Search

AbstractObjectiveMethodResultsConclusionExtraction of digital markers from passive sensors placed in homes is a promising method for understanding real-world behaviors. In this study, machine learning (ML) and multilevel modeling (MLM) are used to examine types of digital markers and whether smart home sensors can predict cognitive functioning, lifestyle behaviors, and contextual factors measured through ecological momentary assessment (EMA).Smart home sensors were installed in the homes of 44 community-dwelling midlife and older adults for 3–4 months. Sensor data were categorized into eight digital markers. Participants responded to iPad-delivered EMA prompts 4×/day for 2 wk. Prompts included an n-back task and survey on recent (past 2 h) lifestyle and contextual factors.ML marker rankings revealed that sensor counts (indicating increased activity) and time outside the home were among the most influential markers for all survey questions. Additionally, MLM revealed for every 1000 sensor counts, mental sharpness, social, physical, and cognitive EMA responses increased by 0.134–0.155 points on a 5-point scale. For every additional 30-minutes spent outside home, social, physical, and cognitive EMA responses increased by 0.596, 0.472, and 0.157 points. Advanced ML joint classification/regression significantly predicted EMA responses from smart home digital markers with error of 0.370 on a 5-point scale, and n-back performance with a normalized error of 0.040.Results from ML and MLM were complimentary and comparable, suggesting that machine learning may be used to develop generalized models to predict everyday cognition and track lifestyle behaviors and contextual factors that impact health outcomes using smart home sensor data. [ABSTRACT FROM AUTHOR]

AbstractObjective: Multitasking is an essential part of everyday functioning often not formally assessed by traditional neuropsychological tests. Although individuals with Parkinson’s disease (PD) experience both motor and cognitive difficulties, previous research has demonstrated more pronounced functional difficulties with the presence of mild cognitive impairment (PD-MCI). The current study compared individuals with PD-MCI, PD with normal cognition (PD-NC), and healthy controls on a naturalistic task of multitasking, the Day Out Task (DOT). Method: Participants were 38 healthy older adults (HOA), 23 individuals with PD-NC, and 15 individuals with PD-MCI. Participants completed a battery of neuropsychological tasks and the DOT. Informants also completed a self-reported questionnaire of participants’ everyday executive functioning. Results: Compared to PD-NC and HOA, participants with PD-MCI were less accurate and efficient and took longer to complete the DOT. After controlling for motor performance, only DOT accuracy remained worse, with poorer accuracy resulted from more subtasks being left incomplete or being completed inaccurately by the PD-MCI group. DOT sequencing was a significant predictor of informant reported everyday dysexecutive symptoms. Conclusions: The findings highlight that individuals with PD-MCI are likely to experience difficulties completing complex everyday tasks due to both motor and cognitive impairments. Clinicians may therefore recommend strategies to support efficiency and accuracy in complex tasks of everyday functioning in treatment considerations. [ABSTRACT FROM AUTHOR]

Objective Traditional measures of cognitive abilities most used by neuropsychologists are generally low in ecological validity and only capture a small proportion of the variance of a person's true functional capacity. This study evaluates the association between clinic-based performance and parallel real-world completion of an everyday planning test, the Overnight Trip Task (OTT). Method A cross-sectional cohort of 65 community-dwelling older adults completed a battery of cognitive assessments and two formats of the OTT: the paper-and-pencil clinic OTT, which was completed remotely through video conferencing (Zoom), and the parallel real-world OTT (RW-OTT), which was completed at home between sessions. Both formats required participants to plan for what they would pack and prepare for a hypothetical overnight trip based on a provided story that included rules and embedded contingencies. Results The clinic OTT demonstrated a small-to-moderate relationship with the RW-OTT (r  = 0.35) and no relationship with measures of learning, long delay recall, an executive function composite, and a measure of everyday planning. Hierarchical regressions indicated that the clinic OTT demonstrated incremental validity above an executive function composite measure and global cognition when predicting self-reported everyday functioning and RW-OTT performance. Conclusions The clinic OTT showed only modest association with the RW-OTT and discriminate but not convergent validity was demonstrated. The clinic OTT showed incremental validity when predicting self-reported everyday functioning and RW-OTT performance above more traditional measures. Before the clinic OTT could be considered a reliable and valid clinic-based measure for predicting real-world behavior, additional research would be needed. [ABSTRACT FROM AUTHOR]

Objective: Given the negative health outcomes associated with functional loss, there is need to better understand the trajectory of functional change and compensation use with age. Many older adults successfully age in place, and there is not a one-to-one relationship between cognitive changes and ability to live independently. This study compared healthy age cohorts' performance and approach on a functional measure, particularly examining compensatory strategy use to support task performance. Methods: 57 young adults (YAs; ages 18–39), 42 young–old adults (YOAs; ages 60–69) and 47 old–old (OOAs; ages 70+) completed the Night Out Task (NOT); an open-ended functional assessment in which participants complete eight subtasks in preparation for a night out with a friend (e.g. prepare tea and gather items for a recipe). The NOT measures both primary outcome variables (e.g. time and accuracy), error types and 'compensation variables', which are process-approach variables intended to map on to the types of compensatory strategies individuals use in their everyday lives (e.g. planning and checking). Results: Results revealed that YAs performed better than the oldest group on the NOT in accuracy, execution time and number of both inefficient and inaccurate/incomplete errors. YAs additionally used fewer compensatory strategies than both older groups. Only one compensation variable had a positive relationship to outcome; double-checking was related to improved accuracy and fewer inaccurate/incomplete errors within the oldest cohort. Conclusion: Together these findings support a spectrum of functional change with age. While compensation use increased with age, the relationship between compensation use and outcome was unclear. Future work is needed to understand under what conditions older adults' self-initiate compensation use and to understand the relationship between compensation use and outcome. [ABSTRACT FROM AUTHOR]

Objective: This study used multiple assessment methods to examine instrumental activities of daily living (IADLs) performance in individuals with Parkinson's disease with mild cognitive impairment (PD-MCI) compared to individuals with mild cognitive impairment (MCI) and cognitively healthy older adults (HOA). Associations between functional performance and cognition were also examined. Methods: Eighteen individuals with PD-MCI, 48 individuals with MCI, and 66 HOAs were assessed with multiple IADL measures, including direct observation, a performance-based measure, and self- and informant-report questionnaires. Performance on the direct-observation measure was further characterized by coding for four error types: omissions, substitutions, and inefficient and irrelevant/off-task actions. Results: Both the PD-MCI and MCI groups performed more poorly on the overall score for all IADL measures relative to HOAs. Although the PD-MCI and MCI groups did not differ in overall performance, on the direct-observation measure, the PD-MCI group took longer and made more inefficient and irrelevant/off-task errors relative to the HOA and MCI groups, whereas the MCI group made more omission and substitution errors relative to HOAs. Further, the pattern of cognitive correlates that associated most strongly with the functional measures varied across groups and functional assessment methods. Conclusion: Compared to HOAs, PD-MCI and MCI groups demonstrated increased difficulties performing everyday activities, and cognitive and motor abilities differentially contributed to the everyday task difficulties of these two groups. [ABSTRACT FROM AUTHOR]

