Objective:Relative to dementia, little is known about informant bias in mild cognitive impairment (MCI). We investigated the influence of informant demographic and relational characteristics on reports of everyday functioning using the Functional Activities Questionnaire (FAQ).Method:Four thousand two hundred eighty-four MCI participants and their informants from the National Alzheimer’s Coordinating Center Uniform Data Set were included. Informants were stratified according to cohabitation, relationship, visit frequency, race/ethnicity, education, and sex. Informant-rated Mean FAQ score was compared across these groups using univariate general linear model analyses and post hoc tests. Interactions were tested between informant variables. The predictive contribution of informant variables to FAQ score was explored using hierarchical linear regression. Analyses covaried for participant cognition using a cognitive composite score, and for participant age, sex, and depression.Results:After controlling for participant cognition, depression, age, and sex, informant-rated FAQ scores varied significantly across all informant variables (p’s < .005, ηp2’s ≤ .033) except sex and visit frequency. FAQ scores were higher (more impaired) among informants who cohabitate with the participant, among paid caregivers, spouses, and adult children, and among informants with higher levels of education. Scores were lowest (less impaired) among Black/African American informants as compared to all other racial/ethnic groups.Conclusions:Demographic and relational characteristics of informants influence the perception and reporting of instrumental activities of daily living in adults with MCI. As everyday functioning is crucial for differential diagnosis and treatment outcome measurement, it is important to be aware of sources of informant report discrepancies.

Objective: This review describes the relatively small body of neuropsychological and cognitive research conducted over the past 100 years focused on theoretical models explaining the neurocognitive processes that support everyday functioning and the breakdown of functional abilities in the face of neurological damage or disease. Method: The historical roots of the theories of everyday activities based on direct observation of behavior in neurology and diary reports of everyday errors in cognitive psychology are presented, followed by a review of the empirical findings and resulting theoretical conceptualizations from case studies and group studies of various clinical populations in neuropsychology. Results: We conclude with a new framework (the goal-control model) that integrates the most recent empirical findings in neuropsychology with mechanisms proposed by cognitive models. Conclusions: The goal-control model offers empirically supported solutions to understanding and predicting functioning in the real world. This new model generates testable predictions for future research and provides guidance for clinical assessment and interventions.

No abstract

Performance of everyday activities requires the coordination of a variety of complex cognitive processes; thus, as cognition changes over time, so too does the ability to perform everyday activities. This chapter will review the extant literature on everyday functioning in healthy aging, mild cognitive impairment (MCI), and dementia from a neuropsychological perspective. The chapter first briefly reviews the various terms used to denote everyday functioning and associated difficulties/impairment. It also discusses the strengths and weaknesses of the methodological approaches to everyday function assessment. Next, the chapter reviews reports of associations between overall level of cognitive function and the ability to perform everyday tasks. Studies mapping the relations between specific cognitive processes and everyday functioning also are reviewed. The authors include a discussion of neuropsychological models (e.g., resource theory, omission–commission model) that have been proposed to account for the observed relations between cognition and everyday function. Finally, the authors make suggestions for future research on everyday functioning in older adults.

No abstract

We describe the performance of an aphasic individual, K.A., who showed a selective impairment affecting his ability to perceive spoken language, while largely sparing his ability to perceive written language and to produce spoken language. His spoken perception impairment left him unable to distinguish words or nonwords that differed on a single phoneme and he was no better than chance at auditory lexical decision or single spoken word and single picture matching with phonological foils. Strikingly, despite this profound impairment, K.A. showed a selective sparing in his ability to perceive number words, which he was able to repeat and comprehend largely without error. This case adds to a growing literature demonstrating modality-specific dissociations between number word and non-number word processing. Because of the locus of K.A.'s speech perception deficit for non-number words, we argue that this distinction between number word and non-number word processing arises at a sublexical level of representations in speech perception, in a parallel fashion to what has previously been argued for in the organization of the sublexical level of representation for speech production.

The loss of the ability to independently complete activities of daily living, such as meal preparation and household chores, is a defining characteristic of clinical dementia; however, minor difficulties in completing everyday activities emerge in the mild cognitive impairment stage, and even healthy older adults exhibit subtle functional difficulties compared to younger adults. These functional difficulties are associated with an array of negative outcomes, including decreased quality of life, higher costs of care, and increased frustration, depression, caregiver burden, and institutionalization. While cognitive models have been proposed to explain the functional deficits seen in dementia and subtler forms of cognitive decline, in contrast to other cognitive disorders such as aphasia, there are essentially no theoretically motivated interventions to address difficulties in everyday functioning. Proposed models of functional impairment share features with cognitive processing models of language, including hierarchical organization of representations and interactive, spreading activation; thus, an examination of aphasia interventions has the potential to inform the development of theoretically motivated interventions for everyday activities. This review first addresses the shared characteristics of cognitive models of everyday function and language, with a focus on linguistic production. Next, we will present aphasia interventions that target single-word production, sentence production, short-term memory, and semantics, and discuss their implications for everyday functioning interventions. We conclude with a discussion of limitations of the language-everyday functioning comparison as well as areas of future research.

No abstract