Patients with MCI had a predominant memory impairment with relative sparing of other cognitive domains and were intermediate between clinically normal individuals and patients with AD on cognitive and functional ratings. These results demonstrate the successful implementation of operational criteria for this unique group of at-risk patients in a multicenter clinical trial.

This article describes the development and validation of an instrument to assess cognitively mediated functional abilities in older adults, Everyday Cognition (ECog). The ECog is an informant-rated questionnaire comprised of multiple subscales. Confirmatory factor analysis (CFA) was used to examine its factor structure. Convergent validity was evaluated by comparing it to established measures of everyday function. External validity was evaluated by comparing ECog results across different clinical groups [cognitively normal, mild cognitive impairment (MCI), dementia]. CFA supported a seven-factor model including one global factor and six domain-specific factors (Everyday Memory, Language, Visuospatial Abilities, Planning, Organization, and Divided attention). The ECog correlated with established measures of functional status and global cognition, but only weakly with age and education. The clinical groups performed differently in each domain. In addition to the global factor, the Everyday Memory factor independently differentiated MCI from Normal, while the Everyday Language domain differentiated Dementia from MCI. Different subtypes of MCI also showed different patterns. Results suggest the ECog shows promise as a useful tool for the measurement of general and domain-specific everyday functions in the elderly.

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The purpose of the present study was to examine the types of impairments in everyday function that accompany mild cognitive impairment (MCI). Data for this study was collected from 434 individuals consecutively evaluated at a university-based Alzheimer's Center. A total of 96 participants were diagnosed with MCI, 105 were cognitively normal, and 233 had dementia. Informant ratings of participants' abilities were obtained across different functional domains reflecting everyday abilities related to memory, language, visual spatial abilities, planning, organization, and divided attention. As expected, the demented group was significantly more impaired than the healthy control and MCI groups across all of the functional domains. The MCI group also showed significantly more functional impairment relative to healthy controls in all of the functional domains. Examination of the effect sizes as a measure of the magnitude of functional impairment in the MCI groups relative to controls showed that the greatest degree of impairment occurred within the Everyday Memory domain. The current findings suggest that individuals with MCI demonstrate deficits in a wide range of everyday functions but that the magnitude of these changes is greatest for those functional abilities that rely heavily on memory. Keywords mild cognitive impairment (MCI); dementia; functional impairmentThe cognitive changes associated with degenerative dementias such as Alzheimer disease (AD) result in progressive declines in the ability to perform activities of daily living (ADL). 1,2 Mild cognitive impairment (MCI), a syndrome intermediate to normality and dementia, has become increasingly well defined and extensively studied as a prodrome to and predictor of dementia. 3 Although numerous studies have examined functional impairments in dementia, far less research has focused on functional change in MCI. The International Working Group on MCI recently noted that there is currently very little known about which aspects of everyday function are affected in MCI. 4 The initial diagnostic criteria for MCI specified intact or "only slightly abnormal ADL. 3 " However, functional change presumably occurs over the course of MCI because it is precisely such cumulative change that leads to eventual conversion to dementia. A few recent studies have, in fact, suggested that mild changes in daily functioning can be detected in MCI groups. 5,6 At present, the natural history of functional change between normal aging and dementia is undefined. This leaves guidelines for rating functional change in MCI The detection of change in everyday function in MCI is dependent on the method of assessment, more so than in dementia where these changes are severe and pervasive. It has been well established that functional impairments in dementia follow a gradient, such that basic self-care activities (eg, eating, dressing, grooming) are affected after higher order functional abilities become impaired. 8,9 Thus, when investigating changes in everyday function associated with MCI ...

Age-related dysfunction of frontal systems can result in deficits in planning, organization, self-control, and awareness of problems, which are likely to affect the ability to care for one's self. The purpose of this study was to determine the relationship between age-related frontal/executive deficits and impairment in instrumental activities of daily living (IADLs) in elderly individuals. Twenty-seven community-dwelling individuals were administered a comprehensive battery of neuropsychological tests and a performance-based evaluation of IADLs. Multiple regression analyses indicated that executive function and depression severity accounted for a significant proportion of variance in IADLs, with executive function making the greatest contribution. Tests measuring other cognitive functions, such as memory, language, and spatial skills, did not contribute significantly to the prediction of functional status. Furthermore, executive measures accounted for more variance than other demographic characteristics such as general health status, age, and educational level. The results of this study indicate that executive dysfunction in normal aging may be the best predictor of functional decline. A better understanding of the mechanisms that underlie IADL skills will ultimately aid in the development of compensatory and intervention strategies designed to delay the onset of assisted living and nursing home placement.

