Test of Executive Functioning in an Emergency (TEFE): A Performance-Based Assessment of Safety for Geriatric Patients With Dementia

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Declines in executive functioning are common complaints in geriatric patients with dementia. Although executive functions are the most complex of behaviors, there are few measurements that directly assess activity related behaviors associated with higher order cognitive processing and safety. The Pillbox test and the Direct Assessment of Functional Status–Revised were developed to help assess functional abilities, but we were unable to find any measure that assessed emergency knowledge and behavior in geriatric patients with dementia. Thus, we developed a Test of Executive Functioning in an Emergency (TEFE), which required the patient to provide information relevant in an emergency and use a telephone to access emergency assistance. The aim of the current study was to investigate the relationship of the TEFE to other measures of executive function, overall cognitive functioning, and measures of functional ability. The second aim investigated the relationship between dementia severity and TEFE performance. Records of 256 patients referred to a medical outpatient memory disorders clinic diagnosed by consensus with mild cognitive impairment and dementia were reviewed. Pearson product–moment correlations and 1-way analysis of variance were utilized to analyze the data. The results suggest that the TEFE correlates well with other measures of executive functioning and that patients with Alzheimer’s disease perform worse on the TEFE than patients diagnosed with mild cognitive impairment and mixed dementia. These findings support the potential use of using the TEFE as a quick measure of executive function that may directly assess safety concerns for independent living, especially for Alzheimer’s disease patients.

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