Re-evaluating the measurement and influence of conscious movement processing on gait performance in older adults: Development of the Gait-Specific Attentional Profile

To develop a 10-minute cognitive screening tool (Montreal Cognitive Assessment, MoCA) to assist first-line physicians in detection of mild cognitive impairment (MCI), a clinical state that often progresses to dementia. Validation study. A community clinic and an academic center. Ninety-four patients meeting MCI clinical criteria supported by psychometric measures, 93 patients with mild Alzheimer's disease (AD) (Mini-Mental State Examination (MMSE) score > or =17), and 90 healthy elderly controls (NC). The MoCA and MMSE were administered to all participants, and sensitivity and specificity of both measures were assessed for detection of MCI and mild AD. Using a cutoff score 26, the MMSE had a sensitivity of 18% to detect MCI, whereas the MoCA detected 90% of MCI subjects. In the mild AD group, the MMSE had a sensitivity of 78%, whereas the MoCA detected 100%. Specificity was excellent for both MMSE and MoCA (100% and 87%, respectively). MCI as an entity is evolving and somewhat controversial. The MoCA is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in patients performing in the normal range on the MMSE.

Attentional control theory is an approach to anxiety and cognition representing a major development of Eysenck and Calvo's (1992) processing efficiency theory. It is assumed that anxiety impairs efficient functioning of the goal-directed attentional system and increases the extent to which processing is influenced by the stimulus-driven attentional system. In addition to decreasing attentional control, anxiety increases attention to threat-related stimuli. Adverse effects of anxiety on processing efficiency depend on two central executive functions involving attentional control: inhibition and shifting. However, anxiety may not impair performance effectiveness (quality of performance) when it leads to the use of compensatory strategies (e.g., enhanced effort; increased use of processing resources). Directions for future research are discussed.