Article

Prediction of Incident Dementia: Impact of Impairment in Instrumental Activities of Daily Living and Mild Cognitive Impairment-Results From the German Study on Ageing, Cognition, and Dementia in Primary Care Patients.

From the Insitute of Social Medicine, Occupational Health and Public Health (TL, ML, SGRH), and LIFE-Leipzig Research Center for Civilization Diseases (TL), Universität Leipzig, Germany
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry (Impact Factor: 3.52). 06/2012; 20(11):943-954. DOI: 10.1097/JGP.0b013e31825c09bc
Source: PubMed

ABSTRACT OBJECTIVES:: There is an increasing call for a stronger consideration of impairment in instrumental activities of daily living (IADL) in the diagnostic criteria of Mild Cognitive Impairment (MCI) to improve the prediction of dementia. Thus, the aim of the study was to determine the predictive capability of MCI and IADL impairment for incident dementia. DESIGN:: Longitudinal cohort study with four assessments at 1.5-year intervals over a period of 4.5 years. SETTING:: Primary care medical record registry sample. PARTICIPANTS:: As part of the German Study on Ageing, Cognition, and Dementia in Primary Care Patients, a sample of 3,327 patients from general practitioners, aged 75 years and older, was assessed. MEASUREMENTS:: The predictive capability of MCI and IADL impairment for incident dementia was analysed using receiver operating characteristics, Kaplan-Meier survival analyses, and Cox proportional hazards models. RESULTS:: MCI and IADL impairment were found to be significantly associated with higher conversion to, shorter time to, and better predictive power for future dementia. Regarding IADL, a significant impact was particularly found for impairment in responsibility for one's own medication, shopping, and housekeeping, and in the ability to use public transport. CONCLUSIONS:: Combining MCI with IADL impairment significantly improves the prediction of future dementia. Even though information on a set of risk factors is required to achieve a predictive accuracy for dementia in subjects with MCI being clinically useful, IADL impairment should be a very important element of such a risk factor set.

Download full-text

Full-text

Available from: Steffi Riedel-Heller, Sep 02, 2015
1 Follower
 · 
271 Views
 · 
171 Downloads
  • The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 11/2012; 20(11):911-4. DOI:10.1097/JGP.0b013e3182702c18 · 3.52 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: One of the key clinical features of Alzheimer's disease (AD) is impairment in daily functioning. Patients with mild cognitive impairment (MCI) also commonly have mild problems performing complex tasks. Information and communication technology (ICT), particularly techniques involving imaging and video processing, is of interest in order to improve assessment. The overall aim of this study is to demonstrate that it is possible using a video monitoring system to obtain a quantifiable assessment of instrumental activities of daily living (IADLs) in AD and in MCI. The aim of the study is to propose a daily activity scenario (DAS) score that detects functional impairment using ICTs in AD and MCI compared with normal control group (NC). Sixty-four participants over 65 years old were included: 16 AD matched with 10 NC for protocol 1 (P1) and 19 MCI matched with 19 NC for protocol 2 (P2). Each participant was asked to undertake a set of daily tasks in the setting of a "smart home" equipped with two video cameras and everyday objects for use in activities of daily living (8 IADLs for P1 and 11 for P2, plus 4 temporal execution constraints). The DAS score was then computed from quantitative and qualitative parameters collected from video recordings. In P1, the DAS score differentiated AD (DAS(AD,P1) = 0.47, 95% confidence interval [CI] 0.38-0.56) from NC (DAS(NC,P1) = 0.71, 95% CI 0.68-0.74). In P2, the DAS score differentiated MCI (DAS(MCI,P2) = 0.11, 95% CI 0.05-0.16) and NC (DAS(NC,P2) = 0.36, 95% CI 0.26-0.45). In conclusion, this study outlines the interest of a novel tool coming from the ICT world for the assessment of functional impairment in AD and MCI. The derived DAS scores provide a pragmatic, ecological, objective measurement which may improve the prediction of future dementia, be used as an outcome measurement in clinical trials and lead to earlier therapeutic intervention.
    Clinical Interventions in Aging 12/2012; 7:539-49. DOI:10.2147/CIA.S36297 · 1.82 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background/Aims: The aim is to examine disability in instrumental activities of daily living (IADL) in elderly persons with mild cognitive impairment (MCI) and Alzheimer's disease (AD), further to identify items of IADL which separate the two conditions and to explore potential gender differences. Methods: A cross-sectional study of 729 patients aged ≥65 years recruited from outpatient memory clinics. Multiple logistic regression analysis was used in the main analysis to explore the association between IADL and diagnosis. Results and Conclusions: We found an association between IADL and diagnosis, and a difference in the proportion of disability in IADL in patients with MCI and AD, i.e. 66 and 88%, respectively. Six of the 8 items revealed differences in the proportions of patients with IADL disability among MCI and AD. No substantial gender differences were found, except for laundry. © 2013 S. Karger AG, Basel.
    Dementia and Geriatric Cognitive Disorders 07/2013; 36(3-4):146-153. DOI:10.1159/000351010 · 2.81 Impact Factor
Show more