Everyday Cognition Scale Items that Best Discriminate Between and Predict Progression From Clinically Normal to Mild Cognitive Impairment

Abstract

Background Impairment in instrumental activities of daily living (IADL) starts as individuals with amnestic mild cognitive impairment (MCI) transition to Alzheimer’s disease (AD) dementia. However, most IADL scales have not shown IADL alterations in clinically normal (CN) elderly. The objective of this study was to determine which of the IADL-related Everyday Cognition (ECog) scale items are most sensitive for detection of early functional changes. Methods We assessed 290 CN and 495 MCI participants from the Alzheimer’s Disease Neuroimaging Initiative. We performed logistic regression analyses predicting the probability of CN vs. MCI diagnosis using only the 17 participant-based and 17 informant-based ECog items related to IADL. We then performed Cox regression analyses to predict progression from CN to MCI. All analyses were adjusted for demographic characteristics. Results We found that worse performance on “remembering a few shopping items” (participant and informant-based p<0.0001), “remembering appointments” (participant and informant-based p<0.0001), “developing a schedule in advance of anticipated events” (participant-based p=0.007), “balancing checkbook” (participant-based p=0.02), and “keeping mail and papers organized” (informant-based p=0.002) best discriminated MCI from CN. We found that worse performance on “keeping mail and papers organized” (participant-based Hazard Ratio (HR)=2.27, p=0.07) marginally predicted greater hazard of progressing from CN to MCI. Conclusions Our results indicate that a few simple questions targeting early functional changes, addressed either to the individual or informant, can effectively distinguish between CN elderly and individuals with MCI. Additionally, one of the above questions related to organization suggested which CN individuals are likely to progress to MCI.

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 .…”

“…Finally, while changes in everyday function have traditionally been thought of as late occurring manifestations of AD, a growing body of literature demonstrates that mild changes in everyday function are commonly observed in MCI 11,12 . More recent studies have shown that very subtle changes in complex everyday functional tasks can also be observed in cognitively normal older adults who later go on to develop MCI 13,14 .…”

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

“…Specifically, there is a growing body of work demonstrating that individuals with Mild Cognitive Impairment (MCI), often a prodromal state prior to a diagnosis of dementia, show mild changes in their ability to perform everyday activities (Brown, Devanand, Liu, Caccappolo, & Alzheimer's Disease Neuroimaging Initiative, 2011; Burton, Strauss, Bunce, Hunter, & Hultsch, 2009; Peres et al, 2011; Perneczky et al, 2006; Tabert et al, 2002). There is even some evidence to suggest that there are detectable functional limitations in cognitively normal elders who later go on to develop MCI (Farias, Chou, et al, 2013; Marshall et al, 2014). …”

Longitudinal Modeling of Functional Decline Associated with Pathologic Alzheimer’s Disease in Older Persons without Cognitive Impairment

“…Although we observed significant differences between the trajectories of functional decline between individuals with and without AD dementia, the effect sizes of functional decline associated with clinical or pathologic diagnosis of AD may have been underestimated. It has been shown care-givers may assesse the functional performance of MCI or AD patients more accurately [14,45,46]. Alternatively, objective measures collected by performance-based tests or digital devices to track a patient’s ability to perform the daily activities of living, such as the patient’s capability to use computer in daily life and whether the patient is taking medications according to prescribed schedule, may give more accurate and quantitative measures of the patient’s functional performance.…”