Background: Compensatory aids can help mitigate the impact of progressive cognitive impairment on daily living.Objective: We evaluate whether the learning and sustained use of an Electronic Memory and Management Aid (EMMA) application can be augmented through a partnership with real-time, activity-aware transition-based prompting delivered by a smart home.Methods: Thirty-two adults who met criteria for amnestic mild cognitive impairment (aMCI) were randomized to learn to use the EMMA app on its own (N = 17) or when partnered with smart home prompting (N = 15). The four-week, five-session manualized EMMA training was conducted individually in participant homes by trained clinicians. Monthly questionnaires were completed by phone with trained personnel blind to study hypotheses. EMMA data metrics were collected continuously for four months. For the partnered condition, activity-aware prompting was on during training and post-training months 1 and 3, and off during post-training month 2.Results: The analyzed aMCI sample included 15 EMMA-only and 14 partnered. Compared to the EMMA-only condition, by week four of training, participants in the partnered condition were engaging with EMMA more times daily and using more basic and advanced features. These advantages were maintained throughout the post-training phase with less loss of EMMA app use over time. There was little differential impact of the intervention on self-report primary (everyday functioning, quality of life) and secondary (coping, satisfaction with life) outcomes.Conclusion: Activity-aware prompting technology enhanced acquisition, habit formation and long-term use of a digital device by individuals with aMCI. (ClinicalTrials.gov NCT03453554). [ABSTRACT FROM AUTHOR]

Objective: Aging older adults and individuals with mild cognitive impairment (MCI) experience changes in ability to self-monitor errors. Difficulties with accurate self-monitoring of errors can negatively impact everyday functioning. Without proper error recognition, individuals will continue to make mistakes and not implement compensatory strategies to prevent future errors. A modified Sustained Attention to Response Task (SART; Robertson et al., 1997) has previously been used to assess self-monitoring by the number of errors individuals were able to recognize. The current study sought to examine the relationship of this laboratory-based error-awareness task with everyday functional abilities as assessed by informants and with real-world error-monitoring. We hypothesized that self-monitoring would be significantly related to real-world error-monitoring and everyday functional abilities. Participants and Methods: 135 community-dwelling participants (110 healthy older adults (HOA) and 25 individuals with MCI) were included from a larger parent study (mean age = 67.73, SD = 8.89). A modified SART was used to measure error-monitoring and create a self-monitoring variable by dividing accurately recognized errors by the total number of errors. Participants also completed simple and complex everyday tasks of daily living (e.g., making lemonade, cooking oatmeal, cleaning, filling medication pillbox) in a university campus apartment. Examiners coded both number of errors committed and self-corrections that were made during task completion. To examine real world error awareness, total self-correct errors were divided by the total number of errors. Knowledgeable informants (KI) completed the Everyday Cognition (ECog) scale, where they rated the participant on domains of memory, language, spatial abilities, planning, organization, and divided attention, to capture changes in everyday function. Pearson correlations were used to examine the relationship between SART self-monitoring and real-world error-monitoring, and changes in everyday functions as rated by their informants. Results: As self-monitoring scores on the SART increased, so too did real-world error awareness scores, r(133) =.18, p =.04. Higher self-monitoring scores on the SART were also significantly positively associated with functional performance abilities on the Ecog total (r(96) = -.24, p =.02). Further, higher self-monitoring on the SART was related to better functional performance within the Ecog domains of everyday memory (r(96) = -.23, p =.02), everyday language (r(96) = -.24, p =.02), everyday spatial abilities (r(96) = -.23, p =.02), and everyday planning (r(96) = -.21, p =.04). SART self-monitoring was not significantly related to everyday organization or divided attention domains. Conclusions: The findings revealed that better error-monitoring performance on a laboratory-based task was related to better error-monitoring when completing real-world activities, and less overall impairment in everyday function as reported by informants. Results support the ecological validity of the SART error-monitoring score and suggest that error-monitoring performance on the modified SART may have important clinical implications in predicting real-world error-monitoring and everyday function. Future research should consider how SART error-monitoring may predict everyday functioning, over and above other clinical measures. [ABSTRACT FROM AUTHOR]

Objective: Older adults often spontaneously use compensatory strategies (CS) to support everyday memory and daily task completion. Recent work suggests that evaluating the quality of CS provides utility in predicting real-world prospective memory (PM) task completion. However, there has been little exploration of how CS quality may vary based on PM demands. This study examined differences in CS use and task completion accuracy across time-based (TB) and event-based (EB) PM tasks. Based on differences in self-monitoring demands and ability to engage in cognitive offloading, it was hypothesized that participants would utilize better quality strategies for TB tasks than EB tasks, which would lead to superior accuracy in completing TB tasks. Participants and Methods: Seventy community-dwelling older adults (Mage = 70.80, SD = 7.87) completed two testing sessions remotely from home via Zoom. Participants were presented two TB PM tasks (paying bill by due date, calling lab at specified time) and two EB PM tasks (presenting a packed bag to examiner upon a cue, initiating discussion about physical activity log upon cue). Participants were encouraged to use their typical CS to support task completion. Quality of CS (0-3 points per task step) and accuracy of task completion (0-4 points per task) were evaluated through lab-developed coding schemas. For each task, CS Quality scores were assigned based on how well strategies supported retrospective memory (RM) and PM task elements, and RM and PM Quality scores were summed to yield a Total Quality score. Because each task consisted of a different number of steps, CS Quality scores for each task were divided by their respective number of steps to yield measures of average quality. Paired-samples t-tests examined differences in average CS quality (Total, RM, and PM) and PM accuracy across TB and EB tasks. Results: Participants' Total CS Quality was equivalent for TB tasks (M = 1.92, SD = 0.64) and EB tasks (M = 1.87, SD = 0.68), t(69) = 0.60, p =.55. Comparisons of subscores revealed that while participants used similar quality RM supports for TB tasks (M = 1.67, SD = 0.66) and EB tasks (M = 1.78, SD = 0.68), t(69) = 1.39, p =.17, participants utilized superior quality PM supports for TB tasks (M = 2.16, SD = 0.70) compared to EB tasks (M = 1.97, SD = 0.73), t(69) = 2.46, p =.02. Additionally, participants completed TB tasks with greater accuracy (M = 3.21, SD = 0.74) than EB tasks (M = 2.84, SD = 0.89), t(69) = 3.62, p <.001. Conclusions: While participants exhibited similar quality CS for RM components across TB and EB tasks, they displayed superior quality CS for PM components of TB tasks. This difference in quality may have contributed to participants completing real-world TB PM tasks with greater accuracy than EB tasks. Results contrast with trends in lab-based PM tasks, in which participants usually complete EB tasks more accurately. Findings may have implications for interventions, such as an enhanced focus on teaching high-quality CS to support real-world EB tasks. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Accurate insight into one's abilities facilitates engagement in rehabilitation and implementation of compensatory strategies. In this study, self-awareness, self-monitoring, and a new self-updating construct of insight were examined in amnestic mild cognitive impairment (aMCI). Individuals with aMCI and healthy older adults (HOAs) completed a list-learning task in a laboratory setting, and a naturalistic task of everyday functioning in a campus apartment along with other standardized neuropsychological tests. Participants made predictions about performance on the memory and functional tasks prior to task experience (self-awareness), immediately after task experience (self-monitoring), and after a delay (self-updating). Individuals with aMCI performed more poorly than HOAs on the memory task and other neuropsychological tests but not the functional task. For both the memory and functional task, performance predictions and prediction accuracy measures revealed that the aMCI group exhibited intact self-awareness, self-monitoring, and self-updating. Prediction accuracy measures showed some association with an executive composite but not a memory composite. Participants with aMCI demonstrated intact self-awareness, self-monitoring, and self-updating for a memory and functional task despite exhibiting poorer performance on neurocognitive tests compared to HOAs. These findings suggest that, even as memory in aMCI degrades, executive abilities may help sustain insight into difficulties, enabling adoption of cognitive strategies to support difficulties. [ABSTRACT FROM AUTHOR]

