Objective The Day Out Task (DOT), a naturalistic task that requires multitasking in a real-world setting, was used to examine everyday functioning in individuals with mild cognitive impairment (MCI). Method Thirty-eight participants with MCI and 38 cognitively healthy older adult controls prioritized, organized, initiated and completed a number of subtasks in a campus apartment to prepare for a day out (e.g., determine and gather change for bus, bring a magazine). Participants also completed tests assessing cognitive constructs important in multitasking (i.e., retrospective memory, prospective memory, planning). Results Compared to controls, the MCI group required more time to complete the DOT and demonstrated poorer task accuracy, performing more subtasks incompletely and inaccurately. Despite poorer DOT task accuracy, the MCI and control groups approached completion of the DOT in a similar manner. For the MCI group, retrospective memory was a unique predictor of the number of subtasks left incomplete and inaccurate, while prospective memory was a unique predictor of DOT sequencing. The DOT measures, but not the cognitive tests, were predictive of knowledgeable informant report of everyday functioning. Conclusions These findings suggest that difficulty remembering and keeping track of multiple goals and subgoals may contribute to the poorer performance of individuals with MCI in complex everyday situations.

The objective of this meta-analysis was to improve understanding of the heterogeneity in the relationship between cognition and functional status in individuals with mild cognitive impairment (MCI). Demographic, clinical, and methodological moderators were examined. Cognition explained an average of 23% of the variance in functional outcomes. Executive function measures explained the largest amount of variance (37%), whereas global cognitive status and processing speed measures explained the least (20%). Short- and long-delayed memory measures accounted for more variance (35% and 31%) than immediate memory measures (18%), and the relationship between cognition and functional outcomes was stronger when assessed with informant-report (28%) compared with self-report (21%). Demographics, sample characteristics, and type of everyday functioning measures (i.e., questionnaire, performance-based) explained relatively little variance compared with cognition. Executive functioning, particularly measured by Trails B, was a strong predictor of everyday functioning in individuals with MCI. A large proportion of variance remained unexplained by cognition.

Objective Few studies have examined functional abilities and complaints in healthy older adults with subjective cognitive concerns (SCC). The aims of this study were to assess everyday functioning in healthy older adults reporting high and low amounts of SCC, and examine cognitive correlates of functional abilities. Method Twenty-six healthy older adults with high SCC, and 25 healthy older adults with low SCC, as well as their knowledgeable informants completed the Instrumental Activities of Daily Living-Compensation (IADL-C), a questionnaire measure of everyday functioning. Results After controlling for depression, the high SCC group self-reported significantly more everyday difficulties on the IADL-C, including all subdomains. Compared to the low SCC group, informants for the high SCC group endorsed more difficulties on the IADL-C and specifically the social skills subdomain. For the high SCC group, poorer self-report of everyday functioning was related to poorer executive functioning and temporal order memory. Conclusions These findings indicate that there may be subtle functional changes that occur early in the spectrum of cognitive decline in individuals with high SCC, and these functional changes are evident to informants. Further work is needed to investigate whether individuals with both SCC and functional difficulties are at an even higher risk for progression to mild cognitive impairment.

Everyday functioning and its executive functioning cognitive correlates (i.e., switching, inhibition, and updating) were investigated in healthy older adults (HOAs) using multiple methods of functional status. In addition to whether computerized experimental tasks would better dissociate these subcomponents than neuropsychological measures of executive functioning, we were also interested in the contributions of both experimental and neuropsychological measures of executive function subcomponents to functional abilities. Seventy HOAs (45 young-old and 25 old-old) and 70 younger adults completed executive function and neuropsychological tests. In addition to self- and informant questionnaires of functional abilities, HOAs completed two performance-based measures. An aging effect was found on all executive function measures. Old-old older adults and their informants did not report more functional difficulties but demonstrated more difficulties on performance-based measures relative to young-old participants. For the HOAs, after controlling for age and education, the neuropsychological measures of executive functioning, but not experimental measures, explained a significant amount of variance in the informant-report and both performance-based measures. Updating measures differentially predicted performance-based measures, while switching was important for questionnaire and performance-based measures. The contribution of executive functioning to functional status when measured with experimental measures specifically designed to isolate the executive subcomponent was not as strong as hypothesized. Further research examining the value of isolating executive function subcomponents in neuropsychological assessment and the prediction of functional abilities in older adults is warranted.

