COGNITIVE AND PHYSICAL BASIS OF DISABLEMENT

残疾的认知和身体基础

• 批准号: 6631476
• 负责人: Steven M Albert
• 金额: $ 32.12万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-03-01 至 2006-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6631476
• 关键词: African American; Hispanic Americans; aging; caucasian American; clinical research; cognition; functional ability; human old age (65+); human subject; longitudinal human study; neuropsychological tests; person with disability; psychological aspect of aging; racial /ethnic difference

This research will test a causal model of "disablement,"in which impairment (low scores on tests of motor or cognitive performance) and functional limitation (inefficient or unsafe performance of daily tasks) result in disability (recognition of difficulty or need for help in instrumental and basic activities of daily living [IADL/BADL]). We will follow 360 elders recruited from an existing multi-ethnic community-based study, the Washington Heights-Inwood Columbia Aging Project (WHICAP), all of whom will have mild-to-moderate disability and not meet criteria for dementia. They will be assessed 3 times, 18 months apart. Within disability groups (1, 2, or 3 domains based on self-reports), half of the subjects will be cognitively normal and half will have mild cognitive impairment or questionable dementia. We will assess the direct and indirect effects of impairment and functional limitation on disability in groups defined by self-reported disability status and cognitive performance, in different race-ethnic groups (African-American, Hispanic, white), and longitudinally. In addition, we will assess the accuracy of self- and proxy-reports of disability using a clinical diagnosis (established in a clinical consensus conference) as a gold standard, and alternatively through use of latent class models that do not assume a gold standard. An important feature of this research is its use of the assessment of Motor and Process Skills (AMPS) , an occupational assessment tool for rating functional limitation in the activities of daily living. AMPS evaluations yield scores for motor and cognitive/process limitations that interfere with efficient and safe performance of IADL/BADL tasks. OT's will conduct AMPS evaluations in subject homes, along with detailed assessments of physical impairment (as well as measures of home and neighborhood environment). The parent WHICAP study will provide data on cognitive performance and neurologic-medical status. Our major goal is to test a causal (structural equations) model of disablement. We hypothesize that impairment is related to disability directly but also indirectly through observed motor and cognitive/process limitations. We will test whether this indirect effect is stronger for some groups of elders (e.g., mild disabled) than others. This finding would suggest that disability may be reduced through remediation of motor and cognitive/process skills, as well as by efforts to reduce impairment.

这项研究将测试“残疾”的因果模型，其中障碍（运动或认知表现测试得分低）和功能限制（日常任务执行效率低下或不安全）导致残疾（认识到日常生活的工具性和基本活动中存在困难或需要帮助[IADL/BADL]）。 我们将跟踪从现有的多种族社区研究华盛顿高地-因伍德哥伦比亚老龄化项目 (WHICAP) 中招募的 360 名老年人，他们都患有轻度至中度残疾，且不符合痴呆症标准。 他们将接受 3 次评估，每次评估间隔 18 个月。 在残疾组（基于自我报告的 1、2 或 3 个领域）中，一半受试者认知正常，一半患有轻度认知障碍或可疑痴呆。我们将纵向评估由自我报告的残疾状况和认知表现定义的不同种族群体（非裔美国人、西班牙裔、白人）中损伤和功能限制对残疾的直接和间接影响。 此外，我们将使用临床诊断（在临床共识会议上建立）作为金标准，或者通过使用不假定金标准的潜在类别模型来评估残疾自我报告和代理报告的准确性。 这项研究的一个重要特点是使用运动和过程技能（AMPS）评估，这是一种职业评估工具，用于评估日常生活活动中的功能限制。 AMPS 评估会产生运动和认知/过程限制的分数，这些限制会干扰 IADL/BADL 任务的高效和安全执行。 OT 将在对象家庭中进行 AMPS 评估，以及对身体损伤的详细评估（以及家庭和邻里环境的测量）。 父级 WHICAP 研究将提供有关认知表现和神经医学状态的数据。 我们的主要目标是测试残疾的因果（结构方程）模型。 我们假设损伤与残疾直接相关，但也通过观察到的运动和认知/过程限制间接相关。 我们将测试这种间接影响对于某些老年人群体（例如轻度残疾）是否比其他老年人群体更强。 这一发现表明，可以通过运动和认知/过程技能的补救以及减少损伤的努力来减少残疾。