Laura A. Cushman

Detecting navigational deficits in cognitive aging and Alzheimer disease using virtual reality.

Background: Older adults get lost, in many cases because of recognized or incipient Alzheimer disease (AD). In either case, getting lost can be a threat to individual and public safety, as well as to personal autonomy and quality of life. Here we compare our previously described real-world navigation test with a virtual reality (VR) version simulating the same navigational environment. Methods: Quantifying real-world navigational performance is difficult and time-consuming. VR testing is a promising alternative, but it has not been compared with closely corresponding real-world testing in aging and AD. We have studied navigation using both real-world and virtual environments in the same subjects: young normal controls (YNCs, n = 35), older normal controls (ONCs, n = 26), patients with mild cognitive impairment (MCI, n = 12), and patients with early AD (EAD, n = 14). Results: We found close correlations between real-world and virtual navigational deficits that increased across groups from YNC to ONC, to MCI, and to EAD. Analyses of subtest performance showed similar profiles of impairment in real-world and virtual testing in all four subject groups. The ONC, MCI, and EAD subjects all showed greatest difficulty in self-orientation and scene localization tests. MCI and EAD patients also showed impaired verbal recall about both test environments. Conclusions: Virtual environment testing provides a valid assessment of navigational skills. Aging and Alzheimer disease (AD) share the same patterns of difficulty in associating visual scenes and locations, which is complicated in AD by the accompanying loss of verbally mediated navigational capacities. We conclude that virtual navigation testing reveals deficits in aging and AD that are associated with potentially grave risks to our patients and the community.

Spatial disorientation in Alzheimer’s disease The remembrance of things passed

Background: Patients with Alzheimer’s disease (AD) and many older adults become lost even in familiar surroundings. This is commonly attributed to memory impairment, but it may reflect impaired spatial cognition. Methods: The authors examined the role of memory, perceptual, and cognitive mechanisms in spatial disorientation by comparing the performance of normal young (YN), middle-aged (MA), older adult (OA), and AD subjects on neuropsychological and spatial orientation tests. Results: The tendency to become lost is shared by almost all patients with AD (93%) and some OA subjects (38%). This impairment is not related to memory impairment. Instead, it reflects an inability to link recognized scenes with locations in the environment. Conclusions: Spatial disorientation reflects the impaired linking of landmarks and routes that should be assessed in conjunction with routine memory testing in elderly patients.

Measuring subjective quality of life following spinal cord injury: a validation study of the assistive technology device predisposition assessment

PURPOSE Assesses the validity of a subset of items of the Assistive Technology Device Predisposition Assessment (ATD PA) as a measure of quality of life (QOL) for persons with new spinal cord injury. METHOD Subjects completed the ATD PA QOL subset, Satisfaction with Life Scale (SWLS), and Brief Symptom Inventory (BSI) while in acute rehabilitation. The internal reliability of the QOL subset of the ATD PA was assessed. Concurrent validity of the ATD PAs QOL subset with the SWLS and construct validity with the BSI depression subscale was assessed using Spearman correlations. Subjects were recruited while acute rehabilitation inpatients in a general hospital and consisted of twenty persons with newly acquired SCI (10 males and 10 females). RESULTS Significant positive correlations between the ATD PAs QOL subset and SWLS (and significant negative correlations with the BSI depression subscale) suggest the QOL subset has concurrent and construct validity. CONCLUSIONS The ATD PAs QOL subset appears to be a valid measure and, thus, it can be useful both in identifying subjective quality of life and predispositions to AT use early in rehabilitation.Purpose: Assesses the validity of a subset of items of the Assistive Technology Device Predisposition Assessment (ATD PA) as a measure of quality of life (QOL) for persons with new spinal cord injury. Method: Subjects completed the ATD PA QOL subset, Satisfaction with Life Scale (SWLS), and Brief Symptom Inventory (BSI) while in acute rehabilitation. The internal reliability of the QOL subset of the ATD PA was assessed. Concurrent validity of the ATD PAs QOL subset with the SWLS and construct validity with the BSI depression subscale was assessed using Spearman correlations. Subjects were recruited while acute rehabilitation inpatients in a general hospital and consisted of twenty persons with newly acquired SCI (10 males and 10 females). Results: Significant positive correlations between the ATD PAs QOL subset and SWLS (and significant negative correlations with the BSI depression subscale) suggest the QOL subset has concurrent and construct validity. Conclusions: The ATD PAs QOL subset appears to be a valid measure and, thus, it can be useful both in identifying subjective quality of life and predispositions to AT use early in rehabilitation.

Montreal Cognitive Assessment and Mini-Mental Status Examination compared as cognitive screening tools in heart failure

BACKGROUND Heart failure (HF) patients run four times the risk of developing cognitive impairment than does the general population, yet cognitive screening is not routinely performed. METHODS This cross-sectional study enrolled 90 community-dwelling adults with HF aged 50 years and above. Participants took the Mini Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA), to measure cognitive function in persons with HF. Participants were predominately men (66%) and Caucasian (78%), aged 50-89 years (62 SD, 9 years), and 77% had an ejection fraction <40%. RESULTS Fifty-four percent of participants scored ≤26 on the MoCA, suggesting mild cognitive impairment (MCI), and 17% scored ≤22, suggesting moderate cognitive impairment, compared with 2.2% on the MMSE. The MoCA scores were lowest for visuospatial/executive domain, short-term memory, and delayed recall. These findings were similar to those in published reports. CONCLUSION These preliminary findings support the use of MoCA for cognitive screening in stable HF.

