Does Mild Functional Impairment Predict Dementia in Older Adults With Normal Cognition?

Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 8704771 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1546-4156 (Electronic) Linking ISSN: 08930341 NLM ISO Abbreviation: Alzheimer Dis Assoc Disord Subsets: MEDLINE

Publication: Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: Lawrence, Kan. : Western Geriatric Research Institute, c1987-

Dementia*/diagnosis ; Cognitive Dysfunction*/diagnosis ; Cognition*/physiology; Humans ; Female ; Male ; Aged ; Longitudinal Studies ; Neuropsychological Tests/statistics & numerical data ; Independent Living ; Cross-Sectional Studies ; Aged, 80 and over

Objectives: Functional impairment can be an early indicator of cognitive decline. However, its predictive utility in cognitively normal (CN) older adults remains unclear. This study aimed to determine whether mild functional impairment (MFI) in CN older adults could predict incident dementia over 6 years, in addition to assessing its association with cognitive performance.
Design: A longitudinal study with a 6-year follow-up.
Participants: A cohort of 296 community-dwelling CN older adults.
Measurements: MFI was defined by cutoffs for impairment on an objective performance-based and/or subjective questionnaire-based functional assessment. Cox regression analysis was conducted to assess the relationship between MFI and risk of incident dementia and cognitive performances over 6 years. Linear regression analysis examined the association between MFI and baseline cognitive performance.
Results: There were no significant longitudinal associations between MFI and incident dementia or changes in cognitive performance over 6 years. Defining MFI using both performance-based and informant-reported assessments was predictive of dementia. Cross-sectional analyses demonstrated significant associations between MFI and poorer baseline global cognition and performance in attention, visuospatial ability, and executive functioning.
Conclusions: CN older adults with MFI were not at an increased risk of developing dementia over 6 years. A definition of functional impairment requiring both performance-based and informant-based assessments may be useful in predicting dementia.
Competing Interests: H.B. has been an advisory board member or consultant to Biogen, Eisai, Eli Lilly, Roche and Skin2Neuron. He is a Medical/Clinical Advisory Board member for Montefiore Homes and Cranbrook Care. The remaining authors declare no conflicts of interest.
(Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Knopman DS, Petersen RC. Mild cognitive impairment and mild dementia: a clinical perspective. Mayo Clin Proc. 2014;89:1452–1459.
Abdulaziz K, Perry JJ, Taljaard M, et al. National survey of geriatricians to define functional decline in elderly people with minor trauma. Can Geriatr J. 2016;19:2–8.
Mlinac ME, Feng MC. Assessment of activities of daily living, self-care, and independence. Arch Clin Neuropsychol. 2016;31:506–516.
Altieri M, Garramone F, Santangelo G. Functional autonomy in dementia of the Alzheimer’s type, mild cognitive impairment, and healthy aging: a meta-analysis. Neurol Sci. 2021;42:1773–1783.
Sikkes SA, Rotrou JD. A qualitative review of instrumental activities of daily living in dementia: what’s cooking? Neurodegener Dis Manag. 2014;4:393–400.
Votruba KL, Persad C, Giordani B. Patient mood and instrumental activities of daily living in Alzheimer disease: relationship between patient and caregiver reports. J Geriatr Psychiatry Neurol. 2015;28:203–209.
Jekel K, Damian M, Wattmo C, et al. Mild cognitive impairment and deficits in instrumental activities of daily living: a systematic review. Alzheimers Res Ther. 2015;7:17.
Reppermund S, Birch RC, Crawford JD, et al. Performance-based assessment of instrumental activities of daily living: validation of the Sydney test of activities of daily living in memory disorders (STAM). J Am Med Dir Assoc. 2017;18:117–122.
McCollum L, Karlawish J. Cognitive impairment evaluation and management. Med Clin North Am. 2020;104:807–825.
Park MH. Informant questionnaire on cognitive decline in the elderly (IQCODE) for classifying cognitive dysfunction as cognitively normal, mild cognitive impairment, and dementia. Int Psychogeriatr. 2017;29:1461–1467.
Liew TM. Trajectories of subjective cognitive decline, and the risk of mild cognitive impairment and dementia. Alzheimers Res Ther. 2020;12:135.
Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment—beyond controversies, towards a consensus: report of the International Working Group on mild cognitive impairment. J Intern Med. 2004;256:240–246.
Petersen RC, Caracciolo B, Brayne C, et al. Mild cognitive impairment: a concept in evolution. J Intern Med. 2014;275:214–228.
Ward A, Tardiff S, Dye C, et al. Rate of conversion from prodromal Alzheimer’s disease to Alzheimer’s dementia: a systematic review of the literature. Dement Geriatr Cogn Dis Extra. 2013;3:320–332.
Michaud TL, Su D, Siahpush M, et al. The risk of incident mild cognitive impairment and progression to dementia considering mild cognitive impairment subtypes. Dement Geriatr Cogn Dis Extra. 2017;7:15–29.
