A Neuropsychological Approach to Mild Cognitive Impairment.

OBJECTIVE: A neuropsychological approach to the detection and classification of mild cognitive impairment (MCI) using "gold standard" clinical ratings (CRs) was examined in a sample of independently functioning community dwelling seniors. The relationship between CRs and life satisfaction, concurrent validity of cognitive screening measures, and agreement between CRs and existing criteria for MCI were also determined. METHOD: One hundred and forty-two participants, aged 75 years and older, were administered a comprehensive battery of neuropsychological tests, along with self-report measures of psychological and psychosocial functioning, and functional independence. CRs were based on demographically corrected neuropsychological variables. RESULTS: The prevalence of MCI identified using CRs in this sample was 26.1%. Single and multiple domain subtypes of MCI were readily identified with subtypes reflecting Amnestic and Executive Function impairment predominating. Executive Function was a significant predictor of Life Satisfaction. The MoCA and MMSE both showed weak performance in detecting MCI based on CRs. There was substantial agreement between CRs and the classification criteria for MCI defined by Petersen/Winblad and Jak/Bondi. A global deficit score had near perfect performance as a proxy for CRs in detecting MCI in this sample. CONCLUSIONS: The results provide strong support for the utility of neuropsychological CRs as a "gold standard" operational definition in the detection and classification of MCI in older adults.

The impact of fall risk assessment on nurse fears, patient falls, and functional ability in long-term care.

PURPOSE: The purpose of this study was to determine whether providing fall risk information to long-term care (LTC) nurses affects restraint use, activities of daily living (ADL), falls, and nurse fears about patient falls. METHODS: One-hundred and fifty LTC residents were randomized to a fall risk assessment intervention or care-as-usual group. Hypotheses were tested using analyses of variance and path analyses. RESULTS: Restraint use was associated with lower ADL scores. In the intervention group, there ceased to be significant relationships between nurse fears about falls and patient falls (after controlling for actual patient risk; post-intervention, nurse fears about falls were based on realistic appraisals), and between fears and restraints (i.e. unjustified nurse fears became less likely to lead to unjustified restraint use). No group differences in falls were identified. CONCLUSION: Despite a lack of group differences in falls, results show initial promise in potentially impacting resident care. Increasing intervention intensity may lead to fall reductions in future research. IMPLICATIONS FOR REHABILITATION: Given the high prevalence rates of falls in LTC and associated injuries, prevention programs are important. Nurse fears about patient falls may impact upon restraint use which, when excessive, can interfere with the patient's ability to perform ADL. Excessive restraint use, due to unjustified nurse fears, could also lead to falls. Providing accurate, concise information to nursing staff about patient fall risk may aid in reducing the association between unjustified nurse fears and the resulting restraint use that can have potential negative consequences.

A controlled investigation of continuing pain education for long-term care staff.

BACKGROUND: The underassessment and undertreatment of pain in residents of long-term care (LTC) facilities has been well documented. Gaps in staff knowledge and inaccurate beliefs have been identified as contributors. OBJECTIVES: To investigate the effectiveness of an expert-based continuing education program in pain assessment/management for LTC staff. METHODS: Participants included 131 LTC staff members who were randomly assigned to either an interactive pain education (PE) program, which addressed gaps in knowledge such as medication management, or an interactive control program consisting of general dementia education without a specific clinical focus. Participants attended three sessions, each lasting 3 h, and completed measures of pain-related knowledge and attitudes/beliefs before, immediately after and two weeks following the program. Focus groups were conducted with a subset of participants to gauge perception of the training program and barriers to implementing pain-related strategies. RESULTS: Analysis using ANOVA revealed that PE participants demonstrated larger gains compared with control participants with regard to pain knowledge and pain beliefs. Barriers to implementing pain-related strategies certainly exist. Nonetheless, qualitative analyses demonstrated that PE participants reported that they overcame many of these barriers and used pain management strategies four times more frequently than control participants. CONCLUSIONS: Contrary to previous research, the present study found that the interactive PE program was effective in changing pain beliefs and improving knowledge. Continuing PE in LTC has the potential to address knowledge gaps among front-line LTC providers.

Revised neurobehavioral scales of the MMPI: sensitivity and specificity in traumatic brain injury.

The ability of 23 previously identified Minnesota Multiphasic Personality Inventory (MMPI) "neurologic content" items to distinguish between individuals with traumatic brain injury (TBI; n = 32) or spinal cord injury (SCI; n = 17) was examined. Principal-components analysis of the 23 items revealed three conceptually coherent, nonoverlapping, and uncorrelated factors (Cognitive, Somatic, Inactivity) that together accounted for 44% of the total variance. Coefficients of internal consistency for the factors were in the moderate to high range. Together, the factors were named the Revised Neurobehavioral Scales of the MMPI. The group with TBI scored significantly higher on the Cognitive scale and significantly lower on the Inactivity scale than the group with SCI (with or without depression as a covariate). The Glasgow Coma Scale correlated significantly and negatively with the Cognitive scale in the group with TBI. Discriminant function analysis revealed that together the scales correctly classified individuals with sensitivity and a positive predictive value (with respect to TBI) of 87% and 81%, respectively. Specificity and a negative predictive value (with respect to SCI) were 68% and 76%, respectively. The overall rate of correct classification of individual cases was 80% (with or without depression in the analysis). The Cognitive scale alone correctly classified individuals in the group with TBI with a positive predictive value of 84%. Findings are discussed in terms of the discriminative validity and potential utility of TBI-related MMPI items, as well as the issue of "neurocorrection" of the MMPI (or MMPI-2) in verified cases of TBI.

The MMPI and closed-head injury.

This study examined Minnesota Multiphasic Personality Inventory profile configuration in matched samples of males (n = 77) and females (n = 25) suffering from closed-head injury. For the males, the mean group high-point was the 5c scale; the mean group high-point for the females was the D scale. For the males, the mean group two-point code was the 8-2 configuration; the mean group two-point code for the females was the 2-3 configuration. The males as a group also scored significantly higher than the females on the Sc scale. The D scale was the most frequently elevated clinical scale and high-point for both groups. The overall pattern of findings also suggested a greater predominance of Hs and Hy two-point code types for the females. The results are discussed in terms of the need to pay critical attention to methodological issues in neuropsychological research and practice.

The MMPI and neurologic dysfunction: Profile configuration and analysis.

This study examined the application of the Minnesota Multiphasic Personality Inventory (MMPI) to the assessment of personality and emotional status in neurologic patients. Eighteen specialists in the clinical neurosciences examined the standard MMPI and indicated those items they felt were potentially tapping valid manifestations of neurologic damage or dysfunction. Forty-four items, loading primarily on the Hs, Hy, and Sc scales, were identified. These items were then deleted from the standard MMPI protocols of a heterogeneous group of 115 verified neurologic patients and the protocols rescored in the usual fashion. Corresponding high-points between the original MMPI and the modified version occurred in 46% of the cases. Comparable two-point code types occurred in only 29% of the cases. Taking into account the neurologic content of the MMPI can thus considerably alter the MMPI profile of a neurologic patient. Caution should thus be exercised with regard to the application and literal interpretation of the MMPI in neurologic cases.