Assessing Everyday Function in Older Adults with the Virtual Kitchen

项目摘要/摘要 这项建议的目标是开发一种客观、标准化和有效的替代方法，用于从健康认知到轻度认知障碍(MCI)以及临床前和临床阿尔茨海默病和阿尔茨海默病相关痴呆(AD/ADRD)等认知老化的现有老年人功能评估方法。在健康的老年人和临床前AD/ADRD或MCI患者中，轻微的功能障碍是未来认知功能下降的强烈预测因素，并可能先于传统认知测试的损害。功能能力水平是区分临床前AD/ADRD和MCI与临床AD/ADRD的标准，与认知能力测试不同，功能状态通常不受种族/民族和社会经济地位(SES)的强烈影响。因此，有关功能状态的信息有助于确定非多数老年人或教育程度/社会经济地位较低的老年人的低认知测试分数的有效性。目前功能评估的基准标准方法是告密者报告，这种方法具有主观性，可能受到关于衰老和AD/ADRD的文化信念的偏见，需要有可用的和有知识的合作伙伴。基于绩效的评估比线人报告更有优势，但管理和评分都很耗时。该提案的目标1将评估一种新颖的、便携的、非沉浸式的虚拟现实范例--虚拟厨房挑战(VKC)的有效性和可靠性。VKC要求参与者在虚拟厨房中完成两项日常任务，使用触摸屏界面选择对象并对步骤进行排序。在任务完成后立即生成详细的自动分数报告，反映完成时间、任务完成情况和绩效效率。180名年龄在65岁及以上的认知能力不同的人(健康n=60，MCI n=60，轻度AD/ADRD n=60)将接受VKC以及传统的认知测试(产生人口统计学调整的分数)，并通过真实对象验证基于性能的任务。举报人还将被要求填写功能状况问卷。我们预测，自动的VKC分数输出将为所有认知能力水平的参与者提供有效、可靠和详细的日常功能特征。 目标2将检验这一假设，即由于其实用的、生态上有效的性质和客观性，基于绩效的功能评估(即VKC)将比标准的认知测量和告密者报告的功能受到较少的种族/民族、教育和社会经济地位的影响。然而，如果我们的假设不被支持，解释VKC分数的人口统计学调整将被识别和应用。这项建议将为不同的老年人提供一种有效和敏感的日常功能测量方法，当提供信息的人不可用或可能不可靠时，该方法可用于临床，并可扩展用于认知老化、MCI以及临床前和临床AD/ADRD的大型纵向研究。

PROJECT SUMMARY/ABSTRACT The goal of this proposal is to develop an objective, standardized, and efficient alternative to current methods of functional assessment for older adults across the spectrum of cognitive aging, from healthy cognition to mild cognitive impairment (MCI), and preclinical and clinical Alzheimer’s disease and Alzheimer’s Disease Related Dementias (AD/ADRD). Mild functional difficulties are a strong predictor of future cognitive decline in healthy older adults and individuals with preclinical AD/ADRD or MCI and may precede impairment on traditional cognitive tests. Functional ability level is a criterion that distinguishes preclinical AD/ADRD and MCI from clinical AD/ADRD, and unlike tests of cognitive abilities, functional status generally is not as strongly influenced by race/ethnicity and socioeconomic status (SES). Consequently, information on functional status is useful for determining the validity of low cognitive test scores in non-majority older adults or older adults with low educational attainment/SES. The current benchmark standard method of functional assessment is informant report, which is subjective in nature, may be biased by cultural beliefs about aging and AD/ADRD, and requires an available and knowledgeable partner. Performance-based assessments offer advantages over informant reports but are time consuming to administer and score. Aim 1 of this proposal will evaluate the validity and reliability of a novel, portable, non-immersive, virtual-reality paradigm, the Virtual Kitchen Challenge (VKC). The VKC requires participants to complete two everyday tasks in a virtual kitchen using a touch-screen interface to select objects and sequence steps. A detailed automated score report reflecting time to completion, task accomplishment and performance efficiency is generated immediately after task completion. 180 individuals aged 65 and older with a range of cognitive abilities (healthy n = 60, MCI n = 60, mild, clinical AD/ADRD n = 60) will be administered the VKC as well as traditional cognitive tests (yielding demographically adjusted scores) and validated performance-based tasks with real objects. Informants also will be asked to complete questionnaires of functional status. We predict that the automated VKC score output will yield valid, reliable, and detailed characterizations of everyday function for participants at all levels of cognitive ability. Aim 2 will test the hypothesis that because of its practical, ecologically valid nature and objectivity, performance-based assessment of functioning (i.e., VKC) will be less influenced by race/ethnicity, education, and SES than standard measures of cognition and informant report of function. However, if our hypothesis is not supported, demographic adjustments for interpreting VKC scores will be identified and applied. This proposal will yield an efficient and sensitive measure of everyday function for diverse older adults that may be used clinically when informants are unavailable or potentially unreliable, and may be scalable for large longitudinal studies of cognitive aging, MCI, and preclinical and clinical AD/ADRD.