Holly Tuokko

The Clock Test: a sensitive measure to differentiate normal elderly from those with Alzheimer disease.

To examine the clinical utility of the Clock Test for identifying dementia.

Mild cognitive impairment and everyday functioning in older adults

The relations between mild cognitive impairment without dementia (MCI/CIND) and everyday functional abilities were examined using data from the Canadian Study of Health and Aging (CSHA). Individuals were identified with MCI/CIND if both caregiver report and clinician judgment agreed on the presence of cognitive impairment in the absence of dementia. Cross-sectional and longitudinal comparisons indicated that individuals with MCI/CIND demonstrated a broad range of impairment in instrumental activities of daily living (IADL) compared to individuals with no cognitive impairment (NCI). In cross-sectional analyses, neuropsychological measures of memory and psychomotor speed were significantly related to impairment in eight areas of functioning. In addition, poorer memory performance was significantly predictive of future impairment in money management. A research personnel award was provided by the Canadian Institutes of Health Research, Institute of Aging, to support HT in the preparation of this manuscript. The Canadian Study of Health and Aging (CSHA) was funded by the Seniors’ Independence Research Program, through the National Health Research and Development Program (NHRDP) of Health Canada (project no. 6606-3954-MC(S)). Additional funding was provided by Pfizer Canada Incorporated through the Medical Research Council/Pharmaceutical Manufacturers Association of Canada Health Activity Program, NHRDP (project no. 6603-1417-302 (R)), Bayer Incorporated, the British Columbia Health Research Foundation (projects no. 38 (93-2) and no. 34 (96-1)). The CSHA was coordinated through the University of Ottawa and the Division of Aging and Seniors, Health Canada.

Vehicle crash involvement and cognitive deficit in older drivers

The driving records of 165 older persons who were classified as having dementia in a clinic assessment were examined in this study. These records were compared with those of a stratified random sample selected from the population of drivers in British Columbia. The dementia group was found to have been involved in over twice the number of collisions as their controls were during identical time periods. Further, over 80% of the dementia group who experienced a crash event (and who were almost all judged at fault) continued driving for up to 3 years following the event, and during this time over one third of these had at least one more accident.

Cognitive impairment with no dementia (CIND): longitudinal studies, the findings, and the issues.

Identification of persons at risk for developing dementia is of increasing importance as the proportion of persons over the age of 65 years grows globally. This review examines the neuropsychological literature specifically addressing the concept of impaired cognitive functioning of insufficient magnitude to warrant a diagnosis of dementia and its meaning with respect to the development of dementia. Although the most obvious finding in the literature is that persons with impaired cognitive functioning have varied outcomes, it is clear that a significant proportion of persons with mild cognitive impairment progress to dementia over a 1- to 2-year interval and approximately 50% progress to dementia by 5 years. The best and most commonly identified predictors of decline to dementia include age and lower baseline performance on neuropsychological measures (e.g., measures of memory). In discussing these findings, issues related to sample definition, sample selection, and methodology are identified and recommendations for future research are provided.

Direct and indirect measurement of physical activity in older adults: a systematic review of the literature

BackgroundDue to physiological and cognitive changes that occur with aging, accurate physical activity (PA) measurement in older adults represents a unique challenge. The primary purpose of this study was to systematically review measures of PA and their use and appropriateness with older adults. A secondary aim was to determine the level of agreement between PA measures in older adults.MethodsLiterature was identified through electronic databases. Studies were eligible if they examined the correlation and/or agreement between at least 2 measures, either indirect and/or direct, of PA in older adults (> 65 years of age).ResultsThirty-six studies met eligibility criteria. The indirect and direct measures of PA across the studies differed widely in their ability to address the key dimensions (i.e., frequency, intensity, time, type) of PA in older adults. The average correlation between indirect and direct measures was moderate (r=0.38). The correlation between indirect and other indirect measures (r=0.29) was weak, while correlations between direct measures with other direct measures were high (real world: r= 0.84; controlled settings: r=0.92). Agreement was strongest between direct PA measures with other direct measures in both real world and laboratory settings. While a clear trend regarding the agreement for mean differences between other PA measures (i.e., direct with indirect, indirect with indirect) did not emerge, there were only a limited number of studies that reported comparable units.ConclusionsDespite the lack of a clear trend regarding the agreement between PA measures in older adults, the findings underscore the importance of valid, accurate and reliable measurement. To advance this field, researchers will need to approach the assessment of PA in older adults in a more standardized way (i.e., consistent reporting of results, consensus over cut-points and epoch lengths, using appropriate validation tools). Until then researchers should be cautious when choosing measures for PA that are appropriate for their research questions and when comparing PA levels across various studies.