The purpose of this study was to examine the utility of specific tests of executive functioning for predicting instrumental activities of daily living (IADLs) in community-dwelling older individuals (n = 30). In addition to tests of frontal and executive functioning, performance-based and caregiver-rated evaluations of IADLs were obtained. Results indicated that different tests of executive functioning were associated with outcomes on performance-based versus caregiver-rated assessments of IADLs. Specifically, the Trail Making Test (Part B) made a significant and unique contribution to the prediction of performance-based IADLs. In contrast, verbal fluency performance and Trail Making Test performance made significant independent contributions to the prediction of IADLs as reported by a caregiver. These findings suggest that different aspects of frontal and executive functions may be related to IADLs, depending on the type of assessment instrument used. Key words: activities of daily living, executive function, older adults

Impaired ability to conduct daily activities is a diagnostic criterion for dementia and a determinant of healthcare services utilization and caregiver burden. What predicts decline in instrumental activities of daily living (IADLs) is not well understood. This study examined measures of episodic memory, executive function, and MRI brain volumes in relation to baseline IADLs and as predictors of rate of IADL change. Participants were 124 elderly persons with cognitive function between normal and moderate dementia both with and without significant small vessel cerebrovascular disease. Random effects modeling showed that baseline memory and executive function (EXEC) were associated with baseline IADL scores, but only EXEC was independently associated with rate of change in IADLs. Whereas hippocampal and cortical gray matter volumes were significantly associated with baseline IADL scores, only hippocampal volume was associated with IADL change. In a model including cognitive and neuroimaging predictors, only EXEC independently predicted rate of decline in IADL scores. These findings indicate that greater executive dysfunction at initial assessment is associated with more rapid decline in IADLs. Perhaps executive function is particularly important with respect to maintaining IADLs. Alternatively, executive dysfunction may be a sentinel event indicating widespread cortical involvement and poor prognosis.

Impaired everyday function is a diagnostic criterion for dementia, and a determinant of healthcare utilization and caregiver burden. Although many previous studies have demonstrated a crosssectional relationships between cognition (particularly executive functions and memory) and everyday function in older adults, very little is known about longitudinal relationships between these domains. This study examined the association between longitudinal change in episodic memory (MEM) and executive functioning (EXEC) and change in everyday function. Participants were a cognitively heterogeneous group of 100 elderly persons including those with normal cognition, as well as those with mild cognitive impairment and dementia. They were followed for an average of five years. Random effects modeling showed that change in both MEM and EXEC were independently associated with rate of change in informant-rated instrumental activities of daily living (IADLs), even after controlling for age, education, and gender. Findings indicate that declines in MEM and EXEC over time make unique and independent contributions to declines in older adults' ability to function in daily life. KeywordsMemory; Executive functioning; Everyday Function; dementia; Alzheimer's disease Mild Cognitive Impairment (MCI) and dementias such as Alzheimer's disease (AD) become increasingly common with age. They are both associated with problems in everyday function that result in patient and caregiver distress, reduced quality of life, increased use of healthcare services, and nursing home placement (Hope, Keene, Gedling, Fairburn, & Jacob, 1998;Vetter et al., 1999). Given its associated burden, an improved understanding of the determinants of functional decline, including the nature of the relationship between the development of specific cognitive impairments and the development of functional impairments is paramount. The assessment of everyday functioning in older adults typically focuses on an individual's ability to carry out activities of daily living (ADLs) because it is these activities that are critical to independent living. Basic ADLs (BADLs) include tasks such as grooming, feeding, and toileting, while instrumental ADLs (IADLs) involve complex behaviors including managing finances, handling medications, and housekeeping. BADLs are highly correlated with motor functioning and coordination (Bennett et al., 2002;Boyle, Cohen, Paul, Moser, & Gordon, 2002;Cahn & Sullican, 1998). In contrast, declines in IADLs have been shown to be more influenced by cognitive functioning, are affected relatively early in the course of dementia (Stern, Hesdorffer, Sano, & Mayeuz, 1990), and can even be present in preclinical dementia states such as mild cognitive impairment (MCI) (Griffith et al., 2003;Ritchie, Artero, & Touchon, 2001).Previous studies have demonstrated cross-sectional relationships between neuropsychological performance and everyday function in older adult populations. Among these studies, the cognitive domains most consistently found to be associat...