The Efficacy of a Computer-Assisted Cognitive Rehabilitation Program for Patients with Mild Cognitive Deficits: A Pilot Study.

Background/Study Context: Whereas computer-assisted cognitive rehabilitation (CR) programs show promise as tools for improving cognition in certain populations, there is not a consensus regarding their efficacy. This study focuses on restorative CR, a treatment designed to improve cognitive functioning affected by progressive brain changes due to disease or aging, through computer-assisted cognitive exercises. The purpose of this study was to investigate the efficacy of a computer-assisted restorative CR intervention for improving cognitive functioning in older rehabilitation patients with relatively mild cognitive deficits. METHODS: Older adult residents in a Maryland retirement community (N = 43) who met inclusion criteria were assigned to either the CR treatment or the control group. Treatment group participants completed 3 weeks (nine sessions) of Memory Match, an online CR module designed to improve attention and visual memory, whereas the control group did not complete the CR program after the baseline assessment. Analyses were based on the 38 (n = 20 treatment, n = 18 control) participants (mean age = 78.08 ± 10.31) who completed the post-assessment Brief Cognitive Assessment Tool (BCAT) and a self-rating inventory (SRI) of cognitive ability. RESULTS: Treatment group participants who received the CR treatment obtained significantly higher BCAT scores (medium to large effect size) at post-assessment than control group participants over the same period. Additional evidence for the efficacy of the CR program was found by comparing responses on a SRI of cognitive ability between the two groups. CONCLUSION: The authors discuss the merits and shortcoming of this pilot study, the utility of the CR program for older rehabilitation patients with relatively mild cognitive deficits, and ideas for future research.

Meaningful Activity for Long-Term Care Residents With Dementia: A Comparison of Activities and Raters.

Purpose of the Study: Engagement in meaningful activities is associated with positive outcomes for persons with dementia, yet studies demonstrating quantitative evidence for which activities can be considered meaningful are lacking. We investigated MemPics™, a program designed to promote meaningful activity for individuals with dementia through engagement and cognitive stimulation. It was compared with other recreation activities offered in U.S. long-term care facilities to determine whether MemPics™ was rated as having more meaningful activity from both the perspectives of participants and recreation staff. Design and Methods: Long-term care residents with mild to moderate dementia that met eligibility criteria were randomly assigned to an activity group (treatment, control). Participants completed 2 sessions of either the experimental or control group activity with facility recreation staff. Both participants and staff rated each activity in terms of meaningfulness following each session. Results: Of the enrolled participants (N = 126), study analyses were based on the 94 participants (n = 48 treatment and n = 46 control; M age = 82.98±9.63) who completed the activity sessions. Compared to the control group activities, MemPics™ had significantly higher participant and staff ratings of meaningfulness. Scores between the 2 rater types were significantly different, with staff reporting higher meaningful activity than participants. Further support for MemPics™ was found in exit survey responses from participating staff. Implications: We discuss the merits and shortcoming of this study, the utility of MemPics™ for providing meaningful engagement in long-term care residents with mild to moderate dementia, and ideas for future research.

Predicting Off-Label Antipsychotic Medication Use in a Randomly Selected Nursing Home Sample Based on Resident and Facility Characteristics.

Reducing off-label antipsychotic medication use for behavioral and psychological symptoms of dementia (BPSD) in nursing home residents has been a centerpiece of government regulation, but without insight into utilization differences based on resident and facility characteristics. To examine whether resident and facility characteristics can predict off-label antipsychotic medication treatment for BPSD, residents prescribed antipsychotic medication (N = 216) from 17 Maryland nursing facilities were randomly selected. Based on physician diagnoses, 59.7% of participants were taking off-label antipsychotic medications for BPSD. Hierarchical logistic regression results suggest that dementia level (indicated by Brief Cognitive Assessment Tool scores) and age, but not facility characteristics, significantly predict greater likelihood of using off-label antipsychotic medications for BPSD. Having moderate-severe dementia was associated with more than a four-fold increase in off-label antipsychotic medication use for BPSD. Off-label use of antipsychotic medications for BPSD remains high, especially for older nursing home residents with more severe dementia, indicating that more targeted reduction approaches are needed. [Res Gerontol Nurs. 2016; 9(6):257-266.].

Mild cognitive impairment (MCI) in long-term care patients: subtype classification and occurrence.

