Skip to main content Accessibility help
×
Home

Profiles of functional deficits in mild cognitive impairment and dementia: benefits from objective measurement

  • FERNANDA SPEGGIORIN PEREIRA (a1), MÔNICA SANCHES YASSUDA (a2), ALEXANDRA MARTINI OLIVEIRA (a1), BRENO SATLER DINIZ (a1), MÁRCIA RADANOVIC (a1), LEDA LEME TALIB (a1), WAGNER FARID GATTAZ (a1) and ORESTES VICENTE FORLENZA (a1)...

Abstract

The magnitude of functional impairment that may indicate the threshold between MCI and incipient Alzheimer’s disease (AD) has not been clearly defined. The objective was to examine the pattern of functional impairment in the continuum MCI-AD. Eighty-nine older adults (32 cognitively unimpaired, 31 MCI, and 26 AD patients) were examined with the Brazilian version of the Direct Assessment of Functional Status (DAFS-BR) at a university-based memory clinic. MCI patients were sub-divided according to the progression to AD upon follow-up, and had baseline cognitive, functional and biological variables analyzed. MCI patients displayed mild deficits in functional abilities, with intermediate scores as compared to controls and AD. The DAFS-BR items that differentiated MCI from controls involved the ability to deal with finances and shopping skills. At baseline, scores obtained by MCI patients who converted to AD were not significantly different from scores of nonconverters. The magnitude of functional deficits was associated with AD-like pathological findings in the CSF. In conclusion, MCI patients present with early functional changes in complex, instrumental abilities that require the integrity of memory and executive functions. The objective measurement of the functional state may help identify older adults with increased risk of developing dementia in the MCI-AD continuum. (JINS, 2010, 16, 297–305.)

Copyright

Corresponding author

*Correspondence and reprint requests to: Orestes V. Forlenza, Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Rua Dr. Ovídio Pires de Campos 785, 3rd floor, 05403-010 São Paulo, S.P., Brazil. E-mail: forlenza@usp.br

