Mild cognitive impairment and everyday functioning in older adults

The relations between mild cognitive impairment without dementia (MCI/CIND) and everyday functional abilities were examined using data from the Canadian Study of Health and Aging (CSHA). Individuals were identified with MCI/CIND if both caregiver report and clinician judgment agreed on the presence of cognitive impairment in the absence of dementia. Cross-sectional and longitudinal comparisons indicated that individuals with MCI/CIND demonstrated a broad range of impairment in instrumental activities of daily living (IADL) compared to individuals with no cognitive impairment (NCI). In cross-sectional analyses, neuropsychological measures of memory and psychomotor speed were significantly related to impairment in eight areas of functioning. In addition, poorer memory performance was significantly predictive of future impairment in money management.     

Mild cognitive impairment and everyday functioning in older adults

The relations between mild cognitive impairment without dementia (MCI/CIND) and everyday functional abilities were examined using data from the Canadian Study of Health and Aging (CSHA). Individuals were identified with MCI/CIND if both caregiver report and clinician judgment agreed on the presence of cognitive impairment in the absence of dementia. Cross-sectional and longitudinal comparisons indicated that individuals with MCI/CIND demonstrated a broad range of impairment in instrumental activites of daily living (IADL) compared to individuals with no cognitive impairment (NCI). In cross-sectional analyses, neuropsychological measures of memory and psychomotor speed were significantly related to impairment in eight areas of functioning. In addition, poorer memory performance was significantly predictive of future impairment in money management.     

MCI is associated with deficits in everyday functioning

The purpose of the present study was to examine the types of impairments in everyday function that accompany mild cognitive impairment (MCI). Data for this study was collected from 434 individuals consecutively evaluated at a university-based Alzheimer's Center. A total of 96 participants were diagnosed with MCI, 105 were cognitively normal, and 233 had dementia. Informant ratings of participants' abilities were obtained across different functional domains reflecting everyday abilities related to memory, language, visual spatial abilities, planning, organization, and divided attention. As expected, the demented group was significantly more impaired than the healthy control and MCI groups across all of the functional domains. The MCI group also showed significantly more functional impairment relative to healthy controls in all of the functional domains. Examination of the effect sizes as a measure of the magnitude of functional impairment in the MCI groups relative to controls showed that the greatest degree of impairment occurred within the Everyday Memory domain. The current findings suggest that individuals with MCI demonstrate deficits in a wide range of everyday functions but that the magnitude of these changes is greatest for those functional abilities that rely heavily on memory.     

Determinants of everyday outcomes in schizophrenia: The influences of cognitive impairment, functional capacity, and symptoms

Deficits in everyday living skills and social skills are associated with the pervasive disability seen in schizophrenia. Cognitive impairments are determinants of these skills deficits and it is known that positive and negative symptoms add to the influence of cognitive impairments for prediction of real-world outcomes. This study examined the relative importance of cognitive impairments measured with a neuropsychological battery, performance-based measures of social and everyday living skills, and positive and negative symptoms for the prediction of real-world outcomes in social and residential domains. In contrast to most previous studies, we examined the importance of individual symptoms, as well as total subscale scores, for predicting clinician rated outcomes in 194 older outpatients with schizophrenia. Symptoms were rated with the Positive and Negative Syndrome Scale; everyday living skills were measured by the UCSD Performance-based Skills Assessment; and social skills were measured with the Social Skills Performance Assessment. For prediction of real-world social outcomes, blunted affect and passive-apathetic social withdrawal accounted for all of the predicted variance, while social competence and cognitive impairments did not enter the final equation. For residential functioning, everyday living skills were the most important predictor, followed by lack of spontaneity. The positive symptoms of hallucinatory behavior and suspiciousness also predicted real-world residential outcomes. These results suggest that real-world disability is the product of a complex array of ability deficits and symptoms, indicating interventions will need to be carefully targeted. For social and everyday living outcomes, variance accounted for by the entire array of predictive variables was less than 40%, suggesting that other factors, such as social and cultural influences, are involved as well.     