OBJECTIVES: This study examines mild cognitive impairment (MCI) in long-term care settings by identifying and quantifying MCI subtypes in a combined sample of nursing home and assisted-living patients. We compared impairment thresholds of 1-SD and 1.5-SD to determine if different cut-offs differentially affect occurrence rates. METHOD: One hundred and eight participants who met general criteria for MCI were included for the purposes of this study. The general diagnosis of MCI was based on criteria. Participants were further grouped into MCI subtypes. Based on previously established norms, Brief Cognitive Assessment Tool (BCAT) factor scores were used to assess whether MCI participants met either the 1-SD and 1.5-SD impairment thresholds for memory, executive functions, and attentional capacity. RESULTS: Using both 1-SD and 1.5-SD impairment thresholds, three clear MCI subtypes were identified: amnestic, single-domain; non-amnestic, single-domain (executive); and amnestic, multi-domain (memory and executive). A fourth category (undifferentiated) was identified in patients who did not meet criteria for a distinct MCI subtype, but still had cognitive impairments. The stricter impairment threshold of 1.5-SD resulted in fewer patients classified as having any of the three domain-specific subtypes. CONCLUSION: Based on a sample of nursing home and assisted-living patients, we identified three MCI subtypes, and a fourth category consisting of participants with general MCI, but without clear evidence of domain-specific cognitive impairment. When selecting impairment thresholds, one should consider the impact on the identification of MCI subtypes and the probability of misdiagnoses.

Rapid Cognitive Assessment of Nursing Home Residents: A Comparison of the Brief Interview for Mental Status (BIMS) and Brief Cognitive Assessment Tool-Short Form (BCAT-SF).

In nursing homes, the ability to identify residents with cognitive impairment is critical; however, many providers fail to address symptoms of dementia due to insufficient time to assess cognition. In the current study, the authors compared two rapidly administered instruments, the Brief Interview for Mental Status (BIMS) and Brief Cognitive Assessment Tool-Short Form (BCAT-SF), in predicting specific cognitive stages. Two hundred twenty-five nursing home residents who were referred for neurocognitive evaluation and met inclusion criteria participated in the study. Both cognitive instruments were found to predict cognitive diagnoses generally, but only the BCAT-SF demonstrated sensitivity in differentiating among all cognitive levels. Receiver operating characteristic analyses did not confirm cutoff scores reported in the original BIMS study. However, sensitivity (0.91) and specificity (0.96) values for the BCAT-SF were robust for differentiating between dementia and non-dementia. The BCAT-SF appears to be a more sensitive instrument for predicting cognitive stages than the BIMS for nursing home residents.

Preliminary investigation of the psychometric properties of the Korean version of the brief cognitive assessment tool-short form for Korean American nursing home residents.

The authors of the current article developed and investigated the psychometric properties of a Korean version of the Brief Cognitive Assessment Tool-Short Form (BCAT-SF-K) to better understand cognitive functioning of Korean American nursing home residents. In Step I, normative values were established for the BCAT-SF-K based on a sample of Korean American community-dwelling older adults (n = 34). In Step II, the authors confirmed construct validity for the BCAT-SF-K in a sample of Korean American nursing home residents (n = 26), described cognitive levels, and reported key demographics. In the nursing home sample, 84.6% of individuals had severe cognitive impairment, 7.7% had mild impairment, and 7.7% had normal cognition. The BCAT-SF-K appears to be a reliable cognitive screening measure for Korean American nursing home residents. Based on the current study's findings, Korean American nursing home residents are both older and more cognitively impaired than their American-born nursing home counterparts. Study findings are discussed in relation to improving care for these vulnerable nursing home residents.

The Brief Anxiety and Depression Scale (BADS): a new instrument for detecting anxiety and depression in long-term care residents.

BACKGROUND: Depression and anxiety are common among long-term care residents, yet both appear to be under-recognized and under-treated. In our survey of 164 geriatric health care professionals from 34 U.S. states, 96% of respondents reported that a new instrument that rapidly assesses both depression and anxiety is needed. The Brief Anxiety and Depression Scale (BADS) is a new screening tool that can identify possible major depressive episodes (MDE) and generalized anxiety disorders (GAD) in long-term care residents. METHODS: The psychometric properties of the BADS were investigated in a sample of 224 U.S. long-term care residents (aged 80.52 ± 9.07). Participants completed a battery of several individually administered mood and cognitive tests, including the BADS. MDE and GAD were diagnosed based on the DSM-IV-TR criteria. RESULTS: Adequate internal consistency and construct validity were found. A principle component analysis (PCA) revealed an Anxiety Factor and a Depression Factor, which explained 50.26% of the total variance. The Anxiety Factor had a sensitivity of 0.73 and specificity of 0.81 for identifying GAD (PPV = 0.69, NPV = 0.84). The Depression Factor had a sensitivity of 0.76 and a specificity of 0.73 for identifying MDE (PPV = 0.77, NPV = 0.72). CONCLUSIONS: The BADS appears to be a reliable and valid screening instrument for MDE and GAD in long-term residents. The BADS can be rapidly administered, is sensitive to mood diagnoses in both patients without dementia and with dementia, and produces separate depression and anxiety factor scores that can be used clinically to identify probable mood diagnoses.

