Independent Older Adult’s IADL and Executive Function According to Cognitive Performance

Lahav, Orit; Katz, Noomi

doi:10.1177/1539449220905813

Cited by 22 publications

(23 citation statements)

References 40 publications

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“…Because we did not have a detailed cognitive assessment to which we could compare WCPA-10 performance, the specific cognitive impairments contributing to deficient performance are unknown. However, prior research has demonstrated an association between the 17-item WCPA and executive functions (17,19,20), suggesting that executive dysfunction may have impacted performance.…”

Section: Discussionmentioning

confidence: 97%

“…The task of entering appointments into a weekly schedule is easily recognized as relevant to functional abilities in everyday life and appears easy on the surface; however, appointment conflicts, rule constraints and unexpected obstacles create significant cognitive challenges that require a strategic approach. The standard 17-item version of the WCPA differentiates between healthy controls and a wide range of populations with executive dysfunction including those with multiple sclerosis ( 19 ), mild cognitive impairment ( 20 ), attention-deficit hyperactivity disorder ( 21 ), pediatric acquired brain injury ( 22 ), and epilepsy ( 23 ). Accuracy on the WCPA correlates with inhibitory control and set-shifting as assessed by the Delis-Kaplan Executive Functioning System ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

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Impaired Performance on a Cognitively-Based Instrumental Activities of Daily Living Task, the 10-Item Weekly Calendar Planning Activity, in Individuals With Stroke Undergoing Acute Inpatient Rehabilitation

et al. 2021

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Performance-based, functionally relevant, and standardized measures of cognitive-instrumental activities of daily living (C-IADL) can complement neuropsychological tests of cognitive impairment and provide valuable clinical information to inform rehabilitation planning. Existing measures have been validated in the outpatient setting. Here, we sought to evaluate a 10-item, short-form of a C-IADL measure, Weekly Calendar Planning Activity (WCPA-10), in inpatients with stroke undergoing acute rehabilitation. The specific goal was to determine if the WCPA-10 could differentiate between stroke patients undergoing acute inpatient rehabilitation and healthy control individuals. We also explored whether the WCPA-10 would identify C-IADL limitations in stroke patients screened as having intact cognition. Seventy-seven stroke inpatients undergoing rehabilitation and 77 healthy control participants completed the WCPA-10, which involves entering a list of simulated, fictional appointments into a weekly schedule while keeping track of and adhering to multiple task rules and ignoring built-in obstacles and distractions. Compared to the control group, stroke patients had significantly worse accuracy, made more errors, used fewer cognitive strategies, followed fewer rules, took more time to complete the task, and were less efficient. 83% of stroke patients were less accurate than predicted by their age, and 64% used less strategies than their age prediction. Among 28 participants who screened as having “normal” cognitive function on the Montreal Cognitive Assessment, the majority had deficits on the WCPA-10. Our results provide initial support for use of a brief C-IADL assessment, WCPA-10, for individuals with stroke undergoing inpatient rehabilitation. They indicate that stroke patients have deficits in C-IADL accuracy, efficiency, and strategy use at this stage of stroke recovery. Results highlight the need to use performance based, functional cognitive assessments, even for those who perform well on cognitive screening tools.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Impaired Performance on a Cognitively-Based Instrumental Activities of Daily Living Task, the 10-Item Weekly Calendar Planning Activity, in Individuals With Stroke Undergoing Acute Inpatient Rehabilitation

et al. 2021

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“…The shorter, 10 item version of the WCPA (WCPA-10) differs from the WCPA-17 only in the number of appointments required to schedule and has an important advantage of taking less time to administer. The WCPA-10 differentiates between healthy adults and individuals' post-stroke (Jaywant et al, 2021) or with MCI (Lahav and Katz, 2020). Lahav and Katz (2020) also reported declining IADL performance in participants with MCI compared with healthy controls although the correlation between IADL performance and WCPA-10 performance was not reported.…”

Section: Introductionmentioning

confidence: 92%

“…The WCPA-10 differentiates between healthy adults and individuals' post-stroke (Jaywant et al, 2021) or with MCI (Lahav and Katz, 2020). Lahav and Katz (2020) also reported declining IADL performance in participants with MCI compared with healthy controls although the correlation between IADL performance and WCPA-10 performance was not reported.…”

Section: Introductionmentioning

confidence: 92%

Awareness of Performance on a Functional Cognitive Performance-Based Assessment Across the Adult Lifespan