Objective: In the real-world environment, multiple and interacting state-dependent factors (e.g., fatigue, distractions) can cause cognitive failures and negatively impact everyday activities. This study used ecological momentary assessment (EMA) and a n-back task to examine the relationship between fluctuating levels of cognition measured in the real-world environment and self-report and performance-based measures of functional status. Method: Thirty-five community-dwelling older adults (M age = 71.80) completed a brief battery of objective and self-report measures of cognitive and functional status. After completing 100, 45-second trials to reach stable performance on a n-back task, EMA data collection began. Four times daily for one week, participants received prompts on a tablet to complete a n-back task and a brief survey. From the EMA n-back trials, measures of EMA average performance and intra-individual variability (IIV) across performances were created. Results: For the EMA n-back, the correlation between IIV and EMA average was weak and non-significant. IIV associated with self-report measures, and EMA average with the objective, performance-based functional status composite. Hierarchical regressions further revealed that IIV was a significant predictor of self-reported functional status and cognitive failures over and above EMA average performance and global cognitive status. In contrast, for the objective, functional status composite, IIV did not explain additional variance. Conclusions: The findings suggest that IIV and self-report measures of functional status and cognitive failures may capture a real-world cognitive capacity that fluctuates over time and with context; one that may not easily be captured by objective, performance-based measures designed to assess optimal function. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to provide regression-based normative data for the written, oral, and incidental recall trials of the Symbol Digit Modalities Test (SDMT). Method Regression-based normative equations for the written and oral trials were derived from 536 healthy men and women between the ages of 18 and 91. Normative equations for the incidental recall trial are provided for a subset of the normative sample (age range = 60–91). The clinical utility of the newly developed norms was examined by comparing mean performance and rates of impaired scores for participants with traumatic brain injury (TBI), mild cognitive impairment (MCI), and dementia. Within-group analyses were used to compare the new norms to the original published norms. Results Age, education, and sex were all significant predictors of written trial performance, age and education were significant predictors of oral trial performance, and only age predicted incidental recall trial performance. As expected, the TBI group demonstrated the highest rates of impaired performance on both written and oral trials. Participants with dementia showed the highest rate of impaired scores on the incidental recall trial, followed by participants with amnestic MCI. Compared to traditional norming methods, the regression-based norms classified more clinical participants as impaired on both the written and oral trials. Conclusions Comprehensive regression-based normative equations with demonstrated clinical utility are provided to improve the detection of cerebral dysfunction using the SDMT. A calculator with the normative equations is provided so that raw scores can be easily converted to demographically-corrected standardized scores. [ABSTRACT FROM AUTHOR]

Objective: Planning, a higher order executive functioning ability important for accomplishing complex everyday tasks, can be differentiated into initial and concurrent (online) planning. In this study, initial plans were codified to assess their impact on task execution. Cognitive correlates of initial planning and task execution were also examined. Method: One-hundred fifty-four community dwelling older adults completed a naturalistic task, called the Day Out Task (DOT), in either a planning or no planning condition. The DOT required participants to multitask and efficiently complete a series of eight subtasks, preparing for a hypothetical day out. Participants also completed a neuropsychological battery with the following cognitive constructs assessed: processing speed, cognitive flexibility, episodic memory, visuoconstructional abilities, and working memory and sequencing. Results: There were no significant differences between the planning and no planning conditions in DOT execution accuracy, efficiency or duration. However, efficiency of the initial plan was a significant predictor of task execution efficiency and initial plans that contained a higher amount of Task Relevant Associations predicted a shorter duration of task execution after controlling for age, processing speed and episodic memory. Furthermore, initial plans that had more Task Relevant Associations and task executions that took less time were associated with better working memory and sequencing ability. Discussion: Quality of the initial plan is important. Initial plans that organize task objectives in an efficient manner may lead to better task execution efficiency, while initial plans that demonstrate a detailed understanding of individual relational aspects of the tasks (i.e., higher rate of Task Relevant Associations) may result in faster task execution. [ABSTRACT FROM AUTHOR]

Objective Research has shown that neurologic conditions, such as traumatic brain injury and multiple sclerosis, result in a number of cognitive and functional deficits. However, little is known about the relationship between various cognitive domains and ability to perform everyday activities. The Community Shopping Task (CST), a naturalistic assessment task conducted in a simulated environment, was used to examine functional abilities and cognitive correlates of everyday functioning in individuals with neurologic conditions. Method Thirty-four participants with neurologic conditions and 34 healthy controls completed the CST as well as traditional paper–pencil measures of cognition. In addition, all participants completed a questionnaire assessing instrumental activities of daily living (IADLs). Results The results indicated that participants with neurologic conditions required significantly more cues and time to complete the CST compared to control participants and that immediate memory and executive functioning were important predictors of CST performance. Furthermore, time to complete the CST accounted for a significant amount of variance in IADL performance, over and beyond the traditional measures of cognition. Conclusions These results provide evidence that a naturalistic task completed in an everyday environment can enhance our understanding of how daily functioning is impacted in individuals with neurologic conditions and subsequently inform rehabilitation strategies. [ABSTRACT FROM AUTHOR]

