Changes in Everyday Function in Individuals with Psychometrically Defined Mild Cognitive Impairment in the Advanced Cognitive Training for Independent and Vital Elderly Study

Abstract

Results demonstrate the importance of MCI as a clinical entity that not only predicts progression to dementia, but also predicts functional declines in activities that are key to autonomy and quality of life. MCI classification guidelines should allow for functional changes in MCI, and clinicians should monitor for such changes. Preservation of function may serve as a meaningful outcome for intervention efforts.

Medical decision-making capacity in mild cognitive impairment

“…8,[34][35][36] The present study contributes to understanding the natural history of functional change in MCI. Prior studies [9][10][11][12] have examined longitudinal changes in functional abilities in MCI using generic selfreport measures of functional ability such as the Lawton and Brody Instrumental Activities of Daily Living Scale. The convergent evidence from these studies indicates that persons with MCI experience increasing levels of difficulty in the performance of daily activities over time, that restriction in complex activities of daily living precedes limitations in more basic functional abilities, and that MCI patients who demonstrate functional difficulties at baseline have a higher risk of progressing to dementia over time.…”

“…The convergent evidence from these studies indicates that persons with MCI experience increasing levels of difficulty in the performance of daily activities over time, that restriction in complex activities of daily living precedes limitations in more basic functional abilities, and that MCI patients who demonstrate functional difficulties at baseline have a higher risk of progressing to dementia over time. [9][10][11][12] We built on these studies by using a performancebased instrument that decomposes a specific functional domain-MDC-into component abilities. We found that the consent ability of understanding declined over 3 years, whereas other consent abilities remained more stable.…”

“…[1][2][3]8 The longitudinal course of such functional restrictions has received less attention. [9][10][11][12] Medical decision-making capacity (MDC) (also referred to as treatment consent capacity or consent capacity) is a higher-order functional capacity. It refers to an individual's cognitive and emotional capacity to accept a medical treatment, refuse treatment, or select among treatment alternatives.…”

Cognición y autonomía en personas mayores dependientes

“…Precede a esta investigación la realizada por Wadley et al (2007) en la que se muestra la importancia del estudio del deterioro cognitivo en relación con las actividades de la vida diaria y la pérdida de funcionalidad en las mismas, siendo éstas, claves para la autonomía y la calidad de vida de la persona. Bowling (1994) define el estado funcional del anciano como el grado en que un individuo es capaz de desarrollar los papeles que tiene asignados libre de limitaciones físicas y/o mentales.…”

The unbearable lightness of MCI

“…The greatest inherent challenge in diagnosing MCI is the inter-individual variability among older adults, both in intellectual function at a given age and in rates of decline over time. In different studies, objective neuropsychological measures have included multiple global and domain-specific tests (Jorm et al, 2005;Wadley et al, 2007;Allegri et al, 2008;Albert et al, 2011). Subjective cognitive concerns are sometimes assumed from the very fact of the patient's seeking services, or reflect spontaneous complaints by patients or families; at other times, they are elicited by a single question or a standardized questionnaire, and/or represent the clinician's impression (St. John et al, 2002;Arnaiz et al, 2004;Di Carlo et al, 2007).…”