Robert Fieo1, Laura Zahodne2, Ming X Tang3, Jennifer J Manly4, Ron Cohen1, Yaakov Stern4. 1. Center for Cognitive Aging and Memory, Department of Geriatric Research, College of Medicine, University of Florida, Gainesville. 2. Psychology Department, University of Michigan, College of Literature, Science, and the Arts, Ann Arbor. 3. Department of Biostatistics, School of Public Health, Columbia University College of Physicians and Surgeons, New York. 4. Cognitive Neuroscience Division, Department of Neurology and Taub Institute, Columbia University College of Physicians and Surgeons, New York.
Abstract
Background: Decrements in instrumental activities (IADL) have been observed in the prodromal phase of dementia. Given the long predementia stage in neurodegenerative diseases, it has been proposed that subtle functional changes may precede clinical IADL impairment. Incorporating more challenging advanced ADLs (eg, volunteer work) into the assessment process may increase the sensitivity of functional measures, thus expanding the window for monitoring or interventions. Methods: Longitudinal cohort study was used (follow-ups, 18-24 month), with subjects aged 60 and older (n = 3,635). To elucidate the relationship between cognitive ability and functional status we employed an IADL scale with an extended range (ADL-extended; includes IADL but also more challenging advanced ADLs) that meets item response theory properties of dimensionality, monotonicity, and item hierarchy. Procedures involved (a) a dynamic change model employed to inspect the temporal relationship between ADL-extended and cognitive status and (b) Cox proportional hazards to assess the risk of incident dementia based on ADL-extended scores. Results: Growth curve modeling: baseline ADL-extended was significantly associated with all four cognitive domains investigated. Worse baseline ADL-extended was associated with more rapid declines in speed/executive function, and worse baseline memory was associated with more rapid declines in ADL-extended; a concurrent association was found for language and ADL-extended. Cox model: the risk of dementia was decreased for each additional ADL-extended item endorsed (hazard ratio [HR], 0.85; 95% confidence interval = 0.81-0.90). Conclusions: An increased risk of dementia could be observed in the ADL-extended items, which reflects an area of the functional continuum beyond IADL competencies.
Background: Decrements in instrumental activities (IADL) have been observed in the prodromal phase of dementia. Given the long predementia stage in neurodegenerative diseases, it has been proposed that subtle functional changes may precede clinical IADL impairment. Incorporating more challenging advanced ADLs (eg, volunteer work) into the assessment process may increase the sensitivity of functional measures, thus expanding the window for monitoring or interventions. Methods: Longitudinal cohort study was used (follow-ups, 18-24 month), with subjects aged 60 and older (n = 3,635). To elucidate the relationship between cognitive ability and functional status we employed an IADL scale with an extended range (ADL-extended; includes IADL but also more challenging advanced ADLs) that meets item response theory properties of dimensionality, monotonicity, and item hierarchy. Procedures involved (a) a dynamic change model employed to inspect the temporal relationship between ADL-extended and cognitive status and (b) Cox proportional hazards to assess the risk of incident dementia based on ADL-extended scores. Results: Growth curve modeling: baseline ADL-extended was significantly associated with all four cognitive domains investigated. Worse baseline ADL-extended was associated with more rapid declines in speed/executive function, and worse baseline memory was associated with more rapid declines in ADL-extended; a concurrent association was found for language and ADL-extended. Cox model: the risk of dementia was decreased for each additional ADL-extended item endorsed (hazard ratio [HR], 0.85; 95% confidence interval = 0.81-0.90). Conclusions: An increased risk of dementia could be observed in the ADL-extended items, which reflects an area of the functional continuum beyond IADL competencies.
Authors: Gad A Marshall; Natacha Lorius; Joseph J Locascio; Bradley T Hyman; Dorene M Rentz; Keith A Johnson; Reisa A Sperling Journal: J Alzheimers Dis Date: 2014 Impact factor: 4.472
Authors: Benjamin D Capistrant; Nicte I Mejia; Sze Y Liu; Qianyi Wang; M Maria Glymour Journal: J Gerontol A Biol Sci Med Sci Date: 2014-01-20 Impact factor: 6.053
Authors: Eric Jutkowitz; Richard F MacLehose; Joseph E Gaugler; Bryan Dowd; Karen M Kuntz; Robert L Kane Journal: J Gerontol A Biol Sci Med Sci Date: 2016-04-29 Impact factor: 6.053
Authors: Maria Vassilaki; Jeremiah A Aakre; Walter K Kremers; Michelle M Mielke; Yonas E Geda; Mary M Machulda; David S Knopman; Preciosa M Coloma; Barbara Schauble; Prashanthi Vemuri; Val J Lowe; Clifford R Jack; Ronald C Petersen; Rosebud O Roberts Journal: J Am Geriatr Soc Date: 2018-11-21 Impact factor: 5.562
Authors: John D Peipert; Lee A Jennings; Tahmineh Romero; Ron D Hays; Neil S Wenger; Emmett Keeler; David B Reuben Journal: J Am Geriatr Soc Date: 2020-11-30 Impact factor: 5.562
Authors: Jeremy Reich; Mark G Thompson; Benjamin J Cowling; A Danielle Iuliano; Carolyn Greene; Yuyun Chen; Rachael Phadnis; Nancy H L Leung; Ying Song; Vicky J Fang; Cuiling Xu; Qigang Dai; Jun Zhang; Hongjun Zhang; Fiona Havers Journal: PLoS One Date: 2020-08-11 Impact factor: 3.752
Authors: Maria Vassilaki; Jeremiah A Aakre; Walter K Kremers; Timothy G Lesnick; Michelle M Mielke; Yonas E Geda; Mary M Machulda; David S Knopman; Lesley Butler; Martin Traber; Prashanthi Vemuri; Val J Lowe; Clifford R Jack; Rosebud O Roberts; Ronald C Petersen Journal: Ann Clin Transl Neurol Date: 2020-04-21 Impact factor: 4.511