Response inhibition and everyday memory complaints in older adult women

OBJECTIVE: To explore the association of executive functions to the everyday memory complaints of healthy older adults. METHODS: Ninety-nine community-dwelling women aged 60 and above were administered a battery that included neuropsychological tests of executive functions and memory, along with self-report measures of everyday memory complaints, depression, and anxiety. RESULTS: Multivariate regression analyses revealed that a measure of response inhibition (Stroop Color-Word) accounted for unique variance in predicting memory complaints above and beyond measures of episodic memory, depression, and anxiety. Depression, however, accounted for the largest variance in memory complaints. CONCLUSIONS: Higher frequency of everyday memory complaints among older adults was associated with decreased response inhibition independent of episodic memory and affective state. Further research is needed to understand the interrelationships among these and other predictors of everyday memory complaints.     

Rehabilitation of everyday memory deficits in paediatric brain injury: Self-instruction and diary training

Memory problems that interfere with everyday living are frequently reported in children who have sustained acquired brain injury (ABI), but their nature and rehabilitation is under-researched. This study aimed to (1) determine neuropsychological correlates of everyday memory deficits in children with ABI, and (2) investigate the effectiveness of a newly developed programme for their rehabilitation. We assessed everyday memory, verbal memory, attention and behaviour in 15 children with ABI. The children attended the everyday memory rehabilitation programme: six weekly sessions that involved diary training, self-instruction training and case examples. At the onset we found that everyday memory problems were related to impaired attention and behavioural difficulties. On completion of the programme there was a significant increase in children's abilities to perform daily routines that demanded recall of information and events. In addition, children used diaries more frequently. Moreover, significant secondary gains were found in attention and mood (anxiety and depression). In conclusion, the results provided preliminary evidence that our six week programme could be effective in reducing everyday memory difficulties and improving psychological well-being in children with ABI.     

Rehabilitation of everyday memory deficits in paediatric brain injury: self-instruction and diary training

Memory problems that interfere with everyday living are frequently reported in children who have sustained acquired brain injury (ABI), but their nature and rehabilitation is under-researched. This study aimed to (1) determine neuropsychological correlates of everyday memory deficits in children with ABI, and (2) investigate the effectiveness of a newly developed programme for their rehabilitation. We assessed everyday memory, verbal memory, attention and behaviour in 15 children with ABI. The children attended the everyday memory rehabilitation programme: six weekly sessions that involved diary training, self-instruction training and case examples. At the onset we found that everyday memory problems were related to impaired attention and behavioural difficulties. On completion of the programme there was a significant increase in children's abilities to perform daily routines that demanded recall of information and events. In addition, children used diaries more frequently. Moreover, significant secondary gains were found in attention and mood (anxiety and depression). In conclusion, the results provided preliminary evidence that our six week programme could be effective in reducing everyday memory difficulties and improving psychological well-being in children with ABI.     

Memory failures in everyday life following severe head injury

Abstract

Questionnaires concerning the incidence of memory failures in everyday life were used in a postal survey of the aftereffects of severe head injury. Several years after a severe injury, 50 patients were compared to 33 patients a similar period after a very mild injury. A questionnaire completed on behalf of each patient by someone living in daily contact with him appeared to have some validity as a memory measure. The pattern of memory failures reported was similar to that found in a previous study and this may primarily reflect the ease with which certain forms of memory failure can be observed. A questionnaire completed by the patients themselves had little validity, possibly because severely injured patients could not recall their own memory failures. Only a minority of severely injured patients were reported to be significantly handicapped by memory failures at this stage in their recovery.     

Cognitive functioning and everyday problem solving in older adults

The relationship between cognitive functioning and a performance-based measure of everyday problem-solving, the Everyday Problems Test (EPT), thought to index instrumental activities of daily living (IADL), was examined in 291 community-dwelling non-demented older adults. Performance on the EPT was found to vary according to age, cognitive status, and education. Hierarchical regression analyses revealed that, after adjusting for demographic and health variables, measures of cognitive functioning accounted for 23.6% of the variance in EPT performance. In particular, measures of global cognitive status, cognitive decline, speed of processing, executive functioning, episodic memory, and verbal ability were significant predictors of EPT performance. These findings suggest that cognitive functioning along with demographic variables are important determinants of everyday problem-solving.     

