Enhancing ‘meaningfulness’ of functional assessments: UK adaptation of the Amsterdam IADL questionnaire

ABSTRACT Objective: Commonly used measures of instrumental activities of daily living (IADL) do not capture activities for a technologically advancing society. This study aimed to adapt the proxy/informant-based Amsterdam IADL Questionnaire (A-IADL-Q) for use in the UK and develop a self-report version. Design: An iterative mixed method cross-cultural adaptation of the A-IADL-Q and the development of a self-report version involving a three-step design: (1) interviews and focus groups with lay and professional stakeholders to assess face and content validity; (2) a questionnaire to measure item relevance to older adults in the U.K.; (3) a pilot of the adapted questionnaire in people with cognitive impairment. Setting: Community settings in the UK. Participants: One hundred and forty-eight participants took part across the three steps: (1) 14 dementia professionals; 8 people with subjective cognitive decline (SCD), mild cognitive impairment (MCI), or dementia due to Alzheimer’s disease; and 6 relatives of people with MCI or dementia; (2) 92 older adults without cognitive impairment; and (3) 28 people with SCD or MCI. Measurements: The cultural relevance and applicability of the A-IADL-Q scale items were assessed using a 6-point Likert scale. Cognitive and functional performance was measured using a battery of cognitive and functional measures. Results: Iterative modifications to the scale resulted in a 55-item adapted version appropriate for UK use (A-IADL-Q-UK). Pilot data revealed that the new and revised items performed well. Four new items correlated with the weighted average score (Kendall’s Tau −.388, −.445, −.497, −.569). An exploratory analysis of convergent validity found correlations in the expected direction with cognitive and functional measures. Conclusion: The A-IADL-Q-UK provides a measurement of functional decline for use in the UK that captures culturally relevant activities. A new self-report version has been developed and is ready for testing. Further evaluation of the A-IADL-Q-UK for construct validity is now needed.

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Known-Groups and Convergent Validity of the Telephone Rey Auditory Verbal Learning Test total Learning Scores for Distinguishing Between Older Adults With Amnestic Cognitive Impairment and Subjective Cognitive Decline

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa085 ◽

2020 ◽

Author(s):

Shreya Jagtap ◽

Deirdre R Dawson ◽

Susan Vandermorris ◽

Nicole D Anderson ◽

Naomi Davids-Brumer ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Cognitive Decline ◽

Convergent Validity ◽

Verbal Learning ◽

Subjective Cognitive Decline ◽

Total Recall ◽

Auditory Verbal Learning Test ◽

Auditory Verbal Learning ◽

Learning Test

Abstract Objective To examine known-groups validity of a telephone administration of the total learning scores of the Rey Auditory Verbal Learning Test (RAVLT) in discriminating between people with subjective cognitive decline (SCD) and amnestic mild cognitive impairment (aMCI) and convergent validity of the telephone-RAVLT. Method In total, 83 older adults (age = 71.4 ± 7.0) with SCD or aMCI completed the RAVLT learning trials over the telephone and the Hopkins Verbal Learning Test (HVLT) in-person. Results Telephone-RAVLT total recall significantly correlated with HVLT total recall (r = .49, p < .001). Significant between group differences were found (effect size = 0.94). Conclusions This study provides support for known-groups and convergent validity of the telephone-RAVLT.

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Measuring psychological mechanisms in meditation practice: Using a phenomenologically grounded classification system to develop theory-based composite scores

10.31231/osf.io/s6qxn ◽

2021 ◽

Author(s):

Marco Schlosser ◽

Thorsten Barnhofer ◽

Florence Requier ◽

Yacila Isabela Deza-Araujo ◽

Oussama Abdoun ◽

...

