Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-29T10:01:37.889Z Has data issue: false hasContentIssue false
  • English
  • Français

Profiles of functional deficits in mild cognitive impairment and dementia: benefits from objective measurement

Published online by Cambridge University Press:  22 February 2010

FERNANDA SPEGGIORIN PEREIRA ,
MÔNICA SANCHES YASSUDA ,
ALEXANDRA MARTINI OLIVEIRA ,
BRENO SATLER DINIZ ,
MÁRCIA RADANOVIC ,
LEDA LEME TALIB ,
WAGNER FARID GATTAZ  and
ORESTES VICENTE FORLENZA
FERNANDA SPEGGIORIN PEREIRA
Affiliation:
Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
MÔNICA SANCHES YASSUDA
Affiliation:
Department of Gerontology, School of Arts, Sciences and Humanities (EACH). University of São Paulo, São Paulo, São Paulo, Brazil
ALEXANDRA MARTINI OLIVEIRA
Affiliation:
Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
BRENO SATLER DINIZ
Affiliation:
Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
MÁRCIA RADANOVIC
Affiliation:
Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
LEDA LEME TALIB
Affiliation:
Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
WAGNER FARID GATTAZ
Affiliation:
Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
ORESTES VICENTE FORLENZA*
Affiliation:
Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
*
*Correspondence and reprint requests to: Orestes V. Forlenza, Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Rua Dr. Ovídio Pires de Campos 785, 3rd floor, 05403-010 São Paulo, S.P., Brazil. E-mail: forlenza@usp.br
Get access Rights & Permissions [Opens in a new window]

Abstract

The magnitude of functional impairment that may indicate the threshold between MCI and incipient Alzheimer’s disease (AD) has not been clearly defined. The objective was to examine the pattern of functional impairment in the continuum MCI-AD. Eighty-nine older adults (32 cognitively unimpaired, 31 MCI, and 26 AD patients) were examined with the Brazilian version of the Direct Assessment of Functional Status (DAFS-BR) at a university-based memory clinic. MCI patients were sub-divided according to the progression to AD upon follow-up, and had baseline cognitive, functional and biological variables analyzed. MCI patients displayed mild deficits in functional abilities, with intermediate scores as compared to controls and AD. The DAFS-BR items that differentiated MCI from controls involved the ability to deal with finances and shopping skills. At baseline, scores obtained by MCI patients who converted to AD were not significantly different from scores of nonconverters. The magnitude of functional deficits was associated with AD-like pathological findings in the CSF. In conclusion, MCI patients present with early functional changes in complex, instrumental abilities that require the integrity of memory and executive functions. The objective measurement of the functional state may help identify older adults with increased risk of developing dementia in the MCI-AD continuum. (JINS, 2010, 16, 297–305.)

