Abstract
IntroductionThere is a growing body of evidence that subtle deficits in instrumental activities of daily living (IADL) may be present in mild cognitive impairment (MCI). However, it is not clear if there are IADL domains that are consistently affected across patients with MCI. In this systematic review, therefore, we aimed to summarize research results regarding the performance of MCI patients in specific IADL (sub)domains compared with persons who are cognitively normal and/or patients with dementia.MethodsThe databases PsycINFO, PubMed and Web of Science were searched for relevant literature in December 2013. Publications from 1999 onward were considered for inclusion. Altogether, 497 articles were retrieved. Reference lists of selected articles were searched for potentially relevant articles. After screening the abstracts of these 497 articles, 37 articles were included in this review.ResultsIn 35 studies, IADL deficits (such as problems with medication intake, telephone use, keeping appointments, finding things at home and using everyday technology) were documented in patients with MCI. Financial capacity in patients with MCI was affected in the majority of studies. Effect sizes for group differences between patients with MCI and healthy controls were predominantly moderate to large. Performance-based instruments showed slight advantages (in terms of effect sizes) in detecting group differences in IADL functioning between patients with MCI, patients with Alzheimer’s disease and healthy controls.ConclusionIADL requiring higher neuropsychological functioning seem to be most severely affected in patients with MCI. A reliable identification of such deficits is necessary, as patients with MCI with IADL deficits seem to have a higher risk of converting to dementia than patients with MCI without IADL deficits. The use of assessment tools specifically designed and validated for patients with MCI is therefore strongly recommended. Furthermore, the development of performance-based assessment instruments should be intensified, as they allow a valid and reliable assessment of subtle IADL deficits in MCI, even if a proxy is not available. Another important point to consider when designing new scales is the inclusion of technology-associated IADL. Novel instruments for clinical practice should be time-efficient and easy to administer.
Highlights
There is a growing body of evidence that subtle deficits in instrumental activities of daily living (IADL) may be present in mild cognitive impairment (MCI)
The aim of the present review is to summarize research results regarding the performance of patients with MCI in specific IADLdomains compared with persons who are cognitively normal and/or patients with dementia
Mild cognitive impairment sample characteristics For the diagnosis of MCI, the criteria of Petersen or Winblad were applied across studies; their operationalization, varied
Summary
There is a growing body of evidence that subtle deficits in instrumental activities of daily living (IADL) may be present in mild cognitive impairment (MCI) It is not clear if there are IADL domains that are consistently affected across patients with MCI. The most commonly used criteria for MCI— known as Mayo criteria—were proposed by Petersen et al [1,2] These criteria require (1) a memory complaint, (2) normal activities of daily living, (3) normal general cognitive function, (4) abnormal memory for age and (5) absence of dementia. These criteria have been modified to expand the original MCI concept, including impairments in cognitive domains other than memory. Discussion about the MCI criteria and their operationalization is ongoing [4], as the criteria neither specify methods to assess cognitive or functional capacity nor provide cutoff points for cognitive or functional scales to differentiate MCI from mild dementia
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