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Health care professionals (HCPs) are a critical source of recommendations for older adults. Aging services technologies (ASTs), which include devices to support the health-care needs of older adults, are underutilized despite evidence for improving functional outcomes and safety and reducing caregiver burden and health costs. This study evaluated a video-based educational program aimed at improving HCP awareness of ASTs. Sixty-five HCPs viewed AST videos related to medication management, daily living, and memory. Following the program, participants' objective and perceived AST knowledge improved, as did self-efficacy and anticipated AST engagement. About 95% of participants stated they were more likely to recommend ASTs postprogram. Participants benefitted equally regardless of years of experience or previous AST familiarity. Furthermore, change in self-efficacy and perceived knowledge were significant predictors of engagement change. Overall, the educational program was effective in improving HCPs' awareness of ASTs and appeared to benefit all participants regardless of experience and prior knowledge. [ABSTRACT FROM AUTHOR]

Objective: Functional ability declines with age and cognitive impairment. This study investigated errors of omission made by community-dwelling older adults completing everyday tasks in a naturalistic setting.Method: Sixty-five cognitively healthy older adults (HOA), 19 individuals with single domain mild cognitive impairment (sdMCI), 33 individuals with multi-domain MCI (mdMCI), and 13 individuals with dementia completed measures of memory, processing speed, working memory, and executive functioning, as well as eight different activities of daily living in a naturalistic environment. Task steps were divided into preparatory, action-oriented, and concluding steps.Results: For action-oriented steps, the number of omission errors increased with level of cognitive impairment beyond sdMCI (i.e., HOA = sdMCI < mdMCI < dementia). In contrast, for preparatory and concluding steps, the dementia group committed more omission errors than the HOA, sdMCI, and mdMCI groups, which did not differ.Conclusions: The results suggest that the more complex and integrative action-oriented steps may be the first type of everyday task step to be affected in the process of cognitive decline, with preparatory and concluding steps being preserved longer and only showing decline in later stages of impairment (i.e., dementia). Individuals with sdMCI may use other intact abilities to compensate for task omission errors. [ABSTRACT FROM AUTHOR]

Objective Difficulties managing medications, particularly among older adults experiencing cognitive deficits, is an important contributing factor to medication nonadherence that may have significant negative financial and health outcomes. The current study examined the performance of healthy older adults' (HOA) and individuals with amnestic mild cognitive impairment (aMCI) on the medication management abilities assessment's (MMAA, a performance-based measure of medication management) original scoring criteria and derived error process measures, assessing medication overtaking and undertaking magnitude. Exploratory correlations between performances on the MMAA and self-reported confidence in medication management skills and cognitive abilities were also examined. Method A sample of 25 HOAs with aMCI and 25 age- and education-matched HOAs completed the MMAA, a self-reported medication management confidence rating and a battery of neuropsychological tests. Results HOAs performed significantly better on the MMAA score and committed significantly less process errors than individuals with aMCI. Despite these differences in MMAA performance, the HOA and aMCI groups rated similar high levels of confidence in their ability to manage a new medication routine. Notably, while the HOA group's performance on all of the MMAA measures did not relate to cognitive measures, the aMCI group's performance on the MMAA score was significantly related to memory and executive functioning and a new process error score for overtaking was related to processing speed. Conclusions Although these results present promising potential for the MMAA as a measure of medication management in a clinical setting, further studies need to examine the validity of the MMAA against real-world adherence measures. [ABSTRACT FROM AUTHOR]

Critical thinking when engaged in science problem solving around even simple tasks such as the Piagetian volume conservation task is a complex endeavor. Tasks such as the conservation task often require the interaction of multiple cognitive systems. Parity judgment, retrieval, and lateral thinking are three examples of such systems interacting with critical thinking during a student's attempt to solve the Piagetian task. The purpose of this computational ablation study is to establish the role of critical thinking as a necessary component of a system of cognition used for the completion of the Piagetian volume conservation task. This ablation study consists of three phases. The confidence interval between the ablation model and the elementary students do not overlap, indicating they are not statistically significantly different. This provides evidence that the model successfully emulates aspects of human cognition and the model can provide a robust picture of science student cognitive processes. [ABSTRACT FROM AUTHOR]

Objectives: Accumulating research indicates that engaging in healthy lifestyle behaviors (e.g. exercise, cognitive and social engagement, stress reduction) can prevent illness and disability as people age and improve mental health. The Healthy Aging Activity Engagement (HAAE) scale was developed to holistically assess an individual's level of engagement in healthy aging behaviors across multiple health domains. Methods: Participants were 275 healthy younger, midlife and older adults. Participants rated engagement in 38 healthy aging lifestyle behaviors over the past 7 days on a scale from 1 (strongly disagree) to 5 (strongly agree). Results: Traditional measurement analysis and Rasch modelling techniques resulted in a 32-item scale with three subscales representing biologic health, social and cognitive strategies, and health safeguard behaviors. With the exception of the health safeguard subscale, the HAAE total score and subscales demonstrated good internal consistency, test-retest reliability, convergent and discriminant validity, and responsiveness to a program designed to promote engagement in healthy brain aging behaviors. Discussion: With further validation, the HAAE may be useful for holistic clinical assessment of behaviors that promote healthy aging, support brain and mental health, and for treatment planning. Furthermore, the HAAE can be used to measure the outcome of multi-domain lifestyle interventions. [ABSTRACT FROM AUTHOR]