Objective: Older adults often spontaneously engage in compensatory strategies (CS) to support everyday task completion, but factors that influence success of chosen CS remain unclear. This study examines whether real-world prospective memory (PM) task completion is better predicted by CS count or a CS quality rating. Method: Seventy mid-life and older adult participants were presented four novel, real-world PM tasks via remote assessment and encouraged to use their typical CS. The examiner captured detailed information about planned CS at task presentation (T1) and utilized CS at follow-up testing (T2). From this information, count (CS Count; quantity of CS) and quality (CS Quality; rating of CS thoroughness and utility) scores were coded separately for the planned and utilized CS. PM task performance accuracy was also coded (PM Accuracy). Results: Hierarchical regressions revealed planned CS Count and Quality did not predict PM Accuracy. In contrast, the utilized CS Quality predicted a significant amount of PM Accuracy variance over and above CS Count, global cognition, and age (R2 =.47, ΔR2 =.24, ΔF = 29.36, p <.001, f2 =.45). Furthermore, utilized CS Quality accounted for a similar amount of variance in PM Accuracy when utilized CS Count was removed from the model. Conclusions: This study's CS coding system can capture and quantify the quality of strategies, which uniquely predicts real-world PM performance. This coding system may provide researchers with a nuanced CS measure and lead to improved CS interventions designed to support everyday PM performance, such as targeted CS trainings. [ABSTRACT FROM AUTHOR]

Objective: The primary aim of this study was to identify the independent and differential associations of obesity and hypertension with cognitive, physical, and directly observed functional abilities among middle age and older adults. Method: Participants were 119 adults between the ages of 51 and 89, who underwent a cross-sectional assessment of cognitive, physical, functional and relevant health-related variables. Results: Obesity predicted significantly poorer executive functions (β = -.301, t = -3.86, p < .001), mobility (β = .329, t = 3.59, p < .001), observed functional abilities (β = .220, t = 2.52, p = .013), and self-reported ability to perform activities of daily living that require physical capability (β = -.365, t = -4.23, p < .001). In contrast, hypertension was not independently associated with any of the outcome measures (ps > .05). Results from the path analysis revealed that executive functions mediated the association between obesity and poorer directly observed functional abilities. Additionally, obesity had a direct and indirect (through mobility) effect on self-reported basic activities of daily living. Conclusions: These findings suggest a link between obesity, executive functions, and limitations in physical function and instrumental activities of daily living among middle age and older adults, however, longitudinal research is needed to further delineate the trajectory of these factors. [ABSTRACT FROM AUTHOR]

Thirty-two younger adults (YAs) and 64 older adults (OAs) completed the Amap Task, a naturalistic measure designed to evaluate the formulation and execution stages of planning. Participants read a map layout of a university apartment and planned an efficient strategy to complete several tasks. To determine whether execution abilities are augmented by formulating a plan, we compared formal (i.e., written strategy) and informal (i.e., initiate task when ready without writing out a strategy) planning conditions. Participants did not have access to their plan during task execution. Amap scores were also compared with informant-report of everyday functioning. For the formal planning condition, OAs were less accurate and less efficient than YAs during the formulation stage, while there were no group differences in total formulation time for the informal planning condition. Across conditions, OAs obtained poorer execution accuracy and efficiency scores, took longer during execution, and omitted more task parts. Formal planning improved execution efficiency but not accuracy, suggesting one's approach to the task (i.e., efficiency, finesse) may improve with preplanning even if overall accuracy does not. Significant relationships between Amap scores and informant-report of everyday functioning highlight the ecological validity of the Amap as a measure sensitive to everyday planning abilities. [ABSTRACT FROM AUTHOR]

Primary objective: Impairments in attention following traumatic brain injury (TBI) can significantly impact recovery and rehabilitation effectiveness. This study investigated the multi-faceted construct of selective attention following TBI, highlighting the differences on visual nonsearch (focused attention) and search (divided attention) tasks.Methods and procedures: Participants were 30 individuals with moderate to severe TBI who were tested acutely (i.e. following emergence from PTA) and 30 age- and education-matched controls. Participants were presented with visual displays that contained either two or eight items. In the focused attention, nonsearch condition, the location of the target (if present) was cued with a peripheral arrow prior to presentation of the visual displays. In the divided attention, search condition, no spatial cue was provided prior to presentation of the visual displays.Main outcomes and results: The results revealed intact focused, nonsearch, attention abilities in the acute phase of TBI recovery. In contrast, when no spatial cue was provided (divided attention condition), participants with TBI demonstrated slower visual search compared to the control group.Conclusions: The results of this study suggest that capitalizing on intact focused attention abilities by allocating attention during cognitively demanding tasks may help to reduce mental workload and improve rehabilitation effectiveness. [ABSTRACT FROM PUBLISHER]

Objective: Current proxy measures for assessing everyday functioning (e.g., questionnaires, performance-based measures, and direct observation) show discrepancies in their rating of functional status. The present study investigated the relationship between multiple proxy measures of functional status and content memory (i.e., memory for information), temporal order memory, and prospective memory in an older adult sample. Method: A total of 197 community-dwelling older adults who did (n = 45) or did not meet (n = 152) criteria for mild cognitive impairment (MCI), completed six different assessments of functional status (two questionnaires, two performance-based tasks, and two direct observation tasks) as well as experimental measures of content memory, prospective memory, and temporal order memory. Results: After controlling for demographics and content memory, the temporal order and prospective memory measures explained a significant amount of variance in all proxy functional status measures. When all variables were entered into the regression analyses, content memory and prospective memory were found to be significant predictors of all measures of functional status, whereas temporal order memory was a significant predictor for the questionnaire and direct observation measures, but not performance-based measures. Conclusion: The results suggest that direct observation and questionnaire measures may be able to capture components of everyday functioning that require context and temporal sequencing abilities, such as multi-tasking, that are not as well captured in many current laboratory performance-based measures of functional status. Future research should aim to inform the development and use of maximally effective and valid proxy measures of functional ability. [ABSTRACT FROM AUTHOR]

Objective:Understanding functional abilities for those with neurologic disorders is a growing area of investigation. In this paper, performance-based naturalistic tasks used to assess cognitive and functional deficits were reviewed to determine current evidence for effectiveness as valid and reliable assessment measures and to make recommendations for future research.Method:Performance-based naturalistic tasks were defined as observable, rule-based, open-ended tasks completed in an environment that either mimics the real world or is the real world. Thirty-eight studies, discussed by the environment in which the task was performed (i.e. vocational, kitchen, hospital/store, and home), were reviewed.Results:Many studies were found to have significant methodological limitations (e.g. low sample size) and few studies evaluated the relationship between performance on the naturalistic task and everyday functioning. The efficacy of using naturalistic tasks to better understand functional status has yet to be clearly demonstrated across neurologic populations. Numerous factors, including ease of use, limited research on how to best utilize these tasks, and cost impact the use of naturalistic tasks. Nonetheless, given the promising theoretical foundation, opportunities are ripe for further development of assessment strategies that use contextually relevant environments and allow for enhanced safety and controllability of tasks, increased face validity, capitalization on automatic processes, and improved ecological validity.Conclusions:Future research is needed to increase the knowledge base regarding the use of naturalistic tasks, especially as they relate to everyday functioning, because of the potential benefits to advance the standard of care for individuals with neurologic conditions. [ABSTRACT FROM AUTHOR]

