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Naturalistic assessment of everyday functioning in individuals with mild cognitive impairment: the day-out task.

ABSTRACT: The day-out task (DOT), a naturalistic task that requires multitasking in a real-world setting, was used to examine everyday functioning in individuals with mild cognitive impairment (MCI).Thirty-eight participants with MCI and 38 cognitively healthy older adult controls prioritized, organized, initiated, and completed a number of subtasks in a campus apartment to prepare for a day out (e.g., determine and gather change for bus, bring a magazine). Participants also completed tests assessing cognitive constructs important in multitasking (i.e., retrospective memory, prospective memory, planning).As compared with controls, the MCI group required more time to complete the DOT and demonstrated poorer task accuracy, performing more subtasks incompletely and inaccurately. Despite poorer DOT task accuracy, the MCI and control groups approached completion of the DOT in a similar manner. For the MCI group, retrospective memory was a unique predictor of the number of subtasks left incomplete and inaccurate, while prospective memory was a unique predictor of DOT sequencing. The DOT measures, but not the cognitive tests, were predictive of knowledgeable informant report of everyday functioning.THESE findings suggest that difficulty remembering and keeping track of multiple goals and subgoals may contribute to the poorer performance of individuals with MCI in complex everyday situations.

SUBMITTER: Schmitter-Edgecombe M

PROVIDER: S-EPMC3546511 | biostudies-literature | 2012 Sep

REPOSITORIES: biostudies-literature

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Naturalistic assessment of everyday functioning in individuals with mild cognitive impairment: the day-out task.

Schmitter-Edgecombe Maureen M McAlister Courtney C Weakley Alyssa A

Neuropsychology 20120730 5

<h4>Objective</h4>The day-out task (DOT), a naturalistic task that requires multitasking in a real-world setting, was used to examine everyday functioning in individuals with mild cognitive impairment (MCI).<h4>Method</h4>Thirty-eight participants with MCI and 38 cognitively healthy older adult controls prioritized, organized, initiated, and completed a number of subtasks in a campus apartment to prepare for a day out (e.g., determine and gather change for bus, bring a magazine). Participants al ...[more]

PMID: 22846035

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Project description:Studies have suggested that insulin resistance plays a role in cognitive impairment in individuals with type 2 diabetes. We aimed to determine whether an improvement in insulin resistance could explain cognitive performance variations over 36 weeks in older individuals with mild cognitive impairment (MCI) and type 2 diabetes.A total of 97 older individuals (mean +/- SD age 76 +/- 6 years) who had recently (<2 months) started an antidiabetes treatment of metformin (500 mg twice a day) (n = 30) or metformin (500 mg/day)+rosiglitazone (4 mg/day) (n = 32) or diet (n = 35) volunteered. The neuropsychological test battery consisted of the Mini-Mental State Examination (MMSE), Rey Verbal Auditory Learning Test (RAVLT) total recall, and Trail Making Tests (TMT-A and TMT-B) performed at baseline and every 12 weeks for 36 weeks along with clinical testing.At baseline, no significant differences were found between groups in clinical or neuropsychological parameters. Mean +/- SD values in the entire population were as follows: A1C 7.5 +/- 0.5%, fasting plasma glucose (FPG) 8.6 +/- 1.3 mmol/l, fasting plasma insulin (FPI) 148 +/- 74 pmol/l, MMSE 24.9 +/- 2.4, TMT-A 61.6 +/- 42.0, TMT-B 162.8 +/- 78.7, the difference between TMT-B and TMT-A [DIFFBA] 101.2 +/- 58.1, and RAVLT 24.3 +/- 2.1. At follow-up, ANOVA models tested changes in metabolic control parameters (FPI, FPG, and A1C). Such parameters improved in the metformin and metformin/rosiglitazone groups (P(trend) < 0.05 in both groups). ANCOVA repeated models showed that results for the metformin/rosiglitazone group remained stable for all neuropsychological tests, and results for the diet group remained stable for the MMSE and TMT-A and declined for the TMT-B (P(trend) = 0.024), executive efficiency (DIFFBA) (P(trend) = 0.026), and RAVLT memory test (P(trend) = 0.011). Results for the metformin group remained stable for the MMSE and TMTs but declined for the RAVLT (P(trend) = 0.011). With use of linear mixed-effects models, the interaction term, FPI x time, correlated with cognitive stability on the RAVLT in the metformin/rosiglitazone group (beta = -1.899; P = 0.009).Rosiglitazone may protect against cognitive decline in older individuals with type 2 diabetes and MCI.

Project description:IntroductionMild cognitive impairment (MCI) is associated with an increased risk of developing dementia. However, many individuals diagnosed with MCI are found to have reverted to normal cognition on follow-up. This study investigated factors predicting or associated with reversion from MCI to normal cognition.MethodsOur analyses considered 223 participants (48.9% male) aged 71-89 years, drawn from the prospective, population-based Sydney Memory and Ageing Study. All were diagnosed with MCI at baseline and subsequently classified with either normal cognition or repeat diagnosis of MCI after two years (a further 11 participants who progressed from MCI to dementia were excluded). Associations with reversion were investigated for (1) baseline factors that included diagnostic features, personality, neuroimaging, sociodemographics, lifestyle, and physical and mental health; (2) longitudinal change in potentially modifiable factors.ResultsThere were 66 reverters to normal cognition and 157 non-reverters (stable MCI). Regression analyses identified diagnostic features as most predictive of prognosis, with reversion less likely in participants with multiple-domain MCI (p?=?0.011), a moderately or severely impaired cognitive domain (p?=?0.002 and p?=?0.006), or an informant-based memory complaint (p?=?0.031). Reversion was also less likely for participants with arthritis (p?=?0.037), but more likely for participants with higher complex mental activity (p?=?0.003), greater openness to experience (p?=?0.041), better vision (p?=?0.014), better smelling ability (p?=?0.040), or larger combined volume of the left hippocampus and left amygdala (p<0.040). Reversion was also associated with a larger drop in diastolic blood pressure between baseline and follow-up (p?=?0.026).DiscussionNumerous factors are associated with reversion from MCI to normal cognition. Assessing these factors could facilitate more accurate prognosis of individuals with MCI. Participation in cognitively enriching activities and efforts to lower blood pressure might promote reversion.

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Naturalistic assessment of everyday functioning in individuals with mild cognitive impairment: the day-out task.

Publications

Naturalistic assessment of everyday functioning in individuals with mild cognitive impairment: the day-out task.

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