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Clock drawing and functional impairment in a large group of frail elderly
Abstracts /Archives
of Clinical Neuropsychology
15 (2000) 653-850
755
previously. Potassium supplements were discontinued as well despite multiple prescription medications with diuretic properties due to cardiac ailments. In addition, visual inspection of all prescription medications revealed the client to be taking Synthroid despite having no history of thyroid dysfunction. The client was referred back to her primary care physician for medication adjustment without neuropsychological testing as the results would not provide a valid indication of her functional capacity. Psychotropic medications were discontinued, and estrogen and potassium supplements were reinitiated. Six-week follow-up revealed no further paranoia/ psychosis and nearly complete functional recovery. Residual memory problems were seen, and although these were judged by the family members as significant they were not seen as threatening the day-to-day functioning of the client. This case illustrates the quality and comprehensive nature of services performed by a neuropsychologist and the methods in which a client’s best interests can be served.
Clock Drawing Lewis MS, Bowen
and Functional
Impairment
in a Large Group of Frail Elderly
C, Miller LS.
The utility of the clock-drawing test (CDT) in the assessment of cognitive decline and dementia has been demonstrated in a number of studies (Shulman, Gold & Zucchero, 1993; Mendez, Ala & Underwood, 1992). However, few researchers have looked at direct relationships between performance on the CDT and measures of functional ability including activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Given the success of the CDT in assessing cognitive decline, the CDT may &her-more be an efficient and simple test of functional ability. Thus, as part of a larger, ongoing research project, the CDT was administered to I5 1 elderly care recipients along with the Neurocognitive Status Exam and measures of ADLs and IADLs. Clock-drawing performance was evaluated for overall accuracy, and performance in six qualitative domains including, as outlined by Rouleau, Salmon & Butters (1996), size, graphic ability, stimulus-bound response, conceptual deficit, planning error and perseverative response. The CDT was found to correlate significantly with a categorical summary score on the NCSE used by researchers in the past (Mitrushina, Abara & Blumenfeld, 1994) (r=-.285, p< .O1). Additionally, the quantitative overall accuracy CDT score was found to be significantly correlated with measures ofboth ADLs (r=-.281, pc.01) and IADLs (r=-.456, pc.001) as were the qualitative CDT scores of size accuracy, graphic ability and conceptual deficit. Such findings further support the CDT as a sensitive test for cognitive impairment and give evidence for the practical use of the CDT as an indicator of functional impairment in the elderly.
PSYCHIATRIC
Behavioral Zakzanis
memory impairment
KK, Silverberg
ILLNESS
in abstinent MDMA (Ecstasy) users
AMJ.
Methyleneddioxymethamphetamine (MDMA, or Ecstasy) is a popular recreational drug of abuse that is known to damage brain serotonergic neurons in animals and possibly humans. Few functional consequences of MDMS-induced serotonin neurotoxicity have been identified, either in animals or humans. The present study used the Rivermead Behavioral Memory Test (RBMT) along with other neurocognitive measures to determine whether individuals with a history of
of Clinical Neuropsychology
15 (2000) 653-850
755
previously. Potassium supplements were discontinued as well despite multiple prescription medications with diuretic properties due to cardiac ailments. In addition, visual inspection of all prescription medications revealed the client to be taking Synthroid despite having no history of thyroid dysfunction. The client was referred back to her primary care physician for medication adjustment without neuropsychological testing as the results would not provide a valid indication of her functional capacity. Psychotropic medications were discontinued, and estrogen and potassium supplements were reinitiated. Six-week follow-up revealed no further paranoia/ psychosis and nearly complete functional recovery. Residual memory problems were seen, and although these were judged by the family members as significant they were not seen as threatening the day-to-day functioning of the client. This case illustrates the quality and comprehensive nature of services performed by a neuropsychologist and the methods in which a client’s best interests can be served.
Clock Drawing Lewis MS, Bowen
and Functional
Impairment
in a Large Group of Frail Elderly
C, Miller LS.
The utility of the clock-drawing test (CDT) in the assessment of cognitive decline and dementia has been demonstrated in a number of studies (Shulman, Gold & Zucchero, 1993; Mendez, Ala & Underwood, 1992). However, few researchers have looked at direct relationships between performance on the CDT and measures of functional ability including activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Given the success of the CDT in assessing cognitive decline, the CDT may &her-more be an efficient and simple test of functional ability. Thus, as part of a larger, ongoing research project, the CDT was administered to I5 1 elderly care recipients along with the Neurocognitive Status Exam and measures of ADLs and IADLs. Clock-drawing performance was evaluated for overall accuracy, and performance in six qualitative domains including, as outlined by Rouleau, Salmon & Butters (1996), size, graphic ability, stimulus-bound response, conceptual deficit, planning error and perseverative response. The CDT was found to correlate significantly with a categorical summary score on the NCSE used by researchers in the past (Mitrushina, Abara & Blumenfeld, 1994) (r=-.285, p< .O1). Additionally, the quantitative overall accuracy CDT score was found to be significantly correlated with measures ofboth ADLs (r=-.281, pc.01) and IADLs (r=-.456, pc.001) as were the qualitative CDT scores of size accuracy, graphic ability and conceptual deficit. Such findings further support the CDT as a sensitive test for cognitive impairment and give evidence for the practical use of the CDT as an indicator of functional impairment in the elderly.
PSYCHIATRIC
Behavioral Zakzanis
memory impairment
KK, Silverberg
ILLNESS
in abstinent MDMA (Ecstasy) users
AMJ.
Methyleneddioxymethamphetamine (MDMA, or Ecstasy) is a popular recreational drug of abuse that is known to damage brain serotonergic neurons in animals and possibly humans. Few functional consequences of MDMS-induced serotonin neurotoxicity have been identified, either in animals or humans. The present study used the Rivermead Behavioral Memory Test (RBMT) along with other neurocognitive measures to determine whether individuals with a history of