To characterize the prevalence of functional limitations among older adults with cognitive impairment without dementia (CIND).
Methods:
Secondary data analysis was performed using the Aging, Demographics, and Memory Study data set. A total of 856 individuals aged ≥ 71 years were assigned to 3 diagnostic cognitive categories. A questionnaire was completed by a proxy informant regarding functional limitations for 744 of the 856 respondents.
Results:
Of the 744 patients, 263 (13.9%) had dementia, 201 (21.3%) had CIND, and 280 (64.8%) had normal cognition. Informants reported ≥1 instrumental activities of daily living (ADLs) limitation in 45% of the patients with CIND compared to 13% of the patients with normal cognition and 85% of the patients with dementia (P < .001). The ADL impairments among individuals with CIND were primarily attributed to physical health problems (n = 41; 40%).
Conclusions:
Many individuals with CIND have impairment in a range of complex and basic daily activities, largely due to physical health problems.
PlassmanBLLangaKMFisherGGPrevalence of cognitive impairment without dementia in the United States. Ann Intern Med. 2008;148(6):427–434.
2.
LopezOLJagustWJDeKoskySTPrevalence and classification of mild cognitive impairment in the cardiovascular health study cognition study: part 1. Arch Neurol. 2003;60(10):1385–1389.
3.
PetersenRCStevensJCGanguliMTangalosEGCummingsJLDeKoskyST. Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review) - Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001;56(9):1133–1142.
4.
EdlandSDRoccaWAPetersenRCChaRHKokmenE.Dementia and Alzheimer disease incidence rates do not vary by sex in Rochester, Minn. Arch Neurol. 2002;59(10):1589–1593.
5.
PetersenRC. Mild cognitive impairment as a diagnostic entity. J Intern Med. 2004;256(3):183–194.
6.
LopezOLKullerLHBeckerJTIncidence of dementia in mild cognitive impairment in the cardiovascular health study cognition study. Arch Neurol. 2007;64(3):416–420.
7.
LyketsosCGLopezOJonesBFitzpatrickALBreitnerJDeKoskyS. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment - Results from the cardiovascular health study. JAMA. 2002;288(12):1475–1483.
8.
TabertMAlbertSMBorukhova-MilovLFunctional deficits in patients with mild cognitive impairment - Prediction of AD. Neurology. 2002;58(5):758–764.
9.
PerneczkyRPohlCSorgCImpairment of activities of daily living requiring memory or complex reasoning as part of the MCI syndrome. Int J Geriatr Psychiatry. 2006;21(2):158–162.
10.
WadleyVGCroweMMarsiskeMChanges in everyday function in individuals with psychometrically defined mild cognitive impairment in the advanced cognitive training for independent and vital elderly study. J Am Geriatr Soc. 2007;55(8):1192–1198.
11.
FariasSTMungasDReedBRHarveyDCahn-WeinerDDecarliC. MCI is associated with deficits in everyday functioning. Alzheimer Dis Assoc Dis. 2006;20(4):217–223.
12.
BoylePABuchmanASWilsonRSLeurgansSEBennettDA. Physical frailty is associated with incident mild cognitive impairment in community-based older persons. J Am Geriatr Soc. 2010;58(2):248–255.
13.
WestonABartonCLesselyongJYaffeK. Functional deficits among patients with mild cognitive impairment. Alzheimers Dement. 2011;7(6):611–614.
14.
BaldereschiMAmaducciLMaggiSCognitive impairment without dementia in older people: prevalence, vascular risk factors, impact on disability. The Italian Longitudinal Study on Aging. J Am Geriatr Soc.2000;48(7):775–782.
15.
PerneczkyRPohlCSorgCComplex activities of daily living in mild cognitive impairment: conceptual and diagnostic issues. Age Ageing. 2006;35(3):240–245.
16.
MarianiEMonasteroRErcolaniSInfluence of comorbidity and cognitive status on instrumental activities of daily living in amnestic mild cognitive impairment: results from the ReGA1 project. Int J Geriatr Psychiatry. 2008;23(5):523–530.
17.
PeresKHelmerCAmievaHNatural history of decline in instrumental activities of daily living performance over the 10 years preceding the clinical diagnosis of dementia: a prospective population-based study. J Am Geriatr Soc. 2008;56(1):37–44.
18.
