Predictors of functional impairment and awareness in people with dementia, mild cognitive impairment and healthy older adults from a middle-income country

Abstract

ObjectiveTo investigate the demographic, clinical and cognitive correlates of functional capacity and its awareness in people with dementia (PwD; n = 104), mild cognitive impairment (PwMCI; n = 45) and controls (healthy older adults; n = 94) in a sample from a middle-income country.MethodsDementia and MCI were diagnosed, respectively, with DSM-IV and Petersen criteria. Performance in activities of daily living (ADL) at three different levels [basic (The Katz Index of Independence), instrumental (Lawton instrumental ADL scale) and advanced (Reuben’s advanced ADL scale)], measured through self- and informant-report, as well as awareness (discrepancy between self- and informant-report), were compared between groups. Stepwise regression models explored predictors of ADL and their awareness.ResultsPwD showed impairment in all ADL levels, particularly when measured through informant-report. No differences were seen between controls and PwMCI regardless of measurement type. PwD differed in awareness of instrumental and basic, but not of advanced ADL, compared to controls. Age, gender, education and fluency were the most consistent predictors for ADL. Diagnosis was a significant predictor only for instrumental ADL. Awareness of basic ADL was predicted by memory, and awareness of instrumental ADL was predicted by general cognitive status, educational level, and diagnosis.ConclusionResults reinforce the presence of lack of awareness of ADL in PwD. Use of informant-reports and cognitive testing for fluency are suggested for the clinical assessment of ADL performance. Finally, assessment of instrumental ADL may be crucial for diagnostic purposes.

A Novel Dual-Language Touch-Screen Intervention to Slow Down Cognitive Decline in Older Adults: A Randomized Controlled Trial

“…Although our study focused on the cognitive benefits of DL training and did not examine the clinical significance of the training, past studies showed that the Clock Drawing Test is one of the important indicators that predict the future dementia progression of a cognitively healthy older adult ( Tsiaras et al, 2023 ; Umegaki et al, 2020 ), as well as whether an MCI older adult will revert back to healthy cognition in the near future ( Tsiaras et al, 2023 ). Similarly, the RAVLT score is found to correlate with more independent activities of daily living in healthy older adults ( Hartle et al, 2022 ; Mograbi et al, 2014 ) and better quality of life in Parkinson’s Disease patients ( Olchik et al, 2016 ). Furthermore, the RAVLT score is suggested to predict whether an MCI patient would remain as MCI or progress to dementia within 2 years to a decade ( Dawidowicz et al, 2021 ; Quaranta et al, 2023 ).…”

Prediction Model for Cognitive Impairment among Disabled Older Adults: A Development and Validation Study

“…These scales reflect the level of disability, with higher scores associated with poorer ability to live independently [53,54]. Dysfunction was significantly associated with cognitive decline in older adults [55,56]. This association may stem from the simultaneous decline in physical and cognitive functioning caused by aging related to changes in brain circuitry and pathology [57,58].…”

“…A study on older adults from middle-income countries found that both ADL and IADL were predictors of dementia and MCI. Notably, IADL may have a more sensitive measurement effect [56]. A possible explanation is that the IADL scale involves memory and execution.…”