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English Language Proficiency, Hearing Impairment, and Functional Change in Mild Cognitive Impairment
Accepted Manuscript Title: English Language Proficiency, Hearing Impairment and Functional Change in Mild Cognitive Impairment Author: Paul J Regal PII: DOI: Reference:
S1064-7481(17)30379-2 http://dx.doi.org/doi: 10.1016/j.jagp.2017.06.021 AMGP 879
To appear in:
The American Journal of Geriatric Psychiatry
Received date: Accepted date:
22-6-2017 23-6-2017
Please cite this article as: Paul J Regal, English Language Proficiency, Hearing Impairment and Functional Change in Mild Cognitive Impairment, The American Journal of Geriatric Psychiatry (2017), http://dx.doi.org/doi: 10.1016/j.jagp.2017.06.021. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
English language proficiency, hearing impairment and functional change in mild cognitive impairment
Paul J Regal, MD Keywords: Cognitive impairment; dementia; hearing impairment
I congratulate the authors 1 for successfully deconstructing the DSM-V criteria for minor neurocognitive disorder (MCI). This article ranks among the five most important MCI papers in the past year. My comments apply to three issues. First is the exclusion of subjects with non-English speaking background in this analysis. The authors explored “non-English speaking background” in a previous article 2. They suggest that those with non-English speaking background must be analyzed separately in studies of incident dementia because of impaired comprehension of test items. Looking at this issue from a root level, neuropsychological tests can be administered at baseline and again a follow-up several years later using the subject as his or her own control to assess incident MCI or incident dementia. English language proficiency is very unlikely to change during this interval except for recent immigrants from non-English speaking countries. The second issue is hearing impairment. The Sydney Memory and Aging Study did not exclude subjects with hearing impairment nor did they use portable amplifiers with headphones for subjects with poor hearing. Given the age bracket 70-90 we assume that at least 40% had hearing impairment. The third issue is Bayer ADL Scale which contains 96% instrumental activities of daily living (IADL) items. At least 75% of items on Bayer ADL are highly prone to interpretation and would be rated differently by various family members. Has the inter-rater reliability been measured and compared to other IADL scales? Examples of Bayer items are listed in table 1 3. Is “music” a correct answer to “describing what he or she has just seen or heard” in Beethoven’s Ninth Symphony? Is sweeping the floor and singing a correct answer to “doing two things at the same time?” Is “concentrating on reading” the act of reading a book the person has read and understood before? The 22-item Nottingham IADL 4, in contrast to the Bayer ADL, is much easier to interpret. Items for Page 1 of 2
driving, cooking a hot snack, washing a full load of laundry, and crossing the road are easy to interpret. In summary I find the Bayer ADL too subjective and prone to multiple interpretations. The Lawton Brody IADL 5 has only eight items, which limits its ability to capture the functional transition from normal cognition to MCI and then dementia. When an IADL is partitioned cognitive disability is revealed. Assume a patient has dense right hemiplegia, homonymous hemianopia and dysphasia from a stroke. IADL items related to these impairments can be excluded from the cognitive IADL. Reppermund 3 demonstrated partitioning with factor analysis rather than by matching individual patient disabilities. Low and colleagues 2 from Sydney Memory and Ageing Study used such partitioning of the Bayer ADL. Study table 2 3 shows partitioning of IADL into high versus low cognitive demand. For high cognitive demand a Bayer-IADL of at least 2.5 SD was present in 10.9% of subjects. My comments should not be seen as diminishing the high impact of Brodaty’s article 1. References: 1. Brodaty H, Aerts L, Crawford JD et al. Operationalizing the diagnostic criteria for mild cognitive impairment: the salience of objective measures in predicting incident dementia. Am J Geriatr Psychiatry 2017; 25:485-497 2. Low LF, Harrison F, Kochan NA, Draper B et al. Can mild cognitive impairment be accurately diagnosed in English speakers from linguistic minorities? Results from the Sydney Memory and Ageing Study. Am J Geriatr Psychiatry 2012; 20:866-877 3. Reppermund S, Brodaty H, Crawford JD et al. Impairment in instrumental activities of daily living with high cognitive demand is an early marker of mild cognitive impairment: the Sydney Memory and Ageing Study. Psychological Medicine 2013; 43:2437-2445 4. Regal P, Carter A. Instrumental Activities of Daily Living Questionnaires for Dementia and Mild Cognitive Impairment. J Neurology Research 2015; 5:153-159 5. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969; 9:179-186
