Instrumental Activities Of Daily Living Deficits Research Articles

The Role of Functional Deficits, Depression, and Cognitive Symptoms in the Perceived Loneliness of Older Adults in Mexico City.

The world is aging and experiencing loneliness. Functional impairment in instrumental activities of daily living (IADL) in older people (OP) with mild neurocognitive disorder (MNCD) predicts loneliness. After the pandemic, there was an increase in perceived loneliness. We explored the association between loneliness, depression, deficits in IADL, and cognitive symptoms among OP. From February to December 2023, using a cross-sectional design, we interviewed probable cases with mild cognitive impairment and caregivers in two public facilities. We administered the UCLA Loneliness Scale v3, Lawton IADL Scale, Mini-Mental State Examination (MMSE), and Yesavage's Geriatric Depression Scale. Samples were matched: 85 per group, 82.4% were women, married (52.95%), and mean age of 69.17 (±6.93) years. In our study, 30% displayed moderate to high levels of perceived loneliness. Multivariate analysis showed loneliness was associated with depression, low levels of IADL, and older age, but not with cognitive symptoms, which explained 22% of the total variance (F 165) = 16.99, (p < 0.001). Targeting symptoms and behaviors that could be modified (i.e., depression and functionality) can improve feelings of perceived loneliness and have an impact on morbidity and mortality with which it is associated.

Screening older adults for potential deficits in IADL using the Menu Task and Medi‐Cog‐R

AbstractBackgroundThe identification of deficits in functional performance is critical to sustaining the community independence of older adults. Screening for difficulties in the performance of cognitively demanding instrumental activities of daily living (IADL) can facilitate earlier identification of and intervention for people with impairment (Rodakowski et al., 2014). We examined whether two brief performance‐based screening measures ‐ the Menu Task and the Medi‐Cog‐R ‐ can identify those at risk of functional cognitive deficits as indicated by poor performance on the Weekly Calendar Planning Activity (WCPA).MethodUsing a cross‐sectional design we administered the Menu Task, Medi‐Cog‐R, and the WCPA to community dwelling adults 55 years of age and older (N = 280). Using established cut scores, we examined the sensitivity and specificity of the two screening measures to poor performance on WCPA Accuracy (≤ 20th percentile). Known‐group construct validity were examined by comparing impaired and unimpaired groups on the screening measures on subtests of the WCPA.ResultThe sample was 73.57% female and 73.57% white. Mean age was 69.72 (SD = 8.81) and mean education was 15.61 (SD = 3.30) years. The Menu Task demonstrated a sensitivity of .84 and a specificity of .62 and the Medi‐Cog‐R demonstrated a sensitivity of .77 and a specificity of .66 in correctly classifying individuals with potential for impaired IADL as indicated by a score at or below the 20th percentile on the WCPA. The impaired groups on both screening measures scored significantly lower on WCPA subtests of Accuracy, Appointments Entered, Efficiency, Rules, and Strategies than the unimpaired group (p &lt; .001).ConclusionThe Menu Task and the Medi‐Cog‐R could both alert clinicians to the potential for functional cognitive deficits and need for IADL support in community dwelling older adults. Performance‐based screening measures of functional cognition can be used to prompt further assessment and intervention to promote community independence.

