Cognitive stimulation and cognitive and functional decline in Alzheimer's disease: the cache county dementia progression study.

OBJECTIVES: To examine the association of engagement in cognitively stimulating activities with cognitive and functional decline in a population-based sample of incident Alzheimer's disease (AD). METHOD: After diagnosis, 187 participants (65% females) were followed semiannually for a mean 2.7 (SD = 0.4) years. Mean age and education were 84.6 (SD = 5.8) and 13.2 (SD = 2.9) years. Caregivers enumerated cognitively stimulating leisure activities via the Lifestyle Activities Questionnaire. Cognition was assessed using the Mini-Mental State Examination and functional ability via the Clinical Dementia Rating sum of boxes. Linear mixed models tested the association between stimulating activities and change over time in each outcome. Covariates were demographic factors, estimated premorbid IQ, presence/absence of the APOE ε4 allele, duration of dementia, level of physical activity, and general health. RESULTS: At initial assessment, 87% of participants were engaged in one or more stimulating activities, with mean (SD) activities = 4.0 (3.0). This number declined to 2.4 (2.0) at the final visit. There was a statistical interaction between dementia duration and number of activities in predicting rate of cognitive decline (p = .02) and overall functional ability (p = .006). DISCUSSION: Active involvement in cognitively stimulating pursuits may be beneficial for persons with AD.

A nonverbal phoneme deletion task administered in a dynamic assessment format.

PURPOSE: The purpose of the project was to design a nonverbal dynamic assessment of phoneme deletion that may prove useful with individuals who demonstrate complex communication needs (CCN) and are unable to communicate using natural speech or who present with moderate-severe speech impairments. METHOD: A nonverbal dynamic assessment of phoneme deletion with a systematic prompting and scoring system was developed and compared to the same measure administered using a traditional "static" format. Both versions were administered to 64 typically developing children ranging in age from 6 to 8;5. The dynamic phoneme deletion task was designed so that no verbal response was required. Children were asked to point to pictures representing each stimulus item. The same stimulus items were administered to children in a traditional static format, without the use of pictures. For example, in the dynamic assessment task, children were asked to point to 1 of 4 pictures (e.g., ice) to indicate their response when asked to delete "m" from "mice." In the static format, children were asked to "say" the real word left over after deleting "m" from "mice." Correlations between phoneme deletion tasks and word-level reading tasks were calculated. RESULTS: Internal reliability for the nonverbal dynamic phoneme deletion task was α=.88 for the total sample. Correlations between the dynamic and static formats were high (r=.84) as were correlations between the deletion tasks and the measure of word-level reading (dynamic; r=.54, static; r=.53). CONCLUSIONS: These preliminary findings suggest that the nonverbal dynamic phoneme deletion task holds promise for use with children for whom speech output is compromised. Implications for use with children who use AAC or who have significant speech impairments and recommendations for future research are discussed. LEARNING OUTCOMES: Readers will learn about a nonverbal dynamic assessment of phoneme deletion that may prove useful for measuring phoneme awareness for children who are unable to communicate using natural speech or who present with moderate-severe speech impairments. Readers will learn about the importance of accurate measurement of phoneme awareness for children with complex communication needs. Readers will also learn about how to develop and utilize reliable and valid measures of phoneme awareness for this population of children with communication impairments.

What constitutes health-related quality of life in dementia? Development of a conceptual framework for people with dementia and their carers.

BACKGROUND: The evaluation of multi-dimensional outcomes such as health-related quality of life (HRQL) is particularly relevant in dementia where the disease can compromise all areas of functioning. The nature of dementia can make self-report difficult, yet the subjective nature of HRQL makes the value of proxy reports limited. Previous work suggests that there are domains of HRQL that are unique to dementia. We aimed to develop a conceptual framework of HRQL in dementia from the perspective of people with dementia and their carers and to examine differences in the reports of the HRQL of these two groups. METHODS: We combined existing literature and new qualitative data to develop the conceptual framework and analysed qualitative data using content analysis. RESULTS: We identified five domains: daily activities and looking after yourself, health and well-being, cognitive functioning, social relationships and self-concept, and each was defined by specific descriptive components. There were differences between people with dementia and carers in the way they described these domains. CONCLUSIONS: We have developed a conceptual framework of HRQL in dementia that incorporates the views of people with dementia and their carers. This provides the basis for the development of a new measure of HRQL in dementia (DEMQOL).