Keywords

NeuropsychologyActivities of daily livingMild cognitive impairmentAlzheimer’s diseaseDementiaCSF biomarkers
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 16 , Issue 2 , March 2010 , pp. 297 - 305
Copyright
Copyright © The International Neuropsychological Society 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Abreu, I.D., Nunes, P.V., Diniz, B.S., & Forlenza, O.V. (2008). Combining functional scales and cognitive tests in screening for mild cognitive impairment at a university-based memory clinic in Brazil. Revista Brasileira de Psiquiatria (São Paulo, Brazil: 1999), 30, 346–349.CrossRefGoogle Scholar
Allaire, J.C., Gamaldo, A., Ayotte, B.J., Sims, R., & Whitfield, K. (2009). Mild cognitive impairment and objective instrumental everyday functioning: The everyday cognition battery memory test. Journal of the American Geriatric Society, 57, 120–125.CrossRefGoogle ScholarPubMed
Army Individual Test Battery. (1944). In: Manual of Directions and Scoring. Washington, DC: War Department, Adjunct General’s Office Trail.Google Scholar
Artero, S., Touchon, J., & Ritchie, K. (2001). Disability and mild cognitive impairment: A longitudinal population-based study. International Journal of Geriatric Psychiatry, 16, 1092–1097.CrossRefGoogle ScholarPubMed
Barberger-Gateau, P., Dartigues, J.F., & Letenneur, L. (1993). Four instrumental activities of daily living score as a predictor of one-year incident dementia. Age and Ageing, 22, 457–463.CrossRefGoogle ScholarPubMed
Barberger-Gateau, P., Fabrigoule, C., Amieva, H., Helmer, C., & Dartigues, J.F. (2002). The disablement process: A conceptual framework for dementia-associated disability. Dementia and Geriatric Cognitive Disorders, 13, 60–66.CrossRefGoogle ScholarPubMed
Barberger-Gateau, P., Fabrigoule, C., Rouch, I., Letenneur, L., & Dartigues, J.F. (1999). Neuropsychological correlates of self-reported performance in instrumental activities of daily living and prediction dementia. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 54, 293–295.CrossRefGoogle ScholarPubMed
Blessed, G., Tomlinson, B.E., & Roth, M. (1968). The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. British Journal of Psychiatry, 114, 797–811.CrossRefGoogle ScholarPubMed
Boyle, P.A., Malloy, P.F., Salloway, S., Cahn-Weiner, D.A., Cohen, R., & Cummings, J.L. (2003). Executive dysfunction and apathy predict functional impairment in Alzheimer disease. American Journal of Geriatric Psychiatry, 11, 214–221.CrossRefGoogle ScholarPubMed
Cahn-Weiner, D.A., Farias, S.T., Julian, L., Harvey, D.J., Kramer, J.H., Reed, B.R., et al. . (2007). Cognitive and neuroimaging predictors of instrumental activities of daily living. Journal of the International Neuropsychological Society: JINS, 13, 747–757.CrossRefGoogle ScholarPubMed
Diniz, B.S., Nunes, P.V., Yassuda, M.S., Pereira, F.S., Flaks, M.K., Viola, L.F., et al. . (2008). Mild cognitive impairment: Cognitive screening or neuropsychological assessment? Revista Brasileira de Psiquiatria (São Paulo, Brazil: 1999), 30, 316–321.CrossRefGoogle ScholarPubMed
Diniz, B.S., Pinto Júnior, J.A., & Forlenza, O.V. (2008). Do CSF total tau, phosphorylated tau, and beta-amyloid 42 help to predict progression of mild cognitive impairment to Alzheimer’s disease? A systematic review and meta-analysis of the literature. The World Journal of Biological Psychiatry, 9, 172–182.CrossRefGoogle ScholarPubMed
Erzigkeit, H. (1991). The development of the SKT project. In Hindmarch, I., Hippius, H.G., & Wilcock, K. (Eds.), Dementia: Molecules, Methods and Measures (pp. 101–108). Chichester, England: Wiley.Google Scholar
Farias, S.T., Mungas, D., Reed, B.R., Harvey, D., Cahn-Weiner, D., & Decarli, C. (2006). MCI is associated with deficits in everyday functioning. Alzheimer Disease and Associated Disorders, 20, 217–223.CrossRefGoogle ScholarPubMed
Fillenbaum, G.G. (1985). Screening the elderly. A brief instrumental activities of daily living measure. Journal of the American Geriatric Society, 33, 698–706.CrossRefGoogle ScholarPubMed
Flaks, M.K., Yassuda, M.S., Regina, A.C.B., Cid, C.G., Camargo, C.H., Gattaz, W.F., et al. . (2006). The Short Cognitive Performance Test (SKT) _ A transcultural test for early detection and discrimination of dementia: A preliminary study in Brazil. International Psychogeriatrics / IPA, 18, 121–133.CrossRefGoogle Scholar
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle Scholar
Forlenza, O.V., & Chiu, E. (2008). Mild cognitive impairment: A concept ready to move on? Current Opinion in Psychiatry, 21, 529–532.CrossRefGoogle ScholarPubMed
