Summary of field trial of cognition question

1. Summary of field trial of cognition question Howard Meltzer Department of Health Sciences University of Leicester United Kindom Presentation for the Washington Group on Disability Statistics, Uganda, 10-14 October 2006

2. Cognition questions in ICF terms (1) • Memory functions (b144) • Short term and long term memory • Memory span • Retrieval of memory • Remembering • Functions used in recalling and learning

3. Cognition questions in ICF terms (2) • Attention functions (b140) • Sustained attention • Shifting attention • Dividing attention • Sharing attention • Concentration • Distractability

4. Cognition questions in ICF terms (3) • Memory and concentration are a small part of mental function: others excluded are: • Consciousness functions • Orientation functions (time, place, person) • Intellectual functions (mental retardation, dementia) • Global psychosocial functions • Temperament and personality functions • Energy & drive functions (motivation, appetite, sleep) • Emotional and perceptual functions • Thought functions including higher level cognition

5. How did respondents interpret the concepts of remembering and concentrating? • A review of verbatim responses suggest that respondents had no difficulty understanding the WG question. • All responses included words such as forgetting, remembering, concentrating. • Mostly in reference to work or school. • There was no reference to difficulties in orientation (time, place, person)

6. How did respondents interpret the concepts of remembering and concentrating? • A number of respondents gave medical cause: • Accident • Brain injury, stroke, paralysis • Cerebral palsy • Epilepsy • Blindness • Deafness • On dialysis

7. How did respondents interpret the concepts of remembering and concentrating? • A number of respondents gave other causes: • I am stressed so I forget • Poor people do forget • I tend to forget due to my old age.

8. How did respondents interpret the concepts of remembering and concentrating? Some respondents qualified degree of difficulty • Sometimes I forget what people have told me • Sometimes I have to keep looking for things, not remembering where I have put them • I forget things that I have talked about 2 to 3 days before.

9. Approach to quantitaive analysis • Producing dichotomous variables • Carrying out simple logistic regression analysis • Carrying out multiple logistic regression analysis • Producing a composite score of significant correlates. • Running some crosstabulations

10. Correlates of cognition difficulty (1)

11. Correlates of cognition difficulty (2)

12. Correlates of cognition difficulty (3)

13. Socio- demographic correlates of cognition difficulty

14. Significantconcepts Frequency Degree of effort Restriction in activities Duration of difficulty Significant concepts Worried or concerned about it. Problems with orientation Learning new things or problem solving Significant correlates of cognition difficulty (unadjusted)

15. Significant correlates of cognition difficulty (adjusted)

16. Cognition difficulty by number of problem areas

17. Cognition: frequency by severity

18. Conclusions & recommendations (1) • Within the specified aspects of mental functioning, the WG question works quite well. • The only meaningful statistic is derived from the distinction between “a lot and impossible” compared with “none and a little”. • The key concepts independently related to degree of difficulty are frequency, effort, worried about it, remembering names, problem solving.

19. Conclusions & recommendations (2) • Need to repeat analysis on proxy data. • Need to know the reason for proxy data. • Investigate how question works for children • Investigate how question works in relation to socio-demograhic and socio-economic factors. • Carry out external validity tests

20. Summary of cognitive testing of cognition Howard Meltzer Department of Health Sciences University of Leicester United Kindom Presentation for the Washington Group on Disability Statistics, Uganda, 10-14 October 2006