Functional Impairment in Elderly Patients With Mild Cognitive Impairment and Mild Alzheimer Disease<alt-title>Impairment in MCI and AD Patients</alt-title>
Open accessAbstract
CONTEXT: The original mild cognitive impairment (MCI) criteria exclude substantial functional deficits, but recent reports suggest otherwise. Identifying the extent, severity, type, and correlates of functional deficits that occur in MCI and mild Alzheimer disease (AD) can aid in early detection of incipient dementia and can identify potential mechanistic pathways to disrupted instrumental activities of daily living (IADLs). OBJECTIVES: To examine the number, type, and severity of functional impairments and to identify the clinical characteristics associated with functional impairment across patients with amnestic MCI (aMCI) and those with mild AD. DESIGN: Study using baseline data from the Alzheimer's Disease Neuroimaging Initiative. SETTING: Multiple research sites in the United States and Canada. Patients Samples included 229 control individuals, 394 patients with aMCI, and 193 patients with AD. MAIN OUTCOME MEASURE: The 10-item Pfeffer Functional Activities Questionnaire (FAQ) assessed function. RESULTS: Informant-reported FAQ deficits were common in patients with aMCI (72.3%) and AD (97.4%) but were rarely self-reported by controls (7.9%). The average severity per FAQ deficit did not differ between patients with aMCI and controls; both were less impaired than patients with AD (P < .001). Two FAQ items (remembering appointments, family occasions, holidays, and medications and assembling tax records, business affairs, or other papers) were specific (specificity estimate, 0.95) in differentiating the control group from the combined aMCI and AD groups (only 34.0% of patients with aMCI and 3.6% of patients with AD had no difficulty with these 2 items). The severity of FAQ deficits in the combined aMCI and AD group was associated with worse Trail Making Test, part A scores and smaller hippocampal volumes (P < .001 for both). Within the aMCI group, functionally intact individuals had greater hippocampal volumes and better Auditory Verbal Learning Test 30-minute delay and Trail Making Test, part A (P < .001 for each) scores compared with individuals with moderate or severe FAQ deficits. Patients with a high number of deficits were more likely to express the apolipoprotein ε4 allele (63.8%) compared with patients with no (46.8%) or few (48.4%) functional deficits. CONCLUSIONS: Mild IADL deficits are common in individuals with aMCI and should be incorporated into MCI criteria. Two IADLs--remembering appointments, family occasions, holidays, and medications and assembling tax records, business affairs, or other papers--appear to be characteristic of clinically significant cognitive impairment. In patients with aMCI, impairment in memory and processing speed and greater medial temporal atrophy were associated with greater IADL deficits.
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Age-related cognitive decline can result in a loss of independence and a reduction in social-cognitive functioning.
“Age-related cognitive decline can result in a loss of independence and a reduction in social-cognitive functioning (Brown et al., 2011; Washburn & Sands, 2006)”
From Longitudinal Associations Between Loneliness and Cognitive Ability in the Lothian Birth Cohort 1936 (2019) · cites this paper as Brown et al., 2011
The Abstract conclusions and Discussion link cognitive impairment in older patients with MCI or mild Alzheimer disease to deficits in daily activities, supporting reduced independence. The paper does not establish a reduction in social-cognitive functioning; its measures concern activities such as remembering appointments and managing affairs. (LLM, conf=0.85)
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Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975) · Journal of Psychiatric Research · doi:10.1016/0022-3956(75)90026-6 · Cited by 88,282 · see citing works
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & Stadlan, E. M. (1984) · Neurology · doi:10.1212/wnl.34.7.939 · Cited by 27,915 · see citing works
Frailty in Older Adults: Evidence for a Phenotype
