Abstract
BackgroundInstrumental activities of daily living (IADL) start to decline during the progression of amnestic mild cognitive impairment (aMCI) to Alzheimer disease (AD). Cognitive and physical decline are involved in the loss of functional independence. However, little is known about AD-related neural change that leads to IADL impairment. The purpose of this study was to clarify the effects of regional white matter hyperintensity (WMH) on IADL impairment in persons with AD and aMCI.MethodsThe participants were 347 female subjects aged 65–85 years diagnosed with AD (n = 227), aMCI (n = 44) or normal cognition (n = 76). IADL was assessed by the Lawton Index. Cognition, mood and mobility function were evaluated by comprehensive geriatric assessment batteries. WMH and brain atrophy were analyzed with brain magnetic resonance imaging, using an automatic segmentation program. Regional WMH was measured in the frontal, temporal, occipital and parietal lobes.ResultsAbility to carry out IADL of shopping, food preparation, mode of transportation, responsibility for own medication, and ability to handle finances was obviously impaired in the early stage of AD. Frontal WMH was specifically associated with disability to do shopping and food preparation even after adjusting for several confounders including brain atrophy.ConclusionsIADL subcategories were differentially impaired along with cognitive status in persons with AD and aMCI. Frontal WMH was an important predictor of impaired ability to do shopping and food preparation. A preventive strategy for WMH might lead to suppression of IADL disability and slow the progression of AD.
Highlights
White matter hyperintensity (WMH) is observed as hyperintense areas in T2-weighted and fluid-attenuated inversion recovery (FLAIR) images, and isointense or hypointense areas in T1-weighted images on magnetic resonance (MR) images
Ability to carry out Instrumental activities of daily living (IADL) of shopping, food preparation, mode of transportation, responsibility for own medication, and ability to handle finances was obviously impaired in the early stage of Alzheimer disease (AD)
Frontal white matter hyperintensity (WMH) was associated with disability to do shopping and food preparation even after adjusting for several confounders including brain atrophy
Summary
White matter hyperintensity (WMH) is observed as hyperintense areas in T2-weighted and fluid-attenuated inversion recovery (FLAIR) images, and isointense or hypointense areas in T1-weighted images on magnetic resonance (MR) images. Instrumental activities of daily living (IADL) are composed of several activities required to maintain independent living such as shopping, cooking, handling medication and managing finances. These activities require more complex behaviors and higher executive function than does self-maintenance of basic ADL. IADL start to decline during the progression of amnestic mild cognitive impairment (aMCI) to Alzheimer disease (AD) [8]. Instrumental activities of daily living (IADL) start to decline during the progression of amnestic mild cognitive impairment (aMCI) to Alzheimer disease (AD). The purpose of this study was to clarify the effects of regional white matter hyperintensity (WMH) on IADL impairment in persons with AD and aMCI
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