Performance on the Texas Functional Living Scale in a Memory Disorder Clinic
Grueninger, Kathryn Kim
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Objective: The present study examines the clinical utilization of an objective performance-based measure in a memory disorder clinic sample. Method: One year of archival cognitive testing data from a total of 176 Health First Memory Disorder Clinic patients was utilized for the current study. Participants were included in this study if they completed a brief neuropsychological evaluation which included the Texas Functional Living Scale (TFLS) and were also diagnosed with Normal Cognition (NC), Mild Cognitive Impairment (MCI), or Alzheimer’s disease (AD). Patients’ psychosocial history regarding their self-reported or informant-reported abilities with performing instrumental activities of daily living (IADLs) was obtained from their electronic medical records and included as predictors in this present study. Results: Results showed that overall TFLS scores differed significantly across diagnostic category. Specifically, scores from the AD group were significantly lower than both MCI and NC groups. Correlation analysis revealed that overall TFLS scores were positively and significantly correlated with overall MoCA total score, suggesting that those who tend to score higher on the MoCA (a brief screener of global cognitive functioning), also obtained higher TFLS score. Further correlational analyses demonstrated that there were positive correlations found between TFLS scores and tests of executive functioning, as well as other tests of cognition. Lastly, results demonstrated that patients who had reported impaired abilities in at least 2 of 3 IADLs (i.e., medication management, financial management, and driving) demonstrated lower TFLS scores, suggesting more impaired abilities in completing basic adaptive functioning skills. Meanwhile, those who reported intact abilities in 2 of3 IADLs demonstrated higher TFLS scores, suggesting more intact abilities in completing basic adaptive functioning skills. Conclusion: Not surprisingly, the TFLS scores among the AD group were significantly worse compared to MCI and NC groups; therefore, further assisting in the differential diagnosis, particularly between individuals who fall between MCI and AD presentations. Although TFLS scores positively correlated with measures of global cognitive functioning (MoCA) and tests of executive functioning, they also demonstrated positive correlations with many other areas of testing, suggesting that the TFLS measures more than just executive functioning. Future research studies should continue to repeat similar study designs to demonstrate reliability strength, and to also increase sample size among the diagnostic categories. This study was limited by the data collection time frame; in the future, it would be helpful to have more time to collect data from more diverse diagnostic groups (i.e., including other dementias). However, this study suggests that the TFLS demonstrated significant clinical utility, particularly with differential diagnosis among the three diagnostic groups (with the exception of MCI and NC). This study also provides clinical relevance with making diagnostic decisions, which will then assist with appropriate treatment recommendations.