2021

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As people age, their cognitive skills and ability to complete complex instrumental activities of daily living often decline in subtle ways. Older adults who are aware of these slight cognitive and functional changes spontaneously adapt and implement strategies to maximize performance. On the other hand, older adults with limited self-awareness are less likely to adjust performance or initiate compensatory strategies as they may not recognize the need to do so. This places them at higher risk of functional decline and loss of independence. Research on awareness of functional performance in healthy adults is, however, limited, and there is a paucity of assessment tools available to address questions of awareness and strategy use in functional tasks. We used the Weekly Calendar Planning Activity (WCPA) – a performance-based assessment of functional cognition including measures of awareness and strategy use – to investigate differences in performance, awareness, and strategy use across the adult lifespan. The WCPA requires examinees to schedule appointments into a weekly calendar while following rules designed to increase task demands. Healthy adults (n=342) from ages 18–92 were observed for strategy use and error recognition, while a post-test interview probed participants’ reported strategy use and estimation of accuracy. The discrepancy between participant estimation and actual accuracy provided a measure of online awareness of performance where a larger estimation discrepancy indicated over-estimation of performance. Performance on the WCPA declined across the adult lifespan. Older adults were less likely to use self-monitoring strategies and used less effective strategies overall. Overestimation was associated with use of fewer strategies and lower accuracy in all age groups. Importantly, twice as many older adults overestimated compared to younger adults. Furthermore, the subset of older adults who had good awareness of performance was more likely to use effective strategies, to recognize errors, and achieved accuracy on par with their younger counterparts. Our results emphasize the importance of examining self-awareness of performance and analyzing the strategies used to perform a complex functional task. This information can provide a foundation for early detection of functional decline in aging and for designing interventions to maximize functional independence in aging.

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“…It also assesses a person’s cognitive strategy use in facilitating efficient performance. The standard 17-item version of the WCPA differentiates between healthy controls and a wide range of populations with executive dysfunction including those with multiple sclerosis (12), mild cognitive impairment (13), attention-deficit hyperactivity disorder (14), pediatric acquired brain injury (15), and epilepsy (16). It is responsive to change in executive functions in individuals with schizophrenia undergoing a metacognitive cognitive rehabilitation program (17).…”

Section: Introductionmentioning

confidence: 99%

Impaired everyday executive functions and cognitive strategy use on the Weekly Calendar Planning Activity in individuals with stroke undergoing acute inpatient rehabilitation

Jaywant

Arora

Lussier

et al. 2021

Preprint

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Executive dysfunction is common in stroke patients undergoing acute inpatient rehabilitation. However, comprehensive neuropsychological evaluation of executive functions is often not feasible in this setting. Objective, standardized, and performance-based measures of cognitively-based instrumental activities of daily living (C-IADL) can capture everyday executive functions and inform rehabilitation planning and interventions. The goal of this study was to compare performance of individuals with stroke to healthy age-matched adults in performance on the 10-item Weekly Calendar Planning Activity (WCPA). 77 stroke inpatients undergoing rehabilitation and 77 healthy control participants completed the WCPA, a C-IADL measure involving scheduling appointments that requires planning, working memory, shifting, and inhibitory control. Compared to the control group, stroke patients had significantly worse accuracy, made more errors, used fewer cognitive strategies, followed fewer rules, took more time to complete the task, and were less efficient. 83% of stroke patients were less accurate than predicted by their age, and 64% used less strategies than their age prediction. Among 28 participants who screened as having “normal” cognitive function on the Montreal Cognitive Assessment, the majority had deficits on the WCPA. Our results indicate that the WCPA is sensitive to executive dysfunction in stroke patients undergoing acute inpatient rehabilitation and underscores deficits in C-IADL accuracy, efficiency, and strategy use at this stage of stroke recovery. The WCPA may be a useful measure to ascertain executive dysfunction and to incorporate in cognitive rehabilitation.

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Independent Older Adult’s IADL and Executive Function According to Cognitive Performance

Cited by 22 publications

References 40 publications

Impaired Performance on a Cognitively-Based Instrumental Activities of Daily Living Task, the 10-Item Weekly Calendar Planning Activity, in Individuals With Stroke Undergoing Acute Inpatient Rehabilitation

Impaired Performance on a Cognitively-Based Instrumental Activities of Daily Living Task, the 10-Item Weekly Calendar Planning Activity, in Individuals With Stroke Undergoing Acute Inpatient Rehabilitation

Awareness of Performance on a Functional Cognitive Performance-Based Assessment Across the Adult Lifespan

Impaired everyday executive functions and cognitive strategy use on the Weekly Calendar Planning Activity in individuals with stroke undergoing acute inpatient rehabilitation

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