A New Scale for the Assessment of Functional Status in Alzheimer's Disease and Related Disorders

Loewenstein, David; Amigo, Ellen; Duara, Ranjan; Guterman, Andrew; Hurwitz, Deborah; Berkowitz, Nancy; Wilkie, Frances L.; Weinberg, Gloria; Black, Barbara; Gittelman, Betsy; Eisdorfer, Carl

doi:10.1093/geronj/44.4.p114

Cited by 323 publications

(238 citation statements)

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“…Given the dearth of measures of everyday functioning available for use in minority and non-English speaking populations, the IQCODE appears to have significant cross-cultural applications. There are some limitations to this and other functional measures which rely solely on information obtained from an informant rather than performance-based measures of everyday behaviors (e.g., Direct Assessment of Functional Status, Loewenstein et al, 1989). However, it also has many advantages over such performance-based measures including ease and brevity of administration, as well as cost efficiency.…”

Section: Discussionmentioning

confidence: 99%

Everyday functioning in relation to cognitive functioning and neuroimaging in community-dwelling Hispanic and Non-Hispanic older adults

Farias

Mungas

Reed

et al. 2004

J. Inter. Neuropsych. Soc.

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The purpose of this study was to examine how a specific informant-based measure of everyday functioning, the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE; Jorm & Korten, 1988) relates to cognition and structural neuroimaging in a large multicultural, multilingual sample of Caucasians and Hispanics. Cognitive variables included selected subtests from the Spanish and English Neuropsychological Assessment Scales (SENAS; Mungas et al., 2000): Verbal Memory, Object Naming, Verbal Attention Span, Verbal Conceptual Thinking, and Pattern Recognition. The association between the IQCODE and selected neuroimaging variables, hippocampal volume and white matter hyperintensity, was evaluated in a subsample of English-and Spanish-speaking Hispanic individuals. The cognitive variables showed strong bivariate relationships with the IQCODE, although only Verbal Memory and Object Naming independently predicted level of functional ability. Verbal Memory was the strongest predictor of functional status, accounting for 23% of the variance in the IQCODE. White matter hyperintensity was also independently related to the IQCODE, accounting for 18% of the variance. Hippocampal volume was related to the IQCODE in a simple bivariate analysis, but was not an independent predictor of reported functional status after controlling for age. The relationships between cognitive variables and functional status, as well as between the imaging variables and the IQCODE, did not differ across language-ethnic groups.

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Section: Discussionmentioning

confidence: 99%

Everyday functioning in relation to cognitive functioning and neuroimaging in community-dwelling Hispanic and Non-Hispanic older adults

Farias

Mungas

Reed

et al. 2004

J. Inter. Neuropsych. Soc.

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“…Cognitive constructs that overlap with judgment include everyday problem solving, everyday decision making, social problem solving, and practical intelligence (Marsiske & Margrett, 2006;Thornton & Dumke, 2005;Willis, 1996), and objective measures of these constructs include the following: Predicaments Task (Channon & Crawford, 1999), Reflective Judgment Dilemmas (Kajanne, 2003), Practical Problems Test (Denney & Pearce, 1989); Everyday Cognition Battery (Allaire & Marsiske, 1999); Everyday Problems Test (Willis & Marsiske, 1993), Everyday Problem Solving Inventory (Cornelius & Caspi, 1987), Everyday Problems Test for Cognitively Challenged Elderly (EPCCE; Willis, 1993;Willis et al, 1998), and the Direct Assessment of Functional Status (Lowenstein et al, 1989). Instruments also have been developed to assess competence to consent to medical treatment and/or research (see Fitten, Lusky, & Hamann, 1990;Grisso, Appelbaum, & HillFotouhi, 1997;Marson, Hawkins, McInturff, & Harrell, 1997;Marson, Schmitt, Ingram, & Harrell, 1994;Vellinga, Smit, van Leeuwen, van Tilburg, & Jonker, 2004).…”

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confidence: 99%

Judgment in older adults: Development and psychometric evaluation of the Test of Practical Judgment (TOP-J)

