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Characterization of Activities of Daily Living in Individuals With Mild Cognitive Impairment

From the Department of Neurology, Alzheimer’s Disease Center, Boston University School of Medicine, Boston, MA (ALJ, LKB, SV, SL, SW); Department of Psychology, University of Victoria, Victoria, BC, Canada (SV); Department of Psychology, University of Massachusetts at Boston, Boston, MA (SL); Tufts University School of Medicine, Boston, MA (SW); Department of Biostatistics, Boston University School of Public Health, Boston, MA (AO); and Department of Medicine, Division of Geriatric Medicine, Center for Bioethics, University of Pennsylvania School of Medicine, Philadelphia, PA (JHK).

Objective: To determine whether participants with mild cognitive impairment (MCI) differ from cognitively normal (NC) older adults on traditional and novel informant-based measures of activities of daily living (ADL) and to identify cognitive correlates of ADLs among participants with MCI.

Design: Cross-sectional.

Setting: University medical setting.

Participants: Seventy-seven participants (NC: N = 39; MCI: N = 38), 60 to 90 years old (73.5 ± 6.6 years; 53% female).

Measurements: Neuropsychological and ADL measures.

Methods: Neuropsychological tests were administered to NC and MCI participants. Informants completed the Lawton and Brody Instrumental Activities of Daily Living and Physical Self-Maintenance Scale, including instrumental (IADL) and basic ADL (BADL) scales, as well as the Functional Capacities for Activities of Daily Living (FC-ADL), an error-based ADL measure.

Results: No statistically or clinically significant between-group differences emerged for the BADL or IADL subscales. However, a robust difference was noted for the FC-ADL scale (MCI errors > NC errors; F_(1,75)= 13.6, p <0.001; d = 0.84). Among MCI participants, correlations revealed that a measure of verbal learning was the only neuropsychological correlate of FC-ADL total score (r = –0.39, df = 36, p = 0.007). No neuropsychological measures were significantly associated with the IADL or BADL subscale score.

Conclusion: Traditional measures assessing global ADLs may not be sensitive to early functional changes related to MCI; however, error-based measures may capture the subtle evolving functional decline associated with MCI. Among MCI participants, early functional difficulties are associated with verbal learning performance, possibly secondary to the hallmark cognitive impairment associated with this cohort.

Key Words: Instrumental activities of daily living • MCI • memory • functional errors • neuropsychology

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