66 Association of Executive Functions and Instrumental Activities of Daily Living in Parkinson’s Disease

Objective:Executive function (EF) abilities tend to decline with age, and disproportionately so for people with neurodegenerative disorders such as Parkinson’s Disease (PD), where EF deficits are commonly seen in the early stages of the disease. Due to their nature, EF are essential for performing tasks of daily life, particularly for the more complex instrumental activities of daily living (IADL), and deficits can impair the ability to execute IADL in PD participants. The aim of this study was to examine how EF impairments relate to IADL deficits in both healthy elderly controls and PD participants.Participants and Methods:Seventy-four participants with idiopathic PD and 66 elderly controls were recruited. All participants were non-demented. A comprehensive neuropsychological assessment was administered including the following measures of EF: Hayling Sentence Completion, Brixton Spatial Anticipation, Trail Making Test A and B, Stroop Color-Word Test, Symbol Span (Wechsler Memory Scale-III), Digit Span (Wechsler Adult Intelligence Scale-III), F-A-S test, and Semantic Fluency (Animals and Actions). Z scores were calculated from respective test manuals. Independence was measured using the 8-item Lawton IADL Scale where items are coded from 0 (dependent) to 1 (independent) and the total score ranges from 0 to 8. Motor impairments were assessed using Part III of the Movement Disorder Society Unified Parkinson’s Disease Rating Scale. Regression models were run with each cognitive measure as the dependent variable, with group (control vs. PD), age, sex, education, and motor severity as predictors, to examine the effect of group on each cognitive variable. Correlations were then run between the total IADL score, demographic variables, and cognitive variables for each participant group separately to identify the relationship between IADL and EF measures.Results:PD participants were predominantly males (n=51, 68.9%), with an average age of 70.64±6.03 and 15.22±2.78 education years. Controls were predominantly female (n=34, 51.5%) and had an average age of 71.19±7.75 and 15.85±2.82 education years. Regarding IADL function, all participants were relatively independent in their IADLs (PD: 7.72±0.69, range 4-8, Controls: 7.98±0.13, range 7-8). The most difficult IADL items for PD participants were shopping (8.2% dependent) and food preparation (12.2% dependent). When correcting for age, education, sex, and motor severity, only the Stroop Interference z-score was significant for participant group (b=0.44, t=2.14, p=0.034), where controls had slightly lower scores (-0.33±0.77) than PD participants (-0.31±0.91). Correlations in controls were significant between IADL total score and Hayling trials 1 (r=0.35, p=0.005) and 2 (r=0.33, p=0.008), and semantic fluency actions trial (r=0.34, p=0.006). In PD participants, IADL total score was only correlated with semantic fluency (animals trial, r=0.26, p=0.028).Conclusions:There were only weak associations between EF abilities and IADL in both healthy controls and PD participants, suggesting that impairments in EF do not necessarily translate into worse ability to execute IADL in PD. More correlations were found in the control group, which may be confounded by the inclusion (in both groups) of participants who already had cognitive impairment. This highlights a further need to examine whether EF impairments in people with PD influence IADL functioning above and beyond normal aging and whether specific deficits have more real-life consequences not attainable through IADL questionnaires.

Subtle cognitive impairment is associated with subtle instrumental activities of daily living defecits, but not severity of memory complaints in sucjective cognitive decline

AbstractBackgroundSubjective cognitive decline (SCD) can be considered as the preclinical manifestation of Alzheimer’s disease. The objective of this study was to examine whether there would be differences of the clinical correlates due to evidence of subtle cognitive imparment (SCI) in inividuals with SCD.MethodOne‐hundred‐and‐fifty‐five individuals with SCD (mean age: 68.18 ± 8.09 years) were included in this study. The participants underwent clinical assessments and completed detailed neuropsychological tests. The functional assessment was performed by the Korean Instrumental Activities of Daily Living (IADL) scale. Memory complaints were assessed using the Prospective and Retrospective Memory Questionnaire (PRMQ) consisting of 16 items that describe everyday memory failure.ResultSCD individuals with SCI (n = 20) had lower Mini‐Mental State Examination scores and showed lower performances in the neuropsychological tests than the SCD only group (n = 135). In addition, the SCI group had worse IADL performance than the SCD only group. There were no differenes in depressive symptoms and PRMQ scores between two groups.ConclusionIn SCD individuals, SCI was associated with subtle IADL deficits, but not with the severity of self‐reported memory complaints, compared to the SCD only group. These results suggest that functional assesments would be helpful for the clinical evaluation of individuals with SCD.

The Prevalence and Trends of Instrumental Activities of Daily Living Impairments in the United States from 2008-2018.