References

Hide All
Abreu, I.D., Nunes, P.V., Diniz, B.S., & Forlenza, O.V. (2008). Combining functional scales and cognitive tests in screening for mild cognitive impairment at a university-based memory clinic in Brazil. Revista Brasileira de Psiquiatria (São Paulo, Brazil: 1999), 30, 346349.
Allaire, J.C., Gamaldo, A., Ayotte, B.J., Sims, R., & Whitfield, K. (2009). Mild cognitive impairment and objective instrumental everyday functioning: The everyday cognition battery memory test. Journal of the American Geriatric Society, 57, 120125.
Army Individual Test Battery. (1944). In: Manual of Directions and Scoring. Washington, DC: War Department, Adjunct General’s Office Trail.
Artero, S., Touchon, J., & Ritchie, K. (2001). Disability and mild cognitive impairment: A longitudinal population-based study. International Journal of Geriatric Psychiatry, 16, 10921097.
Barberger-Gateau, P., Dartigues, J.F., & Letenneur, L. (1993). Four instrumental activities of daily living score as a predictor of one-year incident dementia. Age and Ageing, 22, 457463.
Barberger-Gateau, P., Fabrigoule, C., Amieva, H., Helmer, C., & Dartigues, J.F. (2002). The disablement process: A conceptual framework for dementia-associated disability. Dementia and Geriatric Cognitive Disorders, 13, 6066.
Barberger-Gateau, P., Fabrigoule, C., Rouch, I., Letenneur, L., & Dartigues, J.F. (1999). Neuropsychological correlates of self-reported performance in instrumental activities of daily living and prediction dementia. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 54, 293295.
Blessed, G., Tomlinson, B.E., & Roth, M. (1968). The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. British Journal of Psychiatry, 114, 797811.
Boyle, P.A., Malloy, P.F., Salloway, S., Cahn-Weiner, D.A., Cohen, R., & Cummings, J.L. (2003). Executive dysfunction and apathy predict functional impairment in Alzheimer disease. American Journal of Geriatric Psychiatry, 11, 214221.
Cahn-Weiner, D.A., Farias, S.T., Julian, L., Harvey, D.J., Kramer, J.H., Reed, B.R., et al. . (2007). Cognitive and neuroimaging predictors of instrumental activities of daily living. Journal of the International Neuropsychological Society: JINS, 13, 747757.
Diniz, B.S., Nunes, P.V., Yassuda, M.S., Pereira, F.S., Flaks, M.K., Viola, L.F., et al. . (2008). Mild cognitive impairment: Cognitive screening or neuropsychological assessment? Revista Brasileira de Psiquiatria (São Paulo, Brazil: 1999), 30, 316321.
Diniz, B.S., Pinto Júnior, J.A., & Forlenza, O.V. (2008). Do CSF total tau, phosphorylated tau, and beta-amyloid 42 help to predict progression of mild cognitive impairment to Alzheimer’s disease? A systematic review and meta-analysis of the literature. The World Journal of Biological Psychiatry, 9, 172182.
Erzigkeit, H. (1991). The development of the SKT project. In Hindmarch, I., Hippius, H.G., & Wilcock, K. (Eds.), Dementia: Molecules, Methods and Measures (pp. 101108). Chichester, England: Wiley.
Farias, S.T., Mungas, D., Reed, B.R., Harvey, D., Cahn-Weiner, D., & Decarli, C. (2006). MCI is associated with deficits in everyday functioning. Alzheimer Disease and Associated Disorders, 20, 217223.
Fillenbaum, G.G. (1985). Screening the elderly. A brief instrumental activities of daily living measure. Journal of the American Geriatric Society, 33, 698706.
Flaks, M.K., Yassuda, M.S., Regina, A.C.B., Cid, C.G., Camargo, C.H., Gattaz, W.F., et al. . (2006). The Short Cognitive Performance Test (SKT) _ A transcultural test for early detection and discrimination of dementia: A preliminary study in Brazil. International Psychogeriatrics / IPA, 18, 121133.
Folstein, M.F., Folstein, S.E., & 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.
Forlenza, O.V., & Chiu, E. (2008). Mild cognitive impairment: A concept ready to move on? Current Opinion in Psychiatry, 21, 529532.
Forlenza, O.V., Diniz, B.S., Nunes, P.V., Memoria, C.M., Yassuda, M.S., & Gattaz, W.F. (2009). Diagnostic transitions in mild cognitive impairment subtypes. International Psychogeriatrics / IPA, 21, 10881095.
Fuld, P. (1980). Guaranteed stimulus processing in the evaluation of memory and learning. Cortex, 16, 255271.