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., et al. (2001) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/56.3.m146 · Cited by 24,907 · see citing works
Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living
Lawton, M. P., & Brody, E. M. (1969) · The Gerontologist · doi:10.1093/geront/9.3_part_1.179 · Cited by 18,540 · see citing works
The Clinical Dementia Rating (CDR): Current version and scoring rules
Morris, J. C. (1993) · Neurology · doi:10.1212/wnl.43.11.2412-a · Cited by 9,882 · see citing works
Mild Cognitive Impairment: Clinical Characterization and Outcome
Petersen, R. C., Smith, G. E., Waring, S. C., Ivnik, R. J., Tangalos, E. G., & Kokmen, E. (1999) · Archives of Neurology · doi:10.1001/archneur.56.3.303 · Cited by 8,980 · see citing works
VALIDITY OF THE TRAIL MAKING TEST AS AN INDICATOR OF ORGANIC BRAIN DAMAGE
Reitan, R. M. (1958) · Perceptual and Motor Skills · doi:10.2466/pms.1958.8.3.271 · Cited by 7,925 · see citing works
Sheikh (1986) · doi:10.1300/j018v05n01_09 · Cited by 7,236 · see citing works
The processing-speed theory of adult age differences in cognition
Salthouse, T. A. (1996) · Psychological Review · doi:10.1037/0033-295x.103.3.403 · Cited by 5,568 · cited 1× · see citing works
“Processing speed declines with age.(46,47) Although researchers have focused on the association between executive dysfunction and daily functional deficits,(48) the present study concurs with recent findings by Wadley and colleagues,(15) who showed that individuals with aMCI differed from healthy controls in speed of…”
Winblad, B., Palmer, K., Kivipelto, M., Jelic, V., Fratiglioni, L., Wahlund, L. ‐., Nordberg, A., Bäckman, L., Albert, M., Almkvist, O., et al. (2004) · Journal of Internal Medicine · doi:10.1111/j.1365-2796.2004.01380.x · Cited by 4,946 · see citing works
Manual for the Wechsler Adult Intelligence Scale.
Wechsler, D. (1955) · Psychological Corp. eBooks · Cited by 4,941 · see citing works
The Alzheimer’s disease neuroimaging initiative (ADNI): MRI methods
Jack, C. R., Bernstein, M. A., Fox, N. C., Thompson, P., Alexander, G., Harvey, D., Borowski, B., Britson, P. J., L. Whitwell, J., Ward, C., et al. (2008) · Journal of Magnetic Resonance Imaging · doi:10.1002/jmri.21049 · Cited by 4,347 · see citing works
L’examen Clinique en Psychologie
Rubé, P. (1959) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.1959.13.4.989 · Cited by 3,299 · see citing works
. Cerebral blood flow in dementia.
Hachinski, V. C., Iliff, L. D., Zilhka, E., Du Boulay, G. H., McAllister, V. L., Marshall, J., Russell, R. W. R., & Symon, L. (1975) · Archives of Neurology · doi:10.1001/archneur.1975.00490510088009 · Cited by 3,186 · see citing works
Measurement of Functional Activities in Older Adults in the Community
PFEFFER, R. I., Kurosaki, T., Harrah, C. H., Chance, J. M., & Filos, S. (1982) · Journal of Gerontology · doi:10.1093/geronj/37.3.323 · Cited by 2,978 · see citing works
The Alzheimer's Disease Neuroimaging Initiative
Mueller, S. G., Weiner, M. W., Thal, L. J., Petersen, R. C., Jack, C., Jagust, W., Trojanowski, J. Q., Toga, A. W., & Beckett, L. (2005) · Neuroimaging Clinics of North America · doi:10.1016/j.nic.2005.09.008 · Cited by 1,525 · see citing works
Aging and measures of processing speed
Salthouse, T. A. (2000) · Biological Psychology · doi:10.1016/s0301-0511(00)00052-1 · Cited by 1,114 · see citing works
Fried, L. P. (2001) · Journals of Gerontology Series A-biological Sciences and Medical Sciences · Cited by 1,103 · see citing works
Hippocampal and entorhinal atrophy in mild cognitive impairment
Devanand, D. P., Pradhaban, G., Liu, X., Khandji, A., Santi, S. D., Segal, S., Rusinek, H., Pelton, G. H., Honig, L. S., Mayeux, R. P., et al. (2007) · Neurology · doi:10.1212/01.wnl.0000256697.20968.d7 · Cited by 739 · see citing works
Portet, F. (2006) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2005.085332 · Cited by 652 · see citing works
Lenze, E. J., Rogers, J. C., Martire, L. M., Mulsant, B. H., Rollman, B. L., Dew, M. A., Schulz, R., & Reynolds, C. F. (2001) · The American Journal of Geriatric Psychiatry · doi:10.1097/00019442-200105000-00004 · Cited by 593 · see citing works
