Think of all of the seemingly simple everyday tasks you do during the course of a day—dress in the morning, prepare a meal, pay bills, and so on. Now imagine that you have experienced a change in your cognitive skills and you are no longer able to accomplish everyday tasks quickly, efficiently, or without errors. You cannot find your shoes when you dress; you forget to turn off the stove when you prepare a meal; and you pay the same gas bill three times. This is the challenging reality for over 45 million people in the world who suffer from dementia. Everyday dysfunction is a core diagnostic criterion for dementia and is associated with a wide range of negative outcomes, including institutionalization, depression, and mortality.
The Cognitive Neuropsychology Lab, led by Dr. Tania Giovannetti, seeks to understand the difficulties with everyday tasks from a cognitive perspective. Several studies conducted in the lab have shown that people with dementia differ in the problems that they experience with everyday tasks. Some people fail to complete large segments of the task while others complete all task steps, but do so in a disorganized fashion, repeating task steps and completing steps in the wrong order. These different functional deficit profiles are associated with unique cognitive deficits and brain markers in neuroimaging tests. More importantly, people with different functional deficits respond differently to prompts and cues; thus, knowing the functional deficit profile informs the behavioral intervention that will be most effective at reducing errors and accomplishing everyday task goals.
The Cognitive Neuropsychology Lab is currently working on identifying indicators of early functional problems in older adults at risk for dementia. Studies by Sarah Seligman Rycroft (graduatestudent) and Ross Divers (undergraduate/4+1 student) have added to the accumulating evidence that functional dysfunction does not occur at once (Figure 1). Older adults show changes in the precision of their everyday activities relative to younger adults, and older adults with mild cognitive impairment (MCI), a syndrome that is characterized by a mild decline in cognition that is not severe enough to meet the diagnostic criteria for dementia, show functional difficulties at a level between healthy older adults and people with dementia.
Kate Devlin (graduate student) and undergraduate research assistants Elizabeth Schell, Carrie Lamberson, and Jessica Kurczewski have shown that adults with mild cognitive impairment due to HIV infection possess functional difficulties that differ across individuals depending on their unique cognitive deficit profile (Figure 2). Thus, by identifying and characterizing subtle functional difficulties early, behavioral interventions may be applied to prevent further functional decline and dementia. Early interventions are expected to be more effective than interventions that are delivered once individuals already meet criteria for dementia. Accurate measurement of subtle functional difficulties presents numerous challenges. Because self-report may be unreliable, the lab is working on other methods. Rachel Mis (graduate student) is working to better understand how informants report functional changes in older adults, and recent collaborations with computer scientists at Temple (Dr. Chiu Tan) and Tokyo University of Sciences (Dr. Takehiko Yamaguchi) are focused on developing new performance-based measures, including a smartwatch and a Virtual Kitchen, to detect subtle errors and changes in speed and trajectory of arm movements during everyday tasks.
The lab also continues to work on developing interventions to improve everyday functioning in older adults, and recent work is emphasizing the use of technology to provide cues and efficient training. Undergraduates Ross Divers and Lillian Ham are using the Virtual Kitchen (Figure 5) to train everyday tasks in people with dementia, and future studies will use smartphones and smartwatches to provide prompts and directions to reduce errors in everyday tasks. Emma Rhodes (graduate student) is conducting important research on the role of non-cognitive factors, such as grit, on older adults’ use of compensatory strategies; her work, which was recently cited in U.S. News and World Report, will help ensure that older adults actually use interventions that are effective in improving everyday functioning.