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Relationship of Neuropsychological Performance to Functional Status in Nursing Home Residents and Community-Dwelling Older Adults

Received March 6, 2004; revised July 26, September 12, 2004; accepted September 15, 2004. From the Dept. of Psychiatry, Mount Sinai School of Medicine, New York, NY (MAR,MSB,JS,MS,JMS,VH), the Dept. of Psychiatry, Bronx Veterans Affairs Hospital, Bronx, NY (MAR,MS,VH), and the Dept. of Biomathematical Sciences, Mount Sinai School of Medicine, New York, NY (JS). Send correspondence and reprint requests to Michael A. Rapp, M.D., Ph.D., Dept. of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Pl., Box 1240, New York, NY 10029-6574. e-mail: Michael.Rapp{at}mssm.edu
© 2005 American Association for Geriatric Psychiatry

Objectives: The authors examined the association between neuropsychological tests of executive functioning and episodic memory and functional disability in nursing home residents versus community-dwelling older adults. Methods: The neuropsychological performance of 96 residents from the Jewish Home and Hospital, Bronx, NY and 192 gender- and age-matched older adults from residential communities in the New York metropolitan area was assessed in eight tasks (Word List Recall, Delayed Recall, Recognition, Boston Naming, Verbal Fluency, Trailmaking A and B, and Digit Symbol Substitution). Functional status was derived from the Clinical Dementia Rating scale (CDR) extended activities of daily living scores. Regression analyses were performed to test for differences in cross-sectional age-gradients for cognitive and functional status between nursing home residents and community-dwellers. Furthermore, regression analyses, controlling for age, gender, dementia status, and education, were performed to determine the association between neuropsychological performance and functional status, comparing domains of executive functioning and memory. Results: Community-dwelling older adults showed age-related deficits both in overall cognitive status and functional disability, which were larger in nursing home residents. Executive functioning was associated with functional disability beyond the effects of age, gender, education, dementia status, residential status, overall cognitive status, memory, and cognitive speed. Conclusion: Executive functioning is associated with functional deficits in both community-dwelling older adults and nursing home residents. Measures of executive functioning may prove useful in intervention studies aimed at delaying institutionalization.

Key Words: Functional Status • Neuropsychological Measures • Nursing Home Patients

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