Keyword(s):

Older Adults ◽

Psychometric Properties ◽

Classification System ◽

Convergent Validity ◽

Well Being ◽

Self Report ◽

Subjective Cognitive Decline ◽

Future Research ◽

Psychological Mechanisms ◽

Composite Scores

Objectives: Deepening our understanding of the mechanisms by which meditation practices impact well-being and human flourishing is essential for advancing the science of meditation. The phenomenologically grounded classification system introduced by Dahl, Lutz, and Davidson (2015) distinguishes attentional, constructive, and deconstructive forms of meditation based on the psychological mechanisms these practices primarily target or necessitate. Our main aim was to understand whether this theory-based taxonomy could be used as a guiding principle for combining established psychological self-report measures of meditation-related mechanisms into psychometrically adequate composite scores. Methods: We used cross-sectional data to compute meditation composite scores in three independent samples, namely meditation-naïve healthy older adults from the Age-Well trial (n = 135), meditation-naïve older adults with subjective cognitive decline from the SCD-Well trial (n = 147), and healthy long-term meditators (≥10,000 hours of practice including one three-year meditation retreat) from the Brain & Mindfulness project (n=29). The psychometric properties of the composite scores were assessed via floor and ceiling effects, composite intercorrelations, interpretability, and convergent validity in relation to well-being, anxiety, and depression. Results: Three theoretically derived meditation composite scores, reflecting mechanisms involved in attentional, constructive, and deconstructive practices, displayed adequate psychometric properties. Separate secondary confirmatory factor analyses empirically corroborated the theoretically predicted three-factor structure of this classification system. Conclusions: Complementing data-driven approaches, this study offers preliminary support for using a theoretical model of meditation-related mechanisms to create empirically meaningful and psychometrically sound composite scores. We conclude by suggesting conceptual and methodological considerations for future research in this area.

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Androgen deprivation therapy and radiation for prostate cancer—cognitive impairment, sleep, symptom burden: a prospective study

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2021-003098 ◽

2021 ◽

pp. bmjspcare-2021-003098

Author(s):

Joshua Tulk ◽

Joshua A Rash ◽

John Thoms ◽

Richard Wassersug ◽

Brian Gonzalez ◽

...

Keyword(s):

Prostate Cancer ◽

Cognitive Impairment ◽

Androgen Deprivation Therapy ◽

Sleep Onset ◽

Symptom Burden ◽

Physical Symptoms ◽

Androgen Deprivation ◽

Self Report ◽

Subjective Cognitive Decline ◽

Subjective Time

ObjectivesThis paper (1) sought to compare sleep, mood and physical symptom profiles of men with prostate cancer (PCa) who experienced subjective and objective cancer-related cognitive impairment (CRCI) during the first year of treatment and (2) examine if fluctuations in mood and physical symptoms are associated with change in subjective or objective CRCI.MethodsThis prospective observational cohort study examined 24 new patients with PCa receiving androgen deprivation therapy (ADT) and radiation therapy (RT) during the first 12 months of treatment. Participants completed subjective and objective assessments of cognition, sleep continuity and self-report measures of insomnia, fatigue, depression and anxiety. Independent sample t-tests, correlations and hierarchical regressions were used to compare groups, explore associations, and assess change over time. Effects are reported as corrected Cohen’s d (dc).ResultsMen with objective CRCI reported worse subjective time asleep (dc=0.47) and more depression (dc=0.55). Men with subjective CRCI reported worse insomnia (dc=0.99), hot flashes (dc=0.76), sleep quality (dc=0.54), subjective total sleep time (dc=0.41), wake after sleep onset (dc=0.71), sleep efficiency (dc=0.49), fatigue (dc=0.67) and objectively estimated sleep latency (dc=0.72) than men without subjective CRCI. Declines in perceived cognition was associated with higher anxiety (p=0.05), fatigue (p≤0.01) and symptoms of insomnia (p=0.01). Finally, subjective time awake during the night (p=0.03) and fatigue (p=0.02) were associated with subjective cognitive decline, controlling for objective change.ConclusionsSubjective concerns of CRCI appear more critical to patient experience than objective measurements in men with PCa who have received RT and ADT. Interventions to improve sleep may result in an improved perception of cognition.

