Impact of Functional Deficits in Instrumental Activities of Daily Living in Mild Cognitive Impairment

Abstract

Background The utility of functional deficits in patients with mild cognitive impairment is not established. Method In 3,886 individuals with mild cognitive impairment evaluated and followed at 34 National Alzheimer’s Coordinating Center sites, informant-reported Pfeffer Functional Activities Questionnaire (FAQ) items associated with progression to dementia were derived in a training set (n=1943) and tested in the validation set (n=1943). Results In the training set, the optimal combination comprised six FAQ items (FAQ6): difficulties with finances (2 items), remembering events/appointments, playing games of skill, current events, and travel. In the validation set, hazard ratio for dementia increased from 2.00 for one FAQ6 deficit to 5.56 for six FAQ6 deficits. In patients 50–67 years old with high Mini Mental State Exam (MMSE) scores, dementia risk rose from 12.06% for no FAQ6 deficits to 56.75% for six functional deficits. Likelihood of progression to dementia reached 80–89% in older age groups with low MMSE and severe FAQ6 deficits. Conclusion Specific functional deficits increased dementia risk and, with age and global cognition, constituted a validated clinical algorithm to estimate dementia risk. Clinicians can use this clinically important algorithm to personalize decision-making about further investigation and identify high-risk patients for early treatment or inclusion in clinical trials.

Practical recommendations for timely, accurate diagnosis of symptomatic Alzheimer’s disease (MCI and dementia) in primary care: a review and synthesis

“…Early signs and symptoms of cognitive–behavioural impairment due to AD often include subjective complaints and behavioural changes; work‐related problems; the abandonment of hobbies or interests; trouble managing finances; difficulty remembering appointments, important dates or taking medications as prescribed; problems playing games of skill; challenges keeping track of current events; and difficulties with travel (e.g. public transportation) [ 133 , 134 ]. Importantly, these difficulties may be reported more reliably by informants than by patients themselves.…”

Association Between Gait, Cognition, and Gray Matter Volumes in Mild Cognitive Impairment and Healthy Controls

“…This raises the importance of identifying factors that predict cognitive decline in these patients. Several factors have been shown to increase progression to dementia in MCI patients, including psychiatric factors 4 , vascular factors 5 , instrumental functioning deficits 6 , carotid atherosclerosis 7 , CSF and neuroimaging biomarkers 8 . Recently, research has focused on motor functioning, including gait control, as a potential clinical marker in persons in the prodromal phase of dementia.…”

Diagnosing early cognitive decline—When, how and for whom?

“…Compared to healthy controls, patients with MCI needed longer to complete tasks and made more mistakes (17). Functional deficits in MCI were also found to predict the likelihood of dementia (18).…”