Instrumental activities of daily living (IADL) are neuropsychological-driven tasks that are linked to cognitive dysfunction. Examining population-based IADL deficits may reveal insights for the presence of these impairments in the United States. This investigation sought to evaluate the prevalence and trends of IADL impairments in Americans. A secondary analysis of data from the 2006-2018 waves of the Health and Retirement Study was conducted. The overall unweighted analytic sample included 29,764 Americans aged≥50 years. Respondents indicated their ability to perform six IADLs: manage money, manage medications, use a telephone, prepare hot meals, shop for groceries, and use a map. Persons reporting difficulty or an inability to complete an individual IADL were considered as having a task-specific impairment. Similarly, those indicating difficulty or an inability to perform any IADL were classified as having an IADL impairment. Sample weights were utilized to generate nationally-representative estimates. Having an impairment in using a map (2018 wave: 15.7% (95% confidence interval (CI): 15.0-16.4) had the highest prevalence in individual IADLs regardless of wave examined. The overall prevalence of IADL impairments declined during the study period (p < 0.001) to 25.4% (CI: 24.5-26.2) in the 2018 wave. Older Americans and women had a consistently higher prevalence of IADL impairments compared to middle-aged Americans and men, respectively. The prevalence of IADL impairments was also highest among Hispanics and non-Hispanic Blacks. IADL impairments have declined over time. Continued surveillance of IADLs may help inform cognitive screening, identify subpopulations at risk of impairment, and guide relevant policy.

Impact of radiotherapy on daily function among older adults living with advanced cancer (RT impact on function in advanced cancer)

BackgroundWhile radiation therapy (RT) improves function, and quality of life for patients with advanced cancers, patients frequently experience a period of acute toxicity during which functional abilities may decline. Little is understood about changes in functional outcomes after RT in older adults. This study aims to examine changes in daily function at 1 and 6 months following RT. MethodsWe reviewed the charts of 117 patients who underwent palliative RT on a prospective registry. Activities of daily living (ADL) and instrumental activities of daily living (IADL) scores ranging from 0 to 6 and 0–8, respectively, were collected at baseline, one-month, and six months post-RT. Patients were classified as low deficit for ADL/IADL if they had 0–1 deficits and high deficit if they had 2+ deficits. ResultsOne-hundred seventy RT courses were identified; 99 were evaluable at each time point. The median age was 67 years. At baseline, 29.5 and 29.9% of patients were classified as high-deficit for ADL and IADL functioning, respectively. At one-month, the majority of patients who were low-deficit at baseline remained so for both measures while approximately one quarter of high-deficit patients showed improvement. Most patients identified as low-deficit at one-month remained so at six-months, while no high-deficit patients improved from one- to six-months. Factors associated with high ADL and IADL deficits included: time (six months), increasing age, and Hispanic/other race. Compared to those with ECOG score of 3, patients with lower scores (0–2) had lower odds of high deficit. ConclusionADL and IADL tools may be useful in describing changes in daily function after palliative RT and in identifying groups of patients who may benefit from additional supportive geriatric care interventions.

Effect of Geriatric Assessment and Intervention on Overall Survival Among Older Adults with Hematologic Malignancies

