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Objectives In Alzheimer's Disease (AD) research, choosing appropriate method for measuring change in cognitive function over time can be challenging. The aim for this study was to examine the sensitivity of four neuropsychological tests used to measure cognition during the transition from mild cognitive impairment (MCI) to AD, and the impacts of associated covariates. Methods We enrolled 223 patients with MCI who progressed to AD and had completed multiple follow-up assessments in the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. We constructed nonlinear mixed model for multivariate longitudinal data assuming that multiple neuropsychological tests would exhibit nonlinear transformation of a common factor in the latent cognitive process underlying the progression from MCI to AD. Results The Clinical Dementia Rating-Sum of the Boxes (CDR-SB) and Alzheimer's Disease Assessment Scale (11 items; ADAS-11) were more sensitive to cognitive changes in individuals with higher cognitive function, the Functional Activities Questionnaire (FAQ) was more sensitive to cognitive changes in individuals with middle cognitive function, and the Mini-Mental State Examination (MMSE) was more sensitive to cognitive changes in individuals with lower cognitive function. Gender (p = 0.0139) and educational level (p = 0.0094) had varying effects on different tests, such that men performed better on the FAQ and CDR-SB, and individuals with higher educational level tended to perform better on the FAQ and MMSE. Conclusions When choosing appropriate neuropsychological tests in cognitive measurements, the cognitive functional level of the patient as well as the impacts of covariates should be considered.

Background: Progression trajectories of patients with mild cognitive impairment (MCI) are currently not well understood. Objective: To classify patients with incident MCI into different latent classes of progression and identify predictors of progression class. Methods: Participants with incident MCI were identified from the US National Alzheimer’s Coordinating Center Uniform Data Set (09/2005-02/2019). Clinical Dementia Rating (CDR®) Dementia Staging Instrument-Sum of Boxes (CDR-SB), Functional Activities Questionnaire (FAQ), and Mini-Mental State Examination (MMSE) score longitudinal trajectories from MCI diagnosis were fitted using growth mixture models. Predictors of progression class were identified using multivariate multinomial logistic regression models; odds ratios (ORs) and 95% confidence intervals (CIs) were reported. Results: In total, 21%, 22%, and 57% of participants (N = 830) experienced fast, slow, and no progression on CDR-SB, respectively; for FAQ, these figures were 14%, 23%, and 64%, respectively. CDR-SB and FAQ class membership was concordant for most participants (77%). Older age (≥86 versus≤70 years, OR [95% CI] = 5.26 [1.78–15.54]), one copy of APOE ɛ4 (1.94 [1.08–3.47]), higher baseline CDR-SB (2.46 [1.56–3.88]), lower baseline MMSE (0.85 [0.75–0.97]), and higher baseline FAQ (1.13 [1.02–1.26]) scores were significant predictors of fast progression versus no progression based on CDR-SB (all p

Objective To assess the predictive value of common measures validated to predict falls in other geriatric populations in patients presenting with suspected Normal Pressure Hydrocephalus (NPH). Methods One hundred ninety-five patients over the age of 60 who received the Fall Risk Questionnaire were retrospectively recruited from the CSF Disorders clinic within the departments of Neurosurgery and Neurology. Multiple logistic regression was used to create a model to predict falls for patients with suspected NPH using common measures: Timed Up & Go, Dual Timed Up & Go, 10 Meter Walk, MiniBESTest, 6-Minute Walk, Lower Extremity Function (Mobility), Fall Risk Questionnaire, and Functional Activities Questionnaire. Results The Fall Risk Questionnaire and age were shown to be the best predictors of falls. The model was 95.92% (Positive predictive value: 83.93%) sensitive and 47.92% specific (Negative predictive value: 77.78%). Conclusion Patients presenting with suspected NPH are at an increased fall risk, 75% of the total patients and 89% of patients who responded to a temporary drain of CSF had at least one fall in the past 6 months. The Fall Risk Questionnaire and age were shown to be predictive of falls for patients with suspected NPH. The preliminary evidence indicates measures that have been validated to assess fall risk in other populations may not be valid for patients presenting with suspected NPH.

We examined the associations between baseline neuropsychiatric symptoms (NPS) and longitudinal changes in functional performance among 5,394 non-demented individuals aged ≥50 years (2,729 males; median age 74.2 years; 4,716 cognitively unimpaired, 678 mild cognitive impairment). After adjusting for age, sex, education, and medical comorbidities, NPS assessed by the Neuropsychiatric Inventory Questionnaire, clinical depression (Beck Depression Inventory score ≥13) and anxiety (Beck Anxiety Inventory score ≥10) were significantly associated with an increase in the Functional Activities Questionnaire score, indicating functional decline over time. This association may vary depending on the degree of cognitive impairment at baseline.

Objective To examine the association of baseline elevated brain amyloid and neurodegeneration with changes in activities of daily living in participants without dementia (ND; i.e., cognitively unimpaired and participants with mild cognitive impairment) at baseline in the population‐based Mayo Clinic Study of Aging. Methods We included 1747 ND participants with 11C‐PiB PET and MR imaging in the study, with data on activities of daily living (as assessed by the Functional Activities Questionnaire (FAQ) and the Clinical Dementia Rating scale Sum of Boxes for functional domains (CDR‐SOB (functional)), with a median (range) of 4.3 (0.0–12.7) years of follow‐up. Abnormal (elevated; A+) 11C‐PiB‐PET retention ratio was defined as standardized uptake value ratio ≥ 1.48, and abnormal (reduced) AD signature cortical thickness as ≤ 2.68 mm (neurodegeneration; N+). Associations were examined with mixed effects models, adjusting for age, sex, education, apolipoprotein E ε4 allele carrier status, and global cognitive z‐score. Results Mean age (SD) was 71.4 years (10.1), 46.7% were females, 195 (11.2%) had A+N‐, 442 (25.3%) had A‐N+, and 339 (19.4%) had A+N+ biomarkers. The A+N+ group had the largest annualized change in the FAQ score from baseline (difference in annual change A+N+ vs. A‐N‐; ß (SE): 0.80 (0.07)); associations were substantially attenuated when a time‐varying global cognitive composite was included in the model (A+N+ vs. A‐N‐; ß (SE): 0.31 (0.05)). CDR‐SOB (functional) findings partly agreed with FAQ score findings. Interpretation The longitudinal increase in functional limitations is greater for individuals with abnormal neuroimaging biomarkers, especially for those with both elevated brain amyloid and neurodegeneration.

