TUESDAY, July 1 (HealthDay News) -- A new questionnaire may help
in both diagnosing older adults facing dementia and also in
identifying individuals who need help with daily living.
The Everyday Cognition instrument consists of 39 questions to be
answered by people who know the patient well.
"There have been a number of studies that show that people with
mild cognitive impairment who have functional problems in addition
to performing poorly on neuropsychological testing are more likely
to progress in the near future," said study author Sarah
Tomaszewski Farias, an assistant professor of neurology at the
University of California, Davis, Medical Center in Sacramento. "One
of our hopes is that this instrument will be able to help identify
very early on those people at increased risk for developing
Alzheimer's disease."
That would help both patients and family members prepare for
what lies ahead and identify patients who need to be more closely
monitored.
In addition, Farias said, the test would also help identify
"people who are having [functional] problems so that we know who
needs help and who doesn't."
"What's nice about this is that it is designed to pick up very
early memory problems, and it's an entirely caregiver-based
survey," said Dr. Scott Turner, incoming director of the Memory
Disorders Program at Georgetown University Medical Center, in
Washington, D.C. "This is something the caregiver can fill out,
while the practitioner is looking at the patient. It could be used
for screening, for diagnosis and for drug development, if you want
to look for some proof that your drug is having some effect, so it
has a lot of potential uses."
"They want something that they could use to ask a family member
about the potential patient's everyday functioning to see if that's
sensitive to picking up the likelihood of dementia early on," added
Dr. Gary J. Kennedy, director of geriatric psychiatry at Montefiore
Medical Center in New York City.
The findings were published in the July issue of
Neuropsychology.
Existing neuropsychological tests tend to be very abstract. For
the last 40 years, these tests have looked at two categories:
so-called "basic" activities (such as grooming, feeding, dressing),
which are affected in later stages of dementia, and "instrumental"
activities of daily living (such as managing medication, finances,
cooking, driving).
"I was interested in understanding how our neuropsychology tests
translated into everyday problems, how our cognitive tests . . .
translate into everyday problems that a person is experiencing and
that a caregiver is concerned about," Farias explained.
Farias and her colleagues divided everyday functioning into
seven cognitive "domains:" memory, language, semantic or factual
knowledge, visual and spatial abilities, planning, organization and
divided attention.
An original list of 138 items was eventually culled to 39, which
was then tested in 576 older adults: 174 of whom were cognitively
normal, 126 who had mild cognitive impairment (MCI), and 276 who
had been diagnosed with dementia.
"Informants" (people who had known the patient for an average of
almost 45 years) provided details on whether the patient could
remember shopping items without a list, reading a map, balancing
the checkbook, and cooking or working and talking at the same
time.
Not only did the instrument confirm established diagnoses, it
was also able to distinguish people with MCI from those with
full-blown dementia, meaning it was able to pick up on subtle
differences in function.
The results also weren't highly influenced by occupation and
education levels, as are existing tests.
"This is really the first step in development the instrument,"
Farias said. "What we're really interested in doing is to track
people over time to get a better understanding of the early signs
of functional impairment."
More information
Visit the
Alzheimer's Association for more on this
condition.