Background: Older adults with hematologic malignancies have inferior survival outcomes due to multiple factors including under-treatment, drug toxicity, treatment discontinuation and concerns of frailty. However, aging is heterogeneous and chronological age is a poor indicator of underlying health. Standardizing the approach to identify frailty is an unmet need in malignant hematology. We have established a multi-disciplinary clinical model designed to identify frailty and develop personalized treatment based on objective measures of health. We have standardized a geriatric assessment (GA) model to identify vulnerability, frailty and geriatric syndromes. Here we report, the largest cohort to date, of older adults with hematologic malignancies (HM) depicting geriatric deficits and interventions with long-term clinical outcomes. Methods: From Feb 2016 to October 2019, 311 older adults with HM were evaluated in our multi-disciplinary Cancer and Aging Resiliency (CARE) clinic. The CARE clinic is a 7-member team prescriptively evaluating the following domains: pharmacy, audiology, psychosocial needs, nutrition, physical functioning, and cognition. Geriatric syndromes were documented by CARE physician. Referral to CARE clinic is recommended for patients 60 years of age or older but all referrals are accepted independent of age. Data was abstracted by retrospective chart review. Descriptive statistics for patient characteristics, frailty measures, and prescribed interventions in each of the GA domains were provided. Univariable and multivariable Cox models were fit to associate clinical factors with OS. OS by Rockwood Clinical Frailty Scale and deficits in activities of daily living (ADLs) was evaluated by Kaplan-Meier method. Correlation between number of geriatric syndromes, clinical frailty score, and deficits in ADLs and instrumental ADLs (IADLs) was also assessed. Results: Over the 42-month study period, 311 older adults with HM with a median age of 75.9 years were evaluated in CARE clinic. Key demographic features and the frequency of specific frailty measures are outlined in table 1.Geriatric interventions were common with 59% requiring 1-2 interventions and 34% requiring 3+ interventions. In univariable analysis, any degree of frailty by Clinical Frailty Scale (Hazard Ratio [HR]: 2.63, 95% Confidence Interval [CI]: 1.43-4.82, p &amp;lt;0.01) and increasing number of geriatric syndromes (HR:1.13, 95% CI: 1.00-1.27, p = 0.04) were associated with inferior OS. In both univariable and multivariable analyses, 10-year increase in age (multivariable HR: 2.05, 95% CI:1.44-2.91, p&amp;lt;0.01), deficit in ADL (multivariable HR: 2.60, 95% CI: 1.38-4.87, p&amp;lt;0.01), diagnosis of acute leukemia (multivariable HR: 4.53, 95% CI:1.91-10.78, p&amp;lt;0.01), and prescribed nutrition intervention (multivariable HR: 2.04, 95% CI: 1.32-3.15, p&amp;lt;0.01) were associated with inferior OS. Anemia was also associated with OS in both univariable and multivariable analysis (multivariable HR for 1 g/dL increase in hemoglobin: 0.79, 95% CI: 0.69-0.91, p&amp;lt;0.01). Additional variables for univariable and multivariable analyses are presented in table 2. There was significant correlation between the Clinical Frailty Scale and number of geriatric syndromes (Spearman correlation p &amp;lt; 0.01). The same was true of correlation between ADL or IADL deficits and Clinical Frailty Scale (p &amp;lt; 0.01 for both). OS by Clinical Frailty Scale and ADL deficit is pictured in figure 1. Discussion: The Clinical Frailty Scale is predictive of OS among older adults with HM. GA-directed intervention is warranted in the vast majority of older adults with HM. In univariable analysis, Clinical Frailty Scale, increasing age, anemia, high risk HM, and increasing geriatric syndromes are associated with inferior OS. In multivariable analysis, age, anemia, and high risk HM remain significant. Nutrition and physical function are key modifiable risk factors predictive of inferior OS. Prospective studies focusing on geriatric interventions are warranted in this population with an emphasis on modifiable risk factors. This demonstrated prognostic significance of both geriatric assessments and interventions in older adults with HM should give way to future improvements in OS, quality of life, and treatment tolerability through GA-directed intervention. Disclosures No relevant conflicts of interest to declare.

Instrumental activities of daily living, amyloid, and cognition in cognitively normal older adults screening for the A4 Study.

IntroductionWe examined the associations among instrumental activities of daily living (IADL), cortical amyloid, and cognition in cognitively normal (CN) older adults.MethodsCN participants screening for the A4 Study (n = 4486) underwent florbetapir (amyloid) positron emission tomography. IADL were assessed using the Alzheimer's Disease Cooperative Study Activities of Daily Living Prevention Instrument. Separate logistic regression models were run with cortical amyloid or cognition as independent variable and IADL as dependent variable, adjusting for age and sex.ResultsIADL difficulties were endorsed infrequently (≤16%). Overall IADL and four select IADL item difficulties (“remembering appointments,” “finding belongings,” “following TV programs,” and “remembering current events”) reported by both participant and study partner were significantly associated with greater amyloid burden and worse cognition.DiscussionAlthough IADL deficits were infrequent in this CN cohort, greater participant and study partner report of overall IADL deficits and subtle difficulties in specific IADL items were associated with mildly higher amyloid burden and worse cognition.

Association between fulfilling the recommendations for health-enhancing physical activity with (instrumental) activities of daily living in older Austrians.

