Charles Van Liew

Cognitive performance on the mini-mental state examination and the montreal cognitive assessment across the healthy adult lifespan.

Objective:We sought to compare age-related performance on the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) across the adult lifespan in an asymptomatic, presumably normal, sample. Background:The MMSE is the most commonly used brief cognitive screening test; however, the MoCA may be better at detecting early cognitive dysfunction. Methods:We gave the MMSE and MoCA to 254 community-dwelling participants ranging in age from 20 to 89, stratified by decade, and we compared their scores using the Wilcoxon signed rank test. Results:For the total sample, the MMSE and MoCA differed significantly in total scores as well as in visuospatial, language, and memory domains (for all of these scores, P<0.001). Mean MMSE scores declined only modestly across the decades; mean MoCA scores declined more dramatically. There were no consistent domain differences between the MMSE and MoCA during the third and fourth decades; however, significant differences in memory (P<0.05) and language (P<0.001) emerged in the fifth through ninth decades. Conclusions:We conclude that the MoCA may be a better detector of age-related decrements in cognitive performance than the MMSE, as shown in this community-dwelling adult population.

Usefulness of the Montreal Cognitive Assessment (MoCA) in Huntington's disease.

The Montreal Cognitive Assessment (MoCA) is a brief screening instrument for dementia that is sensitive to executive dysfunction. This study examined its usefulness for assessing cognitive performance in mild, moderate, and severe Huntingtons disease (HD), compared with the use of the Mini–Mental State Examination (MMSE).

Predictors of pain and functioning over time in fibromyalgia syndrome: An autoregressive path analysis

Fibromyalgia is a disabling, chronic pain condition of unknown etiology. Although many factors have been recognized as important contributors to the pain experiences and functional abilities of fibromyalgia patients, the factors that are most impactful (and therefore represent optimal targets for intervention) are still unclear. The aim of the present study was to examine the pathways among depression, self‐efficacy, pain, and physical functioning in a large sample of fibromyalgia patients over a 1‐year timeframe.

The Effects of Self-Efficacy on Depression and Pain in Fibromyalgia Syndrome: Does Initial Depression Matter?

Abstract Objective: Fibromyalgia syndrome [FMS] is a chronic pain condition of unknown etiology. Non-myalgic aspects of the disorder have become increasingly focal in its evaluation. Research has suggested that subgrouping FMS patients based on factors other than pain may abet diagnostic and interventional processes. Self-efficacy and depression are two such constructs that appear to be important in FMS. However, it is not known whether the consequentiality of self-efficacy in FMS is dependent on depression. The present study examined the pathways among depression, self-efficacy and pain, in a large sample of depressed and non-depressed FMS patients over a one-year timeframe to determine whether differential relationships existed. Method: Participants completed assessments of pain intensity, depression and self-efficacy at baseline, 6 months and 1 year as part of an intervention study. Approximately half of the participants met the cutoff for depression in chronic pain populations on the Centers for Epidemiologic Studies Depression Scale. Results: Participants who were depressed at baseline experienced a general decline in pain intensity and depression, whereas depression and pain for non-depressed participants appeared to be far more stable across time. Though self-efficacy was a significant predictor of changes in both pain and depression for depressed participants, self-efficacy did not predict changes in pain for non-depressed participants. Conclusion: Our findings support subgrouping FMS patients based on psychological factors. The results indicated that relationships between pain, depression and self-efficacy differed between depressed and non-depressed participants, implying that individuals with FMS and depression may benefit most from interventions that aim to decrease lability and increase self-efficacy for the most challenging times.

THE FUNCTIONAL IMPLICATIONS OF MOTOR, COGNITIVE, PSYCHIATRIC, AND SOCIAL PROBLEM-SOLVING STATES IN HUNTINGTON'S DISEASE

Objective: Huntingtons disease (HD) is a genetic, neurodegenerative disorder characterized by motor, cognitive, and psychiatric dysfunction. In HD, the inability to solve problems successfully affects not only disease coping, but also interpersonal relationships, judgment, and independent living. The aim of the present study was to examine social problem-solving (SPS) in well-characterized HD and at-risk (AR) individuals and to examine its unique and conjoint effects with motor, cognitive, and psychiatric states on functional ratings. Method: Sixty-three participants, 31 HD and 32 gene-positive AR, were included in the study. Participants completed the Social Problem-Solving Inventory–Revised: Long (SPSI-R:L), a 52-item, reliable, standardized measure of SPS. Items are aggregated under five scales (Positive, Negative, and Rational Problem-Solving; Impulsivity/Carelessness and Avoidance Styles). Participants also completed the Unified Huntingtons Disease Rating Scale functional, behavioral, and cognitive assessments, as well as additional neuropsychological examinations and the Symptom Checklist-90-Revised (SCL-90R). A structural equation model was used to examine the effects of motor, cognitive, psychiatric, and SPS states on functionality. Results: The multifactor structural model fit well descriptively. Cognitive and motor states uniquely and significantly predicted function in HD; however, neither psychiatric nor SPS states did. SPS was, however, significantly related to motor, cognitive, and psychiatric states, suggesting that it may bridge the correlative gap between psychiatric and cognitive states in HD. Conclusion: SPS may be worth assessing in conjunction with the standard gamut of clinical assessments in HD. Suggestions for future research and implications for patients, families, caregivers, and clinicians are discussed.

