The hierarchy of functional loss associated with cognitive decline in older persons
Abstract
OBJECTIVES: We studied a representative cohort of community-dwelling elderly persons to (i) examine the relationship between the loss of specific functional activities and cognitive status at the time of these losses, (ii) compare the cognitive status of participants who have and have not lost independence in these functional activities, and (iii) determine whether a hierarchical scale of functional loss is associated with declining cognitive status. METHODS: A cohort of 5874 community-dwelling persons aged 65 years and older from the Canadian Study of Health and Aging I and II were analyzed. At baseline and 5 years later, cognitive status with the Modified Mini-Mental State Examination (3MS) and functional status with 14 Older American Resources and Services (OARS) items were measured. For each OARS functional item, the mean 3MS scores for persons who lost independence during the 5-year period versus those who did not were compared. RESULTS: For each functional item, the 5-year decline in 3MS scores of persons who lost independence were significantly greater than those who remained independent (e.g., ability to do finances), with an 18-point decline for those who lost independence and a 2-point decline for those who retained independence. A hierarchy of functional items existed, with instrumental activities of daily living (ADLs) (e.g., shopping, banking, and cooking) being lost at higher cognitive scores than basic ADL items (e.g., eating, dressing, and walking), although there was some overlap. CONCLUSIONS: This is the first prospective study using a large representative cohort of elderly persons to demonstrate that progressive cognitive decline is associated with a specific pattern of loss of functional tasks. Clear cognitive thresholds at which development of dependency in OARS functional items occurred. By providing estimates of the cognitive status of persons at the time at which they developed dependency in specific functional items, a natural hierarchy of functional loss associated with cognitive decline emerged. For caregivers, clinicians, and health policy makers, this information can help anticipate the pattern of functional decline and the subsequent care needs of persons with declining cognition, potentially improving the quality of life of these persons and their caregivers and playing an important part in health care planning.
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People who live alone are often solely responsible for completing household tasks, such as paying the bills, shopping, cleaning, maintenance, and answering the telephone or door, which all require cognitive input.
“People who live alone are often solely responsible for completing household tasks, such as paying the bills, shopping, cleaning, maintenance, and answering the telephone or door, which all require cognitive input (Jekel et al., 2015;Njegovan, Man-Son-Hing, Mitchell, & Molnar, 2001).”
From Living alone and cognitive function in later life (2019) · cites this paper as Njegovan et al., 2001
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- Authors
- Njegovan, V., Man-Son-Hing, M., Mitchell, S. L., & Molnar, F. J.
- Affiliations
- Ottawa Hospital (CA)
- Corresponding author
- Njegovan, V.
- ORCID
- Molnar, F. J.
- Venue
- The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
- Publisher
- Oxford University Press (OUP)
- Published
- 2001-10-01
- Volume
- 56
- Issue
- 10
- Pages
- M638-M643
- ISSN
- 1079-5006 (ISSN-L)
- 1758-535X
- OpenAlex
- W2139100680
- Cited by
- 359
- References
- 23
- Citations by year
- 2026: 14 · 2025: 19 · 2024: 15 · 2023: 15 · 2022: 13 · 2021: 19 · 2020: 19 · 2019: 22 · 2018: 9 · 2017: 15 · 2016: 15 · 2015: 21 · 2014: 23 · 2013: 9 · 2012: 18
- FWCI
- 3.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journals of Gerontology Series A (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- cognitive decline, functional loss, older adults, instrumental activities of daily living, basic activities of daily living, dependency, cognitive thresholds, community-dwelling older adults, Canadian Study of Health and Aging, care needs
- MeSH terms
- Activities of Daily Living, Aged, Aged, 80 and over, Canada, Cognition, Cognition Disorders, Female, Persons with Disabilities, Disabled Persons, Humans, Male, Prospective Studies, Reference Values, Risk Factors, Cohort Studies, Geriatric Assessment, Incidence, Multivariate Analysis, Age Distribution, Sex Distribution, Disease Progression, Risk Assessment
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