Comparison of Performance-Based Measures of Functional Cognition

PURPOSE: The Centers for Medicare & Medicaid Services (CMS) issued a call for a standardized assessment of cognition and functional ability to accurately identify patients with mild cognitive deficits before discharge. Current cognitive assessments do not accurately identify patients with mild cognitive impairment who then exhibit functional deficits in the community and are at risk for hospital readmission (Anderson & Birge, 2016). The purpose of this study was to establish and compare the construct validity of the Menu Task, the Performance Assessment of Self-Care Skills (PASS), and the Medication Organizer task to determine which of these performance-based assessments has potential to be used as a screening tool for functional cognition and to predict competence in instrumental activities of daily living (IADLs).

METHOD: This study used a standard methodological approach to test validation with a convenience sample of 100 adults aged 55 and older in the community. Participants were recruited using flyers and face-to-face recruitment. Inclusion criteria for participants included age ≥55, living independently in the community, and able to read English. Testing was performed by occupational therapy students trained to administer the test battery in a setting of the participant’s choice and took approximately 45 min.

To evaluate the Menu Task, the following measures of cognition and IADL performance were administered: the Brief Interview of Mental Status, the Montreal Cognitive Assessment (MoCA), Trail Making Test Parts A and B, the Medi-Cog, the PASS, and the Alzheimer’s Disease Cooperative Study (ADCS) activities of daily living inventory. Descriptive statistics for all participants were analyzed and reported. A multitrait–multimethod matrix was used to determine the construct validity of the performance-based measures (Campbell & Fiske, 1959). Impaired and unimpaired groups were established using criterion scores of the measures to determine whether the Menu Task was sensitive as a screening tool to predict executive function deficits in daily life. The internal consistency of the Menu Task was evaluated using Cronbach’s alpha (Cronbach, 1951).

RESULTS: Results support the reliability and construct validity of the Menu Task. The construct validity of the Menu Task was stronger than that of the two medication management tasks. Significant correlations were found between the Menu Task and the MoCA (p < .001) and Trails B (p < .001). Results support moderate convergent validity and weak discriminant validity of the PASS and the Medication Organizer task. The Menu Task (r = .37) and the PASS (r = .31) showed moderate correlations with the ADCS, a self-report measure of IADL performance. The overall alpha coefficient for the Menu Task indicated moderate internal consistency (α = .66).

CONCLUSION: The Menu Task is a quick and easy screening tool for impairment in functional cognition. Our results suggest that the Menu Task has moderate construct validity and moderate internal consistency and was sensitive in predicting executive function deficits in the context of daily life. The Menu Task is a potential answer to CMS’s call for increased screening and support for people at risk for hospital readmission.

IMPACT STATEMENT: The Menu Task may enable clinicians to easily identify patients who require comprehensive evaluation and referral to occupational therapy for individuals who previously may have gone unrecognized, thus potentially decreasing rates of hospital readmission.

References

Anderson, R. E., & Birge, S. J. (2016). Cognitive dysfunction, medication management, and the risk of readmission in hospital inpatients. Journal of the American Geriatric Society, 64, 1464–1468. https://doi.org/10.1111/jgs.14200

Campbell, D. T., & Fiske, D. W. (1959). Convergent and discriminant validation by the multitrait–multimethod matrix. Psychological Bulletin, 56, 81–105. https://doi.org/10.1037/h0046016

Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16, 297–334. https://doi.org/10.1007/BF02310555