Screening for Functional Cognitive Deficits in Community Dwelling Older Adults
[Thesis]
Al-Heizan, Muhammad Osama
Edwards, Dorothy F.
The University of Wisconsin - Madison
2019
176
Ph.D.
The University of Wisconsin - Madison
2019
Older adults experience subtle cognitive changes that may impact their everyday activities, particularly Instrumental Activities of Daily Living (IADL's). These cognitive deficits may affect functional cognitive abilities in older adults within clinical and community settings. Better and more efficient identification of impaired functional cognition has the potential to result in better quality of care and reduction of the financial burden of hospital readmission. The Menu Task was developed as performance-based screening measure of functional cognition to meet this need. The goal of this dissertation was to establish the psychometric properties for the Menu Task (MT) in community dwelling older adults, as well as to understand the use of self-generated cognitive strategies and its relationship with functional cognition, and to compare two different screening measures (the Montreal Cognitive Assessment [MoCA] and the MT), particularly regarding their ability to predict impairment in functional cognition. Three separate but related studies were conducted to achieve this goal. In the first study, we established psychometric support for the MT as a screening measure of functional cognition. In addition, we found that individuals who were impaired on complex assessments of functional cognition had significantly lower scores on the MT than those unimpaired supporting the validity of the MT. Also, the MT had strong sensitivity in distinguishing between older adults with impaired and intact functional cognition supporting its use as a screening tool in clinical settings. In the second study, we found that individuals impaired on the MT used significantly less self-generated cognitive strategies while completing a complex functional cognitive assessment than those unimpaired controlling for performance efficiency, age, and education. In the third study, we found that individuals unimpaired on the MT had better performance on an established functional cognitive measure despite being mildly impaired on the MoCA. The findings of this dissertation support the use of the MT as a screening measure of functional cognition. Further, we found that a performance-based screening measure such as the MT might be more sensitive and accurate in identifying functional cognitive impairment than a neuropsychological screening measure such as the MoCA. Future research should further explore the clinical utility of the MT in clinical settings and compare the predictive validity of the MT and MoCA to determine the most effective measure of functional cognition across a variety of acute and post-acute settings.