Evaluation of a Measure of Everyday Function in Older Adults; Use of a Rural-Serving, Outpatient Neurology Clinic Sample

Abstract

Background: Understanding a patient’s ability to complete instrumental activities of daily living (IADLs) provides valuable insight into the cognitive and functional decline associated with diseases of aging, such as neurocognitive disorders. Early and accurate evaluation of IADLs permits healthcare professionals to conceptualize level of impairment, track disease progression, and tailor interventions to support patients in preserving quality of life and, in some cases, slow decline for as long as possible. Revised in 2021, the Everyday Cognition scale (ECog-II; Farias et al., 2021) is a measure of IADLs, unique for its evaluation of everyday functioning relative to specific cognitive domains often examined in comprehensive neuropsychological evaluations and for its ability to be used both by patients and their informants.

Purpose: The purpose of the present study was to evaluate the clinical utility of the ECog-II Patient- and Informant-Reports in an outpatient neurology clinic that primarily serves rural-living patients in the southeastern United States presenting with comorbid medical and mental health conditions.

Methods: A total of 106 patients from an outpatient neurology clinic in Eastern North Carolina who were internally referred for neuropsychological testing were included in the present study. The sample included 52 patients with mild cognitive impairment (MCI), 48 patients with dementia, and six patients without any objective cognitive impairment. Patient reports and informant reports from the ECog-II were administered, which include a total Global factor score and six domain-specific factor scores: Everyday Language, Everyday Memory, Everyday Visual-spatial/perceptual abilities, Executive Functioning (EF): Everyday Planning, EF: Everyday Organization, and EF: Everyday Divided Attention. All patients also completed a neuropsychological test battery as standard of care, and age-normed standard scores were calculated for each measure. The study sought to examine differences between respondent types, evaluate construct and predictive validity, and develop cut-off scores for the global factor.

Results: Evidence of convergent validity between ECog-II responses and gold standard neuropsychological measures of similar constructs was demonstrated. Observed trends are highlighted in the manuscript. Predictive validity between diagnostic severity, but not etiology, was established using informant reports. Global cutoff scores for ECog-II informant report data with adequate sensitivity and specificity were established. Data from patient self-reports were less significant overall, and predictive validity was no better than chance. As such, global cutoff scores were unable to be established based on patient-report data. Overall, results from the current study suggest that informant reports of patient IADLs and everyday cognitive functioning map on better to objective neuropsychological measures compared to patient reports.

Discussion: Results suggest that when evaluating neurocognitive impairment in rural-living older adults with varying comorbid medical health conditions, objective neuropsychological assessment remains the gold standard as subjective reports are not as predictive of actual cognitive functioning. Patient reports of IADL functioning are encouraged for enhanced understanding of patient awareness and insight. Collateral reports are encouraged for use in clinical decision making to supplement, but not replace, neuropsychological test data. Future studies are encouraged to collect a larger, heterogeneous diagnostic sample to further understand cognitive and functional impairment in a predominantly rural-living, southeastern patient population.