Aim A simple approach to detecting dementia in its early stages may help improve patient care. We therefore aimed to assess the power of the Functional Activities Questionnaire (FAQ) for screening dementia among rural-dwelling older adults who are at high-risk for cognitive impairment. Methods This study included 961 participants at a high-risk for dementia who had been identified from a population-based survey of Chinese rural residents. All participants were aged 65 years and older and positive for cognitive impairment according to the Mini-Mental State Examination or the Ascertain Dementia 8-item Informant Questionnaire screening tests. The FAQ scale was used to evaluate daily activities. Dementia was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria. Receiver operating characteristic curve analyses were used to determine the FAQ's optimal cut-offs for dementia. The power (or accuracy) of the FAQ for screening dementia was analyzed in the total sample and in subgroups categorized by age, gender, and educational level. Results Of the 961 participants, 84 (8.7%) were clinically diagnosed with dementia. Among individuals who were positive for cognitive impairment on the Mini-Mental State Examination or the Ascertain Dementia 8-item Informant Questionnaire, the parameters for an FAQ cut-off score ≥6 as a means of discriminating those with dementia from those without dementia were area under curve = 0.899, sensitivity = 94.1%, specificity = 75.1%, positive likelihood ratio = 3.78, and accuracy = 0.768. The discriminant abilities of the FAQ scale varied with age, gender, and educational level. The discriminant parameters of the FAQ scale were similar overall among individuals who were positive on either the Mini-Mental State Examination or the Ascertain Dementia 8-item Informant Questionnaire test alone. Conclusion The FAQ scale has high discriminative power to screen for dementia among rural older residents with suspected cognitive impairment.

Objective:To develop and validate the Discrepancy-based Evidence for Loss of Thinking Abilities (DELTA) score. The DELTA score characterizes the strength of evidence for cognitive decline on a continuous spectrum using well-established psychometric principles for improving detection of cognitive changes.Methods:DELTA score development used neuropsychological test scores from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort (two tests each from Memory, Executive Function, and Language domains). We derived regression-based normative reference scores using age, gender, years of education, and word-reading ability from robust cognitively normal ADNI participants. Discrepancies between predicted and observed scores were used for calculating the DELTA score (range 0–15). We validated DELTA scores primarily against longitudinal Clinical Dementia Rating-Sum of Boxes (CDR-SOB) and Functional Activities Questionnaire (FAQ) scores (baseline assessment through Year 3) using linear mixed models and secondarily against cross-sectional Alzheimer’s biomarkers.Results:There were 1359 ADNI participants with calculable baseline DELTA scores (age 73.7 ± 7.1 years, 55.4% female, 100% white/Caucasian). Higher baseline DELTA scores (stronger evidence of cognitive decline) predicted higher baseline CDR-SOB (ΔR2 = .318) and faster rates of CDR-SOB increase over time (ΔR2 = .209). Longitudinal changes in DELTA scores tracked closely and in the same direction as CDR-SOB scores (fixed and random effects of mean + mean-centered DELTA, ΔR2 > .7). Results were similar for FAQ scores. High DELTA scores predicted higher PET-Aβ SUVr (ρ = 324), higher CSF-pTau/CSF-Aβ ratio (ρ = .460), and demonstrated PPV > .9 for positive Alzheimer’s disease biomarker classification.Conclusions:Data support initial development and validation of the DELTA score through its associations with longitudinal functional changes and Alzheimer’s biomarkers. We provide several considerations for future research and include an automated scoring program for clinical use.

Background Chile has one of the highest life expectancies within Latin American. This is the first study to determine health expectancies in older populations in Chile, considering cognitive status as a health indicator. Methods We estimated prevalence of cognitive decline among people aged 60 years and over based on the Mini-mental State Examination and the Pfeffer Functional Activities Questionnaire, with data from the National Survey of Health (2003, 2009, 2016). Life expectancy free of cognitive impairment was calculated using the Sullivan method. Results At age 60, life expectancy free of cognitive impairment was more than 3 years longer for women, compared to men of the same age. Life expectancy free from cognitive impairment was higher for both men and women aged 60 in 2016 when compared to 2003 (2.1 and 2 years higher, respectively). Conclusions Longer life expectancy in women was accompanied by more years free of cognitive impairment. Men expected to live a similar proportion of years free of cognitive impairment, compared to women. Common and standardised assessments of health status of older people should be adopted in Latin American studies, to allow for time-trend analyses and international comparisons.

Introduction Postoperative delirium (POD) is a common disorder and its frequency varies from 15% to 25% after major elective surgery. There are few data on the incidence of POD in Brazil. Here, we sought to assess the incidence of POD following transurethral resection of the prostate (TURP) and to examine precipitating and predisposing factors associated. Method We performed a prospective observational study of elderly male patients undergoing TURP (N=55) in Northeast Brazil. Information on demographic, medical, cognitive and functional characteristics were collected. The participants were followed until hospital discharge. POD was diagnosed by the Confusion Assessment Method. Results A total of three participants (5.45%) were identified with POD. Episodes of delirium lasted 3±1 days. The study sample consisted of a healthy population. Patients with POD had longer hospital stay and more precipitating factors. The POD group showed statistically significant lower Barthel index score (p

Introduction This study estimated the minimal clinically important difference (MCID) for Mini Mental State Examination, Clinical Dementia Rating Scale sum of boxes, and Functional Activities Questionnaire across the Alzheimer's disease (AD) spectrum. Methods Retrospective analysis of the National Alzheimer's Coordinating Center Uniform Data Set (9/2005-9/2016) and MCID for clinical outcomes were estimated using anchor-based (clinician's assessment of meaningful decline) and distribution-based (1/2 baseline standard deviation) approaches, stratified by severity of cognitive impairment. Results On average, a 1-3 point decrease in Mini Mental State Examination, 1-2 point increase in Clinical Dementia Scale sum of boxes, and 3-5 point increase in Functional Activities Questionnaire were indicative of a meaningful decline. The MCID values generally increased by disease severity; the effect size and standardized response mean for those with meaningful decline were consistently in the acceptable ranges for MCID. Discussion These findings can inform design and interpretation of future clinical trials.

