Functional Impairment in Elderly Patients With Mild Cognitive Impairment and Mild Alzheimer Disease

Functional Impairment in