This meta-analysis summarizes the broad spectrum of neuropsychological research on HIV disease across a sample of 41 primary studies and an aggregate of 8,616 participants for 10 major neuropsychological ability areas. Analyses of the course of cognitive decline within and across Centers for Disease Control classifications reveals statistically significant cognitive deficits from asymptomatic HIV to AIDS. Effect sizes (Cohen, 1988) were calculated to reflect between-group (asymptomatic, symptomatic, AIDS) differences in each neuropsychological domain. Relatively small effect sizes were obtained for the asymptomatic (0.05–0.21) patients, and generally small to moderate effect sizes were obtained for symptomatic (0.18–0.65) HIV+ patients, with motor functioning exhibiting the greatest effects in this later disease stage. The most notable deficits in cognitive functioning were found in the AIDS group with moderate (attention and concentration) to large (motor functioning) effect sizes with values ranging from 0.42–0.82. Comparison of cognitive functioning as a function of disease progression revealed that motor functioning, executive skills, and information processing speed were among the cognitive domains showing the greatest decline from early to later stages of HIV. These findings indicate that cognitive deficits in the early stages of HIV are small and increase in the later phases of the illness, and that specific patterns of cognitive deficits can be detected with disease progression. These results and their clinical utility are further discussed. (JINS, 2002, 8, 410–424.)

The relationship between ethnicity and cognitive test performance was examined in a sample of 161 patients referred for evaluation at a public hospital-affiliated neuropsychology clinic; 83 patients were Caucasian (non-Hispanic), 31 were African-American, 30 were Hispanic, and 17 were Asian. Significant group differences were present on some measures of language (Boston Naming Test), attention (Digit Span ACSS), constructional ability (Rey-Osterrieth [RO] copy), nonverbal processing speed (Trails A), and executive skills (Wisconsin Card Sorting Test [WCST]). Comparison of those who spoke English as a first language (or who learned English concurrently with a second language) versus those who spoke English as a second language (ESL) revealed significantly higher performance in the non-ESL group for Digit Span, Boston Naming Test, and FAS, and a higher score in the ESL group for RO copy. Boston Naming Test scores were significantly related to years educated in the United States; Boston Naming Test and Digit Span scores were significantly correlated with age at which conversational English was first learned and number of years in the United States; and finally, FAS scores were also significantly related to number of years in the United States. These findings are consistent with data from published literature on ethnic differences and the effects of acculturation on cognitive test performance in nonpatients, and also indicate that these observations are not attenuated by the presence of psychiatric or neurologic illness. The results further caution that normative data derived on Caucasian samples may not be appropriate for use with other ethnic groups.

