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Ecological validity of cognitive fluctuations in dementia with Lewy bodies

Published online by Cambridge University Press:  14 April 2023

Troy A. Webber Open the ORCID record for Troy A. Webber [Opens in a new window] ,
Sara A. Lorkiewicz ,
Andrew M. Kiselica Open the ORCID record for Andrew M. Kiselica [Opens in a new window]  and
Steven P. Woods
Troy A. Webber*
Affiliation:
Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA Department of Psychiatry/Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
Sara A. Lorkiewicz
Affiliation:
Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
Andrew M. Kiselica
Affiliation:
School of Health Professions, University of Missouri, Colombia, MO, USA
Steven P. Woods
Affiliation:
Department of Psychology, University of Houston, Houston, TX, USA
*
Corresponding author: Troy A. Webber, E-mail: Troy.Webber@va.gov
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Abstract

Objectives:

Cognitive fluctuations are a core clinical feature of dementia with Lewy bodies (DLB), but their contribution to the everyday functioning difficulties evident DLB are not well understood. The current study evaluated whether intraindividual variability across a battery of neurocognitive tests (intraindividual variability-dispersion) and daily cognitive fluctuations as measured by informant report are associated with worse daily functioning in DLB.

Methods:

The study sample included 97 participants with consensus-defined DLB from the National Alzheimer’s Coordinating Center (NACC). Intraindividual variability-dispersion was measured using the coefficient of variation, which divides the standard deviation of an individual’s performance scores across 12 normed neurocognitive indices from the NACC neuropsychological battery by that individual’s performance mean. Informants reported on daily cognitive fluctuations using the Mayo Fluctuations Scale (MFS) and on daily functioning using the functional activities questionnaire (FAQ).

Results:

Logistic regression identified a large univariate association of intraindividual variability-dispersion and presence of daily cognitive fluctuations on the MFS (Odds Ratio = 73.27, 95% Confidence Interval = 1.38, 3,895.05). Multiple linear regression demonstrated that higher intraindividual variability-dispersion and presence of daily cognitive fluctuations as assessed by the MFS were significantly and independently related to worse daily functioning (FAQ scores).

Conclusions:

Among those with DLB, informant-rated daily cognitive fluctuations and cognitive fluctuations measured in the clinic (as indexed by intraindividual variability-dispersion across a battery of tests) were independently associated with poorer everyday functioning. These data demonstrate ecological validity in measures of cognitive fluctuations in DLB.

Keywords

activities of daily livingfluctuationsdispersiondementiaLewy bodiesecological validity of cognitive fluctuations in dementia with Lewy bodies
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 30 , Issue 1 , January 2024 , pp. 35 - 46
Copyright
Copyright © INS. Published by Cambridge University Press, 2023

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Footnotes

Author Note: Data and study materials may be made available upon request from the National Alzheimer’s Coordinating Center (NACC). All analysis code may be available upon request. The study’s design and analysis were not pre-registered.

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