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New ‘Everyday Cognition’ Scale tracks
how
Older Adults function in daily life
Newswise — As more adults age
into the high-risk period for cognitive
impairment, clinicians need simple and
reliable methods to identify where they may
have problems in everyday life that reveal
underlying changes in the brain.
A new, carefully validated
questionnaire called Everyday Cognition (ECog),
when filled out by someone who knows an
older adult well, can sensitively evaluate
the performance of everyday activities that
reflect basic mental functioning, according
to a report in the July issue of
Neuropsychology, published by the American
Psychological Association.
Keeping track of things,
sorting the mail, following a conversation,
shopping for a few things without a list,
finding the car in a parking lot –
activities such as these, if compromised,
could signal the risk for or presence of
disease.
The quick and easy
identification of mild functional problems
in older adults could be extremely useful in
primary-care settings, where dementia and
its early warning signs are frequently
missed.
Seven academic and Veterans
Administration psychologists, led by
co-authors Sarah Tomaszewski Farias, PhD,
and Dan Mungas, PhD, of the University of
California, Davis, 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, averaging nearly 77
years old, who were evaluated at the
University of California’s Alzheimer’s
Disease Research Center.
Of these individuals, 174
were diagnosed as cognitively normal, 126
were diagnosed with Mild Cognitive
Impairment (which often develops into
dementia), and 276 were diagnosed with
dementia (progressive cognitive decline).
The authors also interviewed
neurologists, nurses, neuropsychologists 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, visuospatial
abilities, planning, organization and
divided attention.
Through pilot studies, they
narrowed an initial list of 138 items to the
39 items used in the validation study.
To validate the instrument,
the new rating scales were completed by
reliable informants, people who lived with
or knew the patients well.
They knew them on average for
nearly 45 years and were with them for an
average of 75 hours a week.
About half the informants
were spouses; 41 percent were adult
children; the rest were other family members
or friends. The average informant was nearly
62 years old and nearly three in four were
women.
The authors relied on
informants rather than patients because
people with dementia lose awareness of their
problems.
The authors also relied on
observation by informants 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
informant-based measures, which have been
unable to detect mild impairment or track
change over time – a “must” for progressive
disorders.
The ECog was shown 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, the ECog was
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.
The 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 the ECog is sensitive
to early functional problems, the
researchers hope that it will shed light on
how functional problems emerge and, over
time, lead to obvious disability.
More immediately, the ECog
can help clinicians to diagnose cognitive
impairment more effectively and to better
understand the “limits, care needs and
interventions appropriate to individuals.”
For example, making
more lists, relying more on calendars and
timers, learning memory techniques for new
names, or organizing household papers in a
new way might enable independent functioning
for a longer length of time.
Article: “The Measurement of
Everyday Cognition (ECog): Scale Development
and Psychometric Properties,” Sarah
Tomaszewski Farias, PhD, and Dan Mungas,
PhD, University of California, Davis; Bruce
R. Reed, PhD, University of California,
Davis, and Veterans Affairs Northern
California Health Care System; Deborah
Cahn-Weiner, PhD, University of California,
San Francisco; William Jagust, MD, School of
Public Health and Helen Willis Neuroscience
Institute, University of California,
Berkeley; Kathleen Baynes, PhD, University
of California, Davis, and Veterans Affairs
Northern California Health Care System; and
Charles DeCarli, MD, University of
California, Davis; Neuropsychology, Vol. 22,
No. 4.
The American Psychological Association (APA),
in Washington, DC, is the largest scientific
and professional organization representing
psychology in the United States and is the
world’s largest association of
psychologists.
APA’s membership includes
more than 148,000 researchers, educators,
clinicians, consultants and students.
Through its divisions in 54
subfields of psychology and affiliations
with 60 state, territorial and Canadian
provincial associations, APA works to
advance psychology as a science, as a
profession and as a means of promoting human
welfare.
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