Professional Documents
Culture Documents
Kta Article
Kta Article
Kta Article
in Senile Dementia of
the Alzheimer's Type:
The Kitchen Task
Assessment
Carolyn Baum, Dorothy F. Edwards
Key Words: activities of daily living.
Alzheimer's disease
/.('(/S
ur OcclipatioJ1o/ Thel'upr
431
Method
Subjects
The subjects in this study came from the Memory and
Aging Project at Washington University, a longitudinal
study of healthy aging and SDAT The subjects were recruited through public annuuncements, the Alzheimer's
Disease and Related Disorders Association, and referrals
from community physicians and uther health professionals. Before enrollment in the Memory and Aging Project,
rotential subjects were tested for hypothyroidism, vitamin B-12 deficiency, and uther potentially reversible
causes of dementia. Thuse with severe h)'pertension,
strokes, severe medical problems, or psychiatric illness
were excluded from partiCipation. This study included
106 suhjects, 56 women and 50 men with a mean age of
71.75 years (range 53.8-85.4). Ninety-three rersons were
married; 13 were widowed or single. All were living in the
community with a caregiver.
Diagnosis and staging were performed hy a team of
neurologists and psychiatrists using the Clinical Dementia Rating [CDRj (Berg, 1988; Burke et aL, 1988). This
alluws the analysis of data across the progressive stages of
the disease. A CDR is derived from the subjeCts' performance in the areas of memory, orientation, judgment and
prohlem solVing, community affairs, home and hohbies,
and personal care. Clinical Dementia Ratings of 0.5,1,2,
and 3 indicate questionable, mild, moderate, and severe
dementia.
Instruments
The KTA tests the cognitively impaired person's ability to
complete the task of making cooked pudding from a
Procedure
The KTA (see Figure 1) was administered in the occurational therapy department kitchen as a part of a Functional Test Battery by an occupational therapist or research
assistant trained in its administratiun. The caregiver was
not present, and the testers were blind to the CDR rating.
Testers recurded observations regarding the assistance
the)' provided during the assessment but the scming was
recorded only after the task was finished. Verbal assistance and physical assistance were marked regardless of
the numher of cues given. The subject may have needed
several verbal cues and only one physical assistance, but if
physical assistance was required, it was recorded.
Five analyses were used in this study: (a) Kendall's
tau B to determine the interrater reliability of the KTA; (b)
correlation analysis to examine the relationship among
the six variables in the measure; (c) factor analysis to
identify common relationships among the variahles; (d)
correlation analysis with other valid instruments to determine the construct validity of the KTA; and (e) analysis of
variance to examine the KTA across stages of SDAT and
between men and women.
Results
For the Kendall's tau B analysis, Videotapes of three subjeCts, each at a different stage of impairment, were scored
by 12 persons. The testers were given an orientation to
the KTA and a descriptiun of the scoring criteria. They
432
Downloaded From: http://ajot.aota.org/ on 02/01/2016 Terms of Use: http://AOTA.org/terms
,11(/1'
'.JAME
DATE
EXAMINEI~
Circle the number that corresponds to the level of support the individual required_
COMPONENT
REQUIRED
PI IYSICAL
ASSISTANCE
NOT
CAPAI3LE
.J
.3
.3
.3
.3
INDEPENDENT
REQIIIRED
VERl3AI. CUES
INITiATION:
DID HE OR SHE I3EGf I TilE
TASK WHEN ASKED TO I3EGIN'
ORGANIZATION:
ITEMS. TOOLS,
INGRP:OIENTS, ETC.
TO DO TIlE .10m
SEQUENCING:
DlD HE OR SIIE DO EVERYHING
IN TilE ORDER THAT MADE
SENSE, GIVE THAT TASK'
COMPLETION:
DID HE OR SHE RECOGNII.E
THAT THE TASK
WAS f'INISHED'
Table 1
Mean, Standard Deviation and Range of Scores on the
Kitchen Task Assessment by Stage of Dementia
CDR O.S
CDH I
CDI{ 2
Cf)I(
.~
(QUte'li()(1;lbk)
(Mild)
(Modcralte)
(Sc\,terte)
('1'< H;11 SUbjl'lIS)
-i2
21
/.7S
-1.6S
0-07
O-IK
9~1
4-1~
10
I:~.~H
7-IH
~.71
a-It-:
55
10(,
433
Table 2
Pearson Correlation Coefficients Among Test Items
(n = 106)
Inilialion
Initialion
Organ il,al il)n
Include All
Stcps
Sequencing
Safc!)'/1 udgmeJ)(
Completion
TOldl KTA
O'gan-
All
il.<Hion
Sleps
Sequcncing
SaFcl)'
Compk:!ion Total
Functional Tests
10
,K2
7K
10
,77
.K2
K6
ID
K9
,72
,77
,7)
79
92
.HI
H,3
9j
.HH
ID
Hl
,H2
ID
H)
94
90
ID
9.3
10
Neuropsychological Tests
Token Test Short Version This tcst (De Renzi & Vignolo, 1968) consists of six parts. It measures verbal pro
cessing and is sensitive to disru pted linguistic processing,
The subject must comprehend the token names and the
instructions and be able to pick the correct response and
take (a motor response) the token from the table, Parts 1
through 4 are progressively more difficult because of the
number of tasks that must be performed in sequence,
The process reqUires the subject to follow a series of
commands. Perseveration (inability to move to another
task) is often seen as the instructions become more complex, If the person fails to respond in 5 seconds, the
instructions are repeated; a half score is recorded for the
second try, Thus, the test contains aspects of initiation
and sequencing. The test is scored so that the higher the
score, the better the performance.
