BRIEF METHODOLOGICAL REPORTS
Mild Cognitive Impairment and Objective Instrumental Everyday Functioning: The Everyday Cognition Battery Memory Test
Jason C. Allaire, PhD, Alyssa Gamaldo, MS, Brian J. Ayotte, PhD, Regina Sims, PhD, and Keith Whitfield, PhD

OBJECTIVES: To examine the performance subjects with and without mild cognitive impairment (MCI) on an objective measure of everyday or real-world memory and subjective items assessing competency within the same instrumental domains; to determine whether the Everyday Cognition Battery (ECB) can uniquely predict MCI status.

DESIGN: Cross-sectional.

SETTING: Independent-living sample of urban dwelling elders in Baltimore Maryland.

PARTICIPANTS: The sample consisted of 555 subjects ranging in age from 50 to 95 (mean 68.8 ± 9.6).

MEASUREMENTS: Objective performance in three instrumental domains (medication use, financial management, nutrition and food preparation) was assessed using the ECB Memory Test. Subjective performance within the same instrumental domains was also assessed.

RESULTS: No difference was found between elderly subjects with and without MCI on the subjective items of instrumental activity of daily living (IADL) competency. A significant multivariate effect for cognitive status group (F3, 507=21.88, P<.05, η2=.12) was observed for the objective measure, with participants with MCI performing, on average, significantly worse than those without on all thee instrumental domain subscales. The medicine use (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.94–0.99) and financial management (OR=0.93, 95% CI=0.91–0.96) subscales of the ECB Memory Test were unique and significant predictors of MCI.

CONCLUSION: This study adds to the growing body of literature suggesting that cognitively complex IADLs might be compromised in elderly people with MCI. Moreover, the ECB Memory Test might be a clinically useful tool in evaluating real-world competency. J Am Geriatr Soc 2009;57(1):120-125.

Inappropriate Medication Use as a Risk Factor for Self-Reported Adverse Drug Effects in Older Adults
Elizabeth A. Chrischilles, PhD, Rachel VanGilder, PhD, Kara Wright, MS, Michael Kelly, PharmD, and Robert B. Wallace, MD, MS

OBJECTIVES: To determine the association between inappropriate medication use and self-reported adverse drug effects (ADEs).

DESIGN: Prospective cohort study with three annual mailed surveys.

SETTING: Population-based sample of Iowa Medicare beneficiaries.

PARTICIPANTS: Cohort members (n=626) with established mobility disability and complete pharmacy dispensing records, continuous Medicare eligibility, and survey data.

MEASUREMENTS: The number of unique drug ingredients dispensed and inappropriate use were assessed for the year before the ADE survey. Inappropriate medication use was defined according to published criteria: contraindicated drugs for elderly people, drug–disease interactions (constructed from linked Medicare claims), drug–drug interactions, and therapeutic duplications. An ADE was defined from the following question: "In the past 12 months, have you experienced an unwanted effect or side effect of a medication?"

RESULTS: Of respondents to the ADE survey, 22.0% reported having experienced an ADE in the past year, and 322 (51.4%) received at least one potential inappropriate medication. Factors associated univariately with ADE self-report were number of medications, number of mobility limitations, any inappropriate medication use, and each of the individual domain appropriateness indicators, as well as number of different domains of inappropriate use. The adjusted odds ratio for developing an ADE was 2.14 (95% confidence interval=1.26–3.65) for those with inappropriate use versus no inappropriate use.

CONCLUSION: Efforts to reduce ADEs by reducing medication inappropriateness should be encouraged as a complement to efforts focused on reducing the number of medications prescribed. J Am Geriatr Soc 2009;57(6):1000-1006.
 

CLINICAL INVESTIGATIONS
Physical Activity and Executive Function in Aging: The MOBILIZE Boston Study
Laura H. P. Eggermont, PhD, William P. Milberg, PhD, Lewis A. Lipsitz, MD, Erik J. A. Scherder, PhD, and Suzanne G. Leveille, PhD, RN

OBJECTIVES: To determine the relationship between physical activity and cognition, specifically executive function, and the possible mediating role of factors such as cardiovascular disease (CVD) and CVD risk factors, chronic pain, and depressive symptoms.

DESIGN: Cross-sectional study.

SETTING: Population-based study of individuals aged 70 and older in the Boston area.

PARTICIPANTS: Older community-dwelling adults (n=544; mean age 78, 62% female).

MEASUREMENTS: Presence of heart disease (self-reported physician diagnosed), pain, and depressive symptomatology were assessed using interviewer-administered questions. Blood pressure was measured. Engagement in physical activity was determined using the Physical Activity Scale for the Elderly (PASE). Cognitive function was measured using a battery of neuropsychological tests.

RESULTS: The older adults who engaged in more physical activity had significantly better performance on all cognitive tests, except for Letter Fluency and the memory test of delayed recall, after adjusting for age, sex, education, and total number of medications. With further adjustment for CVD and CVD risk factors (heart disease, diabetes mellitus, stroke, and hypertension), pain, and depressive symptoms, PASE score remained significantly associated with executive function tests.

CONCLUSION: Even after multivariate adjustment, neuropsychological tests that were executive in nature were positively associated with physical activity participation in this cohort of older community-dwelling adults. In contrast, delayed recall of episodic memory was not associated with physical activity, supporting the idea that the relationship with executive function represents a specific biologically determined relationship. J Am Geriatr Soc 2009;57(10):1750-1756.

OBJECTIVES: To evaluate whether a high-intensity functional weight-bearing exercise program reduces dependency in activities of daily living (ADLs) in older people living in residential care facilities, focusing on people with dementia.

DESIGN: Randomized, controlled trial.

SETTING: Nine residential care facilities.

PARTICIPANTS: One hundred ninety-one older people dependent in ADLs and with a Mini-Mental State Examination score of 10 or greater. One hundred (52.4%) of the participants had dementia.

INTERVENTION: A high-intensity functional weight-bearing exercise program or a control activity consisting of 29 sessions over 3 months.

MEASUREMENTS: The Barthel ADL Index; follow-up at 3 months (directly after the intervention) and 6 months with intention-to-treat analyses.

RESULTS: There were no statistically significant differences between the groups regarding overall ADL performance. Analyses for each item revealed that a smaller proportion of participants in the exercise group had deteriorated in indoor mobility at 3 months (exercise 3.5% vs control 16.0%, P=.01) and 6 months (7.7% vs 19.8%, P=.03). For people with dementia, there was a significant difference in overall ADL performance in favor of the exercise group at 3 months (mean difference 1.1, P=.03) but not at 6 months.

CONCLUSION: A high-intensity functional weight-bearing exercise program seems to reduce ADL decline related to indoor mobility for older people living in residential care facilities. The program does not appear to have an overall effect on ADLs. In people with dementia, the exercise program may prevent decline in overall ADL performance, but continuous training may be needed to maintain that effect. J Am Geriatr Soc 2009;57(10):1741-1749.