Heterogeneity of Informant-Reported Functional Performance in Mild Cognitive Impairment: A Latent Profile Analysis of the Functional Activities Questionnaire

Abstract

Heterogeneity of subtle functional difficulties in mild cognitive impairment (MCI) remains poorly understood. We characterized patterns of informant reports of functional abilities among participants with MCI and the relation between functional ability pattern and cognitive abilities and subsequent decline. Data from 4,273 MCI participants from the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS) were included in latent profile analyses (LPA) of informant responses on the Functional Activities Questionnaire (FAQ). Profiles from the best fitting model were compared on demographic, clinical, and cognitive variables. The best fitting model supported three profiles varying by level and type of difficulty: intact function (n = 3,299), intermediate (n = 769), and high ratings of difficulty (n = 205). For the Intermediate profile, items related to finances, remembering dates, and travel were rated as most difficult. The High Ratings profile also had elevated ratings on the meal preparation item. Participants with either the Intermediate or High Ratings profile demonstrated a three-fold increase in conversion to dementia as compared to participants with the Intact profile. Demographically, the Intact profile was younger and consisted of a higher proportion of minorities. On cognitive tests, the Intact profile showed the best performance, and the Intermediate profile performed comparably to or better than the High Ratings profile. There is meaningful heterogeneity in informant ratings of function in MCI, though individuals with MCI whose informants report even intermediate-level functional difficulties are more likely to progress to dementia, suggesting that even subtle functional difficulties place individuals at higher risk for future decline.

The Cognitive Scale of Basic and Instrumental Activities of Daily Living for Multidomain Mild Cognitive Impairment and Dementia Patients: Validation of its Extended Version

“…These findings differ from what is established by the diagnostic criteria for mdMCI. The present results, together with those of previous studies (Kaur, Belchior, Gelinas, & Bier, 2016;Mis, Devlin, Drabick, & Giovannetti, 2019;Rodríguez-Bailón et al, 2015, show the need to pay special attention to the evaluation of subtle cognitive processes involved in everyday tasks. The contribution of our study to the existing knowledge about the cognitive-functional deficits that characterize patients with mdMCI and dementia in initial stages can help in the early diagnosis of this population using a quick and simple tool that can assess patients in their everyday contexts.…”

Informant Reporting in Mild Cognitive Impairment: Sources of Discrepancy on the Functional Activities Questionnaire

“…That is, according to current clinical diagnostic criteria, individuals with the exact same cognitive test scores may be diagnosed with either mild dementia or MCI depending on their level of functional ability. Further, it has been shown that even small differences in the FAQ can have a robust threshold effect, such that any increase over 1 point on the FAQ sum is associated with a threefold increased risk of conversion from MCI to dementia (Mis, Devlin, Drabick, & Giovannetti, 2019) and a significantly greater risk of conversion to either MCI or dementia in healthy controls (Nowrangi, Rosenberg, & Leoutsakos, 2016). Therefore, even small effects of informant features, such as the modest effect sizes observed in this study (.008 < η p 2 's ≤ .033), may have a meaningful impact on predictive validity of the FAQ.…”

The goal-control model: An integrated neuropsychological framework to explain impaired performance of everyday activities.

“…Although it was once thought that the familiarity and frequency of everyday tasks made them impervious to mild cognitive difficulties, empirical research shows that even relatively simple and highly familiar everyday activities are negatively affected by distraction and subtle cognitive changes or decline (Tucker-Drob, 2011). In fact, in healthy older adults and older adults with MCI, mild functional difficulties are associated with cognitive abilities/deficits (Beaver et al, 2019; Black & Rush, 2002; Colón-Emeric et al, 2013; Freedman et al, 2002) and predict subsequent cognitive decline and dementia (Gomar et al, 2011; Farias et al, 2018; Mis et al, 2019; Tucker-Drob, 2011).…”