OBJECTIVES-To assess the relationship between performance-and informant-based measures of activities of daily living (ADLs) in patients with early dementia and burden or psychological distress experienced by the patients' caregivers. DESIGN-Descriptive study. SETTING-Ambulatory center.PARTICIPANTS-Thirty-four patient-caregiver dyads in which the patient had mild dementia (Mini-Mental State Examination score ≥ 17).MEASUREMENTS-A performance-based ADL measure (the Direct Assessment of Functional Status (DAFS)) was administered to patients with mild dementia. Caregivers completed an informant-based measure of patient functional status (instrumental activities of daily living). Caregivers also completed the Caregiver Burden Inventory (CBI) and the Brief Symptom Inventory (BSI).RESULTS-Significant correlations were found between the informant-based ADL measure and caregiver burden (CBI) and psychological distress (BSI) (correlation coefficient (r) = −0.34 to −0.71, all P < .05). Alternatively, fewer and weaker relationships were observed between the DAFS (performance-based) ADL measure and caregiver burden or distress ratings (r = −0.32 to −0.43, all P < .05). Of the seven tasks assessed using the DAFS, impairments in orientation, communication, financial, and transportation skills in patients were associated with greater time and developmental burden and greater hostility in caregivers. Impairment in financial skills in patients was the strongest Address correspondence to Jill Razani, PhD, Department of Psychology, California State University, Northridge, 18111 Nordhoff Street, Northridge, CA 91330. E-mail: jill.razani@csun.edu. Author Contributions: Jill Razani: design, acquisition of subjects, implementation of study, data analyses, and preparation of the manuscript. Bernadette Kakos: implementation, data analyses, and preparation of the manuscript. Carla Orieta-Barbalace: acquisition of subjects, implementation, data analyses, and preparation of the manuscript. Jennifer T. Wong and Rachel Casas: acquisition of subjects, implementation, and preparation of the manuscript. Po Lu and Cathy Alessi: acquisition of subjects and review and critique of drafts of the manuscript. Karen Josephson: acquisition of subjects and review and critique of drafts of the manuscript. Sponsor's Role:The role of the sponsor (NIH) was to provide funding to the first author (JR) in order to conduct the current study. The sponsor was not involved in the design or implementation of the study. A growing body of literature on the caregivers of patients with dementia indicates that these individuals experience physical, psychological or emotional, social, and financial problems. 4 A study 5 using a brief screening measure to characterize cognitive impairment in patients with Alzheimer's disease found that patients' cognitive scores played a significant role in predicting the amount of time caregivers spent caring for the patient. A number of recent studies have found that caregivers of patients with dementia frequently report physical a...

There is very little research regarding the relationship between tests of executive functioning and actual functional ability in patients with dementia. Thirty-three patients diagnosed with dementia and 35 age-and education-matched healthy controls were administered tests of executing functioning and an observation-and informant-based activities of daily living (ADL). As expected, the results revealed that the controls outperformed the dementia patients on the executive and ADL tests. Additionally, executive functioning correlated significantly with aspects of functional ability in patients with dementia. This relationship was strongest for tests of verbal fluency (i.e., FAS) and a complex test of cognitive flexibility and reasoning ability (i.e., WCST). These findings suggest that some executive function tests are more sensitive than others for predicting specific functional abilities and that they may be most useful to healthcare professionals for treatment planning. Keywordsactivities of daily living; functional ability; executive functioning; dementia; Alzheimer's disease It has been well established that tests of executive functioning are useful in characterizing frontal lobe brain lesions and various forms of dementia (Kramer et al., 2005;Kennedy, 2004;Razani, Boone, Miller, Lee, & Sherman, 2001; Walker, Meares, Sachdev, & Bodaty, Correspondence: Jill Razani, Ph.D., Department of Psychology, California State University, Northridge, 18111 Nordhoff Street, Northridge, CA 91330-8255, jill.razani@csun.edu, (818) 677-4623, (818) Most available studies have examined the relationship between ADLs and brief cognitive screening measures (e.g., MMSE) and ADLs (Vitaliano et al, 1984;Winograd, 1984) and have generally found strong correlations (Ford, Haley, Thrower, West, & Harrell, 1996;Reed, Jagust, & Seab, 1989;Warren et al., 1989). Similarly, few studies have examined the relationship between ADLs and larger neuropsychological test batteries. Cahn-Weiner et al. (2000) found that executive measures accounted for more variance in ADL performance than demographic variables such as age, health status, and education level in a community-dwelling group of elderly. The authors suggest that of the cognitive domains assessed, decline in executive abilities associated with normal aging may be the best predictor of functional deterioration. Boyle et al. (2003) found that that executive dysfunction on the Dementia Rating Scale alone explained 17% of the variance in instrumental ADLs (e.g., handling finances, managing medications) in patient with Alzheimer's disease. However, the executive measures used in this study were brief and the ADL test was informant rated, which is less reliable than observation-based measures (Pearson, 2000). Back-Madruga et al. (2002) found that a group of frontal-variant Alzheimer's disease patients performed worse on ADL tasks than the typical Alzheimer's patients.In the most comprehensive study to date assessing cognitive functioning and ADLs, Farias, Harrell, Neumann, and Houtz (...