Confrontation naming deficit in dementia of depression

Unlike patients with irreversible dementia, elderly depressed patients with cognitive impairment are thought to have relatively preserved recognition, memory, and language abilities. To test this hypothesis, the authors compared memory and naming performance in elderly hospitalized patients with major depression alone, reversible dementia of depression, or irreversible dementia. All patient groups performed worse than nondemented, nondepressed control subjects on memory tasks. Patients with dementia of depression performed worse than depressed patients with normal cognition on tests of free recall, delayed recall, and verbal delayed memory but not on tests of delayed visual memory. Patients with dementia of depression and patients with irreversible dementia were severely compromised in both speed and accuracy on the confrontation naming task.     

Factor analysis of the everyday memory questionnaire in persons with traumatic brain injury

Objectives: To investigate the factor structure of the Everyday Memory Questionnaire (EMQ) in persons with traumatic brain injury (TBI). Method: This was a secondary analysis of baseline data from two clinical trials targeting memory impairment after TBI. Participants were 169 persons with complicated mild, moderate, or severe TBI at an average of 41 months post-injury. They completed the EMQ via clinical interview. Exploratory factor analysis was conducted using a three-factor principal axis factoring estimation method with a polychoric correlation matrix and oblique rotation. Results: The three factors accounted for 49.2% of the variance, with moderate correlations observed among the factors. The three factors appeared to represent general everyday memory (prospective and episodic), conversational memory, and spatial or action memory. The three factors added significantly to the variance in age-corrected objective learning test scores predicted by injury severity, education, and sex. Conclusions: The three factors of the EMQ are consistent with the heterogeneity of memory impairments observed after TBI. The factor scores may be used to target treatments for impaired memory and to evaluate their effectiveness.     

DIVISION 40 SPECIAL PRESENTATION Listing of Training Programs in Clinical Neuropsychology – 2000

Metamemory, or ones knowledge and self-report of memory ability, has been researched extensively; however, few studies have examined it in multiple sclerosis (MS). Because impairment in cognitive domains besides memory may affect memory functioning, patients may self-report problems with memory that are indicative of impairment in cognitive domains besides memory. One goal of the current study was to test this hypothesis in MS. A group of 55 MS patients were administered a variety of cognitive tasks and a self-report metamemory measure; patients significant others were also given a metamemory measure requiring them to rate patients memory abilities. Results indicated that patients metamemory reports were significantly (p &;lt; .05) correlated with verbal recall, attentional, and executive tasks. Significant other ratings of patients metamemory were correlated with verbal recall and attentional measures. Stepwise regression analyses including all relevant cognitive and demographic variables indicated that only education and Symbol Digit accounted for significant independent variance in patients current memory reports. Our results suggest: (1) subjective complaints of memory difficulties by MS patients reflect difficulty in cognitive domains besides memory, (2) MS patient self-reports of memory difficulty are at least as accurate as significant other reports, and (3) patients with more education are more accurate in their metamemory ratings. These findings have implications not only for a better understanding of metamemory in MS, but also for more effective treatment and rehabilitation of MS patients.     

Neuropsychological predictors of everyday functioning in adults with intellectual disabilities

Background Very little is known about the neuropsychological correlates of adaptive functioning in people with intellectual disabilities (ID). This study examined whether specific cognitive deficits and demographic variables predicted everyday functioning in adults with ID. Method People with ID (n = 101; ages 19–41 years; mean education = 11 years; 34% women; 54% competitively employed; 41% with mild ID) completed a comprehensive neuropsychological battery grouped into four cognitive domains: processing speed, verbal memory and comprehension, visual perception/constructive function, and executive function. In addition, parents completed an 89‐item rating scale developed to assess a wide range of independent living skills. Results Confirmatory factor analysis results confirmed a correlated four‐factor model of cognitive function and a unidimensional model of everyday functioning. Furthermore, structural equation modelling results supported the predictive relationship of verbal memory/comprehension and employment status (standardized regression coefficients 0.45, 0.22, P ≤ 0.01 for each) to measures of everyday functioning. The two variables together explained 35% of the variance in everyday functioning. Conclusions Both general cognitive dysfunction and specific verbal memory and comprehension deficit impair daily functions in people with ID. These findings have implications for predictive models of adaptive functioning, and for cognitive rehabilitation and deficit compensation strategies for this group.     