Reppermund S, Brodaty H, Crawford JD, et al. Impairment in instrumental activities of daily living with high cognitive demand is an early marker of mild cognitive impairment: the Sydney Memory and Ageing Study. Psychol Med. 2013;43:2437–2445.
Martin RC, Gerstenecker A, Triebel KL, et al. Declining financial capacity in mild cognitive impairment: a six-year longitudinal study. Arch Clin Neuropsychol. 2018;34:152–161.
Jutten RJ, Dicks E, Vermaat L, et al. Impairment in complex activities of daily living is related to neurodegeneration in Alzheimer’s disease–specific regions. Neurobiol Aging. 2019;75:109–116.
Rajan KB, Hebert LE, Scherr PA, et al. Disability in basic and instrumental activities of daily living is associated with faster rate of decline in cognitive function of older adults. J Gerontol A Biol Sci Med Sci. 2013;68:624–630.
Clemmensen FK, Hoffmann K, Siersma V, et al. The role of physical and cognitive function in performance of activities of daily living in patients with mild-to-moderate Alzheimer’s disease – a cross-sectional study. BMC Geriatr. 2020;20:513.
Ishizaki T, Yoshida H, Suzuki T, et al. Effects of cognitive function on functional decline among community-dwelling non-disabled older Japanese. Arch Gerontol Geriatr. 2006;42:47–58.
Iwasa H, Gondo Y, Yoshida Y, et al. Cognitive performance as a predictor of functional decline among the non-disabled elderly dwelling in a Japanese community: a 4-year population-based prospective cohort study. Arch Gerontol Geriatr. 2008;47:139–149.
Farias ST, Lau K, Harvey D, et al. Early functional limitations in cognitively normal older adults predict diagnostic conversion to mild cognitive impairment. J Am Geriatr Soc. 2017;65:1152–1158.
Marshall GA, Zoller AS, Kelly KE, et al. Everyday cognition scale items that best discriminate between and predict progression from clinically normal to mild cognitive impairment. Curr Alzheimers Res. 2014;11:853–861.
Marshall GA, Zoller AS, Lorius N, et al. Functional activities questionnaire items that best discriminate and predict progression from clinically normal to mild cognitive impairment. Curr Alzheimers Res. 2015;12:493–502.
Nowrangi MA, Rosenberg PB, Leoutsakos J-MS. Subtle changes in daily functioning predict conversion from normal to mild cognitive impairment or dementia: an analysis of the NACC database. Int Psychogeriatr. 2016;28:2009–2018.
Makino K, Lee S, Bae S, et al. Relationship between instrumental activities of daily living performance and incidence of mild cognitive impairment among older adults: a 48-month follow-up study. Arch Gerontol Geriatr. 2020;88:104034.
Sachdev PS, Brodaty H, Reppermund S, et al. The Sydney Memory and Ageing Study (MAS): methodology and baseline medical and neuropsychiatric characteristics of an elderly epidemiological non-demented cohort of Australians aged 70–90 years. Int Psychogeriatr. 2010;22:1248–1264.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV: American Psychiatric Association; 1994.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198.
Hindmarch I, Lehfeld H, de Jongh P, et al. The bayer activities of daily living scale (B-ADL). Dement Geriatr Cogn Disord. 1998;9(Suppl. 2):20–26.
Sánchez-Benavides G, Manero RM, Quiñones-Ubeda S, et al. Spanish version of the bayer activities of daily living scale in mild cognitive impairment and mild Alzheimer disease: discriminant and concurrent validity. Dement Geriatr Cogn Disord. 2009;27:572–578.
D’Agostino RB, Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care. Circulation. 2008;117:743–753.
Anstey KJ, Ee N, Eramudugolla R, et al. A systematic review of meta-analyses that evaluate risk factors for dementia to evaluate the quantity, quality, and global representativeness of evidence. J Alzheimers Dis. 2019;70(s1):s165–s186.
Conradsson M, Rosendahl E, Littbrand H, et al. Usefulness of the geriatric depression scale 15-item version among very old people with and without cognitive impairment. Aging Ment Health. 2013;17:638–645.
Marshall GA, Aghjayan SL, Dekhtyar M, et al. Measuring instrumental activities of daily living in non-demented elderly: a comparison of the new performance-based Harvard automated phone task with other functional assessments. Alzheimers Res Ther. 2019;11:4.
Sikkes SA, de Lange-de Klerk ESM, Pijnenburg YAL, et al. A new informant-based questionnaire for instrumental activities of daily living in dementia. Alzheimers Dement. 2012;8:536–543.
Kwak S, Park SM, Jeon YJ, et al. Multiple cognitive and behavioral factors link association between brain structure and functional impairment of daily instrumental activities in older adults. J Int Neuropsychol Soc. 2022;28:673–686.
Marshall GA, Sikkes SAM, Amariglio RE, et al. Instrumental activities of daily living, amyloid, and cognition in cognitively normal older adults screening for the A4 Study. Alzheimers Dement (Amst). 2020;12:e12118.
Cloutier S, Chertkow H, Kergoat M-J, et al. Trajectories of decline on instrumental activities of daily living prior to dementia in persons with mild cognitive impairment. Int J Geriatr Psychiatry. 2021;36:314–323.

Date Created: 20240823 Date Completed: 20240823 Latest Revision: 20240823

20240823

10.1097/WAD.0000000000000638

39177170