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Depressive Symptoms and Malnutrition are Associated with Other Geriatric Syndromes and Increase Risk for 30-Day Readmission in Hospitalized Older Adults: A Prospective Cohort Study

10.21203/rs.3.rs-1182649/v1 ◽

2022 ◽

Author(s):

Laura Tay ◽

Melvin Chua ◽

Yew Yoong Ding

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Depressive Symptoms ◽

Functional Decline ◽

Oral Intake ◽

Index Admission ◽

Geriatric Syndromes ◽

Poor Oral Intake ◽

Hospitalized Older Adults ◽

Minimal Adjustment

Abstract Background: Readmission in older adults is typically complex with multiple contributing factors. We aim to examine how two prevalent and potentially modifiable geriatric conditions – depressive symptoms and malnutrition – relate to other geriatric syndromes and 30-day readmission in hospitalized older adults. Methods: Consecutive admissions of patients >65 years to a general medical department were recruited over 15 months. Patients were screened for depression, malnutrition, delirium, cognitive impairment, and frailty at admission. Medical records were reviewed for intermediary events including poor oral intake and functional decline during hospitalization. Unplanned readmission within 30-days of discharge was tracked through the hospital’s electronic health records and follow-up telephone interviews. We use directed acyclic graphs (DAGs) to depict the relationship of depressive symptoms and malnutrition with geriatric syndromes that constitute covariates of interest and 30-day readmission outcome. Multiple logistic regression was performed for the independent associations of depressive symptoms and malnutrition with 30-day readmission, adjusting for variables based on DAG-identified minimal adjustment set. Results: We recruited 1619 consecutive admissions, with mean age 76.4 (7.9) years and 51.3% females. 30-day readmission occurred in 331 (22.0%) patients. Depressive symptoms (OR 1.55, 95% CI 1.15-2.07), malnutrition (OR 1.59, 95% CI 1.14-2.23), higher comorbidity burden, hospitalization in the one-year preceding index admission, frailty, delirium, as well as functional decline and poor oral intake during the index admission, were more commonly observed among patients who were readmitted within 30 days of discharge (P<0.05). Patients with active depressive symptoms were significantly more likely to be frail (OR=1.62, 95% CI 1.22-2.16), had poor oral intake (OR=1.35, 95% CI 1.02-1.79) and functional decline during admission (OR=1.58, 95% CI 1.11-2.23). Malnutrition at admission was significantly associated with frailty, delirium, cognitive impairment and poor oral intake during hospitalization (P<0.05). In minimal adjustment set identified by DAG, depressive symptoms (OR=1.38, 95% CI 1.02-1.86) remained significantly associated with 30-day readmission. The association of malnutrition with 30-day readmission was attenuated after adjusting for age, ethnicity and depressive symptoms in the minimal adjustment set (OR=1.40, 95% CI 0.99-1.98, P=0.06). Conclusion: The observed causal associations support screening and targeted interventions for depressive symptoms and malnutrition during admission and in the post-acute period.

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Aspirin and statin therapy for primary prevention of cardiovascular disease in older adults

Heart ◽

10.1136/heartjnl-2021-320154 ◽

2021 ◽

pp. heartjnl-2021-320154

Author(s):

Sophie Montgomery ◽

Michael D Miedema ◽

John Dodson

Keyword(s):

Cardiovascular Disease ◽

Older Adults ◽

Decision Making ◽

Cognitive Impairment ◽

Primary Prevention ◽

Absolute Risk ◽

Functional Decline ◽

Calcium Score ◽

Risk Of Death ◽

Therapeutic Decisions

The value of primary preventative therapies for cardiovascular disease (CVD) in older adults (age ≥75 years) is less certain than in younger patients. There is a lack of quality evidence in older adults due to underenrolment in pivotal trials. While aspirin is no longer recommended for routine use in primary prevention of CVD in older adults, statins may be efficacious. However, it is unclear which patient subgroups may benefit most, and guidelines differ between expert panels. Three relevant geriatric conditions (cognitive impairment, functional impairment and polypharmacy) may influence therapeutic decision making; for example, baseline frailty may affect statin efficacy, and some have advocated for deprescription in this scenario. Evidence regarding statins and incident functional decline are mixed, and vigilance for adverse effects is important, especially in the setting of polypharmacy. However, aspirin has not been shown to affect incident cognitive or functional decline, and its lack of efficacy extends to patients with baseline cognitive impairment or frailty. Ultimately, the utility of primary preventative therapies for CVD in older adults depends on potential lifetime benefit. Rather than basing treatment decisions on absolute risk alone, consideration of comorbidities, polypharmacy and life expectancy should play a significant role in decision making. Coronary calcium score and new tools for risk stratification validated in older adults that account for the competing risk of death may aid in evaluating potential benefits. Given the complexity of therapeutic decisions in this context, shared decision making provides an important framework.