Background: Instruments for measuring functional disability of the elderly, such as the Functional Activities Questionnaire, can be used for the detection and prediction of dementia. Objective: To evaluate the accuracy of the Brazilian version of the Functional Activities Questionnaire (FAQ-BR) in dementia screening. Methodology: Cross-sectional study with 265 elderly and their respective informants. The performance of the FAQBR was compared to the clinical diagnosis of dementia and their score compared to screening instruments for cognitive decline/dementia. The receiver operating curve (ROC curve) was used to determine the sensitivity and specificity of the best cutoff. Results: The area under the ROC curve indicated an accuracy of 79.7% with cutoff point ≥ 14, which showed the highest sensitivity (80.0%) and specificity (72.0%). The FAQ-BR score showed high correlations with the scores of the cognitive decline/dementia screening instruments. Conclusion: The area under the ROC curve, sensitivity and specificity of the FAQ-BR were found to be inappropriate, and it was not possible to recommend its use in dementia screening

Objectives The objectives of the study are to investigate how different levels of functional ability relate to quality of life, well-being, and satisfaction with life, conceptualised as reflecting capability to "live well" in people with dementia. Methods/design Participants were 1496 people with mild-to-moderate dementia and 1188 informants who completed baseline assessments in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort study. Total self-rated and informant-rated scores on the Functional Activities Questionnaire were split into six ability levels to monitor how poorer functioning impacts the ability to live well. We also investigated the potential influence of sociodemographic and diagnostic variables, depression, cognition, and carer stress. Results Multivariate multiple regression models found that people with dementia who had the greatest functional impairment according to self-ratings and informant ratings had poorer living well scores than those with the least functional impairment. Sociodemographic and diagnostic factors and cognition had little impact on effect sizes. For self-ratings, depression attenuated the relationship between functional ability and living well, whereas carer stress attenuated informant ratings. Conclusions People with dementia with the least functional impairments had greater capability to live well than those with the most functional impairment. Even subtle perceived difficulties in functional ability had a detrimental effect on the ability of people with dementia to live well. Depression in people with dementia and carer stress in informants influenced these associations, and therefore, these factors should be routinely included in future research studies and clinical assessments.

Heterogeneity of subtle functional difficulties in mild cognitive impairment (MCI) remains poorly understood. We characterized patterns of informant reports of functional abilities among participants with MCI and the relation between functional ability pattern and cognitive abilities and subsequent decline. Data from 4,273 MCI participants from the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS) were included in latent profile analyses (LPA) of informant responses on the Functional Activities Questionnaire (FAQ). Profiles from the best fitting model were compared on demographic, clinical, and cognitive variables. The best fitting model supported three profiles varying by level and type of difficulty: intact function (n = 3,299), intermediate (n = 769), and high ratings of difficulty (n = 205). For the Intermediate profile, items related to finances, remembering dates, and travel were rated as most difficult. The High Ratings profile also had elevated ratings on the meal preparation item. Participants with either the Intermediate or High Ratings profile demonstrated a three-fold increase in conversion to dementia as compared to participants with the Intact profile. Demographically, the Intact profile was younger and consisted of a higher proportion of minorities. On cognitive tests, the Intact profile showed the best performance, and the Intermediate profile performed comparably to or better than the High Ratings profile. There is meaningful heterogeneity in informant ratings of function in MCI, though individuals with MCI whose informants report even intermediate-level functional difficulties are more likely to progress to dementia, suggesting that even subtle functional difficulties place individuals at higher risk for future decline.

Three patients (mean age = 62) received 18-sessions of PBM stimulation twice per week for nine weeks. Each patient was assessed with Rey- Osterrieth Complex Figure Test (Rey-O testing visual memory) and Hong Kong List Learning Test (HKLLT testing verbal memory), Clinical Dementia Rating Scale (CDR), Functional Activities Questionnaire (FAQ), Geriatric Anxiety Scale-10 Item Version (GAS-10) and Chinese Geriatric Depression Scale (CGDS) before and after PBM.

BACKGROUND: Growth in aging of the population has led to increasing numbers of elderly people presenting cognitive impairment and evolution to dementia. There is still no consensus within primary care on the best strategy for screening for cognitive impairment among elderly people. Standardization of a simple but reasonably accurate instrument for a brief cognitive test, in primary care environments, would enable healthcare professionals to identify individuals who require a more in-depth assessment of cognition. OBJECTIVES: To investigate the instruments used by healthcare professionals in studies conducted worldwide and ascertain the most suitable instruments for screening for cognitive impairment among individuals aged 60 years or over, in the Brazilian population. DESIGN AND SETTING: Scoping review developed at Pontifícia Universidade Católica de São Paulo, Brazil. METHOD: A systematic search of the literature was conducted for primary studies using instruments to screen for cognitive impairment among individuals aged 60 years or over, in the MEDLINE, EMBASE, Cochrane Central and LILACS databases. RESULTS: A total of 983 articles were identified by two independent reviewers, from which 49 were selected for full-text reading, based on the criteria defined for this review. From this, 16 articles adhering to the theme of screening for cognitive impairment among the elderly were selected for in-depth analysis. CONCLUSION: The Mini-Mental State Examination was the instrument most cited in these studies. The Pfeffer Functional Activities Questionnaire and the Verbal Fluency Test (semantic category) present characteristics favoring further studies, for testing as screening instruments for cognitive impairment among elderly people in Brazil.

