In a community-based sample of older, medically complicated patients with dementia, there are neuropsychological differences between dementia subtypes at the time of diagnosis. In particular, patients with Alzheimer disease (AD) alone and AD/Lewy body pathology (LBP) had more severe memory impairment than patients with LBP. LBP alone was associated with more severe executive dysfunction. Patients with AD/LBP had the most rapid rate of cognitive decline.

No abstract

The ability to engage in instrumental activities of daily living (IADLs) is known to rely on cognitive abilities, primarily executive functioning and memory. There is also evidence that good self-awareness, which facilitates the use of compensatory strategies, may prolong functionality and delay the diagnosis of dementia. However, little is known about the mechanisms that mediate self-awareness among healthy elderly. The present study examined the correlates of discrepancies between self-report and performance-based measures of IADLs in a sample of 75 community-dwelling elderly. The results indicate that even among independently living individuals, there is still variability in functionality (i.e., 35% of the sample made IADL performance errors) and self-awareness (i.e., 38% of the sample demonstrated a discrepancy between IADL self-report and performances). Better awareness of IADL weaknesses was associated with higher levels of cognitive reserve but, unexpectedly, lower levels of executive abilities. Additionally, consistent with prior research, better IADL performances were associated with better cognition.

Self-reports of the ability to engage in instrumental activities of daily living (IADLs) among older adults are known to be related to personality traits. However, self-reports are sometimes discrepant with performance-based IADL assessments, and little is known about personality associations with objective functionality or with poor insight about functional deficits. This study examined the NEO Personality Inventory-Revised profiles associated with (a) self-report of functional problems, (b) functional errors evidenced on performance-based IADL assessment, and (c) discrepancies between self-report and performance. Participants were 65 community-dwelling individuals ranging in age from 60 to 87 years. The results showed that self-report of IADL problems are associated with higher neuroticism and lower conscientiousness, actual IADL difficulties with higher neuroticism and lower agreeableness and openness to experience, underreporting of problems with higher conscientiousness, and overreporting of problems with higher extraversion and neuroticism. These relationships were partly mediated by age, education, and cognitive status. When unique personality associations with self-report and performance were examined, neuroticism and agreeableness, respectively, emerged as the strongest predictors.