SummaryAimThe aim of the study was to describe the association between fulfilling the recommendation for health-enhancing physical activity (PA), and deficits in activities of daily living (ADL) and instrumental activities of daily living (IADL) in 3308 subjects aged 65+ years from the Austrian Health Interview Survey 2014.MethodsThe proportion of subjects who fulfilled the minimal recommendations for health-enhancing PA was assessed with the Physical Activity Questionnaire of the European Health Interview Survey (EHIS-PAQ). The ADLs were assessed based on the Barthel index, and IADLs by the IADL scale of Lawton and Brody. Additionally, various sociodemographic and health-related factors were assessed.ResultsOf the participants 54.7% did not fulfil the minimal requirements for aerobic PA, and 67.1% not for muscle strengthening PA, 16.4% reported ADL deficits, and 47.1% IADL deficits. Adjusted for sociodemographic and health-related parameters, not fulfilling the recommendations for aerobe PA was associated with a higher chance for ADL deficits (odds ratio, OR 1.73, 95%-confidence interval 1.36–2.21), and IADL deficits (1.57; 1.34–1.84). Not fulfilling the recommendations for muscle strengthening PA also increased the chance for ADL and IADLs deficits (1.34; 1.04–1.72, and 1.29; 1.09–1.53, respectively).ConclusionThe number of participants who did not fulfil the minimal requirements for aerobic or strengthening PA was very high, and these participants showed significantly more problems in ADLs and IADLs. Therefore, all future efforts should focus on increasing participation and adherence in exercise programs for older people with the intention to improve their performance status and functions in daily life.

Poor awareness of IADL deficits is associated with reduced regional brain volume in older adults with cognitive impairment

Performance of instrumental activities of daily living (IADLs) can become compromised in older adults with mild cognitive impairment (MCI). Patients’ level of insight into their everyday functioning varies both amongst individuals and across domains assessed, with some individuals exhibiting complete unawareness of deficits. The current cross-sectional study examined the neuroanatomical substrates of self-awareness in order to help explain the variability in this phenomenon in older adults across a continuum of cognitive impairment. Eighty-five participants (ages 54–88, mean age = 73 years, 57% female, 89% Caucasian) diagnosed with MCI or mild probable dementia underwent structural magnetic resonance imaging. Level of self-awareness was assessed by calculating the discrepancy between objective and subjective performance across six IADLs (Financial Management, Driving, Grocery Shopping, Nutrition Evaluation, Medication Management, and Telephone Use). Over-estimation of current abilities occurred in 13–31% of the sample depending on which IADL was evaluated. Poor awareness was significantly related to reduced volume in the bilateral medial prefrontal cortex, middle and posterior cingulate cortex, right insular cortex, and cerebellum. No associations were found with total white matter lesion load. These findings were broadly consistent across all functional domains assessed, supporting the theory that cortical midline and cerebellar structures are involved in self-referential processing across a variety of different cognitive and behavioral skills. Longitudinal studies are needed to confirm this association.

The Association between the Montreal Cognitive Assessment and Functional Activity Questionnaire in the Systolic Blood Pressure Intervention Trial (SPRINT)

ObjectiveTo examine the association of global cognitive function assessed via the Montreal Cognitive Assessment (MoCA) and deficiencies in instrumental activities of daily living (IADL) on the Functional Activity Questionnaire (FAQ) in hypertensive older adults in the Systolic Blood Pressure Intervention Trial (SPRINT).MethodsIn cross-sectional analysis, 9,296 SPRINT participants completed the MoCA at baseline. The FAQ was obtained from 2,705 informants for SPRINT participants scoring <21 or <22 on the MoCA, depending on education. FAQ severity ranged from no dysfunction (Score = 0) to moderate/severe dysfunction (Score = 5+).ResultsParticipants who triggered FAQ administration were older, less educated, and more likely to be Black or Hispanic (p < 0.001). Sixty-one percent (n = 1,661) of participants’ informants reported no functional difficulties in IADLs. An informant report, however, of any difficulty on the FAQ was associated with lower MoCA scores after controlling for age, sex, race/ethnicity, and education (p < 0.05). Partial proportional odds regression indicates that participants scoring lower on the MoCA (in the 10th to <25th, fifth to <10th, and <fifth percentiles) had higher adjusted odds of their informant indicating dysfunction on the FAQ, relative to participants scoring at or above the 25th percentile on the MoCA (p < 0.001).ConclusionsWhile lower global cognitive function was strongly associated with IADL deficits on FAQ, informants indicated no functional difficulties for the majority of SPRINT participants, despite low MoCA scores. These findings can help with designing future studies which aim to detect mild cognitive impairment and/or dementia in large, community-dwelling populations.

