Neuropsychological Correlates of Performance Based Functional Status in Elder Adult Protective Services Referrals for Capacity Assessments

Development of the Telephone-based Daily Instrumental Activities of Living (T-DIAL) to assess financial management remotely in older adults

The current study evaluated the reliability and validity of a novel, performance-based banking task in 60 younger (18-34 years) and 60 older (50-85 years) adults. All participants completed the Telephone-based Daily Instrumental Activities of Living (T-DIAL) using interactive voice response technology to complete a series of mock actions with a financial institution via telephone. The T-DIAL showed strong inter-rater reliability and internal consistency. T-DIAL accuracy was significantly and independently related to better self-reported instrumental activities of daily living and executive functions at a large effect size. Findings from this study provided preliminary supportive evidence for the reliability and validity of the T-DIAL, which had robust associations with manifest everyday functioning and higher-order cognitive ability. Future work is needed on the psychometrics (e.g. test-retest reliability, normative standards), and construct validity (e.g. diagnostic accuracy) of the T-DIAL in neurocognitive disorders and under-served communities for whom remote evaluations might be particularly relevant.

Effects of Information and Communication Technology Use on the Executive Function of Older Adults without Dementia: A Longitudinal Fixed-Effect Analysis

BACKGROUND

Impaired executive function is common in older adults. This study examined the causal relationship between the use of information and communication technology (ICT) and executive function in older adults over time.

METHOD

This study performed a secondary analysis of data from four waves (2016-2019) of the National Health and Aging Trends Study. A fixed-effect analysis was conducted to examine the effects of ICT on the executive function of older adults without dementia aged ≥65 years. This study analyzed data from 3,334 respondents.

RESULTS

We observed significant positive effects of ICT use on executive function over time (standardized β=0.043-0.045; 95% confidence interval, 0.001-0.043; p<0.05).

CONCLUSION

The current findings support the use of ICT as a protective approach to prevent decline in executive function in community-dwelling older adults.

Branching Condition of the Color-Word Interference Test Enhances Prediction of Meta-Tasking in Community-Dwelling Older Adults

OBJECTIVES

Meta-tasking (MT) is an aspect of executive functioning (EF) that involves the ability to branch (i.e., to apply "if-then" rules) and to effectively interleave sub-goals of one task with sub-goals of another task. As such, MT is crucial for successful planning, coordination, and execution of multiple complex tasks in daily life. Traditional tests of EF fail to adequately measure MT. This study examined whether Condition 4 of the Color-Word Interference Test (CWIT-4; the inhibition/switching condition that requires branching) predicted MT beyond Condition 3 (CWIT-3; inhibition-only condition) and beyond other subtests from the Delis-Kaplan Executive Function System (D-KEFS) that have a switching condition.

METHOD

Ninety-eight non-Hispanic white community-dwelling older adults completed the first four subtests of the D-KEFS and an ecologically valid measure of MT.

RESULTS

Time to completion and total errors on CWIT-4 accounted for variance in MT above and beyond CWIT-3 and beyond the switching conditions of other D-KEFS subtests. Results remained virtually unchanged when controlling for demographics and general cognitive status.

CONCLUSIONS

Among older adults, CWIT-4 is more strongly associated with MT than other D-KFES tasks. Future research should examine whether CWIT-4 relates to lapses in instrumental activities of daily living among older adults above and beyond other EF tests.

Decisional Capacity and Personality Disorders: Substantially Unable or Substantially Unwilling?

Capacity assessments are performed when there is suspicion that a person is unable to adequately care for their physical, medical, or financial well-being. The purpose of these assessments is to inform the legal system as to whether or not guardianship may be necessary. It is well established that certain mental illnesses, such as neurocognitive disorders (dementia) or psychotic disorders (like schizophrenia), may diminish capacity and, in some cases, lead to the need for establishment of a legal guardian. However, personality disorders are another common category of mental illness which may impair decision-making. There is very little information in the literature about how or why these disorders could impair capacity, and thus, it can often be difficult to discern whether clients with personality disorders are substantially unable to care for themselves-versus unwilling to act in a way contrary to their ingrained habits. We present a series of three cases in which clients are determined to lack capacity primarily mediated by a personality disorder diagnosis. They are demonstrated to have mild deficits in cognitive functioning, but they show impaired decision-making out of proportion to these deficits. In all three cases, it is apparent that the personality disorder is substantially impairing their ability to care for themselves. Discussion includes consideration for ways to incorporate evaluations of cognitive function, activities of daily living, and personality considerations into capacity assessments, and how to approach recommendations (such as guardianship vs. less restrictive option) based on both level and scope of impairment.