Trail Making Test-Part A (Armitage, 1946) is a
timed test of visual conceptual and visuomotor tracking
and involves motor and attention skills. The subject must
connect numbered circles on a page, a task that involves
initiation and sequenCing, The test is scored so that the
higher the score, the poorer the performance,
Crossing Off Developed by Botwinick and Storandt
(1973), this is a timed test of psychomotor speed functions, without a verbal component, that measures initi-
Te'l
Token Tesl
Pan J
Tokcn '1'<:"
Pan 2
Tokcn '1'<:,'1
Pan :\
Tokcn Te.'t
P:1rI .j
Token Test
Pan ')
Token TeSI
Pan 6
T'i:d Making
A (sc-c)
CDr<
Cn >s,'ing-OFF
J3k"ed
Delllcnli;,
Bksscd Dc-
- :IV - AW""
COin
Towl
Safely
pbion
SC()[\!
,:\F
,36"
- ,.')2'"
.4~;:".:
.- AS':'" - AS':'" -
.'j~F'"
Se-
Organ-
SICP,
I''''''
.2H
- AW':'
,:\4':'
- .44':':' - AT':'
,))':--:' -
- .'jD':':' - ,')6';'" -
.:\9':'
A 2"';'
.6:>':'"
.-1:\"""
.6l""'
.-10"""
.S~F'"
.64':--:' - ,64
,:\S';'
23
,:\9'
.))':':'
,)W';'
.04':":'
66"'"
,46':":' - A2: - .4 I ...... - ,,34"""
- .,')6"
.)3":'
,)F'"
- .6W''
-
.66':""
.6J':'"
.6T'"
.-16':'"
,)1';'"
AW""
.:;7:'::":
.S"/':''
.S5':""
.50'"
AT':'
,SO':,"
.59':'"
.62"""
.)W";'
.)11''''"
,59':':'
.5)"""
.)~F"
,64''':'
1l1CI11ia
Cognitive
':p> 00]
';':-P> ,0001
434
Downloaded From: http://ajot.aota.org/ on 02/01/2016 Terms of Use: http://AOTA.org/terms
Discussion
the clinician to administer a .stand3rdil.ed measure without employing an anificial task. The KTA is a valid and
reliahle measul-e that C8n be used as a clinical as well as a
research [001 because it c1isCi"iminates the performance of
persons across all stages of the disease; therefore, it can
record ch3nge.s in the rerson"s rerFormance
The inform3tion obtained from the admlllistration of
the KTA will be helpFul in obtaining objective information
that the clinician can use in training the caregiver to assist
the person with SDAT in daily living tasks. The mean
score oFthose in the mild stage of the disease (CDR = 1)
indicates that verbal cueing is necessary to surr0rt performance; those in the moderate and severe stages oFthe
disease (CDR = 2 and CDR = 3) require rhysical assistance However, the variation demonstrated by the subjeers in the t3sk indiccltes that knowledge of the diagnosis
and the stage oFthe disease does not rerFectly prediCt the
I)erson"s carabilities. Individual assessment is necessary
to cletermine the aCtual functional capabilities of the person with SDAT Some ofrhe variahility in the performance
of subjects in the questionahle and mild SDAT groups
may be attrihuted to their unfamiliarity with the testing
environment. A sludy to test the instrument's ecological
validity in the home and cliniC setting is needed
The health care team will henefit from knowing
whether or not a person with SDAT can perform a complex basic living t,lsk independently and the level of cognitive support necessary for successful t3sk comrletion.
