Hierarchical Cognitive Contributions to Functional Cognitive Ability

BACKGROUND AND PURPOSE: The Menu Task is a new screening tool of functional cognition (FC) developed for use in acute settings to meet the requirements of the IMPACT Act (2014). FC is defined as “the ability to accomplish everyday activities that rely heavily on cognitive abilities” (Donovan et al., 2007). This ability is essential for completion of instrumental activities of daily living (IADLs).

There is a need to develop a new screening tool other than current neuropsychological measurements to identify these deficits in acute settings (Morrison et al., 2014). The purpose of this study was to further examine the construct validity of the Menu Task and to explore hierarchical cognitive contributions to FC ability as measured by the Menu Task. This study is an important step in establishing the psychometric properties of the Menu Task and adds to our understanding of the construct of FC.

METHOD: This study used a prospective cohort design. One hundred healthy community-dwelling adults over age 55 were recruited via flyers and face-to-face recruitment. Inclusion criteria for participants included age 55 and older, living independently in the community, and able to be tested in English. Excluded were people living in skilled nursing facilities or assisted living facilities and people who could not read or speak English.

After consent, participants filled out a brief demographic sheet and then completed a large test battery that included the Menu Task, the Montreal Cognitive Assessment (MoCA), the Brief Interview of Mental Status (BIMS), and the Trail Making Test Parts A and B. We computed descriptive analyses for continuous data and frequency distributions for categorical data.

To further examine the construct validity of the Menu Task and explore cognitive contributions to FC ability as measured by the Menu Task, we conducted a hierarchical multiple regression analysis with the Menu Task as the dependent variable. Control variables of education (in years), sex, and age were entered at Step 1, followed by measures of basic cognitive ability (BIMS, Trails A) at Step 2, and finally measures of higher order cognitive ability (executive function [Trails B, MoCA]) at Step 3.

RESULTS: Each step of the hierarchical regression model yielded significant results. Step 1 significantly explained Menu Task scores (adjusted R ² = .17), and adding measures of basic cognition in Step 2 significantly increased the explained variance (R ² = .08). In Step 3, entry of measures of executive function resulted in a significant increase in the explained variance of Menu Task scores (R ² = .10), with a final adjusted R ² of .35. The MoCA was the only independent variable to have a significant effect on Menu Task scores in our full model.

CONCLUSION: The findings of the current study support the construct validity of the Menu Task as a screening tool for FC. Although the results of the regression model indicate that 35% of the variability in Menu Task scores was explained by the full model, most of the variance was not explained, suggesting that FC as a construct is unique from basic cognition and executive function. This finding supports the use and necessity of the Menu Task, a performance-based screening tool of FC that meets the requirements of the IMPACT Act and the needs of the Centers for Medicare & Medicaid Services. Further research should focus on comparing the Menu Task to other valid performance-based measures of FC and IADLs. Moreover, more research should explore FC as a unique construct within clinical practice.

References

Donovan, N. J., Kendall, D. L., Heaton, S. C., Kwon, S., Velozo, C. A., & Duncan, P. W. (2007). Conceptualizing functional cognition in stroke. Neurorehabilitation and Neural Repair, 22, 122–135. https://doi.org/10.1177/1545968307306239

Improving Medicare Post-Acute Care Transformation (IMPACT) Act, Pub. L. 113-185, 128 Stat. 1952 (2014).

Morrison, M. T., Edwards, D. F., & Giles, G. M. (2014). Performance-based testing in mild stroke: Identification of unmet opportunity for occupational therapy. American Journal of Occupational Therapy, 69, 6901360010. https://doi.org/10.5014/ajot.2015.011528