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Is the Discrimination of Subjective Cognitive Decline from Cognitively Healthy Adulthood and Mild Cognitive Impairment Possible? A Pilot Study Utilizing the R4Alz Battery

Journal of Alzheimer s Disease ◽

10.3233/jad-200562 ◽

2020 ◽

Vol 77 (2) ◽

pp. 715-732

Author(s):

Eleni Poptsi ◽

Despina Moraitou ◽

Emmanouil Tsardoulias ◽

Andreas L. Symeonidisd ◽

Magda Tsolaki

Keyword(s):

Older Adults ◽

Working Memory ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Control ◽

Cognitive Decline ◽

Neurocognitive Disorders ◽

Community Dwelling ◽

Subjective Cognitive Decline ◽

Working Memory Updating

Background: The early diagnosis of neurocognitive disorders before the symptoms’ onset is the ultimate goal of the scientific community. REMEDES for Alzheimer (R4Alz) is a battery, designed for assessing cognitive control abilities in people with minor and major neurocognitive disorders. Objective: To investigate whether the R4Alz battery’s tasks differentiate subjective cognitive decline (SCD) from cognitively healthy adults (CHA) and mild cognitive impairment (MCI). Methods: The R4Alz battery was administered to 175 Greek adults, categorized in five groups a) healthy young adults (HYA; n = 42), b) healthy middle-aged adults (HMaA; n = 33), c) healthy older adults (HOA; n = 14), d) community-dwelling older adults with SCD (n = 34), and e) people with MCI (n = 52). Results: Between the seven R4Alz subtasks, four showcased the best results for differentiating HOA from SCD: the working memory updating (WMCUT-S3), the inhibition and switching subtask (ICT/RST-S1&S2), the failure sets (FS) of the ICT/RST-S1&S2, and the cognitive flexibility subtask (ICT/RST-S3). The total score of the four R4Alz subtasks (R4AlzTot4) leads to an excellent discrimination among SCD and healthy adulthood, and to fare discrimination among SCD and MCI. Conclusion: The R4Alz battery is a novel approach regarding the neuropsychological assessment of people with SCD, since it can very well assist toward discriminating SCD from HOA. The R4Alz is able to measure decline of specific cognitive control abilities - namely of working memory updating, and complex executive functions - which seem to be the neuropsychological substrate of cognitive complaints in community dwelling adults of advancing age.

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Neuropsychological and Functional Impact of COVID-19 on Mild Cognitive Impairment

American Journal of Alzheimer s Disease & Other Dementias® ◽

10.1177/1533317520960875 ◽

2020 ◽

Vol 35 ◽

pp. 153331752096087

Author(s):

Kalpana P. Padala ◽

Christopher M. Parkes ◽

Prasad R. Padala

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Case Report ◽

Mild Cognitive Impairment ◽

Activities Of Daily Living ◽

Older Adult ◽

Daily Living ◽

Functional Decline ◽

Depression And Anxiety ◽

Physically Active

We present a case report to showcase that behavioral, cognitive, and functional decline may be associated with COVID-19 stay-home guidance among older adults with pre-existent cognitive impairment. In a functionally independent and physically active older adult with Mild Cognitive Impairment, there was worsening in depression and anxiety symptoms associated with the restrictions of COVID-19. Functional decline was also noted as assessed by Instrumental Activities of Daily Living. We discuss solutions to mitigate the effects of COVID-19 restrictions in this vulnerable population.

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Cumulative effects of cognitive impairment and frailty on functional decline, falls and hospitalization: A four-year follow-up study with older adults

Archives of Gerontology and Geriatrics ◽

10.1016/j.archger.2019.104005 ◽

2020 ◽

Vol 87 ◽

pp. 104005

Author(s):

Allan Gustavo Brigola ◽

Ana Carolina Ottaviani ◽

Tiago da Silva Alexandre ◽

Bruna Moretti Luchesi ◽

Sofia Cristina Iost Pavarini

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Functional Decline ◽

Cumulative Effects ◽

Follow Up Study

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THE TRUTH ABOUT AGE DIFFERENCES IN PERFORMANCE ON VARYING LENGTHS OF LIKERT-TYPE TEST ITEMS

Innovation in Aging ◽

10.1093/geroni/igz038.2598 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S707-S707

Author(s):

Julie Lutz ◽

Aaron Metzger ◽

Nicholas A Turiano ◽

Rachael Spalding ◽

Emma Katz ◽

...

