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The process of decline in advanced activities of daily living: a qualitative explorative study in mild cognitive impairment

  • Patricia De Vriendt (a1) (a2) (a3), Ellen Gorus (a1) (a4) (a3), Elise Cornelis (a4), Anja Velghe (a2) (a3), Mirko Petrovic (a2) (a3) and Tony Mets (a1) (a4) (a3)...


Background: The notion of “minimal impairment in instrumental activities of daily living (i-ADL)” is important in the diagnosis of mild cognitive impairment (MCI), but is presently not adequately operationalized. ADL is stratified according to difficulty, complexity, and also to vulnerability to early cognitive changes in a threefold hierarchy: basic activities of daily living (b-ADL), i-ADL, and advanced activities of daily living (a-ADL). This study aims to gain a deeper understanding of the functional decline in the process of MCI.

Methods: In a qualitative design, 37 consecutive patients diagnosed with amnestic (a)-MCI and their proxies were interviewed at two geriatric day hospitals. Constant comparative analysis was used for the analysis.

Results: The a-ADL-concept emerged as important in the diagnosis of MCI. All participants were engaged in a wide range of activities, which could be clustered according to the International Classification of Functioning, Disability and Health (ICF). Participants reported subtle difficulties in performance. A process of functional decline was identified in which adaptation and coping mechanisms interacted with the process of reduced skills, leading to an activity disruption and an insufficiency in functioning.

Conclusion: This study asserts the inclusion of an evaluation of a-ADL in the assessment of older persons. When evaluating ADL at three levels (b-ADL, i-ADL, and a-ADL), all the activities one can perform in daily living are covered.


Corresponding author

Correspondence should be addressed to: Patricia De Vriendt, MrSc, Department of Frailty in Ageing (FRIA) Research Group and Gerontology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan, 103, B-1090 Brussels, Belgium. Phone: +32 479 654110; Fax: +02 477 63 64. Email:


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Baltes, P. B. and Baltes, M. M. (1990). Succesful Aging: Perspectives from the Behavioral Sciences. Cambridge: Cambridge University Press.
Bogdan, R. and Biklen, S. (2003). Qualitative Research for Education: An Introduction to Theories and Methods. Boston, MA: Rearson.
Charlson, M. E., Pompei, P., Ales, K. L. and MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40, 373383.
Cieza, A., Geyh, S., Chatterji, S., Kostanjsek, N., Ustun, B. and Stucki, G. (2005). ICF linking rules: an update based on lessons learned. Journal of Rehabilitation Medicine, 37, 212218.
Dubois, B. et al. (2010). Revising the definition of Alzheimer's disease: a new lexicon. Lancet Neurology, 9, 11181127. doi:10.1016/S1474-4422(10)70223-4.
Farias, S. T., Mungas, D., Reed, B. R., Harvey, D., Cahn-Weiner, D. and Decarli, C. (2006). MCI is associated with deficits in everyday functioning. Alzheimer Disease and Associated Disorders, 20, 217223. doi:10.1097/01.wad.0000213849.51495.d9.
Farias, S. T. et al. (2008). The measurement of everyday cognition (ECog): scale development and psychometric properties. Neuropsychology, 22, 531544. doi:10.1037/0894-4105.22.4.531.
Ferguson, E. and Cox, T. (1997). The functional dimensions of coping scale: theory, reliability and validity. British Journal of Health Psychology, 2, 109129.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Freedman, V. A. (2009). Adopting the ICF language for studying late-life disability: a field of dreams? Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 64, 11721174; discussion 11751176.
Geda, Y. E. et al. (2011). Engaging in cognitive activities, aging, and mild cognitive impairment: a population-based study. Journal of Neuropsychiatry and Clinical Neurosciences, 23, 149154. doi:10.1176/appi.neuropsych.23.2.149
Giovannetti, T. et al. (2008). Characterization of everyday functioning in mild cognitive impairment: a direct assessment approach. Dementia and Geriatric Cognitive Disorders, 25, 359365. doi:10.1159/000121005
James, B. D., Boyle, P. A., Buchman, A. S. and Bennett, D. A. (2011). Relation of late-life social activity with incident disability among community-dwelling older adults. Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 66, 467473. doi:10.1093/gerona/glq231.
Jefferson, A. L. et al. (2008). Characterization of activities of daily living in individuals with mild cognitive impairment. American Journal of Geriatric Psychiatry, 16, 375383. doi:10.1097/JGP.0b013e318162f197.
Jette, A. M. (2009). Toward a common language of disablement. Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 64, 11651168.
Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A. and Jaffe, M. W. (1963). Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA, 185, 914919.
Kitwood, T. (1993). Towards a theory of dementia care: the interpersonal process. Ageing and Society, 13, 5167.
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179186.
Lazarus, R. S. and Folkman, S. (1984). Stress, Appraisal and Coping. New York: Springer.
Lindseth, A. and Norberg, A. (2004). A phenomenological hermeneutical method for researching lived experience. Scandinavian Journal of Caring Sciences, 18, 145153. doi:10.1111/j.1471-6712.2004.00258.x.
Mariani, E., Monastero, R. and Mecocci, P. (2007). Mild cognitive impairment: a systematic review. Journal of Alzheimer's Disease, 12, 2335.
Njegovan, V., Hing, M. M., Mitchell, S. L. and Molnar, F. J. (2001). The hierarchy of functional loss associated with cognitive decline in older persons. Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 56, M638643.
Nygard, L. (2003). Instrumental activities of daily living: a stepping-stone towards Alzheimer's disease diagnosis in subjects with mild cognitive impairment? Acta Neurologica Scandinavica (Suppl.), 179, 4246.
Nygard, L. and Ohman, A. (2002). Managing changes in everyday occupations: the experience of persons with Alzheimer's disease. Occupation Participation and Health, 22, 7081.
Pedrosa, H. et al. (2010). Functional evaluation distinguishes MCI patients from healthy elderly people – the ADCS/MCI/ADL scale. Journal of Nutrition, Health and Aging, 14, 703709.
Peres, K., Chrysostome, V., Fabrigoule, C., Orgogozo, J. M., Dartigues, J. F. and Barberger-Gateau, P. (2006). Restriction in complex activities of daily living in MCI: impact on outcome. Neurology, 67, 461466. doi:10.1212/01.wnl.0000228228.70065.f1.
Perneczky, R. et al. (2006). Complex activities of daily living in mild cognitive impairment: conceptual and diagnostic issues. Age and Ageing, 35, 240245. doi:10.1093/ageing/afj054.
Petersen, R. C. (2004). Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 256, 183194. doi:10.1111/j.1365-2796.2004.01388.x.
Petersen, R. C. (2011). Clinical practice. Mild cognitive impairment. New England Journal of Medicine, 364, 22272234. doi:10.1056/NEJMcp0910237.
Preston, L., Marshall, A. and Bucks, R. S. (2007). Investigating the ways that older people cope with dementia: a qualitative study. Aging and Mental Health, 11, 131143. doi:10.1080/13607860600844572.
Reuben, D. B., Laliberte, L., Hiris, J. and Mor, V. (1990). A hierarchical exercise scale to measure function at the Advanced Activities of Daily Living (AADL) level. Journal of the American Geriatrics Society, 38, 855861.
Robinson, L., Clare, L. and Evans, K. (2005). Making sense of dementia and adjusting to loss: psychological reactions to a diagnosis of dementia in couples. Aging and Mental Health, 9, 337347. doi:10.1080/13607860500114555.
Roth, M. et al. (1986). CAMDEX: a standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. British Journal of Psychiatry, 149, 698709.
Sanchez-Benavides, G., Manero, R. M., Quinones-Ubeda, S., de Sola, S., Quintana, M. and Pena-Casanova, J. (2009). Spanish version of the Bayer Activities of Daily Living scale in mild cognitive impairment and mild Alzheimer disease: discriminant and concurrent validity. Dementia and Geriatric Cognitive Disorders, 27, 572578. doi:10.1159/000228259.
Tuokko, H., Morris, C. and Ebert, P. (2005). Mild cognitive impairment and everyday functioning in older adults. Neurocase, 11, 4047. doi:10.1080/13554790490896802.
WHO (2001). International Classification of Functioning, Disability and Health. Geneva: World Health Organisation.
Winblad, B. et al. (2004). Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240246. doi:10.1111/j.1365-2796.2004.01380.x.
Yeh, Y. C., Lin, K. N., Chen, W. T., Lin, C. Y., Chen, T. B. and Wang, P. N. (2011). Functional disability profiles in amnestic mild cognitive impairment. Dementia and Geriatric Cognitive Disorders, 31, 225232. doi:10.1159/000326910.
Yesavage, J. A. et al. (1982). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 17, 3749.



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