Objective: This study examined content and temporal order memory for subject-performed activities in an incidental learning condition in cognitively healthy individuals with Parkinson's disease (PD) (N = 20) and controls (N = 20). Method: Participant's free recall of activities provided a measure of content memory. Temporal order memory was assessed with a reconstruction task of activities. Self- and informant-reports of everyday memory were used to examine the relationship between everyday memory, and content and temporal order memory. Results: Individuals with PD recalled fewer activities although recognition memory was intact. Temporal order memory was also impaired for individuals with PD. For the PD group, both self- and informant-reports of changes in current memory abilities were strongly associated with temporal order memory but not content memory for activities. Conclusions: These findings suggest that there is a strong link between everyday memory abilities and temporal order memory for activities, and support the need for additional study of temporal order memory abilities in PD. [ABSTRACT FROM AUTHOR]

Objective: Few studies have examined functional abilities and complaints in healthy older adults (HOAs) with subjective cognitive concerns (SCC). The aims of this study were to assess everyday functioning in HOAs reporting high and low amounts of SCC and examine cognitive correlates of functional abilities.Method: Twenty-six HOAs with high SCC and 25 HOAs 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. [ABSTRACT FROM PUBLISHER]

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 than did 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. [ABSTRACT FROM PUBLISHER]

Everyday memory lapses experienced by older adults (OAs) 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. [ABSTRACT FROM AUTHOR]

Introduction: The use of compensatory strategies plays an important role in the ability of older adults to adapt to late-life memory changes. Even with the benefits associated with compensatory strategy use, little research has explored specific mechanisms associated with memory performance and compensatory strategies. Rather than an individual’s objective memory performance directly predicting their use of compensatory strategies, it is possible that some other variables are indirectly influencing that relationship. The purpose of this study was to: (a) examine the moderating effects of cognitive reserve (CR) and (b) evaluate the potential mediating effects of memory self-efficacy on the relationship between objective memory performance and compensatory strategy use.Method: Two structural equation models (SEM) were used to evaluate CR (latent moderator model) and memory self-efficacy (mediator model) in a sample of 155 community-dwelling older adults over the age of 55.Results: The latent variable moderator model indicated that CR was not substantiated as a moderator variable in this sample (p= .861). However, memory self-efficacy significantly mediated the association between objective memory performance and compensatory strategy use (β = .22, 95% confidence interval, CI [.002, .437]). More specifically, better objective memory was associated with lower compensatory strategy use because of its relation to higher memory self-efficacy.Conclusions: These findings provide initial support for an explanatory framework of the relation between objective memory and compensatory strategy use in a healthy older adult population by identifying the importance of an individual’s memory perceptions. [ABSTRACT FROM PUBLISHER]

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 strongerwhenassessed 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. [ABSTRACT FROM AUTHOR]

Objective: Within-person variability in cognitive performance is related to neurological integrity, but the association with functional abilities is less clear. The primary aim of this study was to examine the association between cognitive dispersion, or within-person variability, and everyday multitasking and the way in which these variables may influence performance on a naturalistic assessment of functional abilities. Method: Participants were 156 community-dwelling adults, age 50 or older. Cognitive dispersion was calculated by measuring within-person variability in cognitive domains, established through principal components analysis. Path analysis was used to determine the independent contribution of cognitive dispersion to functional ability, mediated by multitasking. Results: Results of the path analysis revealed that the number of subtasks interweaved (i.e., multitasked) mediated the association between cognitive dispersion and task sequencing and accuracy. Although increased multitasking was associated with worse task performance in the path model, secondary analyses revealed that for individuals with low cognitive dispersion, increased multitasking was associated with better task performance, whereas for those with higher levels of dispersion multitasking was negatively correlated with task performance. Conclusion: These results suggest that cognitive dispersion between domains may be a useful indicator of multitasking and daily living skills among older adults. [ABSTRACT FROM AUTHOR]

Objective: Older adults often spontaneously engage in compensatory strategies (CS) to support completion of everyday tasks. However, factors that influence the success of chosen strategies remain unclear. The present study aimed to examine if evaluation of the overall quality of compensatory strategies, as compared to a count of strategies, better predicts completion of real-world prospective memory (PM) tasks. Method: Seventy community-dwelling older adults (M = 70.80, SD = 7.87) completed two testing sessions remotely from their own homes through video conferencing. Participants were presented four novel real-world PM tasks designed to be carried out independently in the future. Upon task presentation, participants were given time to plan and encouraged to use their typical CS. The examiner captured detailed information about CS planned at task presentation and strategies utilized at follow-up testing, as well as PM task accuracy. In addition to a count of CS, participants' CS were assigned a quality score upon video review. Results: Hierarchical regression revealed that Compensatory Strategy Quality (CSQ) score provides incremental validity in predicting PM task accuracy over and above CS count, global cognition, and age (ΔR2 = 0.24, ΔF = 29.36, p < 0.001). CSQ uniquely accounted for 24.01% of the variance in PM task accuracy (sr = 0.49, p < 0.001). Conclusions: Evaluating quality of cognitive CS provides enhanced precision in predicting PM. Findings of this study may provide researchers with tools to study compensation in a more nuanced manner. Furthermore, findings have the potential to be translated into clinical interventions, such as targeted compensatory strategy trainings. [ABSTRACT FROM AUTHOR]

Primary objective: Impaired self-awareness following a traumatic brain injury (TBI) can reduce the effectiveness of rehabilitation, resulting in poorer outcomes. However, little is understood about how the multi-dimensional aspects of self-awareness may differentially change with recovery and impact outcome. Thus, this study examined four self-awareness variables represented in the Dynamic Comprehensive Model of Awareness: metacognitive awareness, anticipatory awareness, error-monitoring and self-regulation. Research design: This study evaluated change of the self-awareness measures with recovery from TBI and whether the self-awareness measures predicted community re-integration at follow-up. Methods and procedures: Participants were 90 individuals with moderate-to-severe TBI who were tested acutely following injury and 90 age-matched controls. Forty-nine of the TBI participants and 49 controls were re-tested after 6 months. Main outcome and results: Results revealed that the TBI group's error-monitoring performance was significantly poorer than controls at both baseline and follow-up. Regression analyses revealed that the self-awareness variables at follow-up were predictive of community re-integration, with error-monitoring being a unique predictor. Conclusions: The results highlight the importance of error-monitoring and suggest that interventions targeted at improving error-monitoring may be particularly beneficial. Understanding the multi-dimensional nature of self-awareness will further improve rehabilitation efforts and understanding of the theoretical basis of self-awareness. [ABSTRACT FROM AUTHOR]