Background and Objectives Smart home auto-prompting has the potential to increase the functional independence of persons with dementia (PWDs) and decrease caregiver burden as instrumental activities of daily living (IADLs) are completed at home. To improve prompting technologies, we sought to inductively understand how PWDs responded to auto-prompting while performing IADL tasks. Research Design and Methods Fifteen PWDs completed eight IADLs in a smart home testbed and received a hierarchy of verbal auto-prompts (indirect, direct, multimodal) as needed for task completion. Two researchers viewed archived videos and recorded the observed behaviors of the PWDs and their reflections watching the PWDs. Using qualitative descriptive methods, an interdisciplinary analytic team reviewed transcripts and organized data into themes using content analysis. Results Context and Communication emerged as the major themes, suggesting that positive user experiences will require auto-prompting systems to account for a multitude of contextual factors (individual and environmental) such as level of cognitive impairment, previous exposure to task, and familiarity of environment. Communicating with another human rather than an automated prompting system may be important if individuals begin to exhibit signs of stress while completing activities. Discussion and Implications Additional work is needed to create auto-prompting systems that provide specific, personalized, and flexible prompts. Holistic conceptualization of "successful task completion" is needed and a positive end-user experience will be key to utility. Such systems will benefit from including positive reinforcement, training, and exploration of how, and whether, direct human involvement can be minimized during the provision of in-home care. [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: 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]

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]

Background: Difficulties in performing "Instrumental Activities of Daily Living" (IADL) such as managing finances and medications can lead to loss of independence among older adults. Performance‐based assessments allow for an objective and systematic quantification of IADLs utilizing real life paradigms. In an ongoing NIA‐funded study, we evaluated the association of a recently developed performance‐based assessment of functional ability (Night Out Task, NOT, Schmitter‐Edgecombe, 2021) with a performance‐based measure of financial capacity and an informant‐based measure of functional and decision‐making capacity in non‐demented older adults with varying degrees of cognitive impairment. Method: Participants (n = 22; mean age = 76) were classified as healthy control (HC, n = 4), subjective cognitive decline (SCD, n = 9), or mild cognitive impairment (MCI, n = 9) based on clinical criteria. The NOT was used to evaluate the ability to efficiently and accurately plan, multitask and complete eight activities in preparation for a night out. The primary outcome variable for the NOT was completion time. Additionally, participants completed the Financial Capacity Instrument (FCI‐SF‐short form), which assesses financial knowledge and problem‐solving skills (Marson, 2015). Meanwhile, informants completed the Assessment of Functional Capacity Interview (AFCI; Pare et al., 2020) which captures decision making related to home safety, financial, medical, and social competence. Result: NOT scores were normally distributed, as assessed by Shapiro‐Wilk's test (p > 0.05). We observed a statistical trend for group on NOT completion time such that greater clinical impairment was associated with greater completion time: MCI (M = 916.38s, SD = 218.54) > SCD (M = 741.83s, SD = 212) > HC (M = 728.05s, SD = 167.45). Similar trends were observed for other NOT variables. Correct sequencing and overall efficiency of NOT tasks were negatively correlated with AFCI Financial domain, r(21) = ‐0.606 and r(21) = ‐0.487, both P <0.05, respectively. Overall NOT task accuracy was negatively correlated with FCI‐SF Total Score, r(21) = ‐0.528, P <0.05. Conclusion: The NOT showed impressive associations with informant reports of functional and decision‐making capacity and objectively assessed financial capacity. The NOT can potentially distinguish among healthy controls and preclinical dementia groups, offering promise for early detection and characterization of cognitive changes. [ABSTRACT FROM AUTHOR]

Background: American Indians present with increased risk factors for Alzheimer's disease and related dementias (ADRDs). Intraindividual cognitive variability (IICV), which measures the variability in performance on neuropsychological tests within a person at a single time, has been proposed as a noninvasive marker of neurodegeneration and early dementia. In this study, we investigated the hypothesis that higher IICV was related to more features of neurodegeneration on magnetic resonance imaging (MRI) measurements among older American Indians. Method: American Indian participants over 64 years of age who underwent MRI and completed a battery of neuropsychological tests were included in the study (N = 750). Data from three neuropsychological tests were used to compute a multidomain IICV measure of cognition along with IICV measures representing the cognitive domains of memory, executive function and processing speed. Regression models estimated IICV associations with total brain volume, hippocampal volume, and graded white matter disease, adjusting for age, sex, education, BMI, and intracranial volume. Result: Memory, executive function and processing speed, and multidomain IICV measures were associated with total brain volume before correction for multiple comparisons. After correction with Bonferroni, only higher IICV of memory was associated with lower total brain volume (Beta = −0.20; 95%CI −0.332, −0.068; p = 0.009). Furthermore, additional adjustment of mean scores from the tests used for the variability measure resulted in loss of significance for all IICV measures, with only mean scores remaining significant. Measures of IICV were not associated with hippocampal volume or white matter disease. Conclusion: These findings suggest that IICV of memory may be associated with imaging measures related to neurodegenerative injury in older American Indians. However, these associations representing variability in cognition are smaller than those representing mean cognition. More research is needed to understand the clinical and etiologic associations for IICV measures. [ABSTRACT FROM AUTHOR]