Story recall and word lists: differential and combined utilities in predicting cognitive diagnosis.

OBJECTIVES: Verbal memory assessment metrics are an essential component of cognitive screening tools. We compared the relative utilities of word list and story recall metrics in predicting cognitive functioning in nondemented and demented nursing home patients. We selected memory metrics from the Brief Cognitive Assessment Tool (BCAT) and the Brief Interview for Mental Status (BIMS). The BCAT incorporates both word lists and story recall metrics, while the BIMS only has a word list feature. METHOD: Two hundred and thirty-nine individuals residing in a Maryland skilled nursing facility were referred for neurocognitive evaluation over a one-year period. These residents met inclusion criteria for retrospective data analysis by completing the BCAT and BIMS and were aged 60 or older. RESULTS: For the entire sample and for demented individuals, all four verbal memory metrics significantly predicted cognitive diagnosis. For nondemented individuals, only the BCAT delayed word list significantly predicted cognitive diagnosis. There appears to be enhanced utility in using both verbal memory metric types, as the inclusion of word list and story recall was a stronger predictor of cognitive diagnosis than any individual verbal memory metric. CONCLUSION: This study highlights the importance of using cognitive screening tools that contain both story recall and word list metrics. This is particularly true in long-term care settings where the base rate of cognitive impairment is high.

Differentiating levels of cognitive functioning: a comparison of the Brief Interview for Mental Status (BIMS) and the Brief Cognitive Assessment Tool (BCAT) in a nursing home sample.

OBJECTIVES: In US nursing homes, cognitive assessment has been an essential component of the federally mandated Minimum Data Set assessment system, inclusive of the Brief Interview for Mental Status (BIMS) for identifying possible cognitive impairment. We compare it with the Brief Cognitive Assessment Tool (BCAT) to determine which instrument is more sensitive in differentiating degrees of cognitive functioning in nursing home residents. We attempt to cross-validate the psychometric properties of both measures. METHOD: Two hundred twenty-nine individuals residing in a Maryland skilled nursing facility were referred for neurocognitive evaluation over a 10-month period. One hundred eighty-nine of these residents met inclusion criteria by completing the BCAT and BIMS, and were aged 60 or older. RESULTS: The BIMS and the BCAT were confirmed to have strong internal consistency reliability and construct validity. Both cognitive tools were found to predict cognitive diagnoses generally, but only the BCAT was able to identify residents at all specific cognitive levels. The BIMS did not differentiate between residents with normal cognition and those with mild cognitive impairment, or between mild and moderate dementia. Both measures demonstrated high specificity and positive predictive values for identifying severe cognitive impairment or probable dementia. The BIMS had lower sensitivity and negative predictive values for identifying dementia compared to the BCAT. The BCAT accounted for an additional 47% of the variance in dementia diagnoses over and above BIMS scores. CONCLUSION: Based on these findings, the BCAT appears to be more sensitive than the BIMS in predicting cognitive level for nursing home residents.

Preliminary investigation of the Kitchen Picture Test (KPT): a new screening test of practical judgment for older adults.

Judgment is widely recognized as an important executive function, and deficits in judgment can lead to health risks, safety concerns, and hospitalizations. Surprisingly, relatively few tests of judgment have been developed specifically for older adults--a population particularly vulnerable to executive and functional declines. The Kitchen Picture Test (KPT) is a new screening measure of practical judgment. In two independent studies (Study 1, N = 99 nursing home patients; Study 2, N = 163 nursing home and assisted living patients), psychometric analyses confirmed strong evidence for reliability, construct validity, and predictive validity. A receiver operating characteristic (ROC) curve was calculated from sensitivity and 1-specificity values for diagnoses of dementia versus no dementia. A KPT cut score can be used for identifying persons to be referred to appropriate health-care professionals who have specific expertise in the evaluation and treatment of cognitive impairment.