Introduction: Deficits in attentional abilities can significantly impact rehabilitation and recovery from traumatic brain injury (TBI). This study investigated the nature and recovery of preattentive (parallel) and attentive (serial) visual search abilities after TBI. Method: Participants were 40 individuals with moderate to severe TBI who were tested following emergence from posttraumatic amnesia and approximately 8 months post injury, as well as 40 age- and education-matched controls. Preattentive (automatic) and attentive (controlled) visual search situations were created by manipulating the saliency of the target item amongst distractor items in visual displays. The relationship between preattentive and attentive visual search rates and follow-up community integration were also explored. Results: The results revealed intact parallel (automatic) processing skills in the TBI group both postacutely and at follow-up. In contrast, when attentional demands on visual search were increased by reducing the saliency of the target, the TBI group demonstrated poorer performances than the control group both postacutely and 8 months post injury. Neither preattentive nor attentive visual search slope values correlated with follow-up community integration. Conclusions: These results suggest that utilizing intact preattentive visual search skills during rehabilitation may help to reduce high mental workload situations, thereby improving the rehabilitation process. For example, making commonly used objects more salient in the environment should increase reliance or more automatic visual search processes and reduce visual search time for individuals with TBI. [ABSTRACT FROM AUTHOR]

The Instrumental Activities of Daily Living – Compensation (IADL-C) scale was developed to capture early functional difficulties and to quantify compensatory strategy use that may mitigate functional decline in the aging population. The IADL-C was validated in a sample of cognitively healthy older adults (N=184) and individuals with mild cognitive impairment (MCI; N=92) and dementia (N=24). Factor analysis and Rasch item analysis led to the 27-item IADL-C informant questionnaire with four functional domain subscales (money and self-management, home daily living, travel and event memory, and social skills). The subscales demonstrated good internal consistency (Rasch reliability 0.80 to 0.93) and test-retest reliability (Spearman coefficients 0.70 to 0.91). The IADL-C total score and subscales showed convergent validity with other IADL measures, discriminant validity with psychosocial measures, and the ability to discriminate between diagnostic groups. The money and self management subscale showed notable difficulties for individuals with MCI, whereas difficulties with home daily living became more prominent for dementia participants. Compensatory strategy use increased in the MCI group and decreased in the dementia group. [ABSTRACT FROM AUTHOR]

There is increasing need for early, pro-active programs that can delay dementia diagnosis and enhance well-being of individuals with mild cognitive impairment (MCI) and their care-partners (i.e., care-dyads). This randomized controlled trial evaluated the efficacy of a combined cognitive rehabilitation and multi-family group treatment (CR-MFG) that was designed to facilitate adoption of newly learned cognitive strategies into the care-dyads everyday lives. Analyzed data included 23 care-dyads who participated in CR-MFG treatment and 23 care-dyads in standard care (SC). The 3-month intervention consisted of individual joining sessions, an educational workshop, and 20/twice weekly multifamily memory strategy training and problem-solving sessions. Everyday functioning, memory, and psychological functioning (i.e., quality-of-life, depression, coping) were assessed. The CR-MFG intervention was associated with significant post-test group differences and improved post-test performances by the MCI participants on performance-based measures of everyday functioning and neuropsychological tests of memory. There was also some suggestion that CR-MFG care-partners perceived positive change in the everyday functioning of the MCI participants. In contrast, no post-test group differences were found for either care-dyad member on the self-report psychological measures; care-partners in the treatment group did self-report improved coping behaviors at post-test. These 3-month results are preliminary but suggestive that CR-MFG may produce modest, practical everyday functional benefits for persons with MCI. (JINS, 2014, 20, 1–12) [ABSTRACT FROM PUBLISHER]

The relationship between, and the cognitive correlates of, several proxy measures of functional status were studied in a population with mild cognitive impairment (MCI). Participants were 51 individuals diagnosed with MCI and 51 cognitively healthy older adults (OA). Participants completed performance-based functional status tests and standardized neuropsychological tests, and performed eight activities of daily living (e.g., watered plants, filled medication dispenser) while under direct observation in a campus apartment. An informant interview about everyday functioning was also conducted. Compared to the OA control group, the MCI group performed more poorly on all proxy measures of everyday functioning. The informant report of instrumental activities of daily living (IADL) did not correlate with the two performance-based measures; however, both the informant-report IADL and the performance-based everyday problem-solving test correlated with the direct observation measure. After controlling for age and education, cognitive predictors did not explain a significant amount of variance in the performance-based measures; however, performance on a delayed memory task was a unique predictor for the informant-report IADL, and processing speed predicted unique variance for the direct observation score. These findings indicate that differing methods for evaluating functional status are not assessing completely overlapping aspects of everyday functioning in the MCI population. [ABSTRACT FROM AUTHOR]

The underlying nature of verbal fluency deficits in Alzheimer's disease (AD) was investigated in this study. Participants were 48 individuals with AD and 48 cognitively healthy older adults. Fluency performance on letter and category tasks was analyzed across two 30-s intervals for total words produced, mean cluster size, and total switches. Compared with the control group, AD participants produced fewer words and switches on both fluency tasks and had a reduced category cluster size. The AD group was differentially impaired on category compared with letter fluency and produced more repetitive responses but fewer category exemplars than controls on the category task. A multidimensional scaling approach revealed that AD participants' semantic maps were similar to controls. Overall, the data suggest that executive abilities involving search and retrieval processes and a reduced availability of semantically related words contributed to the AD group's poorer performance despite similar temporal recall and organizational patterns. [ABSTRACT FROM PUBLISHER]