Neuropsychological deficits, caregivers' perception of deficits and caregiver burden

We tested three hypotheses about the effects of perceived and actual patient deficits on caregiver burden: (1) objective patient deficits directly influence caregiver burden; (2) caregiver burden is the result of caregiver perceptions of patient deficits; (3) objective patient deficits influence caregiver burden indirectly by determining perceived deficits.

Cognitive decline in high-functioning older adults: reserve or ascertainment bias?

The detection of mild cognitive impairment and dementia in high-functioning older adults can be difficult. It has also been observed that high-functioning persons show a lower prevalence of dementia than low-functioning persons. Three alternative explanations for this observation have been proposed in the literature: brain reserve capacity (BRC), cognitive reserve, and ascertainment bias. With data from a prospective, population-based study of incident dementia, the Canadian Study of Health and Aging (CSHA), we classified participants as being high- (HF) or low-functioning (LF) in three ways: educational and occupational attainment, and estimated premorbid IQ. We observed that fewer HF older adults were diagnosed with dementia after five years, which is in accordance with both the BRC and cognitive reserve models. Contrary to expectations, no difference on rate of memory deterioration was observed between those HF and LF persons who exhibited mild cognitive impairment at CSHA-1. However, HF persons who subsequently were diagnosed with dementia (CSHA-2) showed more rapid decline on five of the six memory measures over time than did LF persons diagnosed with dementia at CSHA-2. When performance on measures of memory functioning at CSHA-1 was examined for highly educated older adults, significantly more of those with dementia at CSHA-2 (n = 59) had scores falling within or below the average range in comparison to normative standards than those who continued to show no cognitive impairment (n = 145). Our findings suggest that the lower incidence of dementia for HF persons may be primarily the result of ascertainment bias, not underlying differences in brain or cognitive reserve.

Caregiver physical and mental health predicts reactions to caregiving

Self-reported health and reactions to providing care to older adults with cognitive or physical impairments were examined. Health status was examined on a single occasion in 177 persons (aged 63–94 years) referred to programs within a comprehensive set of geriatric care services and the 133 family members involved in their care (ages 31–96 years). The five-scale Caregiver Reaction Assessment (CRA) was administered to the family members. Reliability analyses revealed that the CRA had good internal consistency. Being older was related to experiencing greater health problems in the caregiver role. Greater health problems from providing care were reported by caregivers in worse physical health and also when the care recipient had more physical pain. Caregivers who reported fewer health problems attributed to caregiving reported better mental health and less depressive symptomatology. Caregivers with health problems may be at increased risk of suffering from stress from caregiving.

A review of the stereotype threat literature and its application in a neurological population

Stereotype threat is a situational phenomenon, leading to test performance decrements, in which a member of a stigmatized group feels pressured by the possibility of confirming or being judged by a negative stereotype. This review article highlights the progression of research in the stereotype threat field, and its relevance to neurological populations. Early studies focused on demonstrating this effect in African American, women, and elderly populations. Since this time, research has continued to focus on these populations but has moved to elucidating stereotype threat’s mediating psychological factors, studying the impact of individual differences in response to stereotype threat, and attempting to reduce its overall effect. A proposal for further study in neurological populations, under the framework of stereotype threat, comprises the last portion of the paper. It is argued that this social psychological phenomenon may, at least in part, account for poor neuropsychological test performance for neurologically compromised individuals.

The Psychological and Physical Costs of Caregiving: The Canadian Study of Health and Aging

Persons with dementia and their caregivers were randomly identified as part of the Canadian Study of Health and Aging. The current study examines the interrelation among demographic and illness variables relative to various outcomes of caregiving (n = 181). From these analyses, two pairings of canonical variates emerge as significantly correlated: The first suggests an underlying affective construct related to activities of daily living and problematic behaviors; the second reflects a caregiver health construct composed of demographic variables, depressive affect, and diagnosis of the care-recipient. These findings suggest that negative caregiving outcomes may arise within distinct affective and physical health domains. Illness would appear to manifest within either system where a predisposition exists among caregivers faced with specific stressors.