Cited by 133Dementia and Cognitive Impairment ResearchAging, Health, and DisabilityCancer-related cognitive impairment studies

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Early diagnosis of mild cognitive impairment and mild dementia through basic and instrumental activities of daily living: Development of a new evaluation tool

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Cornelis, Elise, Gorus, Ellen, Beyer, Ingo, Bautmans, Ivan, De Vriendt, Patricia·2017·PLoS Medicine

DOI 10.1371/journal.pmed.1002250PMC PMC5349421

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Abstract

BACKGROUND: Assessment of activities of daily living (ADL) is paramount to determine impairment in everyday functioning and to ensure accurate early diagnosis of neurocognitive disorders. Unfortunately, most common ADL tools are limited in their use in a diagnostic process. This study developed a new evaluation by adopting the items of the Katz Index (basic [b-] ADL) and Lawton Scale (instrumental [i-] ADL), defining them with the terminology of the International Classification of Human Functioning, Disability and Health (ICF), adding the scoring system of the ICF, and adding the possibility to identify underlying causes of limitations in ADL. METHODS AND FINDINGS: The construct validity, interrater reliability, and discriminative validity of this new evaluation were determined. From 2015 until 2016, older persons (65-93 y) with normal cognitive ageing (healthy comparison [HC]) (n = 79), mild cognitive impairment (MCI) (n = 73), and Alzheimer disease (AD) (n = 71) underwent a diagnostic procedure for neurocognitive disorders at the geriatric day hospital of the Universitair Ziekenhuis Brussel (Brussels, Belgium). Additionally, the ICF-based evaluation for b- and i-ADL was carried out. A global disability index (DI), a cognitive DI (CDI), and a physical DI (PDI) were calculated. The i-ADL-CDI showed high accuracy and higher discriminative power than the Lawton Scale in differentiating HC and MCI (area under the curve [AUC] = 0.895, 95% CI .840-.950, p = .002), MCI and AD (AUC = 0.805, 95% CI .805-.734, p = .010), and HC and AD (AUC = 0.990, 95% CI .978-1.000, p < .001). The b-ADL-DI showed significantly better discriminative accuracy than the Katz Index in differentiating HC and AD (AUC = 0.828, 95% CI .759-.897, p = .039). This study was conducted in a clinically relevant sample. However, heterogeneity between HC, MCI, and AD and the use of different methods of reporting ADL might limit this study. CONCLUSIONS: This evaluation of b- and i-ADL can contribute to the diagnostic differentiation between cognitively healthy ageing and neurocognitive disorders in older age. This evaluation provides more clarity and nuance in assessing everyday functioning by using an ICF-based terminology and scoring system. Also, the possibility to take underlying causes of limitations into account seems to be valuable since it is crucial to determine the extent to which cognitive decline is responsible for functional impairment in diagnosing neurocognitive disorders. Though further prospective validation is still required, the i-ADL-CDI might be useful in clinical practice since it identifies impairment in i-ADL exclusively because of cognitive limitations.

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Fig 1 Formulas to calculate the indices of both b- and i-ADL. TNA = Total Number of Activities; LimActi = the i-th total number of Limited Activities; LimActCi = the i-th total number of Limited Activities because of a Cognitive reason; LimActPi = the i-th total number of Limited Activities because of a Physical reason; ICFscoreActi = the performance score given to the i-th limited activity; ICFscoreActCi = the performance score given to the i-th limited activity with a Cognitive reason of limitation; ICFscoreActPi = the performance score given to the i-th limited activity with a Physical reason of limitation; TNA*4 = Maximal disability; ((∑)^())i=0^NAlimLimActi*ICFscoreActi = absolute disability; ((∑)^())i=0^NAlimLimActCi*ICFscoreActCi = absolute disability because of cognitive reasons; ((∑)^())i=0^NAlimLimActPi*ICFscoreActPi = absolute disability because of physical reasons.CC BY · PubMed Central

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Authors: Cornelis, E., Gorus, E., Beyer, I., Bautmans, I., & De Vriendt, P.
Affiliations: Vrije Universiteit Brussel (BE)
Corresponding author: Cornelis, Elise
ORCID: Cornelis, Elise
Gorus, Ellen
Beyer, Ingo
Bautmans, Ivan
De Vriendt, Patricia
Venue: PLoS Medicine
Publisher: Public Library of Science (PLoS)
Published: 2017-03-14
Volume: 14
Issue: 3
Pages: e1002250
ISSN: 1549-1277 (ISSN-L)
1549-1676
DOI: 10.1371/journal.pmed.1002250
PMC: PMC5349421
OpenAlex: W2597330318
Cited by: 133
References: 115
Citations by year: 2026: 11 · 2025: 9 · 2024: 10 · 2023: 11 · 2022: 26 · 2021: 22 · 2020: 17 · 2019: 9 · 2018: 13 · 2017: 4
FWCI: 9.65
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
Locations: PLoS Medicine (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Figshare (submittedVersion, cc-by)
VUBIR (Vrije Universiteit Brussel) (submittedVersion)
Funders: Wetenschappelijk Fonds Willy Gepts, Universitair Ziekenhuis Brussel, Belgium
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 › Oncology › Cancer-related cognitive impairment studies
Keywords: mild cognitive impairment, mild dementia, Alzheimer's disease, activities of daily living, instrumental activities of daily living, basic activities of daily living, disability index, early diagnosis, functional assessment, older adults, diagnostic accuracy, Katz Index, Lawton scale, construct validity, inter-rater reliability, discriminative validity, cognitive aging, geriatric day hospital
MeSH terms: Activities of Daily Living, Aged, Aged, 80 and over, Belgium, Dementia, Female, Humans, Male, Geriatric Assessment, Early Diagnosis, Cognitive Dysfunction

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Early diagnosis of mild cognitive impairment and mild dementia through basic and instrumental activities of daily living: Development of a new evaluation tool

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