Subtle changes in daily functioning predict conversion from normal to mild cognitive impairment or dementia: an analysis of the NACC database

Abstract

Background There are relatively small but observable changes in functional ability in those without Mild cognitive impairment (MCI) or dementia. The present study seeks to understand whether these individuals go on to develop MCI or dementia by assessing the association between baseline Functional Activities Questionnaire (FAQ) and conversion independent and after adjustment for cognitive tests. Methods The NACC database was used to conduct the analysis of which 7,625 participants were initially identified as having more than one visit and who were cognitively normal at their first visit. Cox proportional hazards were used to fit three models that controlled for executive and non-executive cognitive domains. A similar model was used to assess the effect of FAQ subcategories on conversion. Results Of these individuals, 1,328 converted to either MCI or dementia by visit 10. Converters had a total visit 1 FAQ score significantly higher than non-converters indicating more functional impairment at baseline. After adjustment for cognitive tests, the association between visit 1 FAQ and subsequent conversion was not attenuated. Doing taxes, remembering dates, and traveling were individually identified as significant predictors of conversion. Conclusions The FAQ can be used as an indirect measure of functional ability and is associated with conversion to MCI or dementia. There is a selective and significant association between changes in financial ability and conversion that is in accordance with other research of financial capacity.

Differential Effect of APOE ɛ4 Status and Elevated Pulse Pressure on Functional Decline in Cognitively Normal Older Adults

“…Prior work has shown that a cutoff of ≥6 on the FAQ best discriminated MCI from AD [33]. While this suggests that the change in functional ability captured by the present study may reach the level of dependence on IADLs, previous studies have demonstrated that increased functional difficulty is a significant risk factor for future functional disability and cognitive decline [51][52][53]. Thus, the present findings have implications for the early identification of individuals that are increased risk for functional decline, and they add to a promising body of literature highlighting the utility of employing cardiovascularbased intervention strategies as a method for reducing the prevalence of functional decline due to cognitive impairment in the aging population (see [54] or [55] for a review).…”

Informant Reporting in Mild Cognitive Impairment: Sources of Discrepancy on the Functional Activities Questionnaire

“…That is, according to current clinical diagnostic criteria, individuals with the exact same cognitive test scores may be diagnosed with either mild dementia or MCI depending on their level of functional ability. Further, it has been shown that even small differences in the FAQ can have a robust threshold effect, such that any increase over 1 point on the FAQ sum is associated with a threefold increased risk of conversion from MCI to dementia (Mis, Devlin, Drabick, & Giovannetti, 2019) and a significantly greater risk of conversion to either MCI or dementia in healthy controls (Nowrangi, Rosenberg, & Leoutsakos, 2016). Therefore, even small effects of informant features, such as the modest effect sizes observed in this study (.008 < η p 2 's ≤ .033), may have a meaningful impact on predictive validity of the FAQ.…”

Longitudinal Study-Based Dementia Prediction for Public Health

“…Others have attempted to predict Alzheimer’s disease through genomic analysis, brain imaging, and medical record review [ 24 , 25 , 26 ]. Still others have attempted to predict dementia by changing the examination battery for dementia and its biophysical properties [ 27 , 28 , 29 ].…”

“…They performed various neuropsychological tests such as MMSE, CDRsB, FCSRT, Trail Making Test, categorical and lexical verbal fluencies, Instrumental Activities of Daily Living and Geriatric Depression Scale. Nowrangi et al [ 28 ] predicted dementia from data collected from 7625 volunteers at the National Alzheimer Coordinating Center in the United States. They found that behavioral factors, such as filing taxes, remembering dates, and significant travel affected prediction of dementia progression by surveying patients using the Functional Activities Questionnaire (FAQ).…”