Julene K Johnson1, Li-Yung Lui, Kristine Yaffe. 1. UCSF Department of Neurology, Memory and Aging Center, 350 Parnassus, Suite 706, San Francisco, CA 94117, USA. jjohnson@memory.ucsf.edu
Abstract
BACKGROUND: Functional impairment in community-dwelling older adults is common and is associated with poor outcomes. Our goal was to compare the contribution of impairment in executive function or global cognitive function to predicting functional decline and mortality. METHODS: We studied 7717 elderly women enrolled in a prospective study (mean age 73.3 years) and identified women with poor baseline executive function (score > 1 standard deviation [SD] below the mean on the Trail Making Test B (Trails B; n = 957, 12.4%), poor global cognitive function (score > 1 SD below the mean on a modified Mini-Mental State Examination [mMMSE], n = 387, 5.0%), impairment in both (n = 249, 3.2%), or no impairment (n = 6124, 79.4%). We compared level of functional difficulty (Activities of Daily Living [ADLs] and Instrumental ADLs [IADLs]) at baseline and at 6-year follow-up and survival at follow-up. We also determined if the association was independent of age, education, depression, medical comorbidities, and baseline functional ability. RESULTS: At baseline, women with Trails B impairment only or impairment on both tests reported the highest proportion of ADL and IADL dependence compared to the other groups. At the 6-year follow-up after adjusting for age, education, medical comorbidities, depression, and baseline ADL or IADL, women with only Trails B impairment were 1.3 times more likely to develop an incident ADL dependence (adjusted odds ratio [OR] = 1.34; 95% confidence interval [CI], 1.07-1.69) and 1.5 times more likely to develop a worsening of ADL dependence (adjusted OR = 1.48; 95% CI, 1.16-1.89) when compared to women with no impairment on either test. In addition, women with only Trails B impairment had a 1.5-fold increased risk of mortality (adjusted hazard ratio [HR] = 1.48; 95% CI, 1.21-1.81). In contrast, women with impairment on only mMMSE were not at increased risk to develop incident ADL or IADL dependence, a worsening of ADL or IADL dependence, or mortality. CONCLUSION: Compared to women with no impairment, women with executive function impairment had significantly worse ADL and IADL function cross-sectionally and over 6 years. Individuals with executive dysfunction also had increased risk of mortality. These results suggest that screening of executive function can help to identify women who are at risk for functional decline and decreased survival.
BACKGROUND: Functional impairment in community-dwelling older adults is common and is associated with poor outcomes. Our goal was to compare the contribution of impairment in executive function or global cognitive function to predicting functional decline and mortality. METHODS: We studied 7717 elderly women enrolled in a prospective study (mean age 73.3 years) and identified women with poor baseline executive function (score > 1 standard deviation [SD] below the mean on the Trail Making Test B (Trails B; n = 957, 12.4%), poor global cognitive function (score > 1 SD below the mean on a modified Mini-Mental State Examination [mMMSE], n = 387, 5.0%), impairment in both (n = 249, 3.2%), or no impairment (n = 6124, 79.4%). We compared level of functional difficulty (Activities of Daily Living [ADLs] and Instrumental ADLs [IADLs]) at baseline and at 6-year follow-up and survival at follow-up. We also determined if the association was independent of age, education, depression, medical comorbidities, and baseline functional ability. RESULTS: At baseline, women with Trails B impairment only or impairment on both tests reported the highest proportion of ADL and IADL dependence compared to the other groups. At the 6-year follow-up after adjusting for age, education, medical comorbidities, depression, and baseline ADL or IADL, women with only Trails B impairment were 1.3 times more likely to develop an incident ADL dependence (adjusted odds ratio [OR] = 1.34; 95% confidence interval [CI], 1.07-1.69) and 1.5 times more likely to develop a worsening of ADL dependence (adjusted OR = 1.48; 95% CI, 1.16-1.89) when compared to women with no impairment on either test. In addition, women with only Trails B impairment had a 1.5-fold increased risk of mortality (adjusted hazard ratio [HR] = 1.48; 95% CI, 1.21-1.81). In contrast, women with impairment on only mMMSE were not at increased risk to develop incident ADL or IADL dependence, a worsening of ADL or IADL dependence, or mortality. CONCLUSION: Compared to women with no impairment, women with executive function impairment had significantly worse ADL and IADL function cross-sectionally and over 6 years. Individuals with executive dysfunction also had increased risk of mortality. These results suggest that screening of executive function can help to identify women who are at risk for functional decline and decreased survival.
Authors: A J Fallgatter; A J Bartsch; W K Strik; T J Mueller; S S Eisenack; B Neuhauser; D Aranda; M J Herrmann Journal: Clin Neurophysiol Date: 2001-01 Impact factor: 3.708
Authors: M C Carlson; L P Fried; Q L Xue; K Bandeen-Roche; S L Zeger; J Brandt Journal: J Gerontol B Psychol Sci Soc Sci Date: 1999-09 Impact factor: 4.077
Authors: D H Geschwind; J Robidoux; M Alarcón; B L Miller; K C Wilhelmsen; J L Cummings; Z S Nasreddine Journal: Ann Neurol Date: 2001-12 Impact factor: 10.422
Authors: Patricia A Boyle; Paul F Malloy; Stephen Salloway; Deborah A Cahn-Weiner; Ronald Cohen; Jeffrey L Cummings Journal: Am J Geriatr Psychiatry Date: 2003 Mar-Apr Impact factor: 4.105
Authors: Ashwin A Kotwal; Philip Schumm; David W Kern; Martha K McClintock; Linda J Waite; Joseph W Shega; Megan J Huisingh-Scheetz; William Dale Journal: Alzheimer Dis Assoc Disord Date: 2015 Oct-Dec Impact factor: 2.703
Authors: Guy G Potter; Douglas R McQuoid; Martha E Payne; Warren D Taylor; David C Steffens Journal: Int J Geriatr Psychiatry Date: 2012-01-24 Impact factor: 3.485
Authors: Dane J Genther; Joshua Betz; Sheila Pratt; Steven B Kritchevsky; Kathryn R Martin; Tamara B Harris; Elizabeth Helzner; Suzanne Satterfield; Qian-Li Xue; Kristine Yaffe; Eleanor M Simonsick; Frank R Lin Journal: J Gerontol A Biol Sci Med Sci Date: 2014-07-14 Impact factor: 6.053