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.
© 2010 S. Karger AG, Basel
- Mild cognitive impairment
- Functional impairment
- Activities of daily living
- Memory performance
- Executive function
- Petersen RC: Mild cognitive impairment as a diagnostic entity. J Intern Med 2004;256:183–194.
- McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s disease. Neurology 1984;34:939–944.
- Bruscoli M, Lovestone S: Is MCI really just early dementia? A systematic review of conversion studies. Int Psychogeriatr 2004;16:129–140.
- Rasquin SM, Lodder J, Visser PJ, Lousberg R, Verhey FR: Predictive accuracy of MCI subtypes for Alzheimer’s disease and vascular dementia in subjects with mild cognitive impairment: a 2-year follow-up study. Dement Geriatr Cogn Disord 2005;19:113–119.
- Alexopoulos P, Grimmer T, Perneczky R, Domes G, Kurz A: Progression to dementia in clinical subtypes of mild cognitive impairment. Dement Geriatr Cogn Disord 2006;22:27–34.
- Busse A, Hensel A, Guhne U, Angermeyer MC, Riedel-Heller SG: Mild cognitive impairment: Long-term course of four clinical subtypes. Neurology 2006;67:2176–2185.
- Manly JJ, Tang MX, Schupf N, Stern Y, Vonsattel JP, Mayeux R: Frequency and course of mild cognitive impairment in a multiethnic community. Ann Neurol 2008;63:494–506.
- Albert SM, Michaels K, Padilla M, Pelton G, Bell K, Marder K, Stern Y, Devanand DP: Functional significance of mild cognitive impairment in elderly patients without a dementia diagnosis. Am J Geriatr Psychiatry 1999;7:213–220.
- Di Carlo A, Baldereschi M, Amaducci L, Maggi S, Grigoletto F, Scarlato G, Inzitari D: Cognitive impairment without dementia in older people: prevalence, vascular risk factors, impact on disability. The Italian Longitudinal Study on Aging. J Am Geriatr Soc 2000;48:775–782.
- Tabert MH, Albert SM, Borukhova-Milov L, Camacho Y, Pelton G, Liu X, Stern Y, Devanand DP: Functional deficits in patients with mild cognitive impairment: prediction of AD. Neurology 2002;58:758–764.
- Farias ST, Mungas D, Reed BR, Harvey D, Cahn-Weiner D, Decarli C: MCI is associated with deficits in everyday functioning. Alzheimer Dis Assoc Disord 2006;20:217–223.
- Perneczky R, Pohl C, Sorg C, Hartmann J, Tosic N, Grimmer T, Heitele S, Kurz A: Impairment of activities of daily living requiring memory or complex reasoning as part of the MCI syndrome. Int J Geriatr Psychiatry 2006;21:158–162.
- Cahn-Weiner DA, Farias ST, Julian L, Harvey DJ, Kramer JH, Reed BR, Mungas D, Wetzel M, Chui H: Cognitive and neuroimaging predictors of instrumental activities of daily living. J Int Neuropsychol Soc 2007;13:747–757.
- Wadley VG, Crowe M, Marsiske M, Cook SE, Unverzagt FW, Rosenberg AL, Rexroth D: Changes in everyday function in individuals with psychometrically defined mild cognitive impairment in the Advanced Cognitive Training for Independent and Vital Elderly Study. J Am Geriatr Soc 2007;55:1192–1198.
- Jefferson AL, Byerly LK, Vanderhill S, Lambe S, Wong S, Ozonoff A, Karlawish JH: Characterization of activities of daily living in individuals with mild cognitive impairment. Am J Geriatr Psychiatry 2008;16:375–383.
- Kim KR, Lee KS, Cheong HK, Eom JS, Oh BH, Hong CH: Characteristic profiles of instrumental activities of daily living in different subtypes of mild cognitive impairment. Dement Geriatr Cogn Disord 2009;27:278–285.
- Peres K, Chrysostome V, Fabrigoule C, Orgogozo JM, Dartigues JF, Barberger-Gateau P: Restriction in complex activities of daily living in MCI: impact on outcome. Neurology 2006;67:461–466.
- Di Carlo A, Lamassa M, Baldereschi M, Inzitari M, Scafato E, Farchi G, Inzitari D: CIND and MCI in the Italian elderly: frequency, vascular risk factors, progression to dementia. Neurology 2007;68:1909–1916.
