Abstract
People with Multiple Sclerosis (PwMS) often experience executive function (EF) deficits affecting daily living. The Weekly Calendar Planning Activity (WCPA) is a recently developed tool requiring management of a cognitively challenging functional task. This study sought to validate the WCPA as an assessment of functional cognition for PwMS. We established the WCPA’s discriminant, concurrent, and construct validity. Overall, it can be a useful tool to assess EF function difficulties among PwMS.
Primary Author and Speaker: Diane Rose Allid
Additional Authors and Speakers: Melissa Orenstein
Contributing Authors: Yael Goverover
Executive function difficulties affecting daily functional performance are common among people with multiple sclerosis (PwMS; Preston, Hammersly, & Gallagher, 2013). However, executive function among PwMS is most often assessed using traditional neuropsychological measures, and thus are devoid of the context of functional tasks. Ecologically valid tools that better reflect functional cognition may be necessary to capture the full extent of executive function difficulties in PwMS (Ruet & Brochet, 2018). One assessment of executive function that is considered to be a functional cognition assessment is the Weekly Calendar Planning Activity (WCPA; Toglia, 2015). The WCPA is a recently developed assessment requiring problem solving and management of a cognitively challenging, multi-step activity. The test was designed to assess mild executive function difficulties in adults and adolescents, but has yet to be examined with PwMS. The aim of this study was to establish the discriminant, concurrent, and construct validity of the WCPA by examining whether (1) there is a difference in the WCPA performance between PwMS and healthy controls (HC); (2) there is a relationship between performance in the WCPA and performance on an assessment of functional cognition; and (3) whether there is a relationship between performance in the WCPA and performance in a neuropsychological measure of cognition.
A cross-sectional instrument validation study was used with 62 PwMS and 40 healthy controls (HC) ages 23 to 63 years. Participants were administered (1) the WCPA to measure executive function while organizing appointments into a weekly schedule and following a set of rules; (2) the Actual Reality (AR) to measure functional cognition while purchasing food and a plane ticket using the computer; and (3) the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) to assess cognitive impairments.
Results of the study showed PwMS performed worse overall on the WCPA than HC. Particularly, PwMS entered significantly less appointments accurately and followed less rules than HC in the WCPA. Moreover, there was no significant difference in the number of strategies used and the time to complete the task between the two groups, suggesting that PwMS are less efficient with their use of time and strategies than HC. Better overall performance on the WCPA was also associated with better overall performance on the AR, with better accuracy on the WCPA translating into better accuracy during the computer task. Lastly, better overall performance on the WCPA was associated with better scores on BICAMS, suggesting that the WCPA is able to capture the same constructs of cognition while utilizing a more functional task.
This study provides preliminary evidence for the validity of the WCPA in PwMS. Overall, the WCPA is a valuable tool for assessing executive function difficulties among PwMS because it allows systematic analysis of functional performance in terms of strategy use and errors during a functional task. This can be particularly useful for planning an intervention targeting a specific pattern of errors or difficulty in strategy use among PwMS, and for identifying strategies that work well specific to the individual. To our knowledge, this is the first study comparing the WCPA with actual performance on a functional task, and results of this study show that the WCPA can be an indicator of everyday life performance.
Preston, J., Hammersley, R., & Gallagher, H. (2013). The executive dysfunctions most commonly associated with multiple sclerosis and their impact on occupational performance. British Journal of Occupational Therapy, 76(5), 225-233.
Ruet, A., & Brochet, B. (2018). Cognitive assessment in patients with multiple sclerosis: From neuropsychological batteries to ecological tools. Annals of Physical and Rehabilitation Medicine. Retrieved from https://doi.org/10.1016/j.rehab.2018.01.006
Toglia, J. (2015). The Weekly Calendar Planning Activity [Measurement instrument]. Bethesda, MD: AOTA Press.