Clinical core of the Alzheimer's disease neuroimaging initiative: Progress and plans
Aisen, P. S. S., Petersen, R. C., Donohue, M., Gamst, A. C., Raman, R., Thomas, R. G., Walter, S., Trojanowski, J. Q., Shaw, L. M. J., Beckett, L. A., et al. (2010) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2010.03.006 · Cited by 516 · see citing works
Functional deficits in patients with mild cognitive impairment
Tabert, M. H., Albert, S. M., Borukhova-Milov, L., Camacho, Y., Pelton, G. H., Liu, X., Stern, Y., & Devanand, D. P. (2002) · Neurology · doi:10.1212/wnl.58.5.758 · Cited by 479 · see citing works
Devanand, D. P., Liu, X., Tabert, M. H., Pradhaban, G., Cuasay, K., Bell, K. L., de Leon, M. J., Doty, R. L., Stern, Y., & Pelton, G. H. (2008) · Biological Psychiatry · doi:10.1016/j.biopsych.2008.06.020 · Cited by 396 · see citing works
Newsom, J. T., & Schulz, R. (1996) · Psychology and Aging · doi:10.1037/0882-7974.11.1.34 · Cited by 392 · see citing works
Pérès, K., Helmer, C., Amieva, H., Orgogozo, J., Rouch, I., Dartigues, J., & Barberger‐Gateau, P. (2007) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2007.01499.x · Cited by 374 · see citing works
Assessing Financial Capacity in Patients With Alzheimer Disease
Marson, D. C., Sawrie, S. M., Snyder, S., McInturff, B., Stalvey, T. J., Boothe, A., Aldridge, T., Chatterjee, A. K., & Harrell, L. E. (2000) · Archives of Neurology · doi:10.1001/archneur.57.6.877 · Cited by 340 · see citing works
A prospective longitudinal study of apathy in Alzheimer's disease
STARKSTEIN, S. E. (2005) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2005.069575 · Cited by 339 · see citing works
Vaughan, L., & Giovanello, K. S. (2010) · Psychology and Aging · doi:10.1037/a0017729 · Cited by 317 · see citing works
MCI is Associated With Deficits in Everyday Functioning
Farias, S. T., Mungas, D., Reed, B., Harvey, D. J., Cahn, D. A., & DeCarli, C. S. (2006) · Alzheimer Disease & Associated Disorders · doi:10.1097/01.wad.0000213849.51495.d9 · Cited by 293 · see citing works
Wolk, D. A., Dickerson, B. C., Initiative, T. A. D. N., Weiner, M., Aiello, M., Aisen, P., Albert, M. S., Alexander, G., Anderson, H. S., Anderson, K., et al. (2010) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1001412107 · Cited by 248 · see citing works
Knopman, D. S., Boeve, B. F., & Petersen, R. C. (2003) · Mayo Clinic Proceedings · doi:10.4065/78.10.1290 · Cited by 245 · see citing works
Auyeung, T. W., Kwok, T. C. Y., Lee, J., Leung, P., Leung, J. C. S., & Woo, J. (2008) · Neuroepidemiology · doi:10.1159/000154929 · Cited by 231 · see citing works
MRI predictors of risk of incident Alzheimer disease
Stoub, T. R., Bulgakova, M., Leurgans, S. E., Bennett, D. A., Fleischman, D. A., Turner, D. A., & deToledo‐Morrell, L. (2005) · Neurology · doi:10.1212/01.wnl.0000160089.43264.1a · Cited by 188 · see citing works
Wadley, V. G., Okonkwo, O., Crowe, M., & Ross-Meadows, L. A. (2008) · The American Journal of Geriatric Psychiatry · doi:10.1097/01.jgp.0000310780.04465.13 · Cited by 187 · see citing works
Epidemiology of Apathy in Older Adults: The Cache County Study
Onyike, C. U., Leoutsakos, J., Tschanz, J. T., Norton, M. C., Green, R. C., Steinberg, M., Welsh-Bohmer, K. A., Breitner, J. C. S., & Lyketsos, C. G. (2007) · American Journal of Geriatric Psychiatry · doi:10.1097/01.jgp.0000235689.42910.0d · Cited by 177 · see citing works
Pereira, F., Yassuda, M. S., de Oliveira, A. M., & Forlenza, O. V. (2008) · International Psychogeriatrics · doi:10.1017/s1041610208007631 · Cited by 177 · see citing works
Mild Cognitive Impairment and Everyday Function: An Investigation of Driving Performance
Wadley, V. G., Okonkwo, O. C., Crowe, M. G., Vance, D. E., Elgin, J. M., Ball, K., & Owsley, C. J. (2009) · Journal of Geriatric Psychiatry and Neurology · doi:10.1177/0891988708328215 · Cited by 174 · see citing works
Ballard, C. G., O'Brien, J. T., James, I. A., Mynt, P., Lana, M. M., Potkins, D., Reichelt, K., Lee, L., Swann, A., & Fossey, J. (2001) · International Psychogeriatrics · doi:10.1017/s1041610201007499 · Cited by 173 · see citing works
Caregiving from the recipient's perspective: Negative reactions to being helped.