Psychological assessment in medical rehabilitation.

This text identifies, analyses and compares assessment instruments used in various medical rehabilitative settings, to study such variables as adaptive capacities, cognitive functioning, neurological illness and behaviours elicited by pain.

The sex specificity of navigational strategies in Alzheimer disease.

Alzheimer disease (AD) is associated with navigational impairments that limit functional independence. We have now examined the role of cognitive and perceptual mechanisms in the navigational impairment of AD to test the hypothesis that men and women with AD may focus on different navigational cues. We conducted navigational, neuropsychologic, and psychophysical testing in men and women from 3 groups: older normal controls, patients with mild cognitive impairment, and patients with AD. Men and women showed parallel declines in navigational capacities from the older normal control, to the mild cognitive impairment, to the AD groups with men and women making similar numbers of errors but different types of errors. There were small sex differences in neuropsychologic and psychophysical performance but large sex differences in how those measures related to navigational capacity: men showed strong links between visual motion processing and navigation. Women showed strong links between verbal capacities and navigation. The findings of these cross-sectional comparisons suggest that there may be sex differences in the progressive navigational decline of AD: men and women who are impaired to the same degree may suffer somewhat different patterns of decline with men relying more on visuospatial processing and women relying more on verbal mediation.

A time comparison study of the New York State Safety Belt Use Law utilizing hospital admission and police accident report information

New York state enacted the first safety belt use law in the United States in 1984. We evaluated the effects of the law by reviewing all hospital admissions from motor vehicle crashes in Monroe County, New York. We compared admissions for the 18 months prior to the effective date of the law with those for the 18 months after the law became effective. Police accident reports and hospital records were coupled and intensively reviewed. Motorcyclists, pedestrians, and bicyclists (bicycle collisions with motor vehicles) became controls for the study. Seat belt usage was determined from police and hospital record information. Analysis of the data revealed that safety belt use among patients hospitalized because of motor vehicle accidents increased from 11.2% before the law became effective to 53% after the law became effective. Hospital admissions decreased 11.9% among motor vehicle occupants and increased 2.6% among controls. The ISS decreased from 16.01 to 14.55 for motor vehicle occupants and increased from 14.77 to 15.11 among controls. Among subjects all injuries decreased except injuries of the spine and abdomen, which increased in the postlaw period.

Determining the content for an interactive training programme and interpretive guidelines for the Assistive Technology Device Predisposition Assessment.

Purpose : Develop the content for interpretive guidelines and an interactive training programme for professionals administering the Assistive Technology Device Predisposition Assessment (ATD PA) consumer form, a self-report assessment tool for consumers to identify their perceived functional capabilities and limitations, satisfaction with and priorities for quality of life achievement, psychosocial characteristics and device preferences. Method : Twenty-two professionals (with 1 - 2 consumers each) completed surveys on their use of the ATD PA and recommendations for interpretive guidelines and an interactive training programme. Participants represent eight US states and the country of Italy. Fourteen women and eight men (professionals) participated, and 20% of the sample was comprised of US consumers from Hispanic or African-American ethnic groups. Professionals represented the following disciplines: occupational therapy (n = 1); physical therapy (n = 1); rehabilitation engineering (n = 4); and vocational rehabilitation counselling (n = 16). Additionally, an advisory committee of 14 persons was formed, comprising consumers as well as international AT experts. The committee members prioritized content areas for the training programme and interpretive guidelines. Results/conclusions : Responses strongly support the need for and the continued development of the training programme and interpretive guidelines. Content areas have been identified and prioritized.

Psychiatric Disorders and Motor Vehicle Accidents

The literature has often suggested a relationship between psychiatric illness and increased risk for motor vehicle accidents but few data exist, particularly those from prospective or case-controlled studies. The present study examined detailed accident and injury data from a large series (N = 1778) of motor vehicle crashes that included persons with diagnoses of psychiatric illnesses (n = 17); matched controls were also studied. As expected, drivers with psychiatric diagnoses used psychotropic medications more frequently than did controls. Drivers with psychiatric diagnoses did not have more frequent single-car crashes, unsafe speed or failure to yield violations, or less restraint use than did controls. Such drivers did less often drive motorcycles and tended to be less often cited for alcohol use. Implications of these results for efforts toward prevention and for further study are discussed.

CHARACTERISTICS OF MOTOR VEHICLE ACCIDENTS RESULTING IN SPINAL CORD INJURY

The majority of cases of spinal cord injury (SCI) occur during car crashes. Yet, relatively little is known about the precise accident factors involved. The present study investigated 30 cases of SCI in automobile drivers that occurred in a series of 91 spinal cord injuries. A matched control group was also studied. SCI drivers were not different from controls in terms of mortality, number of rollover crashes, alcohol use, citations for contributing human factors, nighttime accidents, or unfavorable weather and road conditions. However, SCI drivers less frequently used restraints. Results are discussed in terms of preventive measures, specifically, those concerning restraint use, alcohol use, and driving behavior.