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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: 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: 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: 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: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: The purpose of the current study was to use a newly developed digital tablet-based variant of the TMT to isolate component cognitive processes underlying TMT performance.Method: Similar to the paper-based trail making test, this digital variant consists of two conditions, Part A and Part B. However, this digital version automatically collects additional data to create component subtest scores to isolate cognitive abilities. Specifically, in addition to the total time to completion and number of errors, the digital Trail Making Test (dTMT) records several unique components including the number of pauses, pause duration, lifts, lift duration, time inside each circle, and time between circles. Participants were community-dwelling older adults who completed a neuropsychological evaluation including measures of processing speed, inhibitory control, visual working memory/sequencing, and set-switching. The abilities underlying TMT performance were assessed through regression analyses of component scores from the dTMT with traditional neuropsychological measures.Results: Results revealed significant correlations between paper and digital variants of Part A (rs = .541,p < .001) and paper and digital versions of Part B (rs = .799,p < .001). Regression analyses with traditional neuropsychological measures revealed that Part A components were best predicted by speeded processing, while inhibitory control and visual/spatial sequencing were predictors of specific components of Part B. Exploratory analyses revealed that specific dTMT-B components were associated with a performance-based medication management task.Conclusions: Taken together, these results elucidate specific cognitive abilities underlying TMT performance, as well as the utility of isolating digital components. [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]

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]

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 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]

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.