- Rozzini L, Chilovi BV, Conti M, Bertoletti E, Delrio I, Trabucchi M, Padovani A: Conversion of amnestic mild cognitive impairment to dementia of Alzheimer type is independent to memory deterioration. Int J Geriatr Psychiatry 2007;22:1217–1222.
- Artero S, Ancelin ML, Portet F, Dupuy A, Berr C, Dartigues JF, Tzourio C, Rouaud O, Poncet M, Pasquier F, Auriacombe S, Touchon J, Ritchie K: Risk profiles for mild cognitive impairment and progression to dementia are gender specific. J Neurol Neurosurg Psychiatry 2008;79:979–984.
- Goldstein G, McCue M, Rogers J, Nussbaum PD: Diagnostic differences in memory test based predictions of functional capacity in the elderly. Neuropsychol Rehabil 1992;2:307–317.
- Bell-McGinty S, Podell K, Franzen M, Baird AD, Williams MJ: Standard measures of executive function in predicting instrumental activities of daily living in older adults. Int J Geriatr Psychiatry 2002;17:828–834.
- Cahn-Weiner DA, Boyle PA, Malloy PF: Tests of executive function predict instrumental activities of daily living in community-dwelling older individuals. Appl Neuropsychol 2002;9:187–191.
- Farias ST, Mungas D, Reed B, Haan MN, Jagust WJ: Everyday functioning in relation to cognitive functioning and neuroimaging in community-dwelling Hispanic and non-Hispanic older adults. J Int Neuropsychol Soc 2004;10:342–354.
- Royall DR, Palmer R, Chiodo LK, Polk MJ: Executive control mediates memory’s association with change in instrumental activities of daily living: The Freedom House Study. J Am Geriatr Soc 2005;53:11–17.
- Schmitter-Edgecombe M, Woo E, Greeley DR: Characterizing multiple memory deficits and their relation to everyday functioning in individuals with mild cognitive impairment. Neuropsychology 2009;23:168–177.
- Tomaszewski Farias S, Cahn-Weiner DA, Harvey DJ, Reed BR, Mungas D, Kramer JH, Chui H: Longitudinal changes in memory and executive functioning are associated with longitudinal change in instrumental activities of daily living in older adults. Clin Neuropsychol 2009;23:446–461.
- Park KW, Pavlik VN, Rountree SD, Darby EJ, Doody RS: Is functional decline necessary for a diagnosis of Alzheimer’s disease? Dement Geriatr Cogn Disord 2007;24:375–379.
- Tam CW, Lam LC, Chiu HF, Lui VW: Characteristic profiles of instrumental activities of daily living in Chinese older persons with mild cognitive impairment. Am J Alzheimers Dis Other Demen 2007;22:211–217.
- Burton CL, Strauss E, Bunce D, Hunter MA, Hultsch DF: Functional abilities in older adults with mild cognitive impairment. Gerontology 2009;55:570–581.
- Aretouli E, Brandt J: Everyday functioning in mild cognitive impairment and its relationship with executive cognition. Int J Geriatr Psychiatry 2010;25:224–233.
- Morris JC, Weintraub S, Chui HC, Cummings J, Decarli C, Ferris S, Foster NL, Galasko D, Graff-Radford N, Peskind ER, Beekly D, Ramos EM, Kukull WA: The Uniform Data Set (UDS): clinical and cognitive variables and descriptive data from Alzheimer Disease Centers. Alzheimer Dis Assoc Disord 2006;20:210–216.
- Pfeffer RI, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S: Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323–329.
- 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.
- Rosen WG, Terry RD, Fuld PA, Katzman R, Peck A: Pathological verification of ischemic score in differentiation of dementias. Ann Neurol 1980;7:486–488.
- Teng E, Becker BW, Woo E, Knopman DS, Cummings JL, Lu PH: Utility of the Functional Activities Questionnaire for distinguishing mild cognitive impairment from very mild Alzheimer’s disease. Alzheimer Dis Assoc Disord, in press.
- Weintraub S, Salmon D, Mercaldo N, Ferris S, Graff-Radford NR, Chui H, Cummings JL, DeCarli C, Foster NL, Galasko D, Peskind E, Dietrich W, Beekly DL, Kukull WA, Morris JC: The Alzheimer’s Disease Centers’ Uniform Data Set (UDS): the neuropsychologic test battery. Alzheimer Dis Assoc Disord 2009;23:91–101.
- Wechsler D: Wechsler Memory Scale – Revised Edition: Manual. San Antonio, The Psychological Corporation, 1987.