Purpose Older persons have been identified as a vulnerable population with respect to the novel coronavirus outbreak, COVID-19. Aiming to “flatten the curve” a strict Movement Control Order (MCO) was implemented in Malaysia. Older adults with cognitive frailty are prone to physical, cognitive and psychosocial decline. This study aims to compare physical activity patterns, psychological wellbeing and coping strategies of older persons with cognitive frailty in the “WE-RISE” trial (intervention versus control) throughout this period. Materials and Methods This study was conducted as a sub-analysis of the ongoing “WE-RISE” randomized controlled trial. This study included 42 community-dwelling older adults, aged 60 years and above, with cognitive frailty, stratified into intervention (n=21) and control (n=21) groups who are receiving a multi-domain intervention and usual care, respectively, within the Klang Valley, Malaysia. Phone call interviews were conducted during the MCO period. Physical activity patterns were assessed using International Physical Activity Questionnaire (IPAQ) and Functional Activities Questionnaire (FAQ). Psychological wellbeing was assessed using Flourishing Scale (FS) and General Health Questionnaire (GHQ-12), while the Brief Coping Orientation to Problems Experienced (COPE) assessed coping strategies. Data were analysed descriptively and with independent samples t-test. Results The WE-RISE intervention group had significantly higher levels of estimated resting energy expenditure (MET) for “walking activity” (I:μ=1723.1±780.7;C:μ=537.4±581.9)(p, Video Abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/WH3CEERH-8Q

Background Hospitalization can impair physical and functional status of older adults, but it is unclear whether these deficits are transient or chronic. This study determined the association between hospitalization of older adults and changes in long-term longitudinal trajectories of 2 measures of physical and functional status: gait speed (GS) and instrumental activities of daily living measured with Functional Activities Questionnaire (FAQ). Method Linear mixed-effects models assessed the association between hospitalization (nonelective vs elective, and surgical vs medical) and outcomes of GS and FAQ score in participants (older than 60 years) enrolled in the Mayo Clinic Study of Aging who had longitudinal assessments. Results Of 4902 participants, 1879 had ≥1 hospital admission. Median GS at enrollment was 1.1 m/s. The slope of the annual decline in GS before hospitalization was −0.015 m/s. The parameter estimate (95% CI) for additional annual change in GS trajectory after hospitalization was −0.009 (−0.011 to −0.006) m/s, p < .001. The accelerated GS decline was greater for medical versus surgical hospitalizations (−0.010 vs −0.003 m/s, p = .005), and nonelective versus elective hospitalizations (−0.011 vs −0.006 m/s, p = .067). The odds of a worsening FAQ score increased on average by 4% per year. Following hospitalization, odds of FAQ score worsening further increased (multiplicative annual increase in odds ratio per year [95% CI] following hospitalization was 1.05 [1.03, 1.07], p < .001). Conclusions Hospitalization of older adults is associated with accelerated long-term decline in GS and functional limitations, especially after nonelective admissions and those for medical indications. However, for most well-functioning participants, these changes have little clinical significance.

Objective Cognitive-driven activity of daily living (ADL) impairment in Parkinson’s disease (PD) is increasingly discussed as prodromal marker for dementia. Diagnostic properties of assessments for this specific ADL impairment are sparsely investigated in PD. The ability of the Functional Activities Questionnaire (FAQ) for differentiating between PD patients with normal cognition and with mild cognitive impairment (PD-MCI), according to informant and self-reports, was examined. Global cognitive function in groups with and without mild ADL impairment was compared according to different cut-offs. Methods Multicenter data of 589 patients of an international cohort (CENTRE-PD) were analyzed. Analyses were run separately for informant-rated and self-rated FAQ. Receiver operating characteristic (ROC) analysis was conducted to define the optimal FAQ cut-off for PD-MCI (≥ 1), and groups were additionally split according to reported FAQ cut-offs for PD-MCI in the literature (≥ 3, ≥ 5). Binary logistic regressions examined the effect of the Montreal Cognitive Assessment (MoCA) score in PD patients with and without mild ADL impairment. Results Two hundred and twenty-five (38.2%) patients were classified as PD-MCI. For all three cut-off values, sensitivity was moderate to low ( 0.54) with a tendency of higher values for self-reported deficits. For the self-report, the cut-off ≥ 3 showed a significant effect of the MoCA (B = − 0.31, p = 0.003), where FAQ ≥ 3 patients had worse cognition. No effect for group differences based on informant ratings was detected. Conclusion Our data argue that self-reported ADL impairments assessed by the FAQ show a relation to the severity of cognitive impairment in PD.

Wing-Yin Leung,1 Sunil Bhar,1 Ann Reilly,2 Sonja Pedell3 1Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia; 2Client Services Department, Dementia Australia, Melbourne, Victoria, Australia; 3Centre for Design Innovation, Swinburne University of Technology, Melbourne, Victoria, AustraliaCorrespondence: Sunil BharDepartment of Psychological Sciences, Swinburne University of Technology, H99, PO Box 218, Hawthorn, Victoria, 3122, AustraliaTel +1 613 9214 8371Fax +1 613 9819 6857Email sbhar@swin.edu.auBackground: Depressive symptoms are common in people with dementia.Purpose: This study examined the discrepancies in the ratings of depressive symptoms between people with dementia and their family caregivers, and the extent to which these discrepancies varied according to the functional status of people with dementia.Participants and Methods: This study is a cross-sectional secondary analysis. Twenty-five people living with dementia (“participants”) and their family caregivers (“proxies”) participated as pairs in the study (participant mean age = 71.36, SD = 8.63; proxy mean age = 67.54, SD = 11.46). Data were collected in Victoria, Australia between May 2018 and May 2019. Participants were administered a semi-structured interview comprising the Cornell Scale for Depression in Dementia (CSDD). Proxies independently completed the CSDD and the Functional Activities Questionnaire (FAQ). A paired sample t-test was used to investigate differences in CSDD scores between participants and proxies. Kendall’s tau-b correlation was used to examine the relationship between FAQ scores and discrepancy scores of CSDD. Participants were then classified into either low or high functional impairment. Mann–Whitney U-test was used to examine whether the discrepancy scores of CSDD were similar between these two groups. Intraclass correlation coefficients were calculated to indicate the level of agreement between participants and proxies in each group.Results: The CSDD scores of participants were significantly lower than proxies. The size of the discrepancy in CSDD scores was positively correlated with FAQ scores. The “high functional impairment” group had larger discrepancy scores and a lower level of agreement than the “low functional impairment” group.Conclusion: The findings highlighted that relying on proxy CSDD scores may not reflect estimates of depressive symptoms by people with dementia. Hence, both perspectives need to be taken into account, particularly when the level of functional impairment in dementia is advanced.Keywords: cognitive impairment, function, measurement, informants, instrumental activity of daily living, pilot study

