Prediction of Incident Dementia: Impact of Impairment in Instrumental Activities of Daily Living and Mild Cognitive Impairment—Results From the German Study on Ageing, Cognition, and Dementia in Primary Care Patients

Luck, Tobias; Luppa, Melanie; Wiese, Birgit; Maier, Wolfgang; Bussche, Hendrik van den; Eisele, Marion; Jessen, Frank; Weeg, Dagmar; Weyerer, Siegfried; Pentzek, Michael; Leicht, Hanna; Koehler, Mirjam; Tebarth, Franziska; Olbrich, Julia; Eifflaender-Gorfer, Sandra; Fuchs, Ângela; König, Hans‐Helmut; Riedel‐Heller, Steffi G.

doi:10.1097/jgp.0b013e31825c09bc

Cited by 55 publications

(46 citation statements)

References 39 publications

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“…MCI occupies a central location in the spectrum of cognitive aging, and its use as a diagnostic term has been criticized because of the heterogeneity of its prognosis. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] There are many reasons for the wide range of dementia risk in persons designated as MCI, but perhaps the most important one is that cognitive functioning that falls between the designations of "typical cognitive aging" and "definitely demented" is remarkably diverse. Changes in memory, attention, executive, language, and visuospatial domains, as well as the magnitude of those changes, have distinct implications for prognosis.…”

Section: Methodsmentioning

confidence: 99%

“…Because cognitive performance is an intrinsic component of dementia, and because biomarkers share variance with cognitive performance, it is not surprising that cognitive outcomes are often more powerful than biomarkers when they are entered into the same prediction models. 39 We could have explored the interaction between cognition and functional impairment, 17 but it was not feasible for several reasons. We lacked a common instrument between FHS and MCSA, and furthermore, our focus was on the role of domain-specific cognitive impairment.…”

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Spectrum of cognition short of dementia

et al. 2015

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Objective: To understand the neuropsychological basis of dementia risk among persons in the spectrum including cognitive normality and mild cognitive impairment. Methods:We quantitated risk of progression to dementia in elderly persons without dementia from 2 population-based studies, the Framingham Heart Study (FHS) and Mayo Clinic Study of Aging (MCSA), aged 70 to 89 years at enrollment. Baseline cognitive status was defined by performance in 4 domains derived from batteries of neuropsychological tests (that were similar but not identical for FHS and MCSA) at cut scores corresponding to SDs of #20.5, 21, 21.5, and 22 from normative means. Participants were characterized as having no cognitive impairment (reference group), or single or multiple amnestic or nonamnestic profiles at each cut score. Incident dementia over the following 6 years was determined by consensus committee at each study separately.Results: The pattern of hazard ratios for incident dementia, rates of incident dementia and positive predictive values across cognitive test cut scores, and number of affected domains was similar although not identical across the FHS and MCSA. Dementia risks were higher for amnestic profiles than for nonamnestic profiles, and for multidomain compared with single-domain profiles.Conclusions: Cognitive domain subtypes, defined by neuropsychologically derived cut scores and number of low-performing domains, differ substantially in prognosis in a conceptually logical manner that was consistent between FHS and MCSA. Neuropsychological characterization of elderly persons without dementia provides valuable information about prognosis. The heterogeneity of risk of dementia cannot be captured concisely with one test or a single definition or cutpoint. The wide variation in cognitive function in aging, both in levels of performance and rates of change over time, forces clinicians and lay people to focus on categorical descriptions. Labels such as cognitively normal, mild cognitive impairment (MCI), and dementia are applied as if they were discrete entities, but it is accepted that these terms represent demarcations of convenience along the continuum of cognition. MCI occupies a central location in the spectrum of cognitive aging, and its use as a diagnostic term has been criticized because of the heterogeneity of its prognosis. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] There are many reasons for the wide range of dementia risk in persons designated as MCI, but perhaps the most important one is that cognitive functioning that falls between the designations of "typical cognitive aging" and "definitely demented" is remarkably diverse. Changes in memory, attention, executive, language, and visuospatial domains, as well as the magnitude of those changes, have distinct implications for prognosis. The existing studies suggested to us that the diversity of affected domains and cutpoints, rather than a weakness, had

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

Spectrum of cognition short of dementia

et al. 2015

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“…80 Loss of skills related to independent medication management, shopping, housekeeping and use of public transport have also been shown to significantly impact on time to incident dementia. 35 In LAMIC, where low education levels are more prevalent than in HIC, screening tools with minimal education bias are necessary. Cognitive decline contributes to functional impairment and is expressed among instrumental activities before basic activities of daily living.…”

Section: African Journal Of Psychiatry • November 2013mentioning

confidence: 99%

“…This is important as it has been shown that impairment in IADL impacts significantly on the prognostic value of MCI with respect to progression to dementia. [32][33][34][35] Delaying the progression of MCI to dementia by one year will result in significant cost savings 36 , therefore objective measurement criteria for MCI and IADL are essential.…”