- Morris JC, Heyman A, Mohs RC, Hughes JP, van Belle G, Fillenbaum G, Mellits ED, Clark C: The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). 1. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology 1989;39:1159–1165.
- Reitan RM, Wolfson D: The Halstead-Reitan Neuropsychological Test Battery. Theory and Clinical Interpretation. Tucson, Neuropsychology Press, 1989.
- Wechsler D: Wechsler Adult Intelligence Scale – Revised Edition: Manual. San Antonio, The Psychological Corporation, 1981.
- Kaplan E, Goodglass H, Weintraub S: Boston Naming Test. Philadelphia, Lea & Febiger, 1983.
- Velicer WF, Jackson DN: Component analysis versus common factor analysis: some issues in selecting an appropriate procedure. Multivariate Behav Res 1990;25:1–28.
- Pereira FS, Yassuda MS, Oliveira AM, Forlenza OV: Executive dysfunction correlates with impaired functional status in older adults with varying degrees of cognitive impairment. Int Psychogeriatr 2008;20:1104–1115.
- Lezak MD, Howieson DB, Loring DW: Neuropsychological Assessment, ed 4. New York, Oxford University Press, 2004.
- Teng E, Tingus KD, Lu PH, Cummings JL: Persistence of neuropsychological testing deficits in mild cognitive impairment. Dement Geriatr Cogn Disord 2009;28:168–178.
- He J, Farias S, Martinez O, Reed B, Mungas D, Decarli C: Differences in brain volume, hippocampal volume, cerebrovascular risk factors, and apolipoprotein e4 among mild cognitive impairment subtypes. Arch Neurol 2009;66:1393–1399.
- Boone KB, Victor TL, Wen J, Razani J, Ponton M: The association between neuropsychological scores and ethnicity, language, and acculturation variables in a large patient population. Arch Clin Neuropsychol 2007;22:355–365.
- Manly JJ, Jacobs DM, Touradji P, Small SA, Stern Y: Reading level attenuates differences in neuropsychological test performance between African American and White elders. J Int Neuropsychol Soc 2002;8:341–348.
- Luck T, Luppa M, Briel S, Riedel-Heller SG: Incidence of mild cognitive impairment: a systematic review. Dement Geriatr Cogn Disord 2010;29:164–175.
- Alladi S, Arnold R, Mitchell J, Nestor PJ, Hodges JR: Mild cognitive impairment: applicability of research criteria in a memory clinic and characterization of cognitive profile. Psychol Med 2006;36:507–515.
- Loewenstein DA, Acevedo A, Ownby R, Agron J, Barker WW, Isaacson R, Strauman S, Duara R: Using different memory cutoffs to assess mild cognitive impairment. Am J Geriatr Psychiatry 2006;14:911–919.
- Rountree SD, Waring SC, Chan WC, Lupo PJ, Darby EJ, Doody RS: Importance of subtle amnestic and nonamnestic deficits in mild cognitive impairment: prognosis and conversion to dementia. Dement Geriatr Cogn Disord 2007;24:476–482.
- Farias ST, Harrell E, Neumann C, Houtz A: The relationship between neuropsychological performance and daily functioning in individuals with Alzheimer’s disease: ecological validity of neuropsychological tests. Arch Clin Neuropsychol 2003;18:655–672.
- Wadley VG, Okonkwo O, Crowe M, Ross-Meadows LA: Mild cognitive impairment and everyday function: evidence of reduced speed in performing instrumental activities of daily living. Am J Geriatr Psychiatry 2008;16:416–424.
Edmond Teng, MD, PhD
Neurobehavior Unit (116AF), West Los Angeles VA Healthcare Center, Building 500
11301 Wilshire Boulevard
Los Angeles, CA 90073 (USA)
Tel. +1 310 478 3711, ext. 49633, Fax +1 310 268 4181, E-Mail firstname.lastname@example.org
Accepted: April 7, 2010
Published online: August 26, 2010
Number of Print Pages : 9
Number of Figures : 2, Number of Tables : 4, Number of References : 55
Dementia and Geriatric Cognitive Disorders
Vol. 30, No. 3, Year 2010 (Cover Date: October 2010)
Journal Editor: Chan-Palay V. (New York, N.Y.)
ISSN: 1420-8008 (Print), eISSN: 1421-9824 (Online)
For additional information: http://www.karger.com/DEM
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.