Forlenza, O.V., Diniz, B.S., Nunes, P.V., Memoria, C.M., Yassuda, M.S., & Gattaz, W.F. (2009). Diagnostic transitions in mild cognitive impairment subtypes. International Psychogeriatrics / IPA, 21, 1088–1095.CrossRefGoogle ScholarPubMed
Fuld, P. (1980). Guaranteed stimulus processing in the evaluation of memory and learning. Cortex, 16, 255–271.CrossRefGoogle ScholarPubMed
Giovannetti, T., Bettcher, B.M., Brennan, L., Libon, D.J., Burke, M., Duey, K., et al. . (2008). Characterization of everyday functioning in mild cognitive impairment: A direct assessment approach. Dementia and Geriatric Cognitive Disorders, 25, 359–365.CrossRefGoogle ScholarPubMed
Griffith, K., Belue, B.S., Sicola, A., Krzywanski, S., Zamrini, E., Harrell, L., et al. . (2003). Impaired financial abilities in mild cognitive impairment. A direct assessment approach. Neurology, 60, 449–457.CrossRefGoogle ScholarPubMed
Hachinski, V.C., Iliff, L.D., Zilhka, E., Du Boulay, G.H., McAllister, V.L., Marshall, J., et al. . (1975). Cerebral blood flow in dementia. Archives of Neurology, 32, 632–637.CrossRefGoogle ScholarPubMed
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23, 56–62.CrossRefGoogle ScholarPubMed
Jefferson, A.L., Paul, R.H., Ozonoff, A., & Cohen, R.A. (2006). Evaluating elements of executive functioning as predictors of instrumental activities of daily living (IADLs). Archives of Clinical Neuropsychology, 21, 311–320.CrossRefGoogle ScholarPubMed
Jorm, A.F., & Jacomb, P.A. (1989). The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): Sociodemographics correlates, reliability, validity and some norms. Psychological Medicine, 19, 1015–1022.CrossRefGoogle ScholarPubMed
Kim, K.R., Lee, K.S., Cheong, H.-K., Eom, J.S., Oh, B.H., & Hong, C.H. (2009). Characteristic profiles of instrumental activities of daily living in different subtypes of mild cognitive impairment. Dementia and Geriatric Cognitive Disorders, 27, 278–285.CrossRefGoogle ScholarPubMed
Loewenstein, D.A., Amigo, E., & Duara, R. (1989). A new scale for the assessment of functional status in Alzheimer’s disease and related disorders. Journal of Gerontology, 4, 114–121.CrossRefGoogle Scholar
Loewenstein, D.A., Arguelles, S., Bravo, M., Freeman, R.Q., Argüelles, T., Acevedo, A., et al. . (2001). Caregivers’ judgments of the functional abilities of the Alzheimer’s disease patient. A comparison of proxy reports and objective measures of functional status. Journal of Gerontology, 56, 78–94.CrossRefGoogle Scholar
Loewenstein, D.A., & Bates, C.B. (2006). The direct assessment of functional status revised (DAFS-R). Manual for Administration and Scoring. Neuropsychological Laboratories. Miami Beach, FL: Mount Sinai Medical Center, The Wien Center for Alzheimer’s Disease and Memory Disorders.Google Scholar
Martin, R., Griffith, H.R., Belue, K., Harrell, L., Zamrini, E., Anderson, B., et al. . (2008). Declining financial capacity in patients with mild Alzheimer disease: A one-year longitudinal study. American Journal of Geriatric Psychiatry, 16, 209–219.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & Stadlan, E.M. (1984). Clinical diagnosis of Alzheimer disease: Report of NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Service Task Force on Alzheimer’s Disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
Nordlund, A., Rolstad, S., Klang, O., Lind, K., Pedersen, M., Blennow, K., et al. . (2008). Episodic memory and speed/attention deficits are associated with Alzheimer-typical CSF abnormalities in MCI. Journal of the International Neuropsychological Society: JINS, 14, 582–590.CrossRefGoogle ScholarPubMed
Nunes, P.V., Diniz, B.S., Radanovic, M., Abreu, I.D., Borelli, D.T., Yassuda, M.S., et al. . (2008). CAMCOG as a screening tool for diagnosis of mild cognitive impairment and dementia in a Brazilian clinical sample of moderate to high education. International Journal of Geriatric Psychiatry, 23, 1127–1133.CrossRefGoogle Scholar
Nygard, L. (2003). Instrumental activities of daily living: A stepping-stone towards Alzheimer’s disease diagnosis in subjects with mild cognitive impairment. Acta Neurologica Scandinavica. Supplementum, 179, 42–46.CrossRefGoogle ScholarPubMed
Okonkwo, O.C., Wadley, V.G., Griffith, H.R., Ball, K., & Marson, D.C. (2006). Cognitive correlates of financial abilities in mild cognitive impairment. Journal of the American Geriatric Society, 54, 1745–1750.CrossRefGoogle ScholarPubMed
Oliveira, R., & Schmidt, S.L. (1999). Teste Comportamental de Memória de Rivermead (Rivermead Behavioural Memory Test). Rio de Janeiro: Cognição.Google Scholar