Most neuropsychological assessments include at least one measure that is administered, scored, or interpreted by computers or other technologies. Despite supportive findings for these technology-based assessments, there is resistance in the field of neuropsychology to adopt additional measures that incorporate technology components. This literature review addresses the research findings of technology-based neuropsychological assessments, including computer- and virtual reality-based measures of cognitive and functional abilities. We evaluate the strengths and limitations of each approach, and examine the utility of technology-based assessments to obtain supplemental cognitive and behavioral information that may be otherwise undetected by traditional paper-and-pencil measures. We argue that the potential of technology use in neuropsychological assessment has not yet been realized, and continued adoption of new technologies could result in more comprehensive assessment of cognitive dysfunction and in turn, better informed diagnosis and treatments. Recommendations for future research are also provided. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the pattern of performance on letter and category fluency tests of individuals with mild cognitive impairment (MCI). Previous research has suggested that organization strategies, including “clustering” (i.e., groups of related words) and “switching” (i.e., shift from one cluster to another), are important for efficient verbal fluency performance. Participants were 25 individuals with single-domain amnestic MCI (aMCI), 49 with multidomain aMCI, 16 with non-amnestic MCI (naMCI), and 90 cognitively healthy older adults. Fluency performances were analyzed across two 30-s intervals for total words produced, cluster size, and switching. Analyses of variance (ANOVAs) with follow-up tests revealed that the single-domain aMCI group performed comparably with healthy controls on each dependent measure across both fluency tasks. In contrast, the multidomain aMCI group showed performance decrements in total words and switching production compared with healthy controls on both fluency tasks, whereas the naMCI group produced fewer words and switches on letter fluency. Each group generated more words and switches during the first 30-s on both fluency tasks, with the exception of the naMCI group, whose switching on letter fluency did not decrease as the task progressed. As indicated by the single-domain aMCI group's unimpaired performance, our findings demonstrate that verbal fluency performance decreases as domains beyond memory become impaired in MCI. Reduced switching ability, which has been linked to prefrontal executive functioning, contributed the most to the poorer performance of individuals with multidomain MCI and naMCI. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The Brief Visuospatial Memory Test - Revised (BVMT-R) is a commonly used, commercialized, assessment tool to measure visuospatial learning and memory abilities across research and clinical settings. In this study we evaluated the influence of processing speed and executive functioning on BVMT-R learning, memory, and percent retention scores. A total of 141 cognitively healthy older adults completed the BVMT-R along with measures of visuoconstructional abilities (BVMT-R copy), speeded processing (Symbol Digit Modalities Test-oral), and executive function (FAS). After controlling for age and visuoconstructional abilities, hierarchical regression models showed that the processing speed measure was a unique predictor of both BVMT-R learning and memory performances, while the executive function measure was not. The visuoconstructional measure was the only unique predictor of BVMT-R percent retention. The findings suggest that, when interpreting the BVMT-R learning and memory scores of patients who exhibit speeded processing deficits, the impact of slowed processing speed on performance should be considered. [ABSTRACT FROM AUTHOR]

Older adults with mild cognitive impairment (MCI) often have difficulty performing complex instrumental activities of daily living (IADLs), which are critical to independent living. In this study, amnestic multi-domain MCI (N = 29), amnestic single-domain MCI (N = 18), and healthy older participants (N = 47) completed eight scripted IADLs (e.g., cook oatmeal on the stove) in a smart apartment testbed. We developed and experimented with a graded hierarchy of technology-based prompts to investigate both the amount of prompting and type of prompts required to assist individuals with MCI in completing the activities. When task errors occurred, progressive levels of assistance were provided, starting with the lowest level needed to adjust performance. Results showed that the multi-domain MCI group made more errors and required more prompts than the single-domain MCI and healthy older adult groups. Similar to the other two groups, the multi-domain MCI group responded well to the indirect prompts and did not need a higher level of prompting to get back on track successfully with the tasks. Need for prompting assistance was best predicted by verbal memory abilities in multi-domain amnestic MCI. Participants across groups indicated that they perceived the prompting technology to be very helpful. (JINS, 2013, 19, 1–11) [ABSTRACT FROM AUTHOR]

An event-based nonfocal task was used to evaluate prospective memory (PM) and the relationship between PM, neuropsychological testing data, and everyday forgetting. Twenty-four participants with mild cognitive impairment (MCI) and 24 age- and education-matched cognitively healthy adults responded to a nonfocal PM cue, while completing an ongoing working memory task. Neuropsychological testing data and self- and informant-report of frequency of forgetting were also gathered. Compared to healthy adults, the MCI participants exhibited significantly poorer prospective remembering and ongoing task performance, despite similar self-reported effort directed to the PM task. Both self- and informant-report indicated that the MCI group was experiencing a higher frequency of everyday forgetting than the healthy adult group. Self-report of everyday forgetting was correlated with PM task performance for the healthy adults, but not for the MCI participants. For the healthy adults, correlational analyses also showed significant relationships between PM accuracy and tests of memory and executive functioning, suggesting that both spontaneous retrieval processes and effortful, strategic monitoring may be important in supporting prospective remembering for this nonfocal PM task. The stronger relationships between PM accuracy and memory and language tests for the MCI group suggest that their poorer event-based prospective remembering might be linked to impaired spontaneous retrieval processes, which are thought to be supported by medial temporal structures. [ABSTRACT FROM AUTHOR]

Planning ability, a subset of executive functioning, has been shown to decline with normal aging. However, the exact nature of this decline has yet to be adequately examined. In this study, 50 younger adults and 50 older adults completed a map task designed to tease apart the formulation and execution stages of planning. Participants were tasked with reading a map layout of a university apartment and planning an efficient route to complete several tasks. There were two conditions, aid and no-aid. During the formulation stage, participants wrote out their plan for later task completion. In the execution stage, half of the participants were instructed to utilize their written aid during task completion while the other half completed tasks without the use of their aid. Older adults performed more poorly than younger adults during both the formulation and execution stages on measures of accuracy and efficiency. There was no effect of using the aid during execution. Thus, using an open-ended planning task involving real-world stimuli, we found age-related deficits in planning ability associated with both the formulation and execution components, and not exclusively with formulation. We also found that both groups successfully updated and adjusted their formulated plans during execution. [ABSTRACT FROM AUTHOR]

Few studies have investigated the complex nature of everyday activity memory following traumatic brain injury (TBI). This study examined recovery of content and temporal order memory for performed activities during the first year in individuals who suffered moderate to severe TBI. TBI and control participants completed eight different cognitive activities at baseline (i.e., acutely following injury for TBI) and then again approximately one year later (follow-up). Participants' free recall of the activities provided a measure of content memory. Temporal order memory was assessed with a reconstruction task. Self-report and informant report of everyday memory problems at follow-up were used to examine the relationship between activity memory performances and everyday memory. TBI participants showed significant recovery in both content and temporal order memory for activities during the first year. Despite showing significant recovery, the TBI group's activity memory performances remained poorer than that of controls at follow-up. Greater self- and informant report of everyday memory difficulties was associated with poorer temporal order memory but not content memory for activities. These findings demonstrate recovery in multiple memory processes that support activity memory following moderate to severe TBI. The findings also suggest a stronger link between everyday memory abilities and temporal order memory for activities than activity memory content in a TBI population. [ABSTRACT FROM AUTHOR]

Neuropsychologists are often asked to answer questions about the effects of cognitive deficits on everyday functioning. This study examined the relationship between and the cognitive correlates of self-report, performance-based, and direct observation measures commonly used as proxy measures for everyday functioning. Participants were 88 community-dwelling, cognitively healthy older adults (age 50–86 years). Participants completed standardized neuropsychological tests and questionnaires, and performed eight activities of daily living (e.g., water plants, fill a medication dispenser) while under direct observation in a campus apartment. All proxy measures of everyday function were sensitive to the effects of healthy cognitive aging. After controlling for age, cognitive predictors explained a unique amount of the variance for only the performance-based behavioral simulation measure (i.e., Revised Observed Tasks of Daily Living). The self-report instrumental activities of daily living (IADL) and the performance-based everyday problem-solving test (i.e., EPT) did not correlate with each other; however, both were unique predictors of the direct observation measure. These findings suggest that neuropsychologists must be cautious in making predictions about the quality of everyday activity completion in cognitively healthy older adults from specific cognitive functions. The findings further suggest that a self-report of IADLs and the performance-based EPT may be useful measures for assessing everyday functional status in cognitively healthy older adults. (JINS, 2011, 17, 853–864) [ABSTRACT FROM AUTHOR]

