Everyday functioning and cognitive correlates in healthy older adults with subjective cognitive concerns

Abstract

Objective Few studies have examined functional abilities and complaints in healthy older adults with subjective cognitive concerns (SCC). The aims of this study were to assess everyday functioning in healthy older adults reporting high and low amounts of SCC, and examine cognitive correlates of functional abilities. Method Twenty-six healthy older adults with high SCC, and 25 healthy older adults with low SCC, as well as their knowledgeable informants completed the Instrumental Activities of Daily Living-Compensation (IADL-C), a questionnaire measure of everyday functioning. Results After controlling for depression, the high SCC group self-reported significantly more everyday difficulties on the IADL-C, including all subdomains. Compared to the low SCC group, informants for the high SCC group endorsed more difficulties on the IADL-C and specifically the social skills subdomain. For the high SCC group, poorer self-report of everyday functioning was related to poorer executive functioning and temporal order memory. Conclusions These findings indicate that there may be subtle functional changes that occur early in the spectrum of cognitive decline in individuals with high SCC, and these functional changes are evident to informants. Further work is needed to investigate whether individuals with both SCC and functional difficulties are at an even higher risk for progression to mild cognitive impairment.

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

“…Initially, such findings may seem to run counter to most traditional models of symptom development associated with neurodegenerative diseases of aging in which cognitive deterioration, measured by conventional neuropsychological tests of these abilities, are expected to be evident before deterioration in everyday functioning. Our results, however, are consistent with a growing body of research suggesting that older adults who are seemingly cognitively normal may be able to detect subtle changes in their everyday functional abilities (for example, taking longer to complete complex IADLs or being prone to making more errors) before changes are evident on objective tests of neuropsychological function (Tomaszewski Farias et al, 2013; McAlister & Schmitter-Edgecombe, 2016). Our results are consistent with other previous studies that have shown that when subjectively reported functional changes are present in individuals who still perform within the normal range on cognitive tests, it substantially increases the risk they will develop frank cognitive impairment (i.e., MCI) in subsequent years (Amariglio et al, 2015).…”

Is function in instrumental activities of daily living a useful feature in predicting Alzheimer's disease dementia in subjective cognitive decline?

“…11 Another study found significant subtle functional changes, specifically in handling finances, self-management, and travel and event memory, in individuals with high subjective cognitive concerns. 9 Stogmann et al saw a decreased functional performance in SCD patients compared with controls. 12 Second, in longitudinal analyses, impaired IADL in SCD were associated with higher risk of MCI.…”

“…Ogata et al suggested self‐reported impaired higher‐level functional capacity in SCD in women, but not in men . Another study found significant subtle functional changes, specifically in handling finances, self‐management, and travel and event memory, in individuals with high subjective cognitive concerns . Stogmann et al saw a decreased functional performance in SCD patients compared with controls .…”

“…IADL are complex and cognitively demanding tasks, and IADL performance is correlated with the level of general cognitive functioning: IADL impairment increases with progressing cognitive decline . Because of their complexity, difficulties in IADL occur early in the spectrum of progression to dementia …”

“…8 Because of their complexity, difficulties in IADL occur early in the spectrum of progression to dementia. 9 Although we assume that function is largely intact in SCD, there is reason to consider IADL in SCD. First, cross-sectional findings noted a significant association of SCD and impaired function, with every item of the Lawton and Brody IADL scale as well as of the Katz Index of Independence in ADL that were both administered as self-report measures of functional performance.…”