Pereira, F.S., Forlenza, O.V., Oliveira, A.M., Diniz, B.S., & Yassuda, M.S. (submitted). Cross-cultural adaptation, reliability and validity of the DAFS-R in a sample of Brazilian older adults. Archives of Clinical Neuropsychology.Google Scholar
Pereira, F.S., Yassuda, M.S., Oliveira, A.M., & Forlenza, O.V. (2008). Executive dysfunction correlates with impaired functional status in older adults with varying degrees of cognitive impairment. International Psychogeriatrics / IPA, 20, 1104–1115.CrossRefGoogle ScholarPubMed
Péres, K., Helmer, C., Amieva, H., Orgogozo, J.M., Rouch, I., Dartigues, J.F., et al. . (2008). Natural history of decline in instrumental activities of daily living performance over the 10 years preceding the clinical diagnosis of dementia: A prospective population-based study. Journal of the American Geriatric Society, 56, 37–44.CrossRefGoogle ScholarPubMed
Petersen, R.C. (2007). MCI treatment trials: Failure or not? Lancet Neurology, 6, 473–475.CrossRefGoogle ScholarPubMed
Petersen, R.C., Doody, R., Kurz, A., Mohs, R.C., Morris, J.C., Rabins, P.V., et al. . (2001). Current concepts in mild cognitive impairment. Archives of Neurology, 8, 1985–1992.CrossRefGoogle Scholar
Radanovic, M., Diniz, B.S., Mirandez, R.M., Novaretti, T.M., Flaks, M.K., Yassuda, M.S., et al. . (2009). Verbal fluency in the detection of mild cognitive impairment and Alzheimer’s disease among Brazilian Portuguese speakers: The influence of education. International Psychogeriatrics / IPA, 21, 1081–1087.CrossRefGoogle ScholarPubMed
Ritchie, K., Artero, S., & Touchon, J. (2001). Classification criteria for mild cognitive impairment: A population-based study. Neurology, 56, 37–42.CrossRefGoogle Scholar
Roth, M., Tym, E., Mountjoy, C.Q., Huppert, F.A., Hendrie, H., Verma, S., et al. . (1986). CAMDEX: A standardized instrument for the diagnosis of mental disorders in the elderly with special reference to early detection of dementia. British Journal of Psychiatry, 149, 698–709.CrossRefGoogle ScholarPubMed
Royall, D.R., Mahurin, R.K., & Gray, K. (1992). Bedside assessment of executive cognitive impairment: The executive interview. Journal of the American Geriatric Society, 40, 1221–1226.CrossRefGoogle ScholarPubMed
Rozzini, L., Chilovi, B.V., Conti, M., Bertoletti, E., Delrio, I., Trabucchi, M., et al. . (2007). Conversion of amnestic mild cognitive impairment to dementia of Alzheimer type is independent to memory deterioration. International Journal of Geriatric Psychiatry, 22, 1217–1222.CrossRefGoogle ScholarPubMed
Sabbagh, M.N., Lahti, T., Connor, D.J., Caviness, J.N., Shill, H., Vedders, L., et al. . (2007). Functional ability correlates with cognitive impairment in Parkinson’s disease and Alzheimer’s disease. Dementia and Geriatric Cognitive Disorders, 24, 327–334.CrossRefGoogle ScholarPubMed
Schmitter-Edgecombe, M., Woo, E., & Greeley, D.R. (2009). Characterizing multiple memory deficits and their relation to everyday functioning in individuals with mild cognitive impairment. Neuropsychology, 23, 168–177.CrossRefGoogle ScholarPubMed
Sunderland, T., Hill, J.L., Mellow, A.M., Gundersheimer, J., Newhouse, P.A., & Grafman, J.H. (1989). Clock drawing in Alzheimer’s disease. A novel measure of disease severity. Journal of the American Geriatric Society, 37, 725–729.CrossRefGoogle Scholar
Sunderland, T., Linker, G., Mirza, N., Putnam, K.T., Friedman, D.L., Kimmel, L.H., et al. . (2003). Decreased beta-amyloid 1-42 and increased tau levels in cerebrospinal fluid of patients with Alzheimer disease. Journal of the American Medical Association, 289, 2094–2103.Google ScholarPubMed
Tabert, M.H., Albert, S.M., Borukhova-Milov, L., Camacho, Y., Pelton, G., Liu, X., et al. . (2002). Functional deficits in patients with mild cognitive impairment: Prediction of AD. Neurology, 58, 758–764.CrossRefGoogle ScholarPubMed
Wadley, V.G., Crowe, M., Marsiske, M., Cook, S.E., Unverzagt, F.W., Rosenberg, A.L., et al. . (2007). Changes in everyday function in individuals with psychometrically defined mild cognitive impairment in the Advanced Cognitive Training for Independent and Vital Elderly Study. Journal of the American Geriatric Society, 55, 1192–1198.CrossRefGoogle ScholarPubMed
Wadley, V.G., Okonkwo, O., Crowe, M., & Ross-Meadows, L.A. (2008). Mild cognitive impairment and everyday function: Evidence of reduced speed in performing instrumental activities of daily living. American Journal of Geriatric Psychiatry, 16, 416–424.CrossRefGoogle ScholarPubMed
Wechsler, D.I. (1981). Examiner’s Manual: Wechsler Adult Intelligence Scale-Revised. New York: Psychological Corporation.Google Scholar