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P4‐466: The relationship between informant and performance‐based measures of everyday function
Author(s) -
Farias Sarah Tomaszewski,
Mungas Dan,
Reed Bruce
Publication year - 2011
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2011.09.159
Subject(s) - everyday life , dementia , activities of daily living , psychology , cognition , psychological intervention , function (biology) , association (psychology) , gerontology , clinical psychology , disease , cognitive psychology , developmental psychology , medicine , psychiatry , psychotherapist , pathology , evolutionary biology , political science , law , biology
Background: The assessment of everyday function in older adults is important for a number of reasons. Clinically it is important to identify individuals who are having difficulty functioning in their daily life because additional support or a higher level of care may be warranted. Loss of functional abilities is part of the diagnostic criteria for a dementia syndrome and is therefore important for diagnostic purposes. Mild changes in daily function and everyday cognition are also now recognized to frequently occur early in neurodegenerative diseases of aging (i.e. during Mild Cognitive Impairment (MCI)). In fact, the presence of problems in everyday functioning has been associated with more rapidly longitudinal decline and conversion to dementia. As such, the measurement of everyday function also has prognostic value. Finally, everyday function is also a critical outcome in tracking disease progression in clinical contexts and treatment trials. Measures of functional capacity are increasingly being included as endpoints in both pharmacological and non-pharmacological interventions. A variety of methods have been used to measure everyday function. Self report has been used with some success but can be unreliable. Informant ratings of everyday function are likely to be more reliable; other advantages to this method include ease and efficiency of administration and they capitalize on realworld observation. However, concern regarding the validity of informant ratings has been raised given the potential for bias. The present study examines the association between an informant-rated measure of everyday cognition and function, and performance-based measures of functional abilities. Methods: Participants comprised a cognitively heterogeneous group of 78 older adults who underwent evaluation at a university-based Alzheimer’s Disease Research Center. The mean age of the sample was 76.9 (7.0) years and mean education level was 14.9 (3.0) years. 41% of the sample was female and 80% of the sample was Caucasian. All participants received both informant and performance-based measures of everyday function. Informant-ratings of everyday function were based on the ECog (Farias et al. 2007, 2008), which measures everyday cognition across six domains (Everyday Memory, Everyday Language, Everyday Visuospatial abilities, Everyday Planning, Everyday Organization, and Everyday Divided Attention). Performance-based measures of everyday function included two subtests of the UCSD Performance based Skills Assessment (UPSA) (measuring financial skill and the ability to plan for an outing; the ability to read a map was assessed using the Map Reading subtest from the Neuropsychological Assessment Battery (NAB). Performancebased everyday memory was tested using a video presentation of four individual who gave their names and various personal information (i.e. their occupation and a hobby). Results: All correlations between each of the informantand performance-based functional domains were statistically significant, although the magnitude of the relationships varied. The pattern of associations between the informantand performance-based functional measures revealed both general and some domain-specific relationships. For example, recall of information related to ’meeting new people’ (via video presentation) was most strongly correlated with informant ratings in the Everyday Memory domain of the ECog (r 1⁄4 .54); informant ratings of Everyday Memory were less strongly related to the other performancebased functional measures. The performance-based measure related to using a map was most strongly related to informant-ratings of Everyday Visuospatial abilities on the ECog (r 1⁄4 .51) but had relatively lower correlations with informant ratings of Everyday Memory or Everyday Divided Attention (rs 1⁄4 .28 and .30, respectively). Alternatively, the performance-based measures related to financial skills and planning an outing were strongly and about equally associated with informant ratings of Everyday Planning, Everyday Visuospatial abilities and Everyday Language on the ECog (rs ranged from .54 to .46) but had relatively lower correlations with in Everyday Memory, Everyday Organization and Everyday Divided Attention. Conclusions: While the exact domains of everyday function measured by the informantand performance-bases instruments did not perfectly coincide, overall the results suggest that there is substantial overlap in terms of what each method of measurement is capturing. Such findings provide support for the use of informant ratings in situations were performance-based measurement of functional capacity is not possible. However, given that, at best, the correlations were in the moderate range, the most comprehensive approach may be to employ both methods of measuring everyday function when possible.