BACKGROUND: The Clinical Dementia Rating–Sum of Boxes (CDR-SB) has been proposed as a primary outcome for use in prodromal AD trials. However, the psychometric properties of this, and of other commonly used measures, have not been well-established in this patient population. OBJECTIVE: To describe the psychometric properties of commonly used efficacy measures in a clinical trial of prodromal AD. SETTING: Data were gathered as part of a two-year clinical trial. PARTICIPANTS: Patients had biomarker confirmed prodromal AD. MEASUREMENTS: Clinical Dementia Rating (CDR), Functional Activities Questionnaire (FAQ), Alzheimer’s Disease Assessment Scale – Cognition Subscale 11 and 13 (ADAS-Cog), Mini Mental State Exam (MMSE), and Free and Cued Selective Reminding Test (FCSRT-IR [words]). Assessments were conducted at least every 24 weeks. RESULTS: For the CDR-SB, test-retest reliability was good (intra-class correlation coefficient [ICC]=0.83); internal consistency was 0.65 at baseline but above 0.8 at later assessments. Relationships between the CDR-SB and other measures were as expected (higher correlations with more closely related constructs), and the CDR-SB differentiated between patients with different severities of dementia (-2.9 points difference between CDR-Global Score 0.5 and 1, P

The Functional Activities Questionnaire (FAQ) is a collateral-report measure of difficulties in activities of daily living. Despite its widespread use, psychometric analyses have been limited in scope, piecemeal across samples, and limited primarily to classical test theory. This article consolidated and expanded psychometric analyses using tools from generalizability and item response theories among 27,916 individuals from the National Alzheimer’s Coordinating Center database who completed the FAQ. Reliability was evaluated with internal consistency, test–retest, and generalizability analyses. Validity was assessed via convergence with neurocognitive measures, classification accuracy with impairment stage, and confirmatory factor and item response theory analyses. Demographics did not impact scores and there was strong evidence for reliability (0.52-0.95), though coefficients were attenuated when restricted in range to diagnostic groups (e.g., normal cognition). There were strong correlations with neurocognitive measures ( rs: −.30 to −.59), strong classification accuracy (areas under the curve: .81-.99), and a single-factor model had excellent fit. All items evidenced strong item response theory discrimination and provided significant information regarding functional disability, albeit within a relatively restricted range. The FAQ is a reliable and valid measure of activities of daily living concerns for use in clinical/research settings. It best assesses mild levels of functional difficulty, which is helpful in distinguishing normal cognition from mild cognitive impairment and dementia.

IntroductionAssessment of cognition and everyday function is essential in clinical trials for Alzheimer’s disease (AD). Two novel measures of cognition (No Practice Effects (NPE) cognitive battery and Miami Computerized Functional Assessment Scale (CFAS)) were designed to have robust psychometric properties and reduced practice and ceiling effects. This study aims to evaluate if the NPE and CFAS demonstrate stronger psychometric properties and reduced practice effects compared with established measures, including the Preclinical Alzheimer Cognitive Composite (PACC), Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), and Functional Activities Questionnaire (FAQ).MethodsThis parallel group, four-site study will randomize 320 cognitively intact adults aged 60 to 85 years to novel or well-established measures of cognition and function. All participants will receive assessments at baseline (week 0), week 12, and week 52, as well as a brain MRI scan and Apolipoprotein E genetic test at study entry. Analyses will determine psychometric properties of the NPE and CFAS, compare the sensitivity of measures to AD risk markers, and identify cognitive domains within the NPE.DiscussionPractice effects have been a major limitation of Alzheimer’s disease clinical trials that typically assess cognitive changes over serial assessments. Detection of functional impairment in cognitively normal individuals with biomarkers for Alzheimer’s disease requires instruments sensitive to very subtle functional changes. This study is intended to support the validation of two new composite measures, the NPE battery and the CFAS, which may advance clinical testing of interventions for individuals across the spectrum of early stage Alzheimer’s disease.Trial RegistrationNCT03900273

In this chapter, we reviewed the Functional Activities Questionnaire (FAQ) and its use in aging research. The FAQ is a brief informant-based rating scale for the indirect measurement of instrumental activities of daily living (IADL) in older adults. The FAQ has good internal consistency and shows high discriminative validity for the differentiation of functional independence in patients with dementia and mild cognitive impairment (MCI) due to Alzheimer’s disease (AD) and high predictive validity in detecting those at risk for progression from MCI to AD and from normal aging to MCI. The FAQ is also a standard instrument for the detection of functional deficits in subtle cognitive decline, a cognitive disorder in preclinical stages of AD. It is also clinically useful in Parkinson’s disease and frontal lobar neurodegeneration. In sum, FAQ can be recommended as a valid instrument for the detection of functional deficits in older persons at possible risk of developing neurodegenerative disease.