Keyword(s):

Older Adults ◽

Measurement Invariance ◽

Convergent Validity ◽

Age Groups ◽

Community Dwelling ◽

Self Report ◽

Amazon Mechanical Turk ◽

Response Scale ◽

Type Response ◽

Scale Length

Abstract Guidelines for self-report assessment with older adults emphasize the use of shorter Likert-type or agree/disagree response formats to reduce cognitive load (e.g., Yesavage et al., 1983). However, these suggestions are not founded on empirical studies directly comparing younger and older adults’ responses on different scales. Thus, the current study tested differential responding on varying Likert-type response scale lengths between younger, middle-aged, and older adults. Participants completed three versions of the International Personality Item Pool (IPIP) Neuroticism scale with 3, 5, and 7 Likert-type response scale lengths in counterbalanced orders with other questionnaires between versions. Six multi-group confirmatory factor analyses (CFAs) assessed measurement invariance across scale lengths and age groups. Invariance of convergent validity networks was also assessed with multi-group CFAs of the associations between the IPIP and measures of depression, anxiety, anger, worry, and affect. The final sample consisted of 835 adults (327 18-44; 279 45-64; and 229 65 or older) via Amazon Mechanical Turk. Measurement invariance was supported in analyses by age within each scale length and by scale length within each age group, indicating that response patterns across all scale lengths and age groups did not significantly differ. Analyses of convergent validity also supported invariance, suggesting that responses across all scale lengths and age groups reflect the same underlying construct. This study indicates that, among community-dwelling adults, shortened response scale lengths do not yield significantly different or more valid responses for older adults compared to younger adults.

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Development and preliminary evaluation of the anxiety in cognitive impairment and dementia (ACID) scales

International Psychogeriatrics ◽

10.1017/s1041610215001027 ◽

2015 ◽

Vol 27 (11) ◽

pp. 1825-1838 ◽

Cited By ~ 5

Author(s):

Lindsay A. Gerolimatos ◽

Caroline M. Ciliberti ◽

Jeffrey J. Gregg ◽

Sarra Nazem ◽

Patricia M. Bamonti ◽

...

Keyword(s):

Mental Health ◽

Cognitive Impairment ◽

Functional Ability ◽

Convergent Validity ◽

Discriminant Validity ◽

Well Being ◽

Self Report ◽

Preliminary Evaluation ◽

Term Care ◽

General Physical

ABSTRACTBackground:Although rates of anxiety tend to decrease across late life, rates of anxiety increase among a subset of older adults, those with mild cognitive impairment (MCI) or dementia. Our understanding of anxiety in dementia is limited, in part, by a lack of anxiety measures designed for use with this population. This study sought to address limitations of the literature by developing a new measure of anxiety for cognitively impaired individuals, the anxiety in cognitive impairment and dementia (ACID) Scales, which includes both proxy (ACID-PR) and self-report (ACID-SR) versions.Methods:The ACID-SR and ACID-PR were administered to 45 residents, aged 60 years and older, of three long-term care (LTC) facilities, and 38 professional caregivers at these facilities. Other measures of anxiety, and measures of depression, functional ability, cognition, and general physical and mental health were also administered.Results:Initial evaluation of its psychometric properties revealed adequate to good internal consistency for the ACID-PR and ACID-SR. Evidence for convergent validity of measures obtained with the ACID-SR and ACID-PR was demonstrated by moderate-to-strong associations with measures of worry, depressive symptoms, and general mental health. Discriminant validity of measures obtained with the ACID-SR and ACID-PR was demonstrated by weak correlations with measures of cognition, functional ability, and general physical well-being.Conclusions:The preliminary results suggest that the ACID-SR and ACID-PR can obtain reliable and valid measures of anxiety among individuals with cognitive impairment. Given the subjective nature of anxiety, it may be prudent to collect self-report of anxiety symptoms even among those with moderate cognitive impairment.

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