Journal
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
Volume 62, Issue 7, Pages 1347-1352Publisher
WILEY
DOI: 10.1111/jgs.12878
Keywords
cognitive function; mild cognitive impairment; mild neurocognitive disorder; activities of daily; living; instrumental activities of daily living
Categories
Funding
- National Institutes of Health (NIH) [P30 MH090333, R01MH043823, R01 MH072947, T32 MH019986, P50AG05133]
- Clinical and Translational Science Institute [UL1RR024153, UL1TR000005]
- University of Pittsburgh Medical Center Endowed Chair in Geriatric Psychiatry
- NIH [R01 HD074693, R03 HD073770]
- National Institute on Disability and Rehabilitation Research
- SanBio
- University of Pittsburgh Medical Center Rehabilitation Institute
- University of Pittsburgh Office of Research
- Bristol-Myers Squibb
- Forest
- Pfizer
- Lilly
- National Institute of Mental Health
- National Institute on Aging
- National Center for Minority Health Disparities
- National Heart Lung and Blood Institute
- Centers for Medicare and Medicaid Services
- Patient Centered Outcomes Research Institute
- Commonwealth of Pennsylvania
- John A. Hartford Foundation
- National Palliative Care Research Center
- Clinical and Translational Science Institute
- American Foundation for Suicide Prevention
- National Institute of Mental Health [R01 MH072947, MH080240]
- National Institute of Nursing Research [NR010904]
- National Center for Medical and Rehabilitation Research [HD055931]
- National Institute of Disability and Rehabilitation Research [H133B090024, H133A080053]
- Association of Arthritis Health Professionals
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OBJECTIVES: To examine whether preclinical disability in performance of cognitively focused instrumental activity of daily living (C-IADL) tasks can discriminate between older adults with normal cognitive function and those with mild cognitive impairment (MCI) and, secondarily, to determine the two tasks with the strongest psychometric properties and assess their discriminative ability so as to generate diagnosis-relevant information about cognitive changes associated with MCI and mild neurocognitive disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria. DESIGN: Secondary analyses of cross-sectional data from a cohort of individuals diagnosed with normal cognitive function or MCI. SETTING: Pittsburgh, Pennsylvania. PARTICIPANTS: Older adults with remitted major depression (N = 157). MEASUREMENTS: Diagnosis of cognitive status was made at the Alzheimer's Disease Research Center, University of Pittsburgh. Performance on eight C-IADLs was measured using the criterion-referenced, observation-based Performance Assessment of Self-Care Skills (PASS). RESULTS: Ninety-six older adults with normal cognitive function (mean age 72.5 +/- 5.9) and 61 with MCI (mean age 75.5 +/- 6.3) participated. The eight C-IADLs demonstrated 81% accuracy in discriminating cognitive status (area under the receiver operating characteristic curve (AUC) = 0.81, P < .001). Two tasks (shopping and check-book balancing) were the most discriminating (AUC = 0.80, P < .001); they demonstrated similar ability as all eight C-IADLs in determining cognitive status. Assessing performance on these two C-IADLs takes 10 to 15 minutes. CONCLUSION: This is the first demonstration of the discriminative ability of preclinical disability to distinguish older adults with MCI from cognitively normal older adults. These findings highlight potential tasks that, when measured using the observation-based PASS, demonstrate greater effort for individuals with MCI. These tasks may be considered when attempting to diagnose MCI or mild neurocognitive disorder in clinical practice and research.
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