Section: Prevalence Of Dementia and MCImentioning

confidence: 99%

Mild cognitive impairment and dementia in a heterogeneous elderly population: prevalence and risk profile

et al. 2013

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Objective: To describe the demographic, clinical and risk profile of Mild Cognitive Impairment and dementia in a sample of elderly South Africans within a residential setting. Method: One hundred and forty participants residing in a group of residential homes for the elderly were assessed by psychiatrists and assigned diagnoses of dementia or Mild Cognitive Impairment (MCI). Participants diagnosed with dementia were also offered haematological investigations and a CT scan of the brain. Results: The sample consisted of 140 participants comprising 46.4% White, 29.3% Coloured, 20% Asian and 4.3% Black participants. There were 97 (69.3%) females and 106 (75.7%) participants had less than 12 years of education. Eleven (7.9%) dementia and 38 (27.1%) MCI cases were diagnosed. Increasing age was associated with cognitive impairment (MCI and dementia) (p=.020) but there was no association between gender and cognitive impairment (p=.165). MCI was significantly associated with a lower education level (p=.036) and no association was found between depression (current-p=.646; past-p=.719) and dementia or MCI. The presence of vascular risk factors (n=140) ranged from 66.4% (hypertension) to 14.3% (stroke). Subjective memory complaints were significantly associated with cognitive impairment (p=.001). Except for the use of the telephone (p=.225) and the television (p=.08), impairment in all domains of instrumental activities of daily living that were assessed were significantly associated with a dementia diagnosis. Conclusion: The study showed that cognitive impairment was associated with increasing age and low education levels. The presence of vascular risk factors places this population at risk for future cognitive decline. ?? differences in the risk profile (low levels of cardiovascular risk and hypolipidaemia) in LAMIC populations may be contributing to the lower rates. 1 While the incidence and prevalence of dementia have been extensively studied in Western and European countries 5 there remains a dearth of similar studies from Africa. The few studies conducted in Africa prior to 2000 used small samples and was reported to have used 'non-standardised clinical assessments'. 10 Recent studies from Africa reported prevalence figures ranging from 2.6% to 8.1%. 11,12,13 Dementia studies from South Africa include a Western Cape sample of coloured people 14 , with a prevalence of 8.6%, and a Free State sample of indigenous Sotho-speaking elderly black people 15 , which reported a prevalence of 7.7%. This paper describes the clinical and risk profile of a sample of elderly participants who were assessed for the presence of dementia and MCI. In addition, the value of functional assessments and subjective memory complaints in case-finding are also explored. Keywords MethodThe study consisted of three stages: 1) Administration of dementia screening tools; 2) Clinical diagnostic evaluation for dementia; and 3) Administration of a neuropsychological battery of tests. SampleThe study population comprised residents (N=1450) of a ...

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“…2 Cross-sectional and longitudinal studies suggest that cognitive decline (the main difference between normal aging and MCI) precedes functional decline (the main difference between MCI and AD). [3][4][5] This pattern is associated with the main biomarkers of AD and moderated by several factors, including cognitive reserve. 6 Motor impairment may emerge as a phenotype of cognitive decline.…”

Section: Introductionmentioning

confidence: 99%

Impairment of fine motor dexterity in mild cognitive impairment and Alzheimer’s disease dementia: association with activities of daily living

Paula

Albuquerque

Lage

et al. 2016

Rev. Bras. Psiquiatr.

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Objective: Cognitive impairment is a hallmark of mild cognitive impairment (MCI) and Alzheimer's disease dementia (AD). Although the cognitive profile of these patients and its association with activities of daily living (ADLs) is well documented, few studies have assessed deficits in fine motor dexterity and their association with ADL performance. The objective of this research paper is to evaluate fine motor dexterity performance among MCI and AD patients and to investigate its association with different aspects of ADLs. Methods: We assessed normal aging controls, patients with multiple-and single-domain amnestic MCI (aMCI), and patients with mild AD. Fine motor dexterity was measured with the Nine-Hole Peg Test and cognitive functioning by the Mattis Dementia Rating Scale. We analyzed the data using general linear models. Results: Patients with AD or multiple-domain aMCI had slower motor responses when compared to controls. AD patients were slower than those with single-domain aMCI. We found associations between cognition and instrumental ADLs, and between fine motor dexterity and self-care ADLs. Conclusion: We observed progressive slowing of fine motor dexterity along the normal aging-MCI-AD spectrum, which was associated with autonomy in self-care ADLs.

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Prediction of Incident Dementia: Impact of Impairment in Instrumental Activities of Daily Living and Mild Cognitive Impairment—Results From the German Study on Ageing, Cognition, and Dementia in Primary Care Patients

Cited by 55 publications

References 39 publications

Spectrum of cognition short of dementia

Spectrum of cognition short of dementia

Mild cognitive impairment and dementia in a heterogeneous elderly population: prevalence and risk profile

Impairment of fine motor dexterity in mild cognitive impairment and Alzheimer’s disease dementia: association with activities of daily living

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