Everyday multitasking and its cognitive correlates were investigated in an older adult population using a naturalistic task, the Day Out Task. Fifty older adults and 50 younger adults prioritized, organized, initiated and completed a number of subtasks in a campus apartment to prepare for a day out (e.g., gather ingredients for a recipe, collect change for a bus ride). Participants also completed tests assessing cognitive constructs important in multitasking. Compared to younger adults, the older adults took longer to complete the everyday tasks and more poorly sequenced the subtasks. Although they initiated, completed, and interweaved a similar number of subtasks, the older adults demonstrated poorer task quality and accuracy, completing more subtasks inefficiently. For the older adults, reduced prospective memory abilities were predictive of poorer task sequencing, while executive processes and prospective memory were predictive of inefficiently completed subtasks. The findings suggest that executive dysfunction and prospective memory difficulties may contribute to the age-related decline of everyday multitasking abilities in healthy older adults.

Everyday memory lapses experienced by older adults (OA) were examined using a daily-diary checklist and retrospective questionnaire. In Experiment 1, 138 younger and 138 OAs indicated the frequency of forgetting of 16 memory lapses, and whether each occurred daily during the course of a week. OAs reported more memory lapses on the questionnaire, but not the daily diary. OAs reported more frequently forgetting names and words, while younger adults had more difficulty with appointments and personal dates. Fewer memory lapses on the daily diary were related to better performance on a laboratory-memory measure for OAs. In Experiment 2, 62 OAs returned for a five-year follow-up and endorsed experiencing more memory lapses on the daily diary compared to baseline, specifically forgetting more names and words, but not the retrospective questionnaire. Daily checklist memory lapses again correlated with the laboratory-memory measure. A daily checklist may be a viable way to assess everyday memory lapses.

Objective The night out task (NOT) was developed as a naturalistic, open-ended, multitasking measure that requires individuals to complete eight subtasks comparable to those encountered during real-world functioning (e.g., pack travel bag, prepare tea). We examined psychometric properties and administration feasibility of this direct observation measure within a clinic-like setting using a tablet-based coding application. Method A sample of 148 community-dwelling older adults (82% cognitively healthy; 18% mild cognitive impairment) and 57 younger adults completed the NOT along with other neurocognitive tests and questionnaires. Results Inter-rater reliability across NOT primary (i.e., time, accuracy, efficiency) and process-related (e.g., error-types, self-corrections) variables was mostly excellent. NOT primary measures showed expected patterns of convergent and discriminant validity with measures of cognition, demographics, and well-being. External validity was established by the NOT ability to distinguish between age and diagnostic (cognitively healthy vs. mild cognitive impairment) groups. Demonstrating incremental validity, the NOT primary variables (execution time in particular) were predictive of self-reported functional abilities and completion quality of in-home everyday tasks over and earlier variables such as demographics, cognition, and mobility. Conclusions These findings suggest that the NOT and its app interface, which allows for continuous logging of observations, are a feasible in-clinic measure to assess cognitive capacities important for real-world functioning. With further validation, the NOT may allow for earlier detection of functional difficulties. Understanding errors and strategies used during NOT performance could also have implications for individualized interventions.

With further validation, the HAAE may be useful for holistic clinical assessment of behaviors that promote healthy aging, support brain and mental health, and for treatment planning. Furthermore, the HAAE can be used to measure the outcome of multi-domain lifestyle interventions.