Competence in everyday activities as a predictor of cognitive risk and mortality

This study examined the association of a performance-based measure of everyday functioning with clinically meaningful outcomes. Elderly participants in a prospective study of dementia were assessed at two occasions on the Everyday Problems Test for Cognitively Challenged Elderly (EPCCE), a performance-based measure of everyday functioning. Older adults who remained cognitively intact performed approximately 0.66 SD units higher on the EPCCE at both occasions than elders rated as impaired, when covarying on age, education, gender, and cognitive status. Relative to the nonimpaired participants, decline in EPCCE performance over a 2-year interval was significantly greater for impaired participants and those participants who transitioned from nonimpaired to impaired over the course of the study. Increased risk of mortality was associated with lower baseline scores and decline in EPCCE performance even after controlling for demographic variables and performance on the Mini-Mental State Examination. Given the clinical importance of identifying "at risk" elders for impairment, the findings from this study provide initial evidence for the predictive utility of performance-based measures of everyday functioning.     

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.     

Intellectual and adaptive functioning in Sturge-Weber Syndrome

The present study examined the intellectual and adaptive functioning in a sample of children and young adults with Sturge-Weber Syndrome (SWS). A total of 80 research participants from a SWS study database underwent full neurological evaluation as part of their participation or concurrent medical care. Twenty-nine of the participants received neuropsychological evaluations. Analyses indicated no significant demographic or neurological differences between those who did and did not receive neuropsychological evaluations. Overall, the neuropsychological evaluation sample displayed significantly lower functioning relative to published normative data across domains of intellectual and adaptive functioning. Thirty-two percent of the sample displayed impaired performance (standard score ≤ 75) in intellectual functioning and 58% displayed impaired performance in adaptive functioning. Hemiparesis status independently predicted overall adaptive functioning while seizure frequency independently predicted overall intellectual functioning. Younger participants displayed significantly higher (more intact) ratings in adaptive functioning compared to older participants, specifically in overall adaptive functioning, motor skills, and community living skills. A composite measure of neurological status (SWS-NRS) incorporating seizure and hemiparesis status effectively distinguished between individuals with impaired or nonimpaired adaptive and intellectual functioning and showed promise as a screening method for identifying individuals with more involved intellectual and/or adaptive needs.     

Dual-task effects of simulated lane navigation and story recall in older adults with and without memory impairment

ABSTRACT

While driving is a complex task, it becomes relatively automatic over time although unfamiliar situations require increased cognitive effort. Much research has examined driving risk in cognitively impaired elders and found little effect. This study assessed whether mildly memory impaired elders made disproportionate errors in driving or story recall, under simultaneous simulated driving and story recall. Forty-six healthy (61% women; mean age = 76.4) and 15 memory impaired (66% women, mean age = 79.4) elders participated. Cognitive status was determined by neuropsychological performance. Results showed that during dual-task conditions, participants stayed in lane more, and recalled stories more poorly, than when they did the tasks separately. Follow-up analysis revealed that verbatim recall, in particular, was reduced while driving for healthy participants. While memory impaired participants performed more poorly than healthy controls on both tasks, cognitive status was not associated with greater dual-task costs when driving and story recall were combined.     

Memory training and strategy use in older adults: results from the ACTIVE study

Little is known about the long-term effects of memory training in later life on strategy use. Data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (n = 1,401) were used to describe strategy use in a community-dwelling sample of older adults. Strategy clustering scores on verbal list learning tasks of episodic memory were used to test the impact of memory training on strategy use and study longitudinal associations between strategy clustering, memory performance, and everyday functioning. Results suggested that younger, female, white, healthier, and more educated participants show higher strategy clustering scores initially but no characteristics were consistently associated with different trajectories in strategy clustering across all strategy clustering measures together. Memory training had significant immediate effects on all measures of strategy use that were maintained through five years of follow-up. With respect to longitudinal mediation, pre-post training changes in most strategy clustering scores mediate changes in objective memory performance and everyday functioning, implying that strategies can be modified and are closely related to both memory ability and the ability to function independently. This study provides evidence that older adults can be trained to use cognitive strategies, the effects are durable, and strategies are associated with memory and everyday functioning.     

