Skip to main content Accessibility help
×
Home

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

  • S. Reppermund (a1), H. Brodaty (a1) (a2) (a3), J. D. Crawford (a1), N. A. Kochan (a1) (a4), B. Draper (a1) (a3), M. J. Slavin (a1) (a2), J. N. Trollor (a1) (a5) and P. S. Sachdev (a1) (a2) (a4)...

Abstract

Background

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.

Method

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.

Results

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.

Conclusions

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.

Copyright

Corresponding author

*Address for correspondence: S. Reppermund, Ph.D., University of New South Wales Randwick Campus, Building R1f, Sydney NSW 2052, Australia. (Email: s.reppermund@unsw.edu.au)

References

Hide All
Anderson, TM, Sachdev, PS, Brodaty, H, Trollor, JN, Andrews, G (2007). Effects of sociodemographic and health variables on Mini-Mental State Exam scores in older Australians. American Journal of Geriatric Psychiatry 15, 467476.
APA (1994). Diagnostic and Statistical Manual of Mental Health Disorders, 4th edn, revised. American Psychiatric Association: Washington, DC.
Bangen, KJ, Jak, AJ, Schiehser, DM, Delano-Wood, L, Tuminello, E, Han, SD, Delis, DC, Bondi, MW (2010). Complex activities of daily living vary by mild cognitive impairment subtype. Journal of the International Neuropsychological Society 16, 630639.
Barnes, DE, Alexopoulos, GS, Lopez, OL, Williamson, JD, Yaffe, K (2006). Depressive symptoms, vascular disease, and mild cognitive impairment: findings from the cardiovascular health study. Archives of General Psychiatry 63, 273280.
Benton, AL (1967). Problems of test construction in the field of aphasia. Cortex 3, 3258.
Benton Sivan, AB, Spreen, O (1996). Der Benton Test (The Benton Test). Huber: Bern.
Blom, G (1958). Statistical Estimates and Transformed Beta Variables. John Wiley and Sons: New York.
Brown, PJ, Devanand, DP, Liu, X, Caccappolo, E (2011). Functional impairment in elderly patients with mild cognitive impairment and mild Alzheimer disease. Archives of General Psychiatry 68, 617626.
D'Agostino, RB Sr, Vasan, RS, Pencina, MJ, Wolf, PA, Cobain, M, Massaro, JM, Kannel, WB (2008). General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 117, 743753.
De Vriendt, P, Gorus, E, Cornelis, E, Velghe, A, Petrovic, M, Mets, T (2012). The process of decline in advanced activities of daily living: a qualitative explorative study in mild cognitive impairment. International Psychogeriatrics 24, 974986.
Di Carlo, A, Lamassa, M, Baldereschi, M, Inzitari, M, Scafato, E, Farchi, G, Inzitari, D (2007). CIND and MCI in the Italian elderly – frequency, vascular risk factors, progression to dementia. Neurology 68, 19091916.
Erzigkeit, H, Lehfeld, H, Pena-Casanova, J, Bieber, F, Yekrangi-Hartmann, C, Rupp, M, Rappard, F, Arnold, K, Hindmarch, I (2001). The Bayer-Activities of Daily Living Scale (B-ADL): results from a validation study in three European countries. Dementia and Geriatric Cognitive Disorders 12, 348358.
Farias, ST, Mungas, D, Jagust, W (2005). Degree of discrepancy between self and other-reported everyday functioning by cognitive status: dementia, mild cognitive impairment, and healthy elders. International Journal of Geriatric Psychiatry 20, 827834.
Fastenau, PS, Denburg, NL, Mauer, BA (1998). Parallel short forms for the Boston Naming Test: psychometric properties and norms for older adults. Journal of Clinical and Experimental Neuropsychology 20, 828834.
Folstein, MF, Folstein, SE, McHugh, PR (1975). ‘Mini-mental state’: practical method for grading cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189198.
Gold, DA (2011). An examination of instrumental activities of daily living assessment in older adults and mild cognitive impairment. Journal of Clinical and Experimental Neuropsychology 34, 1134.
Gorelick, PB, Scuteri, A, Black, SE, Decarli, C, Greenberg, SM, Iadecola, C, Launer, LJ, Laurent, S, Lopez, OL, Nyenhuis, D, Petersen, RC, Schneider, JA, Tzourio, C, Arnett, DK, Bennett, DA, Chui, HC, Higashida, RT, Lindquist, R, Nilsson, PM, Roman, GC, Sellke, FW, Seshadri, S (2011). Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 42, 26722713.
Hindmarch, I, Lehfeld, H, de Jongh, P, Erzigkeit, H (1998). The Bayer Activities of Daily Living Scale (B-ADL). Dementia and Geriatric Cognitive Disorders 9 (Suppl. 2), 2026.
Jungwirth, S, Zehetmayer, S, Hinterberger, M, Tragl, KH, Fischer, P (2012). The validity of amnestic MCI and non-amnestic MCI at age 75 in the prediction of Alzheimer's dementia and vascular dementia. International Psychogeriatrics 24, 959966.
Kaplan, E, Goodglass, H, Weintraub, S (2001). The Boston Naming Test. Lippincott Williams & Wilkins: Philadelphia.
