Mild Cognitive Impairment and Changes in Everyday Function Over Time: The Importance of Evaluating Both Speed and Accuracy

Abstract

OBJECTIVES Research estimates that a significant percentage of individuals with Mild Cognitive Impairment (MCI) experience functional difficulties. In addition to reduced accuracy on measures of everyday function, cross-sectional research has demonstrated that speed of performing instrumental activities of daily living (IADLs) is slowed in individuals with MCI. The present study investigated whether baseline and longitudinal changes in speed and accuracy of IADL performance differed between persons with MCI and cognitively normal peers. DESIGN Linear mixed models were used to estimate group differences in longitudinal performance on measures of IADLs. SETTING Assessments were conducted at university and medical research centers. PARTICIPANTS The sample consisted of 80 participants with MCI and 80 control participants who were enrolled in the Alzheimer’s Disease Research Center’s Measuring Independent Living in the Elderly Study (MILES). MEASUREMENTS IADL speed and accuracy were directly assessed using selected domains of the Financial Capacity Instrument, the Timed IADL assessment, and driving-related assessments (Useful Field of View, Road Sign Test). RESULTS Individuals with MCI performed worse on speed and accuracy measures of IADLs in comparison to cognitively normal peers and demonstrated significantly steeper rates of decline over 3 years in either speed or accuracy in all domains assessed. CONCLUSION Both speed and accuracy of performance on measures of IADL are valuable indices for early detection of functional change in MCI. The performance pattern may reflect a trade-off between speed and accuracy that can guide clinical recommendations for maintaining patient independence.

Effects of creative expression therapy for older adults with mild cognitive impairment at risk of Alzheimer’s disease: a randomized controlled clinical trial

“…Patients with MCI may not present with significant neuropsychological deficits, but instead with mild cognitive dysfunction, especially in memory, speed, and accuracy, which have been associated with the normal aging process. 35 During CrExp exercises, MCI patients are given the opportunity to use creativity, imagination, and thinking processes that may otherwise remain used. In addition, those who participate in CrExp share stories with peers who may naturally stimulate improved communication, attention, and expression abilities as well as general cognition and well-being.…”

Can we afford this? The capability to make financial decisions in individuals with and without cognitive impairment

“…The FCI is used in twenty-two studies included in this review (i.e., Earnst et al, 2001;Gerstenecker et al, , 2019Gerstenecker, Hoagey, et al, 2017;Gerstenecker, Myers, et al, 2017;Griffith et al, 2003Griffith et al, , 2007Griffith et al, , 2010Lassen-Greene et al, 2017;Martin et al, 2013Martin et al, , 2019Niccolai et al, 2017;Sherod et al, 2009;Stoeckel et al, 2013;Tracy et al, 2017;Triebel et al, 2009). 6.…”

“…In addition, primary outcome measures and the most important results of each paper relevant for the research questions at hand are described (Table 4.2). Some studies describe the use of participants from the same study cohort, i.e., from the Cognitive Observations in Seniors Study (COINS; Gerstenecker et al, , 2019Gerstenecker, Hoagey, et al, 2017;Niccolai et al, 2017) or the Measuring Independent Living in the Elderly Study (MILES;Lassen-Greene et al, 2017;. However, despite the same study cohort has been used, there is insufficient evidence that the same sample has been used in these studies and, therefore, these studies are treated and described as separate studies in the content and meta-analysis.…”

“…In most studies, participants were diagnosed with single-or multiple-domain amnestic MCI (Table 4.2b). However, not all studies reported the subtype of MCI of the participants that were included (Arcara et al, 2019;Benavides-Varela et al, 2015;Duke Han et al, 2015;Kenney et al, 2019;Lassen-Greene et al, 2017;Martin et al, 2019;Triebel et al, 2009). Some studies used a mixed MCI group including both single-and/or multiple-domain amnestic and non-amnestic MCI (Bangen et al, 2010; and three studies divided their sample in people living with MCI who progressed to AD and people living with MCI who showed no progression at follow-up (e.g., MCI converters vs. MCI non-converters, respectively; Bangen et al, 2010;Triebel et al, 2009).…”

“…The domains 'basic monetary skills' and 'financial judgment' of the FCI seem to remain relatively intact in people living with MCI (Gerstenecker et al, , 2019Gerstenecker, Hoagey, et al, 2017;Griffith et al, 2003). Furthermore, people living with MCI appear to have no difficulties with 'expressing a choice' when making financial decisions (Lui et al, 2013), but need more time than healthy controls to complete a FDM task (Lassen-Greene et al, 2017;. In a computer-based simulation task, people living with MCI were found to have more difficulties than healthy controls with the use of an ATM .…”