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Neuropsychologists frequently are asked to comment on everyday functioning, but the research relies mostly on questionnaire-based assessment of daily functioning. While performance-based assessment of everyday functioning has many advantages over commonly used questionnaires, there are few empirically validated comprehensive performance-based measures. We present data here on a performance-based battery of daily living skills, the Functional Impact Assessment (FIA) in 47 unilateral stroke patients and 37 matched healthy controls. The FIA was validated by comparing it to performance on the self- and informant-report version of the Functional Activities Questionnaire (FAQ). We also examined the relationship between the FIA and cognitive functioning using the Neuropsychological Assessment Battery (NAB). The stroke group's performance on the FIA, FAQ (self and informant), and NAB (total and domain scores) was significantly (d′s ≥ .80) lower than the control group. The NAB total score and all domain scores were highly correlated with the FIA in the stroke group (r's > .7), and only one NAB domain score (visuospatial) was a unique predictor. This may be due to the fact that most of the NAB domains have a statistical problem of multicollinearity, which may explain why only the spatial domain was a unique predictor. While the informant FAQ was significantly correlated with FIA total score (r = .48, p < .01), the NAB total score was a significantly better predictor (r = .83, p < .001) than the informant FAQ. NAB total scaled score of less than 86 predicted impairment on the FIA with 92% sensitivity and 84% specificity. Our findings argue that the FIA is sensitive to deficits associated with stroke and is highly associated with all neuropsychological domains (attention, executive functions, language and spatial skills, and memory). (JINS, 2011, 17, 832–840)
Contralesional neglect may be induced by either unawareness of
contralesional stimuli (attentional neglect, AN) or failure to act in
contralesional space (intentional neglect, IN). We examined whether
contralesional cold caloric stimulation differentially affects AN
versus IN. Patients with left-sided neglect (n = 16)
from right-hemisphere lesions performed target cancellation and line
bisection tasks. Using a video-based apparatus that reverses the right
and left side of stimuli, patients with abnormal cancellation
performance were divided into those with AN and those with IN. The 5
subjects with normal cancellation performance but rightward bisection
bias were also separated into 2 neglect groups. Subjects performed
cancellation or bisection tasks before and immediately after irrigation
of the left auditory canal with ice water. Caloric stimulation induced
brisk rightward nystagmus in all subjects. Subjects with AN cancelled
more left-sided targets after stimulation than those with IN
(p = .02). Whereas caloric stimulation significantly shifted
bisection error leftward for both IN and AN groups (p <
.0001), AN patients exhibited a greater magnitude of shift than the IN
patients. While the basis for differential performance remains
undefined, the data indicate that caloric stimulation influences AN
more than IN. (JINS, 2003, 9, 983–988.)
Patients with probable Alzheimer's disease
(AD) often have difficulties associated with semantic knowledge.
Therefore, conceptual apraxia, a defect of action semantics
and mechanical knowledge, may be an early sign of this
disease. The Florida Action Recall Test (FLART), developed
to assess conceptual apraxia, consists of 45 line drawings
of objects or scenes. The subject must imagine the proper
tool to apply to each pictured object or scene and then
pantomime its use. Twelve participants with Alzheimer's
disease (NINCDS–ADRDA criteria) and 21 age- and education-matched
controls were tested. Nine Alzheimer's disease participants
scored below a 2-standarddeviation cutoff on conceptual
accuracy, and the three who scored above the cutoff were
beyond a 2-standard-deviation cutoff on completion time.
The FLART appears to be a sensitive measure of conceptual
apraxia in the early stages of Alzheimer's disease.
(JINS, 2000, 6, 265–270.)
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