Cognitive and psychological predictors of everyday memory in children with intractable epilepsy

Children with epilepsy have known deficits on objective measures of learning and memory. Parents and children report that memory deficits have a negative impact on everyday functioning. In adults with epilepsy, self-report of memory is more strongly associated with depression than performance on memory tests. We investigated the cognitive and psychological predictors of everyday memory in 37 children with medically intractable epilepsy, using children's self-report and parent ratings of everyday memory performance and standard tests of attention, intelligence, visual and verbal memory, working memory, and mood/emotional state. Standard multiple regressions demonstrated that only a parent report measure of attention uniquely and significantly (P< or =0.05) predicted estimates of everyday memory performance, accounting for 33% of variance in children's own ratings and 27% of variance in parents' ratings. Findings suggest that everyday memory in children with intractable epilepsy differs from that of adults; attentional problems may underlie everyday memory problems in these children.     

Memory failures for everyday tasks in caregivers of children with autism

The stress of caring for a loved one with chronic illness has been linked with impairments in cognitive processes such as attention and problem solving, though few studies have examined the impact on memory. Compromised cognition, in particular, aspects of everyday functioning such as remembering medical instructions and appointments, might affect caregivers’ ability to maintain the consistency and quality of care needed by the child. A sample of 31 caregivers of children with autism and 51 parents of neuro-typical children completed an electronic survey assessing their levels of psychological distress and everyday memory. Perceived stress scores were higher in the caregiver group, as were self-reported memory failures for everyday tasks. The negative impact of caregiver stress on everyday memory was particularly salient among caregivers experiencing higher perceived levels of stress. These findings have implications for interventions that aim to improve caregivers’ cognitive well being through targeting the psychological sequelae associated with the caregiving experience.     

Improved verbal learning in the semantic variant of primary progressive aphasia when using semantic cues

The semantic variant of primary progressive aphasia (PPA-S) is characterized by impairments in confrontation naming and single word comprehension. Although episodic memory may be relatively spared, there can be impairment in verbal learning tasks. We report a patient with PPA-S and impaired verbal learning who was tested to learn if when provided with semantic categories, her learning would improve. A 70-year-old right-handed woman with a 2-year history of progressive difficulties with word finding, naming, and memory was tested for language and memory deficits using the Hopkins Verbal Learning Test-Revised (HVLT-R). She was then retested with the HVLT-R after being provided with the three semantic categories to which these words belonged. Confrontation naming was impaired on the Boston Naming Test. Sentence repetition was normal. Comprehension testing with word picture matching and sentence comprehension was normal. On a test of semantic associations, Pyramids and Palm Trees, she was impaired. She was also impaired on tests of verbal learning (HVLT-R) (total: 13) but not recall. When a different version of the HVLT-R was given with the semantic categories of the words given beforehand, her scores improved (total: 26). This patient with PPA-S had an impairment of verbal learning, but not delayed recall. When given a semantic category cue beforehand, her verbal learning performance improved. This observation suggests that this patient did not spontaneously use semantic encoding. Using a semantic cueing strategy may help other patients with PPA-S improve their capacity for verbal learning.     

