Early Cognitively Based Functional Limitations Predict Loss of Independence in Instrumental Activities of Daily Living in Older Adults

Abstract

Objectives Older adults with early forms of neurodegenerative disease are at risk for functional disability, which is often defined by the loss of independence in instrumental activities of daily living (IADLs). The current study investigated the influence of mild changes in everyday functional abilities (referred to as functional limitations) on risk for development of incident functional disability. Method 407 participants, who were considered cognitively normal or diagnosed with mild cognitive impairment (MCI) at baseline, were followed longitudinally over an average 4.1 years (range = 0.8-9.2 years). Informant-based ratings from the Everyday Cognition (ECog; Farias et al., 2008) and the Instrumental Activities of Daily Living (Lawton & Brody, 1969) scales assessed the degree of functional limitations and incident IADL disability, respectively. Results Cox proportional hazards models revealed that more severe functional limitations (as measured by the Total ECog score) at baseline were associated with about a four-fold increased risk of developing IADL disability a few years later. Among the ECog domains, functional limitations in Everyday Planning, Everyday Memory, and Everyday Visuospatial domains were associated with the greatest risk of incident functional disability. These results remained robust even after controlling for participants' neuropsychological functioning on tests of executive functions and episodic memory. Conclusions Current findings indicate that early functional limitations have prognostic value in identifying older adults at risk for developing functional disability. Findings highlight the importance of developing interventions to support everyday abilities related to memory, executive function, and visuospatial skills in an effort to delay loss of independence in IADLs.

Progression from normal cognition to mild cognitive impairment in a diverse clinic‐based and community‐based elderly cohort

“…Such findings suggest that there are subtle changes in everyday functioning present even prior to being able to detect clear cognitive impairment that are harbingers of early disease and subsequent cognitive impairment. This is consistent with other studies showing that there are mild functional limitations present in cognitively normal individuals who later go on to be diagnosed with MCI or dementia 13,14,33 .…”

Monitoring Older Adults’ Health Information Using Mobile Technology: A Systematic Literature Review

“…The loss of autonomy and independence while carrying out activities of daily living and falls are among the top concerns of older adults, because they could lead them to have functional limitations [55,56]. The results of our SLR agree with this, as most of the articles that were selected are related to these two topics, as shown in Figure 3.…”

Self-perceived Difficulties in Everyday Function Precede Cognitive Decline among Older Adults in the ACTIVE Study

“…It is also associated with economic burden as it necessitates the need for assistance by family or formal paid caregivers (Small et al, 2002). Although loss of IADL independence is a key feature of a dementia syndrome, it is also now well recognized that subtle changes in everyday function begin early in a neurodegenerative process, including at the stage of mild cognitive impairment (MCI) (Tomaszewski Farias et al, 2006; Nygård, 2006; Albert 2011) and even in those still considered cognitively normal but who later develop MCI or dementia (Tomaszewski Farias et al, 2013; Tomaszewski Farias et al, 2011; Lau et al, 2016). However, careful characterization of how functional decline develops in association with other clinical features, particularly cognitive decline, is still needed.…”