Sensitive performance-based assessment of everyday action in older and younger adults

Everyday function is compromised by mild cognitive changes in aging. These changes predict risk for future decline and dementia but remain poorly characterized, largely due to a scarcity of sensitive, objective measures.Twenty-seven younger adults and 25 non-demented older adults completed the Naturalistic Action Test (NAT), a performance-based measure of everyday action involving simple and complex tasks. Performance was coded for overt errors and subtle inefficiencies. Participants also completed self-report functional measures and cognitive tests. Mixed ANOVAs revealed that older adults made more subtle NAT errors with high task demands; groups did not differ in overt errors. Correlations did not reveal significant relations between self-report and NAT errors, but NAT performance was correlated with learning and recall.The NAT provides a promising tool for detecting subtle age-related changes and examining decline across levels of impairment. Self-report may lack sensitivity to subtle changes, and episodic memory changes underlie early functional disruption.     

Parent rating of executive function in fetal alcohol spectrum disorder: A review of the literature and new data on Aboriginal Canadian children

Aboriginal children in Canada are at high risk of fetal alcohol spectrum disorder (FASD) but there is little research on the cognitive impact of prenatal alcohol exposure (PAE) in this population. This paper reviews the literature on parent report of executive functioning in children with FASD that used the Behavior Rating Inventory of Executive Function (BRIEF). New data on the BRIEF is then reported in a sample of 52 Aboriginal Canadian children with FASD for whom a primary caregiver completed the BRIEF. The children also completed a battery of neuropsychological tests. The results reveal mean scores in the impaired range for all three BRIEF index scores and seven of the eight scales, with the greatest difficulties found on the Working Memory, Inhibit and Shift scales. The majority of the children were reported as impaired on the index scores and scales, with Working Memory being most commonly impaired scale. On the performance-based tests, Trails B and Letter Fluency are most often reported as impaired, though the prevalence of impairment is greater for parent ratings than test performance. No gender difference is noted for the parent report, but the boys had slightly slower intellectual functioning and were more perseverative than the girls on testing. The presence of psychiatric comorbidity is unrelated to either BRIEF or test scores. These findings are generally consistent with prior studies indicating that parents observe considerable executive dysfunction in children with FASD, and that children with FASD may have more difficulty with executive functions in everyday life than is detected by laboratory-based tests alone.     

Examining the relationship between performance-based and questionnaire assessments of executive function in young preterm children: Implications for clinical practice

The aim of this study was to determine whether specific performance-based executive function assessment tools were associated with executive functioning in everyday life as reported by parents and teachers of four- to five-year-old preterm and term children. At the age of 4 years, 141 preterm children born <33 weeks’ gestation and 77 term children were assessed using performance-based intelligence (WPPSI-III) and executive function (EF) assessment tools (NEPSY-II, Day-Night and Shape School tasks). The assessment results were compared with the parent and teacher completed questionnaires of EF (BRIEF-P) when the children started kindergarten at the age of 4 to 5 years. The performance-based intelligence and EF assessment results were not consistently associated with the parent and teacher reports of EF in everyday life for either preterm or term groups. Clinical implications of using and interpreting performance-based EF assessment tools and EF questionnaires are discussed with a particular focus on young preterm children at the commencement of formal schooling.     

Objective measures of executive functioning are highly discrepant with parent-report in fetal alcohol spectrum disorders

The purpose of the current study was to evaluate the relationship between parent-report and objective measures of executive function in children diagnosed with Fetal Alcohol Spectrum Disorder (FASD). The participants were a clinical sample of 551 children who completed 597 evaluations, including initial and re-evaluations. Participants were 6–16 years old, with a mean age of 10. Pearson correlations were used to determine the relationship between performance-based measures and parent-report measures of executive functioning. Relationships among the same types of measures, that is, performance based or parent report, were also evaluated. The data largely demonstrate low nonsignificant correlations between performance-based measures and parental report of executive function. Parent-report measures were internally consistent as were objective measures. It is possible that a third variable, for example, parental frustration, significantly influences parent reports. It is also likely that objective measures, which are administered in a controlled environment, do not fully capture children’s day-to-day functioning. That is, a child may have the executive function abilities (i.e., good performance on objective measures) but may be unable to deploy the appropriate skills in their daily lives, as evidenced by parental report. Children with FASD who have executive function abilities but not implementation skills likely require different interventions than children who lack abilities and skills.     

