Journal
ALZHEIMER DISEASE & ASSOCIATED DISORDERS
Volume 31, Issue 1, Pages 55-61Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/WAD.0000000000000160
Keywords
function; mild cognitive impairment; algorithm; dementia
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Funding
- National Institute on Aging (NIA) [U01AG016976, 2010-JI-01]
- NIA [R01AG041795, P30 AG019610, P30 AG013846, P50 AG008702, P50 AG025688, P30 AG010133, P50 AG005146, P50 AG005134, P50 AG016574, P50 AG005138, P30 AG008051, P30 AG013854, P30 AG008017, P30 AG010161, P30 AG010129]
- National Institute of Mental Health [K23MH09097]
- NIA/NIH [U01 AG016976]
- NIA
- AbbVie
- Lundbeck
- Astellas
- Intracellular Therapeutics
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Background:The utility of functional deficits in patients with mild cognitive impairment is not established.Materials and Methods:In 3886 individuals with mild cognitive impairment evaluated and followed at 34 National Alzheimer Coordinating Center sites, informant-reported Pfeffer Functional Activities Questionnaire (FAQ) items associated with progression to dementia were derived in a training set (n=1943) and tested in the validation set (n=1943).Results:In the training set, the optimal combination comprised 6 FAQ items (FAQ6): difficulties with finances (2 items), remembering events/appointments, playing games of skill, current events, and travel. In the validation set, hazard ratio for dementia increased from 2.00 for 1 FAQ6 deficit to 5.56 for 6 FAQ6 deficits. In patients 50 to 67 years old with high Mini Mental State Exam scores, dementia risk rose from 12.06% for no FAQ6 deficits to 56.75% for 6 functional deficits. Likelihood of progression to dementia reached 80% to 89% in older age groups with low Mini Mental State Exam and severe FAQ6 deficits.Conclusions:Specific functional deficits increased dementia risk and, with age and global cognition, constituted a validated clinical algorithm to estimate dementia risk. Clinicians can use this clinically important algorithm to personalize decision-making about further investigation and identify high-risk patients for early treatment or inclusion in clinical trials.
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