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Posted: July 08, 2008

New Survey Helps Caregivers Evaluate Elderly's Cognitive State

A new questionnaire, when filled out by a family caregiver, can evaluate the performance of an elderly loved one’s everyday activities that reflect their basic mental functioning, guiding treatment if necessary, according to a report in the journal Neuropsychology.


Development of tools such as Everyday Cognition – or ECog -- is important as more adults age into the high-risk period for cognitive impairment. ECog’s developers say their survey gives clinicians a simple and reliable method to identify where an elderly patient they may have problems in everyday life that reveal underlying changes in the brain.


Such activities as keeping track of things, sorting the mail, following a conversation, shopping for a few things without a list, or finding the car in a parking lot, if compromised, could signal the risk for or presence of disease.


As a result, ECog was developed to give the medical community, in conjunction with family members, a means of quick and easy identification of mild functional problems in older adults -- especially useful in primary-care settings, where dementia and its early warning signs are frequently missed.


Seven California academic and Veterans Administration psychologists teamed up to develop and validate this new 39-question screening tool.


The team first collected data on everyday functioning and mental status for 576 older adults, with an average age of nearly 77, who were evaluated at the University of California’s Alzheimer’s Disease Research Center. Of these, 174 were diagnosed as cognitively normal, 126 were diagnosed with mild cognitive impairment, and 276 were diagnosed with dementia.


Co-authors Sarah Tomaszewski Farias, PhD, and Dan Mungas, PhD, of the University of California, Davis, also interviewed neurologists, nurses, neuron-psychologists and other professionals who work with people with dementia.


Building on their insights, Farias and her colleagues generated items describing everyday function in seven key cognitive domains: memory, language, semantic (factual) knowledge, visuo-spatial abilities, planning, organization and divided attention. Through pilot studies, they narrowed an initial list of 138 items to the 39 items used in the ECog validation study.


Family caregivers and close friends of the survey participants were used to validate the survey. They knew the participants on average for nearly 45 years and were with them for an average of 75 hours a week. About half the caregivers were spouses, 41% were adult children, and the rest were other family members or friends. The average caregiver was nearly 62 years old and nearly three in four were women.


The authors relied on caregivers rather than patients because people with dementia lose awareness of their problems. The authors also relied on observation by caregivers rather than by clinicians because performance assessments, such as watching someone make a peanut-butter-and-jelly sandwich, can be artificial and time-consuming. At the same time, the authors sought to improve on previous caregiver-based measures, which have been unable to detect mild impairment or track change over time.


The research team said ECog was proven to be valid in several ways. First, its results appeared to measure the same things as established tests, a sign of convergent validity. Second, its results “agreed” with participants’ medical diagnoses, a sign of external validity.


By differentiating among people with normal cognition, mild cognitive impairment (MCI), and dementia, ECog is sensitive to the early functional changes present in MCI. Thus, the authors believe, the ECog shows great promise as a useful screening measure for detecting individuals at increased risk for developing dementia. What’s more, its results do not appear to be strongly influenced by the role of education, as is the case in other cognitive tests.


ECog’s results even differentiated between people diagnosed with mild impairment in memory only and those mildly impaired in several areas. This sensitivity could help with differential diagnosis of underlying brain disease.


Because ECog is sensitive to early functional problems, the researchers hope it will shed light on how functional problems emerge and, over time, lead to obvious disability. More immediately, they said ECog can help clinicians diagnose cognitive impairment more effectively and to better understand the “limits, care needs and interventions appropriate to individuals.”

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