Ageing-related stereotypes in memory: When the beliefs come true

Age-related stereotype concerns culturally shared beliefs about the inevitable decline of memory with age. In this study, stereotype priming and stereotype threat manipulations were used to explore the impact of age-related stereotype on metamemory beliefs and episodic memory performance. Ninety-two older participants who reported the same perceived memory functioning were divided into two groups: a threatened group and a non-threatened group (control). First, the threatened group was primed with an ageing stereotype questionnaire. Then, both groups were administered memory complaints and memory self-efficacy questionnaires to measure metamemory beliefs. Finally, both groups were administered the Logical Memory task to measure episodic memory, for the threatened group the instructions were manipulated to enhance the stereotype threat. Results indicated that the threatened individuals reported more memory complaints and less memory efficacy, and had lower scores than the control group on the logical memory task. A multiple mediation analysis revealed that the stereotype threat effect on the episodic memory performance was mediated by both memory complaints and memory self-efficacy. This study revealed that stereotype threat impacts belief in one's own memory functioning, which in turn impairs episodic memory performance.     

Exploring the Within-Person Coupling of Reading Vision and Cognition in the Elderly

ABSTRACT

This study examined the within-person relationship between reading vision and cognitive functioning. Analysis was conducted on 36 community-dwelling elderly (age range?=?60–87) who completed a reading vision task and three cognitive tests (i.e., Rey Auditory Verbal Learning Task (AVLT), Letter Series, and Number Comparison) twice a day over 60 consecutive days. Significant within-person variability was found for the reading vision measure. Additionally, a main effect was found for reading vision and performance on the AVLT and Number Comparison task; such that on occasions when reading vision was poor, cognitive performance suffered.     

Religion, Meaning in Life, and Change in Physical Functioning During Late Adulthood

This study has two primary goals. The first is to see whether select aspects of religion are associated with meaning in life. The second goal is to see whether change in meaning in life is associated with change in physical functioning. Data from a nationwide longitudinal survey of older people provide support for the following relationships: (1) older adults who attend church services more often tend to develop a closer relationship with God; (2) older people who have a closer relationship with God are more likely to provide emotional support to others; (3) elders who give emotional support to their social network members are more likely to have a stronger sense of meaning in life; and (4) older individuals who have a deeper sense of meaning in life are less likely to experience a decline in their physical functioning over time.     

Exploring the within-person coupling of sleep and cognition in older African Americans

This study examined the within-person relationship between sleep and cognitive functioning. Fifty community-dwelling African Americans (age range = 50-80 years) were asked to report their sleep duration and quality the previous evening and to complete cognitive measures over 8 occasions within a 2-3 week period. A within-person daily change in sleep duration was significantly associated with worse global cognitive performance. The greater an individual deviated away from his or her average sleep duration on a particular day, the more likely his or her performance would decline. These results demonstrate that the sleep-cognition relationship can be observed at a within-person level of analysis.     

Relationship of cognitive strategy use to prospective memory performance in a diverse sample of nondemented older adults with varying degrees of cognitive complaints and impairment

Although older adults typically have better performance on prospective memory (PM) tasks carried out in naturalistic settings, a paucity of research directly assesses older adults’ use of compensatory strategies on such tasks. The current study investigates external memory strategy use during performance of a clinical PM test that features both short-term (in laboratory) and long-term (out of laboratory) subtasks (i.e., the Royal Prince Alfred Prospective Memory Test – RPA-ProMem. Nondemented, community-dwelling older adults (n = 214; mean age = 80.5; 68.2% female; 39.7% non-white) with mild cognitive impairment, subjective cognitive decline, and healthy controls completed the RPA-ProMem while external strategy use was permitted and recorded. Overall, participants utilized external strategies 41% of the time on the RPA-ProMem. Increased utilization of external memory strategies was significantly associated with better PM performance. Additionally, better performance on executive functioning tasks was associated with increased use of external memory strategies. Results are discussed in relation to how memory strategy use can be enhanced to improve everyday memory ability in older adults at risk for dementia.     