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S1064-7481(17)30379-2 http://dx.doi.org/doi: 10.1016/j.jagp.2017.06.021 AMGP 879
To appear in:
The American Journal of Geriatric Psychiatry
Received date: Accepted date:
22-6-2017 23-6-2017
Please cite this article as: Paul J Regal, English Language Proficiency, Hearing Impairment and Functional Change in Mild Cognitive Impairment, The American Journal of Geriatric Psychiatry (2017), http://dx.doi.org/doi: 10.1016/j.jagp.2017.06.021. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
English language proficiency, hearing impairment and functional change in mild cognitive impairment
Paul J Regal, MD Keywords: Cognitive impairment; dementia; hearing impairment
I congratulate the authors 1 for successfully deconstructing the DSM-V criteria for minor neurocognitive disorder (MCI). This article ranks among the five most important MCI papers in the past year. My comments apply to three issues. First is the exclusion of subjects with non-English speaking background in this analysis. The authors explored “non-English speaking background” in a previous article 2. They suggest that those with non-English speaking background must be analyzed separately in studies of incident dementia because of impaired comprehension of test items. Looking at this issue from a root level, neuropsychological tests can be administered at baseline and again a follow-up several years later using the subject as his or her own control to assess incident MCI or incident dementia. English language proficiency is very unlikely to change during this interval except for recent immigrants from non-English speaking countries. The second issue is hearing impairment. The Sydney Memory and Aging Study did not exclude subjects with hearing impairment nor did they use portable amplifiers with headphones for subjects with poor hearing. Given the age bracket 70-90 we assume that at least 40% had hearing impairment. The third issue is Bayer ADL Scale which contains 96% instrumental activities of daily living (IADL) items. At least 75% of items on Bayer ADL are highly prone to interpretation and would be rated differently by various family members. Has the inter-rater reliability been measured and compared to other IADL scales? Examples of Bayer items are listed in table 1 3. Is “music” a correct answer to “describing what he or she has just seen or heard” in Beethoven’s Ninth Symphony? Is sweeping the floor and singing a correct answer to “doing two things at the same time?” Is “concentrating on reading” the act of reading a book the person has read and understood before? The 22-item Nottingham IADL 4, in contrast to the Bayer ADL, is much easier to interpret. Items for Page 1 of 2
driving, cooking a hot snack, washing a full load of laundry, and crossing the road are easy to interpret. In summary I find the Bayer ADL too subjective and prone to multiple interpretations. The Lawton Brody IADL 5 has only eight items, which limits its ability to capture the functional transition from normal cognition to MCI and then dementia. When an IADL is partitioned cognitive disability is revealed. Assume a patient has dense right hemiplegia, homonymous hemianopia and dysphasia from a stroke. IADL items related to these impairments can be excluded from the cognitive IADL. Reppermund 3 demonstrated partitioning with factor analysis rather than by matching individual patient disabilities. Low and colleagues 2 from Sydney Memory and Ageing Study used such partitioning of the Bayer ADL. Study table 2 3 shows partitioning of IADL into high versus low cognitive demand. For high cognitive demand a Bayer-IADL of at least 2.5 SD was present in 10.9% of subjects. My comments should not be seen as diminishing the high impact of Brodaty’s article 1. References: 1. Brodaty H, Aerts L, Crawford JD et al. Operationalizing the diagnostic criteria for mild cognitive impairment: the salience of objective measures in predicting incident dementia. Am J Geriatr Psychiatry 2017; 25:485-497 2. Low LF, Harrison F, Kochan NA, Draper B et al. Can mild cognitive impairment be accurately diagnosed in English speakers from linguistic minorities? Results from the Sydney Memory and Ageing Study. Am J Geriatr Psychiatry 2012; 20:866-877 3. Reppermund S, Brodaty H, Crawford JD et al. Impairment in instrumental activities of daily living with high cognitive demand is an early marker of mild cognitive impairment: the Sydney Memory and Ageing Study. Psychological Medicine 2013; 43:2437-2445 4. Regal P, Carter A. Instrumental Activities of Daily Living Questionnaires for Dementia and Mild Cognitive Impairment. J Neurology Research 2015; 5:153-159 5. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969; 9:179-186
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