The infomlation fmm the KTA can assist the te3m in
disch8rge planning and counseling a family on the level of
interaerion necessary to support a cognitively impaired
person in the community This standardization of [he
KTA was on a selected sumple of persons with SDAT For
u~e with other' [)opubtioI1s, the validity of the test with
that l)opulation must be established fir'st. A
Acknowledgments
We thank Lconard Berg, .'111. Director of rhe AJzhellYler's Disease
RcscJrch Ccntcr, Jnfl David Cillesrie, PhD George Warren
Brown School of Social Work;ll Washingron llnlversiry, for rheir
rhoughrful r-evielVs of this pJper
This wmk \\8S supponccl in p,lr( hy rhe National Inslilure on Aging. Granr #A6()399 1 ami The Norman J SlUpp
Foundation
Table 4
Means of KTA Scores across the stages of SOAT for
Females, Males, and All Subjects
Appendix A
Administration Procedure
PIT-resr Ser-up
(:I)!{ () ~
(li Lll"lillll'
1/
,,11k)
f-l'lll;t1C ~c()rc
~(,
~.{)ll"
;\-lale ,u>re
'iO
TIll:l! :-'Cllre
W(,
Ir
I '(,.
(1)1'
CJ)R
CJ)R"
(Illild)
(ll11ld.)
(",('\erc)
-15"
HH5'
II 11';
<) I >it.
15 He-,
l.
'196
-J.6~~
'\ ,A
I,-I.HW
.:'p = <{)'i
435
Appendix B
Scoring Guide
Initiation:
Organization: Was he or she able to get the milk from the refrigerator and use the tools arrrorriatelv~ Some
may use the rools or equirlllent incorreerly; for
examrle, some t1y to cook in the measuring cur.
Did the rerson resrond to verhal help or did he
or she requir-e rhysical assistance~
Perfor-mance Did he or she relfor-m all the major steps - meaof all steps: suring, stirring, pouring - a/()ne~ Diel you have
to assist him or her, for examrle, light the stove?
Was it verhal or rhysical assistance?
Sequencing:
Judgment
and Safety:
References
AJlen, C (1991). Allen Cognitive Level (ACL) Test In Assessfng Adults Functional Measu.res and Successful Outcome
(Section I). Rockville, MD: American Occupational Therapy
Foundation.
Armitage, S. G. (1946). The analysis of certain psychological
tests used for the evaluation of brain injury. Psychological
/'V[onoRraph, 60, series 1 (277), 1-48.
Baum, M. C, Edwards, D. F, & Morrow-Howell, N. (in
rress). Productive behaviors in SDAT. The GerontoloRist.
Berg, 1.., Hughes, C P., Cohen, L. A., Danziger, W. L., Martin, R 1.., & Knesevich,]. (1982). Mild dementia of the Alzheimer
tyre: Research diagnostic criteria, recruitment and deserirtion
of a study ropu!ation.joumal ofNeurologl', Neurosurgery and
Psychiatry, 4.5, 962-968
Berg, I.. (1988). Mild senile dementia of the Alzheimer type:
Diagnostic criteria and natural hiStOIy. N[ounl Sinoijournal of
Medicine, 55, 87-96
Blessed, G., Tomlinson, B. E., & Roth, M. (1968). The association hetween quanritative measures of dementia and of senile
changes in cerehral grey matter of elderly subjects. Britishjournal of Psychial1y, 114, 797-811.
Borwinick,]., & Storandt, M. (1973). Sreecl functions, vocabulary ability, and age. Perceptual and f\!Jotor Skills, 36,
1123-1128
Burke, W. J., Miller,]., Ruhen, E, Morris,)., Cohen, L. A.,
Duchek, J, Wittels, I. G., & Berg, L. (1988). Reliability of the
Washington university clinical demenria rating (CDR). Archives
of Neurology, 45, 31-32
DeRenzi, E., Pieczuro, A., Vignolo, L. A., (1968). Ideational
arraxia: A quantitative stlldy. Neuropsychologia, 6(41),41-52.
Elithorn, A. (1965) Psyrholngical tests: An ohjective approach to the problem of task difficulty. ActaNeurologica Scandinauica, 41 (Suppl. 13, Pan 2), 661-667.
Fisher, A. (1991). The A~sessment of Motor and Process
Skills (AMPS) in Assessing Adults: Functional f\!Jeasures and
Successful Outcome. Section II. Rockville, MD: American Occupational Therapy Foundation.
Heaton, R., & Pendleton, M. (1981). Use of neurorsychological tests to predict ratients every day functioning. joumat
of Consulting and Clinical Psychology, 49, 807-821.
Hughes, C P, Berg, L., Danzinger, W. 1.., et al. (1982). A
new clinical slale for the sraging of dementia. British joumal of
436
Downloaded From: http://ajot.aota.org/ on 02/01/2016 Terms of Use: http://AOTA.org/terms