Introduction Assessment of cognition and everyday function is essential in clinical trials for Alzheimer's disease (AD). Two novel measures of cognition (No Practice Effects (NPE) cognitive battery and Miami Computerized Functional Assessment Scale (CFAS)) were designed to have robust psychometric properties and reduced practice and ceiling effects. This study aims to evaluate if the NPE and CFAS demonstrate stronger psychometric properties and reduced practice effects compared with established measures, including the Preclinical Alzheimer Cognitive Composite (PACC), Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), and Functional Activities Questionnaire (FAQ). Methods This parallel group, four-site study will randomize 320 cognitively intact adults aged 60 to 85 years to novel or well-established measures of cognition and function. All participants will receive assessments at baseline (week 0), 3-months, and 12-months, as well as a brain MRI scan and Apolipoprotein E genetic test at study entry. Analyses will determine psychometric properties of the NPE and CFAS, compare the sensitivity of measures to AD risk markers, and identify cognitive domains within the NPE. Discussion Practice effects have been a major limitation of Alzheimer's disease clinical trials that typically assess cognitive changes over serial assessments. Detection of functional impairment in cognitively normal individuals with biomarkers for Alzheimer's disease requires instruments sensitive to very subtle functional changes. This study is intended to support the validation of two new composite measures, the NPE battery and the CFAS, which may advance clinical testing of interventions for individuals across the spectrum of early stage Alzheimer's disease. Trial Registration: NCT03900273

Background: Instrumental activities of daily living (IADL) impairment can begin in mild cognitive impairment (MCI), and is the core criteria for diagnosing dementia in both Alzheimer’s (AD) and Parkinson’s (PD) diseases. The Functional Activities Questionnaire (FAQ) has high discriminative power for dementia and MCI in older age populations, but is influenced by demographic factors. It is currently unclear whether the FAQ is suitable for assessing cognitive-associated IADL in non-demented PD patients, as motor disorders may affect ratings. Objective: To compare IADL profiles in MCI patients with PD (PD-MCI) and AD (AD-MCI) and to verify the discriminative ability of the FAQ for MCI in patients with (PD-MCI) and without (AD-MCI) additional motor impairment. Methods: Data of 42 patients each of PD-MCI, AD-MCI, PD cognitively normal (PD-CN), and healthy controls (HC), matched according to age, gender, education, and global cognitive impairment were analyzed. ANCOVA and binary regressions were used to examine the relationship between the FAQ scores and groups. FAQ cut-offs for PD-MCI (versus PD-NC) and AD-MCI (versus HC) were separately identified using receiver operating characteristic analyses. Results: FAQ total score did not differentiate between MCI groups. PD-MCI subjects had greater difficulties with tax records and traveling while AD-MCI individuals were more impaired in managing finances and remembering appointments. Classification accuracy of the FAQ was good for diagnosing AD-MCI (69%, cut-off ≥1) compared to HC, and sufficient for differentiating PD-MCI (38.1%, cut-off ≥3) from PD-CN. Conclusion: The FAQ task profiles and classification accuracy differed between MCI related to PD and AD.

Individuals with mild cognitive impairment (MCI) have a much higher risk of developing Alzheimer’s disease (AD) or other types of dementia. Early detection of MCI is critical to identify these high-risk candidates for proper management and early interventional treatment. In this paper, a neuropsychological dataset from the Alzheimer’s Disease Neuroimaging Initiative (ADNI), one of the largest public AD database, was used. Four different machine learning algorithms were investigated to classify MCI from demographically matched cognitively normal (CN) older adults. In total, there were 620 subjects, including 391 MCI and 229 CN. A comprehensive neuropsychological battery was administered to all subjects, and 3 tests were selected for this study: Alzheimer’s Disease Assessment Scale-Cognitive subscale (ADAS-Cog), Mini-Mental State Examination (MMSE), and Functional Activities Questionnaire (FAQ). Of all the classifiers tested, the Support Vector Machine (SVM) classifier with radial basis function (RBF) kernel had the best performance for MCI detection, with an average classification accuracy of 88.06% and the area under the receiver operating characteristic curve (AUC) of 0.945.

PURPOSE: Determine the feasibility and utility of using a battery of tests utilized, so far, to assess neurological-cognitive functions in the typical adult population and identify the spectrum of these functions in adult SBM patients. METHODS: Prospective study in which 15 participants (mean age = 28.7 ± 8.7 years, range = 19–45 years) completed the targeted battery of tests (n = 5–15/test) previously standardized to the general population. Results were compared with normative data. RESULTS: Statistically significant differences with normative means were noted in the following tests: Montreal Cognitive Assessment (MoCA), Functional Activities Questionnaire (FAQ), and NIH Toolbox Fine Motor (Dexterity and Grip Strength) tests. Cohort means for NIH Toolbox Fluid, Crystallized, and Cognitive Composite Scores and Timed Up and GO (TUG) were not different from normative means. CONCLUSION: All tests were successfully completed by cohort. Whereas many aspects of cognition were normal, tests assessing visual-constructural, calculation, motor, and fluency functions did show differences from population means. Numerous tests assessing multiple domains are needed and can be used in future aging studies to appreciate the spectrum of cognitive and motor abilities in adults with SBM.

