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; Institute for Biometrics (BW), Hannover Medical School, Germany; Department of Psychiatry (WM, FJ, FT), University of Bonn, Germany; Department of Primary Medical Care (HVDB, ME, MK), Center for Psychosocial Medicine, and Department of Medical Sociology and Health Economics (HL, HHK), University Medical Center Hamburg-Eppendorf, Germany; Department of Psychiatry (DW, JO), Technical University of Munich, Germany; Central Institute of Mental Health (SW, SEG), Mannheim, Germany; and Department of General Practice (MP, AF), University of Dusseldorf, Medical Faculty, Dusseldorf, Germany.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry (Impact Factor: 3.35). 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.

1 Bookmark
  • [Show abstract] [Hide abstract]
    ABSTRACT: Mild cognitive impairment (MCI) is an intermediate stage in the trajectory from normal cognition to dementia. Despite controversies about the classification of MCI, recent published criteria for MCI allow better comparison of the prevalence, incidence, and outcomes of MCI. Subjects with MCI have a high rate of progression to dementia over a relatively short period. In this review, we present an overview of the classification of MCI, estimates of the incidence and prevalence of MCI, risk factors for MCI, and the outcomes following an MCI diagnosis.
    Clinics in geriatric medicine. 11/2013; 29(4):753-772.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this article is to review the effect of dementia on activities of daily living and consequently on the ability to age in place. Types of evaluation and information conferred from different types of assessment are discussed. Evidence-based interventions for preventing and minimizing activities-of-daily-living disability are outlined.
    Nursing Clinics of North America. 01/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: With the aging of the population, the burden of Alzheimer's disease (AD) is rapidly expanding. More than 5 million people in the US alone are affected with AD and this number is expected to triple by 2050. While men may have a higher risk of mild cognitive impairment (MCI), an intermediate stage between normal aging and dementia, women are disproportionally affected with AD. One explanation is that men may die of competing causes of death earlier in life, so that only the most resilient men may survive to older ages. However, many other factors should also be considered to explain the sex differences. In this review, we discuss the differences observed in men versus women in the incidence and prevalence of MCI and AD, in the structure and function of the brain, and in the sex-specific and gender-specific risk and protective factors for AD. In medical research, sex refers to biological differences such as chromosomal differences (eg, XX versus XY chromosomes), gonadal differences, or hormonal differences. In contrast, gender refers to psychosocial and cultural differences between men and women (eg, access to education and occupation). Both factors play an important role in the development and progression of diseases, including AD. Understanding both sex- and gender-specific risk and protective factors for AD is critical for developing individualized interventions for the prevention and treatment of AD.
    Clinical Epidemiology 01/2014; 6:37-48.


Available from
Jun 4, 2014