The assessment of recognition memory using the Remember/Know procedure in amnestic mild cognitive impairment and probable Alzheimer’s disease

This study used the Remember/Know (R/K) procedure combined with signal detection analyses to assess recognition memory in 20 elders with amnestic mild cognitive impairment (aMCI), 10 patients with probable Alzheimer’s disease (AD) as well as matched healthy older adults. Signal detection analyses first indicated that aMCI and control participants were comparable on general recognition performance. As regards AD patients, they were impaired relative to both aMCI and healthy elders. When assessing Remember and Know responses the aMCI group showed diminished sensitivity for Remember responses but intact Know responses compared to healthy elders. In contrast, AD patients showed decreased sensitivity for both Remember and Know responses compared to control and aMCI participants. The response bias index revealed that AD patients were more liberal than aMCI and control participants when providing Know responses. On the other measures, response bias was comparable between the groups. Overall, this study indicates that the R/K procedure can characterize different aspects of recognition memory performance in persons with aMCI or AD.     

Well- and ill-defined measures of everyday cognition: relationship to older adults' intellectual ability and functional status

The present study examined 2 approaches to the measurement of everyday cognition in older adults. Measures differing in the degree of structure offered for solving problems in the domains of medication use, financial management, and food preparation and nutrition were administered to a sample of 130 community-dwelling older adults ranging in age from 60 to 90 (M = 73 years, SD = 7.02 years). Well-defined and ill-defined everyday problem-solving measures, which varied in the amount of means-end-related information provided to participants, were used. The study found that (a) well- and ill-defined measures were moderately interrelated, (b) the 2 approaches were differentially related to basic cognitive abilities, and (c) together the 2 approaches explained over half of the variance in older adults' everyday instrumental functioning and were in fact better predictors of everyday functioning than traditional psychometric cognitive measures. Discussion focuses on the differential importance of both methods for assessing older adults' everyday cognitive functioning.     

Metamemory following childhood brain injury: A consequence of executive impairment

In this study, we investigated the influence of children’s level of executive functioning on two types of metamemory knowledge following a traumatic brain injury (TBI). For this purpose, 22 children (aged 7 to 14 years) who had sustained a moderate to severe TBI and 44 typically developing children were recruited. The children with TBI were divided into two groups according to the severity of their executive impairment. Injury severity was determined by the Glasgow Coma Scale (GCS) score on admission or by the duration of unconsciousness. All children were then tested on both their knowledge of general memory functioning and their level of memory self-awareness, respectively assessed using the total number of correct responses on an adapted version of a metamemory interview and a self-other discrepancy score on a questionnaire evaluating everyday memory abilities. Data analyses revealed that participants with TBI who suffered impaired executive functions demonstrated less general metamemory knowledge, and underestimated the frequency of their memory problems, compared with children with TBI who had preserved executive functions and with control participants. Considering the well-established effect of metamemory knowledge on people’s spontaneous implementation of strategies, the interest and the importance of these findings on both theoretical and clinical grounds are discussed.     

Correlates of memory decline: a 4-year longitudinal study of older adults with memory complaints.

Change in memory performance and its correspondence to change in speed of performance and self-reported memory functioning were investigated longitudinally in 30 older adults with memory complaints. Subjects were assessed by self-report questionnaires and cognitive tests 3 times, at near 2-year intervals. A significant decline in word-recall scores was found, which was accompanied at the group level by significant self-reported decline in everyday memory functioning and nonsignificant decline in Wechsler Adult Intelligence Scale Digit Symbol scores (alpha = .05). The oldest subjects showed the most substantial declines in memory performance. At the individual level, however, memory change did not significantly correlate with either change in self-reports or change in Digit Symbol scores. Although these results do not support a cognitive slowing model of decline at the intraindividual level, they do have implications for intervention of age-related memory decline.     

Effects of traumatic stress and perceived stress on everyday cognitive functioning

Stressful or traumatic events have been shown to impair cognitive functioning on laboratory-based tasks due to stress-related intrusive thoughts and avoidance. However, research on the effects of stress on everyday cognitive functioning has been lacking. A sample of 909 undergraduates completed measures of perceived stress, PTSD symptoms, and everyday cognitive failures. The results revealed that both perceived stress and PTSD symptoms uniquely predicted cognitive failures, even after controlling for a number of potentially confounding variables. Additionally, there was a significant interaction. Participants with low scores on both measures of stress reported the fewest occurrences of everyday cognitive failures. In contrast, participants with elevated scores on either measure of stress reported higher levels of cognitive failures. These results suggest that there are unique negative effects of perceived stress and PTSD symptoms on everyday cognitive functioning and sharpen our understanding of the relationship between stress and cognition.