Hispanics with Limited English proficiency (LEP) have high rates of functional impairment defined as difficulties carrying out complex day-to-day tasks or instrumental activities of daily living (IADL). Functional impairment is often preceded by cognitive decline, as such, cognitive instruments are often used to make inferences about patients’ functional abilities. However, cognitive instruments have poor ecological validity particularly when used with Hispanics with LEP who often have limited educational attainment and less familiarity with standard test-taking procedures. Thus, our ability to predict declines in IADL is limited. We examined the extent in which informant-ratings of behavioral disturbance improves our ability to predict functional declines in Hispanics with LEP. Analyses were conducted using an archived dataset of 109 Hispanics with LEP with cognitive complaints who underwent a comprehensive neuropsychological evaluation at an outpatient clinic in the Midwest. Linear and hierarchical regressions were conducted to determine whether measures of behavioral disturbance improve our ability to predict IADL when added to cognitive measures of executive functioning while controlling for demographic factors. Hierarchical regression analysis including demographic variables in step 1 (age, sex, education), cognitive variables in step 2 [Wisconsin Card Sorting Test (WCST) and Verbal Fluency], and the apathy subscale of the Frontal System Behavior Scale (FrSBe) in step 3 revealed that Verbal Fluency and FrSBe apathy were the only significant predictors of IADL. Consistent with the main hypothesis, the present study demonstrated that behavioral measures improve the ability to predict adaptive functioning in Hispanics with LEP. Across three hierarchical regression analyses, behavioral disturbance was the best predictor of functional decline relative to demographic and cognitive factors. The present study demonstrated that in Hispanics with LEP, the FrSBe provides valuable clinical information that is non-redundant with existing cognitive instruments.
|Advisor:||Thomas, Adrian, Lu, Lisa H.|
|Commitee:||Kvaal, Steven A., Pliskin, Neil H.|
|School Location:||United States -- Illinois|
|Source:||DAI-B 77/09(E), Dissertation Abstracts International|
|Subjects:||Mental health, Clinical psychology, Hispanic American studies|
|Keywords:||Behavioral disturbance, Cognitive function, Daily living, Executive function, Neuropsychological assessment|
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