Newsom, J. T., & Schulz, R. (1998) · Health Psychology · doi:10.1037/0278-6133.17.2.172 · Cited by 171 · see citing works
Performance-Based Measures of Everyday Function in Mild Cognitive Impairment
Goldberg, T. E., Koppel, J. L., Keehlisen, L., Christen, E., Dreses‐Werringloer, U., Conejero‐Goldberg, C., Gordon, M. L., & Davies, P. (2010) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2010.09050692 · Cited by 150 · see citing works
Ani, C., Bazargan, M., Hindman, D. W., Bell, D. S., Farooq, M. A., Akhanjee, L., Yemofio, F., Baker, R. S., & Rodriguez, M. (2008) · BMC Family Practice · doi:10.1186/1471-2296-9-1 · Cited by 146 · see citing works
Cognitive Correlates of Financial Abilities in Mild Cognitive Impairment
Okonkwo, O. C., Wadley, V. G., Griffith, H. R., et al. (2006) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2006.00916.x · Cited by 143 · see citing works
Okonkwo, O. C., Wadley, V. G., Griffith, H. R., et al. (2008) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e31817e8a9d · Cited by 122 · see citing works
Early Cognitive Change in the General Population: How Do Different Definitions Work?
Stephan, B. C. M., Matthews, F. E., McKeith, I. G., Bond, J., & Brayne, C. (2007) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2007.01386.x · Cited by 117 · see citing works
Albert, S. M., Michaels, K. S., Padilla, M., Pelton, G. H., Bell, K. L., Marder, K. S., Stern, Y., & Devanand, D. P. (1999) · American Journal of Geriatric Psychiatry · doi:10.1097/00019442-199908000-00005 · Cited by 109 · see citing works
Argüelles, S., Loewenstein, D., Eisdorfer, C., & Argüelles, T. (2001) · Journal of Geriatric Psychiatry and Neurology · doi:10.1177/089198870101400209 · Cited by 86 · see citing works
Zunzunegui, M. V., Cuadra, P. G., B�land, F., del Ser, T., & Wolfson, C. M. (2000) · International Journal of Geriatric Psychiatry · doi:10.1002/(sici)1099-1166(200002)15:2 · Cited by 85 · see citing works
Disability in dementia: assessment, prevention, and rehabilitation
Jorm, A. F. (1994) · Disability and Rehabilitation · doi:10.3109/09638289409166286 · Cited by 36 · see citing works
Elderkin‐Thompson, V., Ballmaier, M., Hellemann, G., Pham, D. L., Lavretsky, H., & Kumar, A. (2008) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e3181794629 · Cited by 16 · see citing works
Patterson, T. L., & Harvey, P. D. (2008) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e31817f8cb9 · Cited by 8 · see citing works
Item reduction in a scale for screening
Liu, X., & Jin, Z. (2007) · Statistics in Medicine · doi:10.1002/sim.2853 · Cited by 5 · see citing works
Anxiety disorders in later life: a report from the Longitudinal Aging Study Amsterdam
Beekman (1998) · Pure Amsterdam UMC · doi:10.1002/(sici)1099-1166(1998100)13:10 · Cited by 2 · see citing works
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Langa, K. M., & Levine, D. A. (2014) · JAMA · doi:10.1001/jama.2014.13806 · Cited by 1,337 · see citing works
Jackson, J. C., Pandharipande, P. P., Girard, T. D., Brummel, N. E., Thompson, J. L., Hughes, C. G., Pun, B. T., Vasilevskis, E. E., Morandi, A., Shintani, A. K., et al. (2014) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(14)70051-7 · Cited by 673 · see citing works
