Medical help-seeking intentions for cognitive impairment by the patient.

Objectives: Older adults represent one of the fastest growing population groups. As the aged population increases, incidence of Alzheimer's disease (AD) and other dementias will also increase. Professionals agree that early intervention is essential for therapeutic and quality of life purposes; however, many older adults wait several months or years to seek medical help after first noticing signs of cognitive impairment. The present study sought to identify the predictors of help-seeking for cognitive impairment by an individual for him/herself after the first detection of symptoms.Method: An online survey was administered to adults (N = 250) 50 years old and older. Individuals responded about their help-seeking intentions in response to a hypothetical vignette depicting symptoms of cognitive decline derived from a similar study with caregivers conducted by Qualls and colleagues. Additional standardized measures measuring constructs such as knowledge of Alzheimer's disease were completed.Results: The present study reveals that cognitive (i.e. symptom identification and disease attribution) and affective (i.e. symptom impact and threat appraisal) factors, as well as an interaction between the two, are predictive of help-seeking intentions with excellent model fit.Conclusion: Help-seeking intentions by individuals with possible cognitive impairment are comparable to those of potential caregivers. Contrary to hypotheses, high threat appraisal positively predicted help-seeking intentions despite the expectation that threat-induced fear would lead to avoidance. Recommendations are made for future research to further investigate both patients' help-seeking intentions and actions in response to signs of cognitive impairment.Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2021.1910791 .

Differential item functioning analysis of items on the Geriatric Depression Scale-15 based on the presence or absence of cognitive impairment.

OBJECTIVE: The Geriatric Depression Scale-15 (GDS-15) is a screener for depressive symptoms in older adults. The present study aims to investigate the differential item functioning (DIF) of the GDS-15 items to determine whether or not they are biased by the presence of cognitive impairment. METHOD: Data from 215 older patients were used to examine the GDS-15. Individuals were categorized as cognitively impaired if they scored below the 10th percentile on the Mattis Dementia Rating Scale II. To evaluate DIF, configural invariance, metric invariance, scalar invariance, residual invariance, and factor variance were evaluated. Additional analyses were conducted to know the role identified DIF items play in the screening process. RESULTS: Most levels of invariance indicated that items operated equivalently across groups (p > 0.05). However, analysis of scalar invariance indicated worse model fit (p = 0.001), such that the threshold for Item 13 differed between the groups. Freeing this threshold resulted in scalar invariance (p = 0.12). CONCLUSIONS: Because partial measurement invariance was achieved suggesting that the tool as a whole functions similarly for older adults with and without cognitive impairment, professionals can be confident that the GDS-15 screens for depression as well in individuals with cognitive impairment as those without.

IRT Analysis of the Frontal Systems Behavior Scale: Identifying the Best Items for Use with Geriatric Patients in Primary Care.

OBJECTIVE: The Frontal Systems Behavior Scale (FrSBe) (Grace & Malloy, 2001) assesses behavioral dysfunction associated with frontal-subcortical damage; it is often used to measure these indicators of executive dysfunction in older adults with possible dementia. Although prior research supports the FrSBe's clinical utility and factorial validity, little attempt has been made to examine which items are most useful for geriatric cases. The goal of the present study is to identify these items. METHOD: Data from 304 older patients referred for neuropsychological assessment were used to examine the FrSBe's three subscales: Apathy (A; 14 items), Executive Dysfunction (E; 17 items), and Disinhibition (D; 15 items). Item properties were investigated using the Graded Response Model, a two-parameter polytomous item response theory model. RESULTS: Difficulty parameters, discrimination parameters, and information curves identified 18 items that effectively discriminate (a ≥ 1.70) between levels of behavioral dysfunction and measure a range of dysfunction (bA: -1.23 - 2.22; bD: -.29 - 2.14; bE: -1.81 - 1.77). CONCLUSIONS: Most FrSBe items were effective at discriminating various levels of behavioral dysfunction, though weaker items were identified. CLINICAL IMPLICATIONS: The findings suggest the FrSBe is a useful clinical tool when working with a geriatric population, though some items provide more information than others.