Di CarloABaldereschiMAmaducciLCognitive impairment without dementia in older people: prevalence, vascular risk factors, impact on disability. The Italian Longitudinal Study on Aging. J Am Geriatr Soc.2000;48(7):775–782.
19.
ThomasVS. Excess functional disability among demented subjects? Findings from the Canadian Study of Health and Aging. Dement Geriatr Cogn Disord.2001;12(3):206–210.
20.
Health and Retirement Study, Sample Evolution: 1992-1998 [hrsonline.isr.umich.edu]. 2008[cited October 7, 2012]
21.
LangaKMPlassmanBLWallaceRBThe aging, demographics, and memory study: study design and methods. Neuroepidemiology. 2005;25(4):181–191.
22.
FolsteinMFFolsteinSEMcHughPR. “Mini-mental state”. A practical method for grading cognitive state of patients for clinician. J Psychiatr Res.1975;12(3):189–198.
23.
BreitnerJCWyseBWAnthonyJCAPOE-epsilon 4 count predicts age when prevalence of AD increases, then declines: the Cache County Study. Neurology. 1999;53(2):321–331.
24.
PlassmanBLHavlikRJSteffensDCDocumented head injury in early adulthood and risk of Alzheimer's disease and other dementias. Neurology. 2000;55(8):1158–1166.
25.
PlassmanBLSteffensDCBurkeJRDuke twins study of memory in aging in the NAS-NRC twin registry. Twin Res Hum Genet. 2006;9(6):950–957.
26.
KatzSFordABMoskowitzRWJacksonBAJaffeMW. Studies of Illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963;185:914–919.
27.
SpectorWDKatzSMurphyJBFultonJP.The hierarchical relationship between activities of daily living and instrumental activities of daily living. J Chronic Dis. 1987;40(6):481–489.
28.
McKhannGDrachmanDFolsteinMKatzmanRPriceDStadlanEM.Clinicial diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. 1984;34(7):939–944.
29.
RomanGCTatemichiTKErkinjunttiTVascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology.1993;43(2):250–260.
30.
TatemichiTKSacktorNMayeuxR. Dementia associated with cerebrovascular disease, other degenerative diseases, and metabolic disorders. In: TerryRDKatzmanRBickKL, eds. Alzheimer’s Disease. New York, NY: Raven Press; 1994.
31.
FriedLPEttingerWHLindBNewmanABGardinJ. Physical-disability in older adults: a physiological approach.Cardiovascular Health Study Research Group. J Clin Epidemiol. 1994;47(7):747–760.
32.
KempenGSuurmeijerT. The development of a hierarchical polychotomous ADL-IADL scale for noninstitutionalized elders. Gerontologist. 1990;30(4):497–502.
33.
RubinGSRocheKBPrasadaraoPFriedLP. Visual impairment and disability in older adults. Optom Vis Sci. 1994;71(12):750–760.
34.
FriedLPBandeen-RocheKKasperJDGuralnikJM. Association of comorbidity with disability in older women: the Women's Health and Aging Study. J Clin Epidemiol. 1999;52(1):27–37.
35.
GrundmanMPetersenRCFerrisSHMild cognitive impairment can be distinguished from Alzheimer disease and normal aging for clinical trials. Arch Neurol. 2004;61(1):59–66.
36.
JobeJBSmithDMBallKACTIVE: a cognitive intervention trial to promote independence in older adults. Control Clin Trials. 2001;22(4):453–479.
37.
TellGSFriedLPHermansonBManolioTANewmanABBorhaniNO. Recruitment of adults 65 years and older as participants in the Cardiovascular Health Study. Ann Epidemiol. 1993;3(4):358–366.
38.
Canadian Study Of Health And Aging Working G. Canadian study of health and aging: study methods and prevalence of dementia. CMAJ. 1994;150(6):899–912.
39.
HeeringaSGFisherGGHurdMD. Aging, Demographics and Memory Study: Sampling Design, Weighting and Analysis for ADAMS. Health and Retirement Study; 2007.
40.
DeBettigniesBHMahurinRKPirozzoloFJ. Insight for impairment in independent living skills in Alzheimer's disease and multi-infarct dementia. J Clin Exp Neuropsychol. 1990;12(2):355–363.
41.
MangoneCAHierDBGorelickPBImpaired insight in Alzheimer's disease. J Geriatr Psychiatry Neurol. 1991;4(4):189–193.