Development and Validation of a Performance-Based Test to Assess Instrumental Activities of Daily Living in Spanish Older Adults

Abstract. A key feature of the autonomy and quality of life of the elderly is their ability to perform instrumental activities of daily living (IADLs). When older people have difficulty in performing IADLs, many of their social and community activities may be affected, leading to their progressive isolation from society. This study describes the development and validation of a test that assesses six areas of daily functioning in the elderly: use of medication and healthcare management, administrative, financial management, transportation, meal preparation, and shopping. The study evaluated 164 healthy individuals without cognitive impairment using an extensive cognitive battery. The construct validity and reliability of test were examined. Findings revealed a good internal consistency and high inter-rater and test-retest reliability. As for construct validity, the instrument tasks were grouped into two dimensions, based on the cognitive components involved in each task: fluid and episodic memory tasks and crystallized tasks. The developed instrument may be useful for evaluating IADLs in those elderly who live at home and are somewhat dependent.

Neurobiological Mediators of Squalor-dwelling Behavior

Squalor-dwelling behavior has been characterized as living in conditions so unsanitary that feelings of revulsion are elicited among visitors. This behavior is commonly associated with an insensitivity to distress/disgust and a failure to understand the direness of one's living situation, which leads to social isolation and impairment in quality of life. Etiologically, several associations have been described in the literature, including age-related decline, lower socioeconomic status, and rural dwelling status. Primary neuropsychiatric disorders, such as psychosis, alcoholism, dementia, personality disorders, developmental delays, and learning or physical disabilities are frequently seen in squalor-dwelling individuals. However, none of these disorders seems to be necessary or sufficient to explain the behavior. Neurobiologically, squalor-dwelling behavior has been associated with frontal lobe dysfunction as evidenced by executive dysfunction; however, cognitive impairments also fail to completely explain this behavior. The purpose of this report is to describe a typical case of squalor-dwelling behavior and use it as an example to illustrate the complexity of uncovering the neurobiological basis for this maladaptive personal and public health threat. Neuroimaging findings from our case and a review of the literature point toward decreased activity in the insular cortex and the amygdala as a unifying biological explanation for squalor-dwelling behaviors.

Clock Copying Predicts Mortality in Adult Protective Services Clients

OBJECTIVE

The objective of this study was to determine if a clock copying task predicts 18-month mortality in an Adult Protective Services (APS) sample referred for a decision-making capacity assessment.

METHODS

The authors performed a retrospective medical record review of clients (N = 233) referred by APS for a decision-making capacity assessment during a 3-year time period. Information extracted included demographic data and neuropsychological performance on a battery sensitive to executive function, visuospatial ability, depression, memory, and general cognition. A Cox proportional hazards models was constructed to determine the relationship between Executive Clock Drawing Task Part 2 (CLOX2) performance and survival.

RESULTS

Poor clock copying, as measured by CLOX2, predicted 18-month mortality when covaried for age, education, sex, rural dwelling status, depression, and general cognition.

CONCLUSIONS

Clock copying is an easily administered visuospatial task that may inform survival in this vulnerable population.

Cognitive profiles of elder adult protective services clients living in squalor

The purpose of this study was to determine whether squalor-dwelling Adult Protective Services (APS) clients were more cognitively impaired than non-squalor-dwelling APS clients referred for decision-making capacity assessments. The authors performed a retrospective medical record review of neuropsychological and demographic data gathered during decisional capacity assessments. Squalor dwelling was defined by unsanitary living conditions that posed a danger to the occupant's health or safety. Mean neuropsychological test scores were compared between squalor-dwelling (n = 50) and non-squalor-dwelling (n = 180) subjects. Squalor-dwelling clients were significantly younger than non-squalor-dwelling clients. There were no distribution differences among gender, education, race, or rural-dwelling status. Although both groups performed poorly on each neuropsychological measure, squalor dwellers demonstrated better memory and general cognitive performance. Cognition, depression, gender, race, education, dementia diagnosis, and rural-dwelling status seem insufficient to explain squalor-dwelling behaviors. Other biological and psychosocial variables should be considered.