SIST-M-IR Activities of Daily Living Items that Best Discriminate Clinically Normal Elderly from those with Mild Cognitive Impairment

Abstract

Background Activities of daily living (ADL) impairment is a hallmark of Alzheimer's disease (AD) dementia, but impairment in instrumental ADL (IADL) has been reported in mild cognitive impairment (MCI). The Structured Interview and Scoring Tool-Massachusetts Alzheimer's Disease Research Center (MADRC)-Informant Report (SIST-M-IR) includes 60 graded items that assist in scoring the Clinical Dementia Rating; it assesses the spectrum of cognitive and ADL changes relevant to early AD. Of the 60 SIST-M-IR items, 41 address IADL; we aimed to determine which of these best discriminate individuals with MCI from clinically normal (CN) elderly. Methods We assessed 447 subjects participating in the MADRC longitudinal cohort (289 CN, 158 MCI). We performed logistic regression analyses predicting the probability of CN vs. MCI diagnosis using the SIST-M-IR items. Analyses were adjusted for demographic characteristics. Results We found that 4 SIST-M-IR items best discriminated between CN and MCI subjects (MCI performing worse than CN): “participating in games that involve retrieving words” (p=0.0001), “navigating to unfamiliar areas” (p=0.001), “performing mental tasks involved in a former primary job” (p=0.002), and “fixing things or finishing projects” (p=0.002). Conclusions Our results point to the earliest functional changes seen in elderly at risk for AD, which could be captured by a few simple questions. Honing the sensitivity of clinical assessment tools will help clinicians differentiate those individuals with normal aging from those who are developing cognitive impairment.

Functional Activities Questionnaire Items that Best Discriminate and Predict Progression from Clinically Normal to Mild Cognitive Impairment

“…Several subjective IADL scales have been used to successfully distinguish between CN and MCI: the total score of the FAQ, the CDR, the Structured Interview and Scoring Tool—MADRC Informant Report (SIST-M-IR), the ADL-Prevention Instrument (ADL-PI), and the ECog [3,4,26–28]. Four of the SIST-M-IR items in particular have been shown to best discriminate between CN and MCI [29]. Moreover, the SIST-M-IR and ADL-PI total scores have been shown to successfully predict progression from CN to MCI and future cognitive decline in CN elderly [27,28].…”

Social Markers of Mild Cognitive Impairment: Proportion of Word Counts in Free Conversational Speech

“…Research is increasingly focused on identifying AD at the MCI stage, or even earlier, in order to prompt interventions and to access clinical trials with disease-modifying drugs [ 41 ]. Clearly, higher-order functional activities have been shown to distinguish those at risk of developing MCI from those remaining cognitively normal [ 42 - 44 ]. Studies utilizing continuous, unobtrusively monitored in-home activity data in a community setting also showed that these ecologically valid activity measures could identify early changes among those who convert to MCI [ 13 ].…”

Can you detect early dementia from an email? A proof of principle study of daily computer use to detect cognitive and functional decline

“…Impairments in cognitive and functional abilities can be detected in the prodromal or “mild cognitive impairment (MCI)” stage of dementia . Identifying the earliest symptoms of MCI is important for predicting progression to dementia and in providing a target for potential therapeutic interventions which act in the earlist stages of neurodegenerative diseases such as Alzheimer disease (AD) . Current clinical diagnostic criteria for MCI include problems in performing instrumental activities of daily living (IADL) as a part of the clinical syndrome .…”