Jekel, K., Damian, M., Wattmo, C., Hausner, L., Bullock, R., Connelly, P. J., Dubois, B., Eriksdotter, M., Ewers, M., Graessel, E., et al. (2015) · Alzheimer's Research & Therapy · doi:10.1186/s13195-015-0099-0 · Cited by 640 · see citing works
Weiner, M. W., Veitch, D. P., Aisen, P. S., Beckett, L. A., Cairns, N. J., Cedarbaum, J., Green, R. C., Harvey, D., Jack, C. R., Jagust, W., et al. (2015) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2014.11.001 · Cited by 348 · see citing works
Zhong, B.-L., Chen, S.-L., Tu, X., & Conwell, Y. (2017) · The Journals of Gerontology Series B: Psychological Sciences and Social Sciences · doi:10.1093/geronb/gbw037 · Cited by 259 · see citing works
Initiative, F. T. A. D. N., Skinner, J., Carvalho, J. O., Potter, G. G., Thames, A., Zelinski, E., Crane, P. K., & Gibbons, L. E. (2012) · Brain Imaging and Behavior · doi:10.1007/s11682-012-9166-3 · Cited by 151 · see citing works
Sanders, L. M. J., Hortobágyi, T., Karssemeijer, E. G. A., Van der Zee, E. A., Scherder, E. J. A., & van Heuvelen, M. J. G. (2020) · Alzheimer's Research & Therapy · doi:10.1186/s13195-020-00597-3 · Cited by 154 · see citing works
Psychometric properties of the Brazilian version of Pfeffer's Functional Activities Questionnaire
Assis, L. D. O., de Paula, J. J., Assis, M. G., de Moraes, E. N., & Malloy-Diniz, L. F. (2014) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2014.00255 · Cited by 54 · see citing works
Longitudinal Associations Between Loneliness and Cognitive Ability in the Lothian Birth Cohort 1936
Okely, J. A., & Deary, I. J. (2019) · The Journals of Gerontology: Series B · doi:10.1093/geronb/gby086 · Cited by 36 · see citing works
Ellis, J. L., Altenburger, P., & Lu, Y. (2019) · Journal of Geriatric Physical Therapy · doi:10.1519/jpt.0000000000000143 · Cited by 10 · see citing works
- Authors
- Brown, P. J.
- Affiliations
- New York State Psychiatric Institute (US)
- Corresponding author
- Brown, Patrick J.
- ORCID
- Brown, Patrick J.
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2011-06-06
- Volume
- 68
- Issue
- 6
- Pages
- 617
- ISSN
- 0003-990X (ISSN-L)
- PMC
- PMC3682408
- OpenAlex
- W2142666055
- Cited by
- 242
- References
- 54
- Citations by year
- 2026: 13 · 2025: 8 · 2024: 25 · 2023: 17 · 2022: 13 · 2021: 11 · 2020: 20 · 2019: 12 · 2018: 12 · 2017: 13 · 2016: 17 · 2015: 26 · 2014: 19 · 2013: 18 · 2012: 15
- FWCI
- 11.82
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5u01ag024904-10)
- National Institute on Aging (U01-AG-024904, P30AG010129, R01AG17761, K01AG030514, R01AG017761, U19AG010483)
- National Institute of Mental Health (T32MH020004, T32 MH 20004)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Functions and Memory
- Keywords
- functional disability, mild cognitive impairment, mild Alzheimer disease, instrumental activities of daily living, amnestic MCI, hippocampal volume, Trail Making Test, Auditory Verbal Learning Test, early detection of dementia, Alzheimer's Disease Neuroimaging Initiative, cognitive impairment severity
- MeSH terms
- Activities of Daily Living, Aged, Aged, 80 and over, Alzheimer Disease, Canada, Cognition Disorders, Female, Humans, Male, Memory, Neuropsychological Tests, Severity of Illness Index, United States
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