Predictors of independence in instrumental activities of daily living: Amnestic versus nonamnestic MCI

ABSTRACTIntroduction: Individuals with mild cognitive impairment (MCI) demonstrate deficits in instrumental activities of daily living (IADL) that place them at high risk for progression to dementia. The cognitive profiles, IADL deficits, and risk of progression differ between MCI subgroups of amnestic (aMCI) and nonamnestic MCI (naMCI), though many studies of functional impairment have not examined these subgroups separately. This study aims to determine whether common neuropsychological measures, as well as the related concept of patient anosognosia, are associated with IADL functioning differently in aMCI compared to naMCI. Method: Seventy-one individuals were identified as naMCI, and 99 individuals were identified as aMCI based on neuropsychological evaluation. Controlling for age, gender, and education, we examined whether performance on neuropsychological tests predicted informant-rated IADL dysfunction. We also investigated the ability of patient awareness, as rated by clinicians and informants, to predict informant-rated IADL dysfunction within MCI subgroups. Results: Better performance in cognitive domains of attention/processing speed and executive functioning predicted IADL independence in aMCI, but not in naMCI. Exploratory analysis with a subset of these individuals revealed that after accounting for an estimate of cerebrovascular burden, better performance in Delayed Memory predicted IADL independence in the naMCI group, but not in the aMCI group. Lastly, informant, but not clinician, ratings of patient awareness predicted IADL independence within the aMCI group only. Conclusion: Neuropsychological performance on tests of attention/processing speed and executive functioning may be better able to predict cognitive contributions to IADL dysfunction specifically in aMCI. After controlling for vascular burden, memory deficits may be the earliest cognitive indication of IADL dysfunction in naMCI. These results suggest that executive functions and memory, in addition to patient’s awareness of deficits, differentially predict early IADL dysfunction in subgroups of MCI and can be used to formulate patient prognosis and recommendations on a more individualized basis.

Development of a Proxy-Free Objective Assessment Tool of Instrumental Activities of Daily Living in Mild Cognitive Impairment Using Smart Home Technologies.

Background: The assessment of activities of daily living (ADL) is essential for dementia diagnostics. Even in mild cognitive impairment (MCI), subtle deficits in instrumental ADL (IADL) may occur and signal a higher risk of conversion to dementia. Thus, sensitive and reliable ADL assessment tools are important. Smart homes equipped with sensor technology and video cameras may provide a proxy-free assessment tool for the detection of IADL deficits.Objective:The aim of this paper is to investigate the potential of a smart home environment for the assessment of IADL in MCI.Method: The smart home consisted of a two-room flat equipped with activity sensors and video cameras. Participants with either MCI or healthy controls (HC) had to solve a standardized set of six tasks, e.g., meal preparation, telephone use, and finding objects in the flat.Results: MCI participants needed more time (1384 versus 938 seconds, p < 0.001) and scored less total points (48 versus 57 points, p < 0.001) while solving the tasks than HC. Analyzing the subtasks, intergroup differences were observed for making a phone call, operating the television, and retrieving objects. MCI participants showed more searching and task-irrelevant behavior than HC. Task performance was correlated with cognitive status and IADL questionnaires but not with participants’ age.Conclusion: This pilot study showed that smart home technologies offer the chance for an objective and ecologically valid assessment of IADL. It can be analyzed not only whether a task is successfully completed but also how it is completed. Future studies should concentrate on the development of automated detection of IADL deficits.

Instrumental activities of daily living performance and role satisfaction in people with and without mild cognitive impairment: a pilot project.