Luck, T, Luppa, M, Angermeyer, MC, Villringer, A, Konig, HH, Riedel-Heller, SG (2011). Impact of impairment in instrumental activities of daily living and mild cognitive impairment on time to incident dementia: results of the Leipzig Longitudinal Study of the Aged. Psychological Medicine 41, 10871097.
Luis, CA, Loewenstein, DA, Acevedo, A, Barker, WW, Duara, R (2003). Mild cognitive impairment – directions for future research. Neurology 61, 438444.
Modrego, PJ, Ferrández, J (2004). Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type: a prospective cohort study. Archives of Neurology 61, 12901293.
Nelson, HE, Willison, J (1991). National Adult Reading Test (NART): Test Manual, 2nd edn. NFER Nelson: Windsor.
Pérès, K, Chrysostome, V, Fabrigoule, C, Orgogozo, JM, Dartigues, JF, Barberger-Gateau, P (2006). Restriction in complex activities of daily living in MCI – impact on outcome. Neurology 67, 461466.
Perneczky, R, Pohl, C, Sorg, C, Hartmann, J, Komossa, K, Alexopoulos, P, Wagenpfeil, S, Kurz, A (2006). Complex activities of daily living in mild cognitive impairment: conceptual and diagnostic issues. Age and Ageing 35, 240245.
Petersen, RC (2004). Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine 256, 183194.
Petersen, RC, Smith, GE, Waring, SC, Ivnik, RJ, Tangalos, EG, Kokmen, E (1999). Mild cognitive impairment – clinical characterization and outcome. Archives of Neurology 56, 303308.
Purser, JL, Fillenbaum, GG, Pieper, CF, Wallace, RB (2005). Mild cognitive impairment and 10-year trajectories of disability in the Iowa Established Populations for Epidemiologic Studies of the Elderly cohort. Journal of the American Geriatrics Society 53, 19661972.
Reitan, RM, Wolfson, D (1985). The Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation. Neuropsychological Press: Tucson, AZ.
Reppermund, S, Brodaty, H, Crawford, JD, Kochan, NA, Slavin, MJ, Trollor, JN, Draper, B, Sachdev, PS (2011 a). The relationship of current depressive symptoms and past depression with cognitive impairment and instrumental activities of daily living in an elderly population: the Sydney Memory and Ageing Study. Journal of Psychiatric Research 45, 16001607.
Reppermund, S, Sachdev, PS, Crawford, J, Kochan, NA, Slavin, MJ, Kang, K, Trollor, JN, Draper, B, Brodaty, H (2011 b). The relationship of neuropsychological function to instrumental activities of daily living in mild cognitive impairment. International Journal of Geriatric Psychiatry 26, 843852.
Rey, A (1964). L'Examen Clinique en Psychologie (Clinical Examination in Psychology). Presses Universitaires de France: Paris.
Sachdev, PS, Brodaty, H, Reppermund, S, Kochan, NA, Trollor, JN, Draper, B, Slavin, MJ, Crawford, J, Kang, K, Broe, GA, Mather, KA, Lux, O (2010). Memory and Ageing Study Team. The Sydney Memory and Ageing Study (MAS): methodology and baseline medical and neuropsychiatric characteristics of an elderly epidemiological non-demented cohort of Australians aged 70–90 years. International Psychogeriatrics 22, 12481264.
Sheik, JI, Yesavage, JA (1986). Geriatric Depression Scale (GDS). Recent evidence and development of a shorter version. In Clinical Gerontology: A Guide to Assessment and Intervention (ed. Brink, T. L.), pp. 165173. The Haworth Press: New York.
Spreen, O, Benton, AL (1969). Neurosensory Center Comprehensive Examination for Aphasis: Manual of Instructions (NCCEA). University of Victoria: Victoria, BC.
Tuokko, H, Morris, C, Ebert, P (2005). Mild cognitive impairment and everyday functioning in older adults. Neurocase 11, 4047.
Wadley, VG, Crowe, M, Marsiske, M, Cook, SE, Unverzagt, FW, Rosenberg, AL, Rexroth, D (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.
Wechsler, D (1981). Wechsler Adult Intelligence Scale – Revised. Psychological Corporation: New York.
Wechsler, D (1997 a). Wechsler Memory Scale, 3rd edn. Harcourt Brace & Company: San Antonio.
Wechsler, D (1997 b). Wechsler Adult Intelligence Scale, 3rd edn. Psychological Corporation: San Antonio.
Wilms, HU, Riedel-Heller, SG, Angermeyer, MC (2007). Limitations in activities of daily living and instrumental activities of daily living capacity in a representative sample: disentangling dementia- and mobility-related effects. Comprehensive Psychiatry 48, 95101.
Winblad, B, Palmer, K, Kivipelto, M, Jelic, V, Fratiglioni, L, Wahlund, LO, Nordberg, A, Backman, L, Albert, M, Almkvist, O, Arai, H, Basun, H, Blennow, K, de Leon, M, DeCarli, C, Erkinjuntti, T, Giacobini, E, Graff, C, Hardy, J, Jack, C, Jorm, A, Ritchie, K, van Duijn, C, Visser, P, Petersen, RC (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.
Yesavage, JA, Brink, TL, Rose, TL, Lum, O, Huang, V, Adey, M, Leirer, VO (1982). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research 17, 3749.

Keywords

Metrics

Altmetric attention score

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