The clock drawing test (CDT) has been used as a screening tool for identifying cognitive decline in individuals with Alzheimer disease (AD) and other dementias but has not been extensively evaluated for categorizing individuals with mild cognitive impairment (MCI). This study used both an established quantitative scoring system and a revised scoring method based on qualitative error criteria developed by Rouleau et al to demonstrate the sensitivity of the CDT to MCI. Participants were 66 cognitively healthy older adult, 33 individuals with MCI, and 33 individuals with AD. Sensitivity analyses of the 2 clock drawing methods revealed that the Modified Rouleau scoring method was more sensitive to MCI than the original Rouleau scoring system. Conceptual, graphic, and spatial-planning difficulties were the most commonly committed errors on the CDT across all groups, and conceptual errors along with graphic difficulties were committed more often in the MCI group than the cognitively healthy control group. Participants in the AD group exhibited greater deficits in all error categories and significantly lower total CDT scores compared to both the MCI and older adult controls. Findings observed in this study suggest that qualitative observations of clock drawing errors can help increase sensitivity of the CDT to MCI and that use of a more detailed scoring system is necessary to differentiate individuals with MCI from cognitively healthy older adults. [ABSTRACT FROM AUTHOR]

This study examined awareness of memory problems and memory self-monitoring abilities in individuals with Alzheimer's disease (AD). Participants were 20 individuals with AD and 20 older adult controls. A global performance-prediction paradigm, which required participants to predict the number of words they would remember both prior to and after completing a list-learning memory task, was used as the online assessment measure. Offline assessment of memory involved contrasting self-ratings provided by participants about the frequency of everyday memory failures with ratings from knowledgeable informants. As expected, participants with AD demonstrated poorer recall for the word list than did controls. Participants with AD were also less accurate than controls in their preexperience memory predictions, and findings from the offline assessment method similarly revealed that the AD group overestimated their everyday memory abilities. Despite showing impaired understanding of personal memory ability, the AD group successfully modified their postexperience memory predictions so that they were more accurate following task exposure, demonstrating accurate memory self-monitoring abilities. These findings highlight the complex and multidimensional nature of metamemory. The findings further suggest that while AD patients appear able to immediately benefit from task experience, they have difficulty creating lasting awareness of memory abilities. [ABSTRACT FROM AUTHOR]

We applied the item-specific deficit approach (ISDA) to California Verbal Learning Test data obtained from 56 severe, acceleration-deceleration closed head injury (CHI) participants and 62 controls. The CHI group demonstrated deficits on all ISDA indices in comparison to controls. Regression analyses indicated that encoding deficits, followed by consolidation deficits, accounted for most of the variance in delayed recall. Additionally, level of acquisition played a partial role in CHI-associated consolidation difficulties. Finally, CHI encoding deficits were largely driven by low semantic clustering during list learning. These results suggest that encoding (primary) and consolidation (secondary) deficits account for CHI-associated verbal memory impairment. [ABSTRACT FROM AUTHOR]

This study examined both retrospective and prospective memory self-monitoring abilities in 33 individuals with amnestic mild cognitive impairment (MCI) and 33 healthy older adult controls. Participants learned 36 critical cue-target word pairs. Following a distractor task, participants were asked to recall each target word that corresponded to a given cue word. Confidence ratings were provided for recalled words. For nonrecalled words, feeling-of-knowing judgments about the likelihood of recognizing the target word on a subsequent recognition test were provided. We found that despite poorer episodic memory performance, the MCI individuals demonstrated accurate retrospective self-monitoring of recalled episodic material. In contrast, the MCI participants were less accurate than controls prospectively self-monitoring their memory for newly learned information. These findings suggest that memory self-monitoring is not a unitary construct and that amnestic MCI participants have difficulty with prospective memory self-monitoring abilities. [ABSTRACT FROM AUTHOR]

A performance-prediction paradigm was used to examine metamemory abilities in 27 individuals with amnestic mild cognitive impairment (MCI), 14 individuals with nonamnestic MCI, and 41 controls. To assess memory self-awareness, participants predicted the number of words they would remember before completing a list-learning memory task. Memory self-monitoring was evaluated by participants' ability to increase the accuracy of their predictions after experience with the list-learning task. As expected, participants with amnestic MCI demonstrated poorer memory abilities than the controls and participants with nonamnestic MCI. The amnestic MCI group also correctly predicted that they would recall less information than controls. Furthermore, both MCI groups showed accurate awareness of how differing task demands influence recall and successfully modified their memory predictions to be more accurate following task exposure. These findings revealed that individuals with amnestic and nonamnestic MCI were able to competently assess the demands of an externally driven metamemorial situation and utilize experience with a task to accurately update memory self-knowledge. Accurate metamemory skills may facilitate the ability of individuals with MCI to benefit from targeted behavioral interventions focused on utilizing compensatory strategies for everyday memory problems. [ABSTRACT FROM AUTHOR]

We examined memory self-awareness and memory self-monitoring abilities during inpatient rehabilitation in participants with moderate to severe traumatic brain injury (TBI). A total of 29 participants with moderate to severe TBI and 29 controls matched on age, gender, and education completed a performance prediction paradigm. To assess memory self-awareness, participants predicted the amount of information they would remember before completing list-learning tasks and visual–spatial memory tasks. Memory self-monitoring was assessed by participants' ability to increase accuracy of their predictions after experience with the tests. Although the TBI participants performed more poorly than controls on both episodic memory tasks, no significant group differences emerged in memory self-awareness or memory self-monitoring. The TBI participants predicted that their memory performances would be poorer than that of controls, accurately adjusted their predictions in accordance with the demands of the tasks, and successfully modified their predictions following experience with the tasks. The results indicate that moderate to severe TBI individuals in the early stages of recovery can competently assess the demands of externally driven metamemorial situations and utilize experience with task to accurately update their knowledge of memory abilities. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the effectiveness of semantic cues provided at encoding and during retention for older adults' memory. For the California Verbal Learning Test-II, participants received semantic or nonsemantic cues that were varied across groups at encoding and during the retention interval. Provision of a semantic cue at encoding led to greater semantic clustering at learning, but not increased recall performance. Providing a semantic cue during the retention interval led to better delayed free recall and greater semantic clustering. No group differences in recall or semantic clustering were found at delayed cued recall. The current findings suggest that semantic cues can be beneficial for recalling unstructured information when administered during the retention interval. [ABSTRACT FROM AUTHOR]