Patient and caregiver quality of life in Huntington's disease

Little is known about subjective perceptions of quality of life (QOL) in Huntington's disease (HD). The current study determined correlates of patient and caregiver QOL and assessed change over time. Participants were 22 patient‐caregiver dyads, who rated QOL at baseline and 6 months later. Overall, patients' functional and cognitive impairment were significantly correlated with patient and caregiver QOL. Neuropsychiatric symptoms had differential impact on patient and caregiver QOL. Furthermore, when patients recalled their QOL about a previous time, their recall may have been negatively biased. Clinical implications of results are discussed. Future work is needed because subjective QOL is an important outcome measure in therapeutic trials. © 2008 Movement Disorder Society     

Neuropsychological substrates and everyday functioning implications of prospective memory impairment in schizophrenia

Individuals with schizophrenia demonstrate impairment in prospective memory (ProM), which describes the multifaceted ability to execute a future intention. Despite its clear implications for everyday functioning, the neuropsychological substrates and functional correlates of ProM impairment in schizophrenia remain poorly understood. In this study, the Memory for Intentions Screening Test (MIST), a standardized measure of ProM, was administered to 72 outpatients with schizophrenia or schizoaffective disorder as part of a comprehensive neuropsychological and psychiatric research evaluation. Results showed that ProM was positively correlated with standard clinical tests of attention, working memory, processing speed, learning, and executive functioning, but not delayed recall. In the context of multiple neuropsychological predictors, learning ability was the only domain that independently contributed to ProM. Importantly, better ProM was predictive of higher functional capacity (as measured by the UCSD Performance-Based Skills Assessment-Brief Version), above and beyond the variability explained by demographic and disease factors. Analysis of component processes revealed that event-based ProM, as well as no response (i.e., omission) and task substitution errors were the strongest predictors of everyday functioning. Overall, these findings suggest that ProM impairment in schizophrenia is associated with multiple cognitive substrates, particularly episodic learning deficits, and plays an important role in everyday living skills. Studies regarding the potential effectiveness of ProM-based remediation strategies to improve functional outcomes in schizophrenia are indicated.     

Stages of recovery during post-traumatic amnesia and subsequent everyday memory deficits

Post-traumatic amnesia (PTA) is the period following brain trauma when patients are unable to acquire and retain information. Nineteen patients with brain injury were assessed for PTA, with a new scale, after they regained consciousness, every 24 h. Patients recovered orientation and their capacity to recognise new information, and finally their ability to recall this information. The longer the duration of PTA, the poorer was performance on an everyday memory test given one month after recovery from PTA. Patients with orthopaedic injuries and without brain injury showed minimal impairment on the PTA scale. The predictive value of the scale (multiple R = 0.88) with respect to subsequent everyday memory performance indicates its usefulness as an index of severity of brain injury.     

Validity of the Japanese version of Rivermead Behavioural Memory Test for evaluation of everyday memory function in patients with mild Alzheimer's disease]

OBJECTIVE: To validate the Japanese version of Rivermead Behavioural Memory Test (RBMT) in evaluating everyday memory function in patients with mild Alzheimer's disease (AD). SUBJECTS AND METHODS: Subjects were 100 patients with probable AD of very mild or mild stages of dementia as measured by the Clinical Dementia Rating (CDR). Scores of the Japanese version of RBMT were correlated with scores of the Alzheimer's Disease Assessment Scale-Cognitive part (ADAS-J Cog) and of the Wechsler Memory Scale-Revised (WMS-R). The everyday disability caused by the impairment of memory function was also assessed with the Memory Checklist (CL), and was correlated with the RBMT scores. In addition, the diagnostic value of the RBMT was examined in 46 pairs of AD patients and healthy subjects; the patients were chosen from the present subjects and the healthy subjects from the participants in the previous RBMT standardization study as one-by-one matched for age, sex, and educational level. RESULTS: Both of the total screening score and profile score of RBMT were significantly correlated with all of the weighted sum scores of verbal, visual, general, and delayed memory tests of the WMS-R and the word recall subtest score of the ADAS-J Cog. Both of the RBMT scores were also highly correlated with the CL score and the memory subscale of the CDR. In the analysis of the diagnostic accuracy, both of the RBMT scores correctly classified 98% of AD patients and 96% of normal volunteers by setting the cut-off scores of 6/5 for the total screening score and of 14/13 for the total profile score. CONCLUSIONS: The RBMT is a useful tool in evaluating everyday memory function in patients with mild AD. This test also accurately differentiates AD patients from healthy individuals.