Background Aging military veterans are an important and growing population who are at an elevated risk for developing mild cognitive impairment (MCI) and Alzheimer dementia, which emerge insidiously and progress gradually. Traditional clinic-based assessments are administered infrequently, making these visits less ideal to capture the earliest signals of cognitive and daily functioning decline in older adults. Objective This study aimed to evaluate the feasibility of a novel ecologically valid assessment approach that integrates passive in-home and mobile technologies to assess instrumental activities of daily living (IADLs) that are not well captured by clinic-based assessment methods in an aging military veteran sample. Methods Participants included 30 community-dwelling military veterans, classified as healthy controls (mean age 72.8, SD 4.9 years; n=15) or MCI (mean age 74.3, SD 6.0 years; n=15) using the Clinical Dementia Rating Scale. Participants were in relatively good health (mean modified Cumulative Illness Rating Scale score 23.1, SD 2.9) without evidence of depression (mean Geriatrics Depression Scale score 1.3, SD 1.6) or anxiety (mean generalized anxiety disorder questionnaire 1.3, SD 1.3) on self-report measures. Participants were clinically assessed at baseline and 12 months later with health and daily function questionnaires and neuropsychological testing. Daily computer use, medication taking, and physical activity and sleep data were collected via passive computer monitoring software, an instrumented pillbox, and a fitness tracker watch in participants’ environments for 12 months between clinical study visits. Results Enrollment began in October 2018 and continued until the study groups were filled in January 2019. A total of 201 people called to participate following public posting and focused mailings. Most common exclusionary criteria included nonveteran status 11.4% (23/201), living too far from the study site 9.4% (19/201), and having exclusionary health concerns 17.9% (36/201). Five people have withdrawn from the study: 2 with unanticipated health conditions, 2 living in a vacation home for more than half of the year, and 1 who saw no direct benefit from the research study. At baseline, MCI participants had lower Montreal Cognitive Assessment (P Conclusions Installation and longitudinal deployment of a passive in-home IADL monitoring platform with an older adult military veteran sample was feasible. Knowledge gained from this pilot study will be used to help develop acceptable and effective home-based assessment tools that can be used to passively monitor cognition and daily functioning in older adult samples.

BACKGROUND/OBJECTIVES To evaluate the efficacy of a multidomain intervention to reduce lifestyle risk factors for Alzheimer's disease (AD) and improve cognition in individuals with subjective cognitive decline (SCD) or mild cognitive impairment (MCI). DESIGN The study was an 8‐week two‐arm single‐blind proof‐of‐concept randomized controlled trial. SETTING Community‐dwelling individuals living in Canberra, Australia, and surrounding areas. PARTICIPANTS Participants were 119 individuals (intervention n = 57; control n = 62) experiencing SCD or MCI. INTERVENTION The control condition involved four educational modules covering dementia and lifestyle risk factors, Mediterranean diet, physical activity, and cognitive engagement. Participants were instructed to implement this information into their own lifestyle. The intervention condition included the same educational modules and additional active components to assist with the implementation of this information into participants’ lifestyles: dietitian sessions, an exercise physiologist session, and online brain training. MEASUREMENTS Lifestyle risk factors for AD were assessed using the Australian National University‐Alzheimer's Disease Risk Index (ANU‐ADRI), and cognition was assessed using Alzheimer's Disease Assessment Scale‐Cognitive subscale, Pfeffer Functional Activities Questionnaire, Symbol Digit Modalities Test (SDMT), Trail Making Test‐B, and Category Fluency. RESULTS The primary analysis showed that the intervention group had a significantly lower ANU‐ADRI score (χ2 = 10.84; df = 3; P = .013) and a significantly higher cognition score (χ2 = 7.28; df = 2; P = .026) than the control group. A secondary analysis demonstrated that the changes in lifestyle were driven by increases in protective lifestyle factors (χ2 = 12.02; df = 3; P = .007), rather than a reduction in risk factors (χ2 = 2.93; df = 3; P = .403), and cognitive changes were only apparent for the SDMT (χ2 = 6.46; df = 2; P = .040). Results were robust to intention‐to‐treat analysis controlling for missing data. CONCLUSION Results support the hypothesis that improvements in lifestyle risk factors for dementia can lead to improvements in cognition over a short time frame with a population experiencing cognitive decline. Outcomes from this trial support the conduct of a larger and longer trial with this participant group.

Background/objectives The diagnostic process in a university memory clinic is based largely on cognitive testing. However, input from informants, acquired through interview or questionnaires, may significantly impact diagnosis. We sought to evaluate whether informant questionnaires for basic and instrumental activities of daily living, or for identifying progressive cognitive decline would improve diagnostic predictability of neurodegenerative disorders compared with either the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological test battery or the Mini-Mental State Examination score alone. Design Retrospective data analysis using logit models. Setting University hospital outpatient memory clinic. Participants A total of 394 patients with dementia, mild cognitive impairment (MCI), depression, or subjective cognitive impairment were assessed. Measurements Bristol Activities of Daily Living Scale, Functional Activities Questionnaire, Informant Questionnaire on Cognitive Decline in the Elderly, and the Physical Self-Maintenance Scale questionnaires were obtained. Analyses through logit models were performed to predict outcome diagnoses, based on cognitive scores alone or in combination with one or more informant questionnaires. Results The four questionnaires were highly correlated (.31-.86). The addition of informant questionnaires improved diagnostic predictability between differential diagnoses of MCI and dementia, or dementia and depression. However, the misprediction rate was reduced by up to 6 percentage points only. Adding more than one questionnaire or all CERAD subtests instead of their sum score never improved prediction in regularized logit models to a clinically relevant extent. Conclusion Although questionnaires contribute to a statistically better prediction of the outcome diagnosis, for some sets of differential diagnoses, the benefit may not be clinically pertinent when routine semistructured informant interviews are used by trained personnel. However, standardized assessment, particularly when patients are seen longitudinally, should not be underestimated.

