Date of Award

10-2024

Document Type

Doctoral Research Project

Degree Name

Doctor of Psychology (PsyD)

Department

Psychology

First Advisor

Scott A. Gustafson, Ph.D., ABPP

Second Advisor

Mark T. Harvey, Ph.D., BCBA-D

Third Advisor

Mary Caitlin Fertitta, Psy.D.

Fourth Advisor

Lisa A. Steelman, Ph.D.

Abstract

Objective: Accurate assessment of daily functioning is critical for deriving a correct diagnosis and facilitating effective patient care. While collateral reports from a reliable informant can elucidate patients’ functional capacities, they may be susceptible to misappraisals of functional status. Similarly, patients with limited insight may be prone to misjudging their functional abilities. Performance-based measures of adaptive functioning may detect subtle declines in daily functioning overlooked by self- and informant-report measures. However, these measures may be limited in terms of ecological validity. The current study investigated the association between a performance-based measure of daily functioning and patients’ and informants’ ratings of functional impairment on a self-report measure of daily functioning. It also examined how factors related to patients’ cognitive functioning, frequency of informant-patient contact, informant-patient cohabitation status, and informants’ relationship to the patient influence ratings of functional impairment.

Method: Archival data was collected from 162 patients and their informants at the Health First Memory Disorder Clinic (HFMDC). The sample consisted of patients with intact cognition, mild cognitive impairment, and dementia of various etiologies. All patients were administered the Montreal Cognitive Assessment (MoCA), which was used as an estimate of global cognitive functioning. Patients’ and informants’ functional impairment ratings were obtained via their responses to the Activities of Daily Living Questionnaire (ADLQ). Patients were also administered a performance-based measure of adaptive functioning (i.e., Texas Functional Living Scale; TFLS). Information pertaining to frequency of informant-patient contact, informant-patient cohabitation status, and informants’ relationship to the patient were procured from informants’ responses to questions on their ADLQ form.

Findings: An objective measure of adaptive functioning was a significantly stronger predictor of patients’ estimated global cognitive impairment than either informants’ or patients’ functional impairment ratings. Informants’ rating of functional impairment was not a significantly stronger predictor of patients’ estimated global cognitive impairment than patients’ ratings of functional impairment. Additionally, patients’ estimated global cognitive impairment did not impact the association between patients’ ratings of functional impairment and their performance on an objective measure of adaptive functioning. Moreover, neither frequency of patient contact, cohabitation status, nor relationship to the patient significantly impacted the level of agreement between informants’ ratings of functional impairment and patients’ performance on an objective measure of adaptive functioning. The current findings suggest that performance-based measures of daily functioning may better capture patients’ level of global cognitive impairment than subjective reports of functional status. Meanwhile, there was a consensus in informants’ and patients’ ratings of functional impairment regardless of patients’ degree of cognitive impairment. Additionally, frequency of contact and living situations appeared to have no sizeable influence on informants’ ratings of functional status.

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