We investigated differences in observed performance of instrumental activities of daily living (IADLs) and self-reported satisfaction with social role performance between people with amnestic mild cognitive impairment (a-MCI) and age- and gender-matched control participants. We measured observed performance of 14 IADLs using the Independence, Safety, and Adequacy domains of the Performance Assessment of Self-Care Skills (PASS) and the Patient-Reported Outcomes Measurement Information Systems (PROMIS) to examine satisfaction with social role performance. Total PASS scores were significantly lower in participants with a-MCI (median=40.6) than in control participants (median=44.2; p=.006). Adequacy scores were also significantly lower. No significant differences were found between groups on the PROMIS measures. IADL differences between groups were related more to errors in adequacy than to safety and independence. Occupational therapy practitioners can play a key role in the diagnosis and treatment of subtle IADL deficits in people with MCI.

Mild cognitive impairment and deficits in instrumental activities of daily living: a systematic review.

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.

Disability but not social support predicts cognitive deterioration in late-life depression.

Depression in late life is a risk factor for cognitive decline. Depression is also associated with increased disability and social support deficits; these may precede conversion to dementia and inform risk. In this study, we examined if baseline or one-year change in disability and social support predicted later cognitive deterioration. 299 cognitively intact depressed older adults were followed for an average of approximately seven years. Participants received antidepressant treatment according to a standardized algorithm. Neuropsychological testing and assessment of disability and social support were assessed annually. Cognitive diagnosis was reviewed annually at a consensus conference to determine if participants remained cognitively normal, or if they progressed to either dementia or cognitively impaired, no dementia (CIND). During study participation, 167 individuals remained cognitively normal (56%), 83 progressed to CIND (28%), and 49 progressed to dementia (16%). Greater baseline instrumental activities of daily living (IADL) deficits predicted subsequent conversion to a cognitive diagnosis (CIND or dementia). However, neither baseline measures nor one-year change in basic ADLs (BADLs) and social support predicted cognitive conversion. In post hoc analyses, two IADL measures (managing finances, preparing meals) significantly increased the odds of cognitive conversion. Greater IADL deficits predicted increased risk of cognitive conversion. Assessment of IADL deficits may provide clues about risk of later cognitive decline.

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

Criteria for mild cognitive impairment (MCI) consider impairment in instrumental activities of daily living (IADL) as exclusionary, but cross-sectional studies suggest that some high-level functional deficits are present in MCI. This longitudinal study examines informant-rated IADL in MCI, compared with cognitively normal (CN) older individuals, and explores whether functional abilities, particularly those with high cognitive demand, are predictors of MCI and dementia over a 2-year period in individuals who were CN at baseline. A sample of 602 non-demented community dwelling individuals (375 CN and 227 with MCI) aged 70-90 years underwent baseline and 24-month assessments that included cognitive and medical assessments and an interview with a knowledgeable informant on functional abilities with the Bayer Activities of Daily Living Scale. Significantly more deficits in informant-reported IADL with high cognitive demand were present in MCI compared with CN individuals at baseline and 2-year follow-up. Functional ability in CN individuals at baseline, particularly in activities with high cognitive demand, predicted MCI and dementia at follow-up. Difficulties with highly cognitively demanding activities specifically predicted amnestic MCI but not non-amnestic MCI whereas those with low cognitive demand did not predict MCI or dementia. Age, depressive symptoms, cardiovascular risk factors and the sex of the informant did not contribute to the prediction. IADL are affected in individuals with MCI, and IADL with a high cognitive demand show impairment predating the diagnosis of MCI. Subtle cognitive impairment is therefore likely to be a major hidden burden in society.

