, including maintenance motivation and satisfaction with outcomes, self-regulation, habit, and stable environment. Personal resources were not a consistent predictor of plan adherence.

Conclusion: This is the first study to assess theoretical predictions of WLM within individuals. WLM is a dynamic process including the interplay of motivation, self-regulation, habit, resources, and perceptions of environmental context. Individuals maintaining their weight have unique psychological profiles which could be accounted for in interventions.     

Living donation and cosmetic surgery: a double standard in medical ethics?

The commitment of transplant physicians to protect the physical and psychological health of potential donors is fundamental to the process of living donor organ transplantation. It is appropriate that strict regulations to govern an individual's decision to donate have been developed. Some may argue that adherence to such regulations creates a doctor-patient relationship that is rooted in paternalism, which is in drastic contrast with a doctor-patient relationship that is rooted in patients' autonomy, characteristic of most other operative interventions. In this article we analyze the similarities between cosmetic plastic surgery and living donor surgery as examples of surgeries governed by different ethical principles. It is interesting that, while the prevailing ethical approach in living donor surgery is based on paternalism, the ethical principle guiding cosmetic surgery is respect for patients' autonomy. The purpose of this article is not to criticize either practice, but to suggest that, given the similarities between the two procedures, both operative interventions should be guided by the same ethical principle: a respect for patients' autonomy. We further suggest that if living organ donation valued donors' autonomy as much as cosmetic plastic surgery does, we might witness a wider acceptance of and increase in living organ donation.     

Cognition,daily living,and health-related quality of life in 85-year-olds in Sweden

ABSTRACT

This study investigates how cognition influences activities of daily living and health-related quality of life in 85-year-olds in Sweden (n?=?373). Data collection included a postal questionnaire comprising demographics and health-related quality of life measured by the EQ-5D. The ability to perform personal activities of daily living (PADL) was assessed during a home visit that included administering the Mini Mental State Examination (MMSE). Cognitive impairment was shown in 108 individuals (29%). The majority were independent with respect to PADL. A larger number of participants with cognitive impairment reported that they needed assistance in instrumental activities of daily living (IADL) compared to the group without cognitive impairment. Impaired cognition was significantly related to problems with IADL. Significant but low correlations were found between cognition and health-related quality of life – higher ratings on perceived quality of life correlated with higher results on the MMSE.     

Executive function, intellectual decline and daily living skills

Understanding the cognitive changes associated with compromised daily living skills in elderly individuals is important for making appropriate recommendations about the capacity for independent functioning. To this end, we retrospectively examined data from 92 elderly individuals presenting with cognitive decline who were administered measures of executive functioning, general intelligence, and daily living skills. Multiple regression analyses were used to examine the relationship between executive functioning and daily living skills, while controlling for age, depression, and either IQ decline or current IQ. Executive functioning accounted for additional variance in a broad range of daily living skills after controlling for IQ decline. When FSIQ was used in the regression model rather than IQ decline, executive functioning was no longer uniquely associated with daily living skills. Executive functions appear to be important for daily living skills until a critical threshold of low intellectual functioning is reached, reflecting the combined influence of premorbid ability and the extent of intellectual decline. Our results suggest that understanding the relative contribution of different cognitive domains to functional decline in elderly individuals should take into account general intellectual functioning and estimated decline, and that the initiation and/or persistence of self-directed cognitive processes may be important for adaptive daily functioning. These findings have implications for making more evidence-based recommendations about the capacity for independent living.     

Sources of autonomy support,subjective vitality and physical activity behaviour associated with participation in a lunchtime walking intervention for physically inactive adults

ObjectivesBased on Basic Needs Theory (BNT: Deci & Ryan, 1985), this study examined longitudinal relationships between autonomy support from two sources, psychological need satisfaction, subjective vitality and self-reported physical activity during a walking intervention for physically inactive adults. We proposed that autonomy support provided via a walk leader and the overall programme would independently predict change in subjective vitality and physical activity from baseline to week 16 (post-intervention) and at four month follow-up. Further, we proposed that direct relationships among sources of autonomy support and outcomes would be mediated by autonomy, relatedness, and competence need satisfaction.DesignA longitudinal examination.MethodsParticipants (N = 69; n = 63 females, n = 6 males) from a 16-week walking programme completed a multi-section questionnaire measuring the aforementioned variables at three time points, including a four month post-intervention follow-up.ResultsBoth hypotheses were partly supported. Autonomy support from the walk leader positively predicted changes in subjective vitality from baseline to week 16 and in physical activity from baseline to follow-up. Autonomy support from the programme positively predicted changes in subjective vitality from baseline to week 16. Finally, autonomy gained from the walk leader mediated the relationship between autonomy support and subjective vitality, and between perceived autonomy support and physical activity.ConclusionsFindings indicate that autonomy support from both a walk leader and wider programme can predict psychological need satisfaction, subjective vitality and physical activity. Clinicians and researchers implementing future walking interventions may increase physical activity and subjective vitality by facilitating psychological need satisfaction through autonomy support from both sources.     

The index of autonomous functioning: Development of a scale of human autonomy

A growing interest in the functional importance of dispositional autonomy led to the development and validation of the Index of Autonomous Functioning (IAF) across seven studies. The IAF provides a measure of trait autonomy based on three theoretically derived subscales assessing authorship/self-congruence, interest-taking, and low susceptibility to control. Results showed consistency within and across subscales, and appropriate placement within a nomological network of constructs. Diary studies demonstrated IAF relations with higher well-being, greater daily satisfaction of basic psychological needs, and more autonomous engagement in daily activities. Using an experimental approach, the IAF was shown to predict more positive interactions among dyads. The studies provided a systematic development and validation of a measure of autonomy that is brief and reliable.