Objectives: To evaluate the performance of the Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE) in discriminating between controls and patients with mild cognitive impairment (MCI) and dementia in an illiterate population with low-levels of education.Methods: We compared the cognitive performance of 187 elderly subjects who were illiterate (controls n = 60; MCI n = 64; dementia n = 63). Neuropsychological measures included the RUDAS-PE, Mini-Mental State Examination (MMSE), INECO Frontal Screening (IFS), and Pfeffer Functional Activities Questionnaire (PFAQ). The results were compared to a neuropsychological evaluation (gold standard), including use of Clinical Dementia Rating (CDR) scores.Results: We found a Cronbach's alpha was 0.65; Spearman's correlation coefficient was 0.79 (p < 0.01). The area under the receiver operating characteristics curve for the RUDAS to discriminate dementia from MCI was 98.0% with an optimal cut-off

Background Instrumental activities of daily living (IADL) impairment and apathy occur in early-stage Alzheimer's disease (AD) and are associated with regional atrophy and hypometabolism in vivo and greater tau burden at autopsy. Objective To explore the association between IADL impairment, apathy, and in vivo regional tau in mild cognitive impairment (MCI) and AD dementia. Methods Forty participants (24 MCI, 16 AD dementia) underwent assessments of IADL (Functional Activities Questionnaire, FAQ) and apathy (Apathy Evaluation Scale Informant report, AES-I). Regional tau was assessed using flortaucipir positron emission tomography (PET) and amyloid using Pittsburgh Compound B PET. Regions with unadjusted associations of p≤0.01 were entered into regression models assessing the relationship between tau and FAQ or AES-I, adjusting for age, sex, and cognition, with/without a tau by amyloid interaction. Results Unadjusted IADL impairment but not apathy was associated with greater tau in multiple regions. After adjusting for covariates, for medial orbitofrontal and entorhinal cortex the interaction between tau and amyloid was associated with IADL impairment and for anterior cingulate it was not but independent associations with both tau and amyloid were retained. With whole brain analyses, similar results were seen for IADL, while for apathy tau in small clusters within the right anterior cingulate and dorsolateral prefrontal cortices were seen, which were more pronounced in individuals with greater amyloid. Conclusions This exploratory study suggests that IADL impairment in AD is associated with medial temporal and frontal tau, especially in individuals with elevated amyloid, while apathy may be associated with right frontal tau.

Objective: To evaluate the applicability and the psychometric properties of Montreal Cognitive Assessment Brazilian Version (MoCA-BR) in the elderly, as well as comparing its accuracy as a tracking test for mild cognitive impairment (MCI) and mild Alzheimer’s disease (AD) with the accuracy of Mini-Mental State Examination (MMSE). Method: A transversal study was performed in 4 reference medical centers that care for the elderly. In all, 229 elderly participated in the study. To select the sample, the clinical history of the elderly, Pfeffer Functional Activities Questionnaire, and neuropsychological battery, apart from MMSE and MoCA-BR cognitive tests, were selected. The elderly were classified into control, MCI, and mild AD groups. Results: There was a significant statistical difference between the MoCA-BR scores of the elderly and the control group, MCI, and mild AD (p < 0.001). The Cronbach alpha for MoCA-BR was 0.77, indicating a good internal consistency. The test-retest reliability was elevated, with intraclass correlation coefficient (ICC) 0.91. The inter-examiner reliability was excellent (ICC 0.96). The area under curve of the receiver operating characteristics curve was 0.95, when evaluating the ability of MoCA-BR to discriminate between the elderly with cognitive impairment and cognitively healthy elderly. Conclusions: The results of the study show that the Brazilian version of MoCA is a reliable cognitive tracking tool and is accurate for the detection of MCI and early stage AD, with good applicability on the elderly with education equal to or more than 4 years and adequate to discriminate between cognitively healthy elderly, and those with MCI and mild, proving to be superior to MMSE in tracking MCI and similar to this test when tracking mild AD.

Objectives Patients with aneurysmal subarachnoid hemorrhage (aSAH) often sustain substantial cognitive and functional impairment. Traditional outcome measures have emphasized radiographic and gross clinical outcomes, but cognitive and functional outcomes are less frequently documented. This pilot study assessed the feasibility of administering longitudinal cognitive and neuropsychological testing and tracked patterns of functional improvement in aSAH patients. Patients and methods Standardized cognitive and neuropsychological testing were administered to a prospective cohort of aSAH patients admitted for treatment to our tertiary care center. Thirty consecutive aSAH patients (Hunt and Hess score 1-3) were enrolled over 23-months and baseline evaluations were completed within 24-h after admission. Patients were followed prospectively after treatment (coiling or clipping) at 1-, 3-, 6-, and 12-months. Functional outcome measures included the Montreal Cognitive Assessment, the Neuropsychiatric Inventory–Questionnaire, and the Functional Activities Questionnaire. Results Of the 30 patients, 23 (77%) followed-up at 3-months, 21 (70%) at 6-months, and 19 (63%) at 12-months. Improvement from baseline to follow-up at 12-months was noted for general cognitive function (p = .004), memory (p = .025), and executive function (p = .039), with the greatest improvement occurring within 6-months. Daily function also improved mostly within 6-months (p = .022) while changes in neuropsychological disturbances were insignificant from baseline to follow-up at 12-months (p = .216). Conclusion Standardized cognitive and neuropsychological testing provides metrics for evaluating functional outcomes following treatment of aSAH. The addition of a brief battery of tests to routine clinical and radiographic evaluations is feasible. The main limitations are related to practice and referral patterns, and future studies are needed to evaluate the impact of treatment modalities on functional outcomes.

Background Association between high adiposity and the clinical progression of dementia remains puzzling. Objective To separately examine the association between body mass index (BMI) and cognitive, functional, and behavioral declines before, at, and after diagnosis of dementia, and further stratified by age groups, and sex. Methods A total of 1,141 individuals with incident dementia were identified from the Uniform Data Set of the National Alzheimer's Coordinating Center. Cognitive function was evaluated by Mini-Mental State Exam, functional abilities were assessed using Functional Activities Questionnaire, and behavioral symptoms were captured by Neuropsychiatric Inventory Questionnaire at each follow-up visit. We used separate linear-mixed effects models to examine the association. Results Compared to moderate baseline BMI, high baseline BMI was associated with 0.30-point slower annual progression rates in functional decline. For individuals aged 76 and over, high baseline BMI was associated with 0.42-point faster progression rates in cognitive decline annually. A U-shaped association between baseline BMI and cognitive decline was observed among men. Conclusion BMI levels before dementia diagnosis may facilitate the identification of different risk profiles for progression rates of cognitive and functional declines in individuals who developed dementia.