Giovannetti, T., Bettcher, B.M., Brennan, L., Libon, D.J., Burke, M., Duey, K., et al. . (2008). Characterization of everyday functioning in mild cognitive impairment: A direct assessment approach. Dementia and Geriatric Cognitive Disorders, 25, 359365.
Griffith, K., Belue, B.S., Sicola, A., Krzywanski, S., Zamrini, E., Harrell, L., et al. . (2003). Impaired financial abilities in mild cognitive impairment. A direct assessment approach. Neurology, 60, 449457.
Hachinski, V.C., Iliff, L.D., Zilhka, E., Du Boulay, G.H., McAllister, V.L., Marshall, J., et al. . (1975). Cerebral blood flow in dementia. Archives of Neurology, 32, 632637.
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23, 5662.
Jefferson, A.L., Paul, R.H., Ozonoff, A., & Cohen, R.A. (2006). Evaluating elements of executive functioning as predictors of instrumental activities of daily living (IADLs). Archives of Clinical Neuropsychology, 21, 311320.
Jorm, A.F., & Jacomb, P.A. (1989). The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): Sociodemographics correlates, reliability, validity and some norms. Psychological Medicine, 19, 10151022.
Kim, K.R., Lee, K.S., Cheong, H.-K., Eom, J.S., Oh, B.H., & Hong, C.H. (2009). Characteristic profiles of instrumental activities of daily living in different subtypes of mild cognitive impairment. Dementia and Geriatric Cognitive Disorders, 27, 278285.
Loewenstein, D.A., Amigo, E., & Duara, R. (1989). A new scale for the assessment of functional status in Alzheimer’s disease and related disorders. Journal of Gerontology, 4, 114121.
Loewenstein, D.A., Arguelles, S., Bravo, M., Freeman, R.Q., Argüelles, T., Acevedo, A., et al. . (2001). Caregivers’ judgments of the functional abilities of the Alzheimer’s disease patient. A comparison of proxy reports and objective measures of functional status. Journal of Gerontology, 56, 7894.
Loewenstein, D.A., & Bates, C.B. (2006). The direct assessment of functional status revised (DAFS-R). Manual for Administration and Scoring. Neuropsychological Laboratories. Miami Beach, FL: Mount Sinai Medical Center, The Wien Center for Alzheimer’s Disease and Memory Disorders.
Martin, R., Griffith, H.R., Belue, K., Harrell, L., Zamrini, E., Anderson, B., et al. . (2008). Declining financial capacity in patients with mild Alzheimer disease: A one-year longitudinal study. American Journal of Geriatric Psychiatry, 16, 209219.
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & Stadlan, E.M. (1984). Clinical diagnosis of Alzheimer disease: Report of NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Service Task Force on Alzheimer’s Disease. Neurology, 34, 939944.
Nordlund, A., Rolstad, S., Klang, O., Lind, K., Pedersen, M., Blennow, K., et al. . (2008). Episodic memory and speed/attention deficits are associated with Alzheimer-typical CSF abnormalities in MCI. Journal of the International Neuropsychological Society: JINS, 14, 582590.
Nunes, P.V., Diniz, B.S., Radanovic, M., Abreu, I.D., Borelli, D.T., Yassuda, M.S., et al. . (2008). CAMCOG as a screening tool for diagnosis of mild cognitive impairment and dementia in a Brazilian clinical sample of moderate to high education. International Journal of Geriatric Psychiatry, 23, 11271133.
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. Supplementum, 179, 4246.
Okonkwo, O.C., Wadley, V.G., Griffith, H.R., Ball, K., & Marson, D.C. (2006). Cognitive correlates of financial abilities in mild cognitive impairment. Journal of the American Geriatric Society, 54, 17451750.
Oliveira, R., & Schmidt, S.L. (1999). Teste Comportamental de Memória de Rivermead (Rivermead Behavioural Memory Test). Rio de Janeiro: Cognição.
Pereira, F.S., Forlenza, O.V., Oliveira, A.M., Diniz, B.S., & Yassuda, M.S. (submitted). Cross-cultural adaptation, reliability and validity of the DAFS-R in a sample of Brazilian older adults. Archives of Clinical Neuropsychology.
Pereira, F.S., Yassuda, M.S., Oliveira, A.M., & Forlenza, O.V. (2008). Executive dysfunction correlates with impaired functional status in older adults with varying degrees of cognitive impairment. International Psychogeriatrics / IPA, 20, 11041115.
