Date Presented 04/05/19
The EFPT-e is a new version of the EFPT functional cognitive assessment. The EFPT-e was developed to address a need for a functional cognitive assessment consisting of more complex tasks to assess milder forms of executive dysfunction. A cross-sectional study design evaluated the construct validity of the EFPT-e in the breast cancer population. The EFPT-e demonstrated good construct validity within this population.
Primary Author and Speaker: Anna Boone
Additional Authors and Speakers: Timothy Wolf
PURPOSE: The vast majority of individuals with breast cancer who undergo treatment experience decreases in cognitive abilities. This decreased cognitive functioning is referred to as cancer-related cognitive impairment (CRCI). CRCI persists for up 20 years post-treatment and impacts daily occupational performance, psychosocial functioning, and role fulfillment (Koppelmans, 2012). The Executive Function Performance Test (EFPT) created by Baum and colleagues (2008) was developed to evaluate mild cognitive impairment, but ceiling effects in existing data suggest it may not be sensitive to all individuals with milder forms of neurological injury like CRCI. Therefore, a new version of the EFPT, the EFPT-enhanced (EFPT-e) was developed to address this need consisting of more complex functional tasks to detect a wider range of mild cognitive impairment. The purpose of this study was to evaluate the construct validity of EFPT-e in women with breast cancer.
DESIGN: A cross-sectional study design was employed. Participants (n=20) were recruited through a local cancer treatment facility. Participants were recruited who were females over the age of 18 years with a breast cancer diagnosis and intact cognition as indicated by a score of greater than 26 on the Montreal Cognitive Assessment (MoCA). Participants were excluded who self-reported color-blindness or demonstrated executive dysfunction per a score of equal to or less than 7 on the Delis-Kaplan Executive Function System (DKEFS) Color-Word Interference subtest or Trail Making subtest.
METHOD: Participants completed a two-hour assessment battery consisting of the EFPT-e, MoCA, Wechsler Test of Adult Reading (WTAR), DKEFS Color-Word Interference and Trail Making subtests, and the Cognitive Failures Questionnaire (CFQ). All data were checked for normal distribution using Q-Q plots and the Shapiro-Wilks test. Relationships between normally distributed data were analyzed using the parametric pearson’s r correlation. Relationships involving non-normally distributed data were analyzed using the non-parametric Spearman’s rho. Correlations between the EFPT-e and each of the other measures were evaluated to determine construct validity.
RESULTS: The total number of cues needed in the EFPT-e demonstrated a negligible correlation with the MoCA scores (rho=.058), a small correlation with DKEFS Trail Making (r=-.112), a moderate correlation with the WTAR (r=-.372), and a moderate correlation with the CFQ (r=-.396).
CONCLUSION: The EFPT-e demonstrates good construct validity as evidenced by a moderate relationship with self-reported cognitive errors on the CFQ. While results comparing the EFPT-e with pencil and paper neuropsychological assessments ranged from negligible to moderate, it is expected given these types of assessments evaluate isolated cognitive processes as opposed to functional cognition as measured by the EFPT-e. The difference in these two constructs may explain the lack of relationship with these measures. Development and testing of the EFPT-e is essential for detection of very mild forms of executive function to guide treatment for CRCI.
References
Koppelmans, V., Breteler, M., Boogerd, W., Seynaeve, C., Gundy, C., & Schagen, S. (2012). Neuropsychological performance in survivors of breast cancer more than 20 years after adjuvant chemotherapy. Journal of Clinical Oncology, 30(10), 1080-1086.
Baum, C. M., Connor, L. T., Morrison, T., Hahn, M., Dromerick, A. W., & Edwards, D. F. (2008). Reliability, validity, and clinical utility of the Executive Function Performance Test: A measure of executive function in a sample of people with stroke. American Journal of Occupational Therapy, 62(4), 446-455.