Rabin

Borgos²,

Saykin³

et al. 2007

Journal of Clinical and Experimental Neuropsychology

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This article reports on the development and validation of a novel, objective test of judgment for use with older adults. The Test of Practical Judgment (TOP-J) is an open-ended measure that evaluates judgment related to safety, medical, social/ethical, and financial issues. Psychometric features were examined in a sample of 134 euthymic individuals with mild Alzheimer's disease (AD), amnestic mild cognitive impairment (MCI), or cognitive complaints but intact neuropsychological performance (CC), and demographically-matched healthy controls (HC). Measures of reliability were adequate to high, and TOP-J scores correlated with select measures of executive functioning, language, and memory. AD participants obtained impaired TOP-J scores relative to HCs, while MCI and CC participants showed an intermediate level of performance. Confirmatory factor analyses were consistent with a unidimensional structure. Results encourage further development of the TOP-J as an indicator of practical judgment skills in clinical and research settings. Longitudinal assessments are being performed to examine predictive validity of the TOP-J for cognitive progression in our clinical groups.Judgment can be defined as the capacity to assess situations and draw sound conclusions after careful consideration of the relevant circumstances. From a neuropsychological perspective, judgment falls under the domain of executive functioning (Woods, Patterson, & Whitehouse, 2000) and includes both a cognitive appraisal process (i.e., determining what to do in a situation) and the behavioral follow-through (i.e., engaging in the adaptive/safe behavior). Numerous processes are involved in the execution of good judgment including generating appropriate strategies to approach a problem, identifying suitable goals, shifting from one idea to another, evaluating the potential consequences of different courses of action, inhibiting inappropriate responses, initiating and carrying out purposeful behavior, and monitoring the progress and effectiveness of a chosen solution. In the absence of practiced routines for solving problems in unstructured situations, individuals with compromised executive functioning may exercise poor judgment for a variety or reasons. For example, they may make impulsive decisions based on inadequate exploration of pertinent issues, fixate on a single solution due to compromised mental flexibility, or fail to consider the long-term consequences of their solutions (Channon, 2004;Thornton & Dumke, 2005;Woods et al., 2000). NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptIn addition to executive functioning, judgment relies upon other cognitive processes including aspects of memory and language. For example, when making difficult decisions it is often useful to call to mind relevant past experiences and practical knowledge. Additionally, successful problem solving and good judgment rely upon the ability to comprehend complex aspects of verbal and non-verbal language and effectively communicate one's decisio...

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“…Loewenstein and colleagues (4) reported that the Direct Assessment of Functional Status Scale significantly discriminated clinic patients with Alzheimer's disease from normal elderly subjects and from a group of elderly outpatients with major depression. To our knowledge, the measure has not been tested in a group of older patients with schizophrenia.…”

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confidence: 99%

Direct assessment of functional status in older patients with schizophrenia

Klapow

Evans²,

Patterson³

et al. 1997

AJP

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T he evaluation of functional status can be accomplished by three types of assessment: patients' reports, caregivers' reports, and direct observation of performance. Research has shown low rates of agreement between self-reported and actual performance of activities of daily living among elderly hospitalized patients (1). In addition, caregivers' reports of patients' functioning have been noted to be unreliable in some cases (2). For older outpatients with schizophrenia there is often a paucity of available caregivers (3). The direct evaluation of behaviors essential to daily living provides a more objective index of an individual's ability to complete relevant tasks. Behavior-based assessments, however, often evaluate skills targeted for specific populations or skills related to institutional care. Such shortcomings tend to reduce the sensitivity of these measures to detect subtle changes in functioning (4).A performance-based protocol has been developed to assess directly a broad range of functional abilities in older individuals. The Direct Assessment of Functional Status Scale (4) involves the assessment of behavior during simulated daily activity tasks. Unlike other performance-based measures, which tend to provide information regarding primarily basic, lower-level skills and appear most applicable to institution-based care, this scale assesses a wide range of behaviors that are generalizable to outpatients and ambulatory care settings. It covers seven areas having to do with time orientation, communication, transportation, finance, shopping, grooming, and eating. Within each area, specific tasks that simulate real-world activities are performed (e.g., for the dimension of time orientation, the participant is asked to tell time at each of four progressively more difficult clock settings with the use of an analog clock; the participant is also tested on orientation for time and date).Loewenstein and colleagues (4) reported that the Direct Assessment of Functional Status Scale significantly discriminated clinic patients with Alzheimer's disease from normal elderly subjects and from a group of elderly outpatients with major depression. To our knowledge, the measure has not been tested in a group of older patients with schizophrenia. The present study was conducted to compare the functional abilities of middle-aged and elderly patients with schizophrenia with those of normal subjects, by means of the Direct Assessment of Functional Status Scale, and to determine the predictors of functional disability in the patients.

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A New Scale for the Assessment of Functional Status in Alzheimer's Disease and Related Disorders

Cited by 323 publications

References 0 publications

Everyday functioning in relation to cognitive functioning and neuroimaging in community-dwelling Hispanic and Non-Hispanic older adults

Everyday functioning in relation to cognitive functioning and neuroimaging in community-dwelling Hispanic and Non-Hispanic older adults

Judgment in older adults: Development and psychometric evaluation of the Test of Practical Judgment (TOP-J)

Direct assessment of functional status in older patients with schizophrenia

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