Clinical Utility of Auditory Memory Testing in a Heart Failure Population.
ABSTRACT BACKGROUND:: The self-care regimen necessary in heart failure (HF) is notably complex. A complication to integrating new knowledge and behaviors is that impaired cognition has been frequently reported in patients with HF, which significantly impacts patients' health, admission and mortality rates, and instrumental activities of daily living. OBJECTIVE:: The identification of reliable cognitive screening tools to assess potential difficulties in performing self-care for cardiac populations is essential. As such, the current purposes were to evaluate the validity and stability of the International Shopping List (ISL) auditory learning subtest from the computerized CogState battery as a screening tool in HF populations, determine the ISL's ability to predict functional declines, and evaluate the task's sensitivity in myocardial infarction. METHODS:: Forty patients with chronic HF were enrolled in a longitudinal study evaluating the impact of a cognitive training intervention. Baseline neuropsychological and behavioral measurements before treatment were used in the current study, including measures of auditory memory, orientation, verbal fluency, processing speed, and activities of daily living, and a subset of patients (n = 17) received repeat testing at 8 weeks on some tasks. Analyses also were performed with patients organized based on myocardial infarction status. RESULTS:: The current study indicated that the ISL performed comparably with an established measure of auditory memory (Hopkins Verbal Learning Test-Revised; r = 0.70, P < .001), displayed adequate coefficients of stability (r = 0.53-0.68), and successfully predicted declines over time in daily functioning (β = .47, P < .001) in our HF sample. CONCLUSIONS:: The computerized CogState auditory memory subtest, the ISL, seems to be a beneficial tool in evaluating cognitive change in HF patients. Particularly given its cross-cultural sensitivity and ease of administration and scoring, this task may provide assistance to quickly and reliably monitor memory functioning in these vulnerable patients and gauge their potential for self-care behaviors.
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ABSTRACT: Loss of functioning on complex tasks of daily living is an early indicator of dementia. The performance of 65 older adults with mild to moderate levels of Alzheimer's disease was examined on the Everyday Problems Test for the Cognitively Challenged Elderly (EPCCE), self-report inventories of functional performance, and a broad battery of clinical and neuropsychological measures. The EPCCE was designed to assess older adults on a set of complex tasks of daily living that involved not only global cognitive processes, but also higher-order executive functions. Participants solved an average of 45% of EPCCE tasks with significant differences in scores by disease severity. Performance was significantly related to global cognitive functioning and disease severity, and in particular to executive functions. Significant additional variance was accounted for by these executive functions beyond the variance accounted for by global cognitive measures.The Gerontologist 11/1998; 38(5):569-77. · 2.48 Impact Factor
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ABSTRACT: Reliable detection of mild cognitive impairment (MCI), in many cases preceding AD, is important in determining the efficacy of emerging treatments. The operational definition of MCI is currently imprecise and would be improved by objective criteria. Inherent in the transition from MCI to AD is cognitive decline, which can be detected using multiple assessments over several years. To determine whether multiple assessments on the same day could also differentiate well-studied subjects with very mild MCI from normal control subjects. This study utilized a novel 15- to 18-minute computerized cognitive battery designed for frequent serial use, administered four times within 3 hours. Subjects were participants in a longitudinal healthy aging study (20 with MCI, 40 control subjects matched for age, gender, and education). The MCI group showed significantly attenuated learning performance with repetition on accuracy and reaction time tasks. Discriminant function analysis correctly classified 95% of subjects and 80% of those with MCI. Multiple assessments with standardized, repeatable cognitive measures is a promising method for reliably differentiating patients with early MCI in a single test session and deserves further study for refining patient selection in trials of therapeutic agents for MCI.Neurology 11/2002; 59(7):1042-6. · 8.25 Impact Factor
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ABSTRACT: Impaired cardiac function can adversely affect the brain via decreased perfusion. The purpose of this study was to determine if cardiac ejection fraction (EF) is associated with cognitive performance, and whether this is modified by low blood pressure. Neuropsychological testing evaluating multiple cognitive domains, measurement of mean arterial pressure (MAP), and measurement of EF were performed in 234 individuals with coronary artery disease. The association between level of EF and performance within each cognitive domain was explored, as was the interaction between low MAP and EF. Adjusted global cognitive performance, as well as performance in visuoconstruction and motor speed, was significantly directly associated with cardiac EF. This relationship was not entirely linear, with a steeper association between EF and cognition at lower levels of EF than at higher levels. Patients with low EF and low MAP at the time of testing had worse cognitive performance than either of these alone, particularly for the global and motor speed cognitive scores. Low EF may be associated with worse cognitive performance, particularly among individuals with low MAP and for cognitive domains typically associated with vascular cognitive impairment. Further care should be paid to hypotension in the setting of heart failure, as this may exacerbate cerebral hypoperfusion.Behavioural neurology 01/2010; 22(1-2):63-71. · 1.25 Impact Factor