Honor Thy Parents An Ethnic Multigroup Analysis of Filial Responsibility, Health Perceptions, and Caregiving Decisions

The present study explores patterns of parity and disparity in the effect of filial responsibility on health-related evaluations and caregiving decisions. Participants who identified as White, Black, Hispanic, or Asian/Pacific Islander read a vignette about an older man needing medical care. They were asked to imagine that they were the man’s son and answer questions regarding their likelihood of hiring a health care advocate (HCA) for services related to the father’s care. A multigroup (ethnicity) path analysis was performed, and an intercept invariant multigroup model fits the data best. Direct and indirect effect estimation showed that filial responsibility mediated the relationship between both the perceived severity of the father’s medical condition and the perceived need for medical assistance and the likelihood of hiring an HCA only for White and Hispanic participants, albeit differently. The findings demonstrate that culture and ethnicity affect health evaluations and caregiving decision making.

The Good Life: Assessing the Relative Importance of Physical, Psychological, and Self-Efficacy Statuses on Quality of Well-Being in Osteoarthritis Patients

Background and Purpose. The purpose of the present study was to examine the interrelationships among physical dysfunction, self-efficacy, psychological distress, exercise, and quality of well-being for people with osteoarthritis. It was predicted that exercise would mediate the relationships between physical dysfunction, self-efficacy, psychological distress, and quality of well-being. Methods. Participants were 363 individuals with osteoarthritis who were 60 years of age or older. Data were collected from the baseline assessment period prior to participating in a social support and education intervention. A series of structural equation models was used to test the predicted relationships among the variables. Results. Exercise did not predict quality of well-being and was not related to self-efficacy or psychological distress; it was significantly related to physical dysfunction. When exercise was removed from the model, quality of life was significantly related to self-efficacy, physical dysfunction, and psychological distress. Conclusions. Engagement in exercise was directly related to physical functioning, but none of the other latent variables. Alternatively, treatment focused on self-efficacy and psychological distress might be the most effective way to improve quality of well-being.

Physical function and quality of well-being in fibromyalgia: the applicability of the goodness-of-fit hypothesis.

Objective: The goodness-of-fit hypothesis suggests that the effectiveness of a coping strategy depends on the match between type of strategy (problem-focused, emotion-focused) and the level of perceived control. This hypothesis was examined as a predictor of physical functioning and quality of well-being (QWB) in a large sample of women with fibromyalgia. Methods: Participants were 478 women with diagnosed fibromyalgia (Mage = 54.31, SD = 11.2), who were part of a larger intervention in which no intervention effects were found. Hierarchical, mixed selection regressions were performed to determine whether the relationship between coping and control-predicted physical functioning and QWB. Results: Participants who reported having lower levels of perceived control over their fibromyalgia syndrome and who engaged in more self-controlling coping (emotion-focused strategy) experienced greater QWB and physical functioning than those who used less self-controlling coping. Various main effects for coping and perceived control were also found. Level of physical functioning was also related to escape-avoidance, distancing, and perceived control. The level of QWB was related to social-support seeking, accepting responsibility, distancing, problem-solving, and perceived control. Conclusions: This study provides a greater understanding of the relationships among coping, perceived control, physical functioning, and well-being for women with fibromyalgia. Implications and directions for future research are discussed.

Evaluating Recall and Recognition Memory Using the Montreal Cognitive Assessment Applicability for Alzheimer’s and Huntington’s Diseases

We sought to investigate whether the Montreal Cognitive Assessment (MoCA) could provide a brief assessment of recall and recognition using Huntington disease (HD) and Alzheimer disease (AD) as disorders characterized by different memory deficits. This study included 80 participants with HD, 64 participants with AD, and 183 community-dwelling control participants. Random-effects hierarchical logistic regressions were performed to assess the relative performance of the normal control (NC), participants with HD, and participants with AD on verbal free recall, cued recall, and multiple-choice recognition on the MoCA. The NC participants performed significantly better than participants with AD at all the 3 levels of assessment. No difference existed between participants with HD and NC for cued recall, but NC participants performed significantly better than participants with HD on free recall and recognition. The participants with HD performed significantly better than participants with AD at all the 3 levels of assessment. The MoCA appears to be a valuable, brief cognitive assessment capable of identifying specific memory deficits consistent with known differences in memory profiles.

Caring for a Loved One With Alzheimer’s Disease Views From the Population About Hiring a Health Care Advocate

Objective: Alzheimer’s disease (AD) is associated with considerable caregiver and social burden. It is important to examine ways to minimize the negative effects of AD. Health care advocates (HCAs) may be one means of limiting the aversive effects of AD. Method: Participants completed a short survey that assessed their perceptions of the impact of comorbid AD on health status and their likelihood of hiring an HCA to assist in managing it. A mediational model was proposed: cognitive status (AD vs cognitively healthy) was the independent variable, perception of severity was the mediator, and the probability of hiring an HCA was the dependent variable. Results: The results indicated that the relationship between cognitive status and probability of hiring an HCA was fully mediated by perceptions of severity. Conclusion: This study demonstrated that participants appreciated the impact of AD on health status, and this translated into a greater probability of hiring an HCA.