Péres, K., Helmer, C., Amieva, H., Orgogozo, J.M., Rouch, I., Dartigues, J.F., et al. . (2008). Natural history of decline in instrumental activities of daily living performance over the 10 years preceding the clinical diagnosis of dementia: A prospective population-based study. Journal of the American Geriatric Society, 56, 3744.
Petersen, R.C. (2007). MCI treatment trials: Failure or not? Lancet Neurology, 6, 473475.
Petersen, R.C., Doody, R., Kurz, A., Mohs, R.C., Morris, J.C., Rabins, P.V., et al. . (2001). Current concepts in mild cognitive impairment. Archives of Neurology, 8, 19851992.
Radanovic, M., Diniz, B.S., Mirandez, R.M., Novaretti, T.M., Flaks, M.K., Yassuda, M.S., et al. . (2009). Verbal fluency in the detection of mild cognitive impairment and Alzheimer’s disease among Brazilian Portuguese speakers: The influence of education. International Psychogeriatrics / IPA, 21, 10811087.
Ritchie, K., Artero, S., & Touchon, J. (2001). Classification criteria for mild cognitive impairment: A population-based study. Neurology, 56, 3742.
Roth, M., Tym, E., Mountjoy, C.Q., Huppert, F.A., Hendrie, H., Verma, S., et al. . (1986). CAMDEX: A standardized instrument for the diagnosis of mental disorders in the elderly with special reference to early detection of dementia. British Journal of Psychiatry, 149, 698709.
Royall, D.R., Mahurin, R.K., & Gray, K. (1992). Bedside assessment of executive cognitive impairment: The executive interview. Journal of the American Geriatric Society, 40, 12211226.
Rozzini, L., Chilovi, B.V., Conti, M., Bertoletti, E., Delrio, I., Trabucchi, M., et al. . (2007). Conversion of amnestic mild cognitive impairment to dementia of Alzheimer type is independent to memory deterioration. International Journal of Geriatric Psychiatry, 22, 12171222.
Sabbagh, M.N., Lahti, T., Connor, D.J., Caviness, J.N., Shill, H., Vedders, L., et al. . (2007). Functional ability correlates with cognitive impairment in Parkinson’s disease and Alzheimer’s disease. Dementia and Geriatric Cognitive Disorders, 24, 327334.
Schmitter-Edgecombe, M., Woo, E., & Greeley, D.R. (2009). Characterizing multiple memory deficits and their relation to everyday functioning in individuals with mild cognitive impairment. Neuropsychology, 23, 168177.
Sunderland, T., Hill, J.L., Mellow, A.M., Gundersheimer, J., Newhouse, P.A., & Grafman, J.H. (1989). Clock drawing in Alzheimer’s disease. A novel measure of disease severity. Journal of the American Geriatric Society, 37, 725729.
Sunderland, T., Linker, G., Mirza, N., Putnam, K.T., Friedman, D.L., Kimmel, L.H., et al. . (2003). Decreased beta-amyloid 1-42 and increased tau levels in cerebrospinal fluid of patients with Alzheimer disease. Journal of the American Medical Association, 289, 20942103.
Tabert, M.H., Albert, S.M., Borukhova-Milov, L., Camacho, Y., Pelton, G., Liu, X., et al. . (2002). Functional deficits in patients with mild cognitive impairment: Prediction of AD. Neurology, 58, 758764.
Wadley, V.G., Crowe, M., Marsiske, M., Cook, S.E., Unverzagt, F.W., Rosenberg, A.L., et al. . (2007). Changes in everyday function in individuals with psychometrically defined mild cognitive impairment in the Advanced Cognitive Training for Independent and Vital Elderly Study. Journal of the American Geriatric Society, 55, 11921198.
Wadley, V.G., Okonkwo, O., Crowe, M., & Ross-Meadows, L.A. (2008). Mild cognitive impairment and everyday function: Evidence of reduced speed in performing instrumental activities of daily living. American Journal of Geriatric Psychiatry, 16, 416424.
Wechsler, D.I. (1981). Examiner’s Manual: Wechsler Adult Intelligence Scale-Revised. New York: Psychological Corporation.

Keywords

Related content

Powered by UNSILO

Profiles of functional deficits in mild cognitive impairment and dementia: benefits from objective measurement

  • FERNANDA SPEGGIORIN PEREIRA (a1), MÔNICA SANCHES YASSUDA (a2), ALEXANDRA MARTINI OLIVEIRA (a1), BRENO SATLER DINIZ (a1), MÁRCIA RADANOVIC (a1), LEDA LEME TALIB (a1), WAGNER FARID GATTAZ (a1) and ORESTES VICENTE FORLENZA (a1)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.