Cerebral Metabolism, Cognition, and Functional Abilities in Alzheimer Disease

Patients with Alzheimer disease (AD) exhibit profound difficulties in completing instrumental activities of daily living (IADLs), such as managing finances, organizing medications, and food preparation. It is unclear which brain areas underlie IADL deficits in AD. To address this question, we used voxel-based analysis to correlate the performance of IADLs with resting cerebral metabolism as measured during [(18)F] fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging in 44 patients with AD. Poorer ability to complete IADLs was associated with hypometabolism in right-sided cortical regions, including the parietal lobe, posterior temporal cortex, dorsolateral prefrontal cortex, and frontal pole. Follow-up path analyses examining anatomically defined regions of interest (ROI) demonstrated that the association between metabolism and IADLs was mediated by global cognition in frontal ROIs, and partially mediated by global cognition in the parietal ROI. Findings suggest that hypometabolism of right sided brain regions involved in executive functioning, visuospatial processing, attention, and working memory underlie functional impairments in patients with AD.

Functional Impairment in Elderly Patients With Mild Cognitive Impairment and Mild Alzheimer Disease&lt;alt-title&gt;Impairment in MCI and AD Patients&lt;/alt-title&gt;

The original mild cognitive impairment (MCI) criteria exclude substantial functional deficits, but recent reports suggest otherwise. Identifying the extent, severity, type, and correlates of functional deficits that occur in MCI and mild Alzheimer disease (AD) can aid in early detection of incipient dementia and can identify potential mechanistic pathways to disrupted instrumental activities of daily living (IADLs). To examine the number, type, and severity of functional impairments and to identify the clinical characteristics associated with functional impairment across patients with amnestic MCI (aMCI) and those with mild AD. Study using baseline data from the Alzheimer's Disease Neuroimaging Initiative. Multiple research sites in the United States and Canada. Patients Samples included 229 control individuals, 394 patients with aMCI, and 193 patients with AD. The 10-item Pfeffer Functional Activities Questionnaire (FAQ) assessed function. Informant-reported FAQ deficits were common in patients with aMCI (72.3%) and AD (97.4%) but were rarely self-reported by controls (7.9%). The average severity per FAQ deficit did not differ between patients with aMCI and controls; both were less impaired than patients with AD (P < .001). Two FAQ items (remembering appointments, family occasions, holidays, and medications and assembling tax records, business affairs, or other papers) were specific (specificity estimate, 0.95) in differentiating the control group from the combined aMCI and AD groups (only 34.0% of patients with aMCI and 3.6% of patients with AD had no difficulty with these 2 items). The severity of FAQ deficits in the combined aMCI and AD group was associated with worse Trail Making Test, part A scores and smaller hippocampal volumes (P < .001 for both). Within the aMCI group, functionally intact individuals had greater hippocampal volumes and better Auditory Verbal Learning Test 30-minute delay and Trail Making Test, part A (P < .001 for each) scores compared with individuals with moderate or severe FAQ deficits. Patients with a high number of deficits were more likely to express the apolipoprotein ε4 allele (63.8%) compared with patients with no (46.8%) or few (48.4%) functional deficits. Mild IADL deficits are common in individuals with aMCI and should be incorporated into MCI criteria. Two IADLs--remembering appointments, family occasions, holidays, and medications and assembling tax records, business affairs, or other papers--appear to be characteristic of clinically significant cognitive impairment. In patients with aMCI, impairment in memory and processing speed and greater medial temporal atrophy were associated with greater IADL deficits.

Subtle Deficits in Instrumental Activities of Daily Living in Subtypes of Mild Cognitive Impairment

Background/Aims: Greater cognitive and functional deficits in mild cognitive impairment (MCI) are associated with higher rates of dementia. We explored the relationship between these factors by comparing instrumental activities of daily living (IADLs) among cognitive subtypes of MCI and examining associations between IADL and neuropsychological indices. Methods: We analyzed data from 1,108 MCI and 3,036 normal control subjects included in the National Alzheimer’s Coordinating Center Uniform Data Set who were assessed with the Functional Activities Questionnaire (FAQ). Results: IADL deficits were greater in amnestic than nonamnestic MCI, but within these subgroups, did not differ between those with single or multiple domains of cognitive impairment. FAQ indices correlated significantly with memory and processing speed/executive function. Conclusions: IADL deficits are present in both amnestic MCI and nonamnestic MCI but are not related to the number of impaired cognitive domains. These cross-sectional findings support previous longitudinal reports suggesting that cognitive and functional impairments in MCI may be independently associated with dementia risk.