Well- and ill-defined measures of everyday cognition: relationship to older adults' intellectual ability and functional status

Endorsement of Interpersonal Strategies for Dealing with Hypothetical Everyday Arthritis Problems as a Function of Marital Status, Gender, and Problem Severity

We used hypothetical vignettes to examine whether older adults' endorsement of interpersonal strategies for dealing with health-related (arthritis) everyday problems varied as a function of marital status, gender, and the severity of the problem. Adults 60 years and older ( N = 127, M = 71.40 years, SD = 7.21) rated interpersonal (i.e., discuss with doctor, spouse, relative) and other strategies (e.g., deal with the problem alone, pray) for solving two hypothetical everyday problems (one mild and one severe arthritis problem).

Women reported a greater likelihood of using interpersonal strategies. Married people rated interpersonal strategies that involved their spouse higher than other strategies. Greater severity of problems was associated with greater endorsement of interpersonal strategies. Implications of the results for understanding the conditions under which older adults endorse strategies that may initiate collaborative everyday problem solving are discussed.

Conflict and collaboration in middle-aged and older couples: I. Age differences in agency and communion during marital interaction

Prior theory and research regarding age differences in marital interaction suggest that older couples display and experience more positivity and less negativity than middle-aged couples. However, studies of overt behavior in older couples are relatively rare and have emphasized disagreement, neglecting other important contexts for older couples such as collaboration during everyday problem solving. Further, the affiliation or communion dimension of social interaction (i.e., warmth vs. hostility) is commonly assessed but not the control or agency dimension (e.g., dominance vs. submissiveness). The present study examined affect, cognitive appraisals, and overt behavior during disagreement (i.e., discussing a current conflict) and collaboration (i.e., planning errands) in 300 middle-aged and older married couples. Older couples reported less negative affect during disagreement and rated spouses as warmer than did middle-aged couples. However, these effects were eliminated when older couples' greater marital satisfaction was controlled. For observed behavior, older couples displayed little evidence of greater positivity and reduced negativity-especially women. During collaboration, older couples displayed a unique blend of warmth and control, suggesting a greater focus on emotional and social concerns during problem solving.

Mild cognitive impairment and objective instrumental everyday functioning: the everyday cognition battery memory test

OBJECTIVES

To examine the performance subjects with and without mild cognitive impairment (MCI) on an objective measure of everyday or real-world memory and subjective items assessing competency within the same instrumental domains; to determine whether the Everyday Cognition Battery (ECB) can uniquely predict MCI status.

DESIGN

Cross-sectional.

SETTING

Independent-living sample of urban dwelling elders in Baltimore Maryland.

PARTICIPANTS

The sample consisted of 555 subjects ranging in age from 50 to 95 (mean 68.8 +/- 9.6).

MEASUREMENTS

Objective performance in three instrumental domains (medication use, financial management, nutrition and food preparation) was assessed using the ECB Memory Test. Subjective performance within the same instrumental domains was also assessed.

RESULTS

No difference was found between elderly subjects with and without MCI on the subjective items of instrumental activity of daily living (IADL) competency. A significant multivariate effect for cognitive status group (F(3, 507)=21.88, P<.05, eta(2)=.12) was observed for the objective measure, with participants with MCI performing, on average, significantly worse than those without on all thee instrumental domain subscales. The medicine use (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.94-0.99) and financial management (OR=0.93, 95% CI=0.91-0.96) subscales of the ECB Memory Test were unique and significant predictors of MCI.

CONCLUSION

This study adds to the growing body of literature suggesting that cognitively complex IADLs might be compromised in elderly people with MCI. Moreover, the ECB Memory Test might be a clinically useful tool in evaluating real-world competency.

Daily Physical Activity: Relation to Everyday Memory in Adulthood

We examined the relationship between daily physical activity and everyday memory using an eight-day diary design with young, middle-aged, and older adults. Contrary to expectations, age differences were not reported in the frequency of memory failures and daily physical activity at the between-person level. Multilevel modeling, however, indicated that on days when adults engaged in leisure exercise (physical activity performed during leisure or free time) they reported fewer memory failures, and this was most apparent for older adults. Lagged analyses indicated that when leisure activity was reported on one day, fewer memory failures were reported the next day, and this was especially true for older adults. Thus, findings demonstrate that the benefits of physical activity for memory in later life are observable on a short-term daily basis.

The Apartment Test: validity of a memory measure

The Memory in Reality (MIR) test, or Apartment Test, was designed as an ecologically valid alternative to word list recall measures. Participants name 10 everyday objects, place them in a scale model of an apartment and after a delay with interference, recall the objects and their placement. Two studies are reported. Study 1 included 51 older adult volunteers. Study 2 was a population-based sample of 633 older twins. The Apartment Test Recall and Placement tasks were highly correlated with word list delayed recall. Ecological validity was supported by correlations with informant reports of participants' functioning. Apartment Test Recall was not affected by education. Analysis of Receiver Operating Characteristics (ROC) showed Apartment Test Recall performed as well as word list delayed recall in distinguishing participants with and without dementia. We conclude that the Apartment Test is a valid measure of verbal memory with evidence of ecological and concurrent validity.

Examining the association between lung functioning and cognitive performance in African American adults

The current study examined the extent to which pulmonary functioning, as measured by average peak expiratory flow, was related to performance on seven cognitive measures. Analyses were conducted on a sample of 396 African American adults ranging in age from 22 to 89 years.

RESULTS

Lung functioning was not uniquely associated with cognitive performance in the younger adults, though it emerged as a significant predictor of individual differences in performance on the Telephone Interview of Cognitive Status even after controlling for age, education, and smoking history. Biobehavioral assessments such as the one presented here appear to provide important new insights into the sources of individual differences in cognition observed in this understudied population.

Effect of a structured course involving goal management training in older adults: A randomised controlled trial

OBJECTIVE

The objective of this study was to investigate the effects of a structured 6-week neuropsychological course on the executive functioning of older adults with cognitive complaints.

METHODS

A randomised controlled design was used involving 69 community dwelling individuals aged 55 years and older. Both objective and subjective measures were included to assess executive functioning. General linear model with repeated measures analysis of variance was used to examine the intervention effects.

RESULTS

After the intervention, the participants in the intervention group were significantly less annoyed by their cognitive failures, were better able to manage their executive failures and reported less anxiety symptoms than those in the waiting list control group.

CONCLUSION

These findings indicate that a combination of psycho-education and training has the potential to change the attitude of older individuals towards their cognitive functioning.

PRACTICE IMPLICATIONS

Because this training focussed on cognitive functions that are among the first to decline in older adults and the subjective evaluation of the people after training was quite favourable, the proposed intervention may be considered a valuable contribution to cognitive interventions for older adults.

Long-term effects of cognitive training on everyday functional outcomes in older adults

CONTEXT

Cognitive training has been shown to improve cognitive abilities in older adults but the effects of cognitive training on everyday function have not been demonstrated.

OBJECTIVE

To determine the effects of cognitive training on daily function and durability of training on cognitive abilities.

DESIGN, SETTING, AND PARTICIPANTS

Five-year follow-up of a randomized controlled single-blind trial with 4 treatment groups. A volunteer sample of 2832 persons (mean age, 73.6 years; 26% black), living independently in 6 US cities, was recruited from senior housing, community centers, and hospitals and clinics. The study was conducted between April 1998 and December 2004. Five-year follow-up was completed in 67% of the sample.

INTERVENTIONS

Ten-session training for memory (verbal episodic memory), reasoning (inductive reasoning), or speed of processing (visual search and identification); 4-session booster training at 11 and 35 months after training in a random sample of those who completed training.

MAIN OUTCOME MEASURES

Self-reported and performance-based measures of daily function and cognitive abilities.

RESULTS

The reasoning group reported significantly less difficulty in the instrumental activities of daily living (IADL) than the control group (effect size, 0.29; 99% confidence interval [CI], 0.03-0.55). Neither speed of processing training (effect size, 0.26; 99% CI, -0.002 to 0.51) nor memory training (effect size, 0.20; 99% CI, -0.06 to 0.46) had a significant effect on IADL. The booster training for the speed of processing group, but not for the other 2 groups, showed a significant effect on the performance-based functional measure of everyday speed of processing (effect size, 0.30; 99% CI, 0.08-0.52). No booster effects were seen for any of the groups for everyday problem-solving or self-reported difficulty in IADL. Each intervention maintained effects on its specific targeted cognitive ability through 5 years (memory: effect size, 0.23 [99% CI, 0.11-0.35]; reasoning: effect size, 0.26 [99% CI, 0.17-0.35]; speed of processing: effect size, 0.76 [99% CI, 0.62-0.90]). Booster training produced additional improvement with the reasoning intervention for reasoning performance (effect size, 0.28; 99% CI, 0.12-0.43) and the speed of processing intervention for speed of processing performance (effect size, 0.85; 99% CI, 0.61-1.09).

CONCLUSIONS

Reasoning training resulted in less functional decline in self-reported IADL. Compared with the control group, cognitive training resulted in improved cognitive abilities specific to the abilities trained that continued 5 years after the initiation of the intervention.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00298558.

Competence in everyday activities as a predictor of cognitive risk and mortality

This study examined the association of a performance-based measure of everyday functioning with clinically meaningful outcomes. Elderly participants in a prospective study of dementia were assessed at two occasions on the Everyday Problems Test for Cognitively Challenged Elderly (EPCCE), a performance-based measure of everyday functioning. Older adults who remained cognitively intact performed approximately 0.66 SD units higher on the EPCCE at both occasions than elders rated as impaired, when covarying on age, education, gender, and cognitive status. Relative to the nonimpaired participants, decline in EPCCE performance over a 2-year interval was significantly greater for impaired participants and those participants who transitioned from nonimpaired to impaired over the course of the study. Increased risk of mortality was associated with lower baseline scores and decline in EPCCE performance even after controlling for demographic variables and performance on the Mini-Mental State Examination. Given the clinical importance of identifying "at risk" elders for impairment, the findings from this study provide initial evidence for the predictive utility of performance-based measures of everyday functioning.

Executive function, working memory, and medication adherence among older adults

The purpose of this study was to investigate the association between cognitive processes and medication adherence among community-dwelling older adults. Ninety-five participants (M = 78 years) completed a battery of cognitive assessments including measures of executive function, working memory, cued recall, and recognition memory. Medication adherence was examined over 8 weeks for one prescribed medicine by use of an electronic medication-monitoring cap. In a simultaneous regression, the composite of executive function and working memory tasks was the only significant predictor (beta =.44, p <.01). Findings suggest that assessments of executive function and working memory can be used to identify community-dwelling older adults who may be at risk for failure to take medicines as prescribed.

Contributions of processing ability and knowledge to verbal memory tasks across the adult life-span

This study investigated the relationships of processing capacity and knowledge to memory measures that varied in retrieval difficulty and reliance on verbal knowledge in an adult life-span sample (N = 341). It was hypothesized that processing ability (speed and working memory) would have the strongest relationship to tasks requiring active retrieval and that knowledge (vocabulary ability) would be related to verbal fluency and cued recall, as participants relied upon verbal knowledge to retrieve category items (fluency) or develop associations (cued recall). Measurement and structural equation models were developed for the entire sample and separately for younger (aged 20-54 years, n = 168) and older (aged 55-92 years, n = 173) subgroups. In accordance with the hypotheses, processing ability was found to be most highly related to free recall, with additional significant relationships to cued recall, verbal fluency, and recognition. Knowledge was found to be significantly related only to verbal fluency and to cued recall. Moreover, knowledge was more important for older than for younger adults in mediating variance in cued recall, suggesting that older adults may use age-related increases in knowledge to partially compensate for processing declines when environmental support is available in memory tasks.

Everyday competence and depressive symptoms: social support and sense of control as mediators or moderators?

Depression is common among the elderly members of Hong Kong Chinese society. The objectives of the present study are to assess the relationship between everyday competence and depressive symptoms and to test whether sense of control and social support mediate and moderate the impact of deterioration in everyday competence on depressive symptoms. The respondents were 393 people aged 60 years and older from a cross-sectional study of a representative community sample of the elderly population in Hong Kong and they were interviewed using a structured questionnaire. In multiple regression analyses, we found that everyday competence was significantly and negatively related to depressive symptoms (beta = -0.26, p < 0.01) after we had adjusted age, gender, marital status, years of education, self-rated health status, and number of chronic illnesses. Moreover, both sense of control and social support were mediators in the linkage between everyday competence and depression. However, neither sense of control nor social support moderated the effect of everyday competence on depression. Findings suggest that both sense of control and social support play important roles in the relationship between everyday competence and depression.

Age Differences in Everyday Problem-Solving and Decision-Making Effectiveness: A Meta-Analytic Review

The authors report a meta-analysis of age differences in everyday problem-solving/decision-making effectiveness (EPSE). Effect sizes were calculated to reflect 3 age group comparisons: old versus young, young versus middle-aged, and middle-aged versus old. Findings from the meta-analysis of 28 separate studies with an aggregate of 4,482 participants do not support theories of preserved EPSE in late adulthood. Although significant age differences of moderate magnitude persisted across methodological and theoretical domains, rating criteria (experimenter vs. participant) emerged as a significant moderator of the effect magnitude and direction. In addition, EPSE in older adults was bolstered when problem content was interpersonal and when samples were highly educated. Finally, the current results support the conceptual integration of findings from the everyday problem-solving and everyday decision-making literatures.

The Revised Observed Tasks of Daily Living: A Performance-Based Assessment of Everyday Problem Solving in Older Adults

The Revised Observed Tasks of Daily Living (OTDL-R), a performance-based test of everyday problem solving, was administered to a sample of community-dwelling older adults. The OTDL-R included nine tasks, representing medication use, telephone use, and financial management. The OTDL-R had a desirable range of difficulty and satisfactory internal consistency and showed a relatively invariant pattern of relations between measured tasks and the underlying latent dimensions they represent across White and non-White subsamples. The OTDL-R also correlated significantly with age, education, self-rated health, a paper-and-pencil measure of everyday problem solving, and measures of basic cognitive functioning. Thus, the OTDL-R is a reliable and valid objective measure of everyday problem solving that has great practical utility for assessing performance in diverse populations.

Relationships among health factors and everyday problem solving in african americans

This study examined whether measures of health status enhance the prediction of performance on everyday problem solving in adult African Americans. The sample consisted of 209 community-dwelling African American adults with a mean age of 66.82 years (SD=7.95). The following variables were included in the analysis: Everyday Problems Test (EPT), summary index of chronic illnesses (cardiovascular disease, hypertension, arthritis, stroke, and diabetes), self-rated health (current health, health in the past month, health compared with others, health compared with 5 years ago), and demographic information. Using hierarchical regression and follow-up communality analysis, the authors found that the number of chronic illnesses and self-rated health as compared with 5 years prior were significant and unique predictors of performance on the EPT but did not account for all of the demographic-related variance. The results indicate that health indices contribute to the variability in everyday cognition in this understudied population.

Perceived self-efficacy and everyday problem solving among young and older adults

This research tested the hypothesis that age differences in both self-efficacy perceptions and problem-solving performance would vary as a function of the ecological relevance of problems to young and older adults. The authors developed novel everyday problem-solving stimuli that were ecologically representative of problems commonly confronted by young adults (young-adult problems), older adults (older adult problems), or both (common problems). Performance on an abstract problem solving task lacking in ecological representativeness (the Tower of Hanoi problem) also was examined. Although young persons had higher self-efficacy beliefs and performance levels on the Tower of Hanoi task problem and the young-adult problems, this pattern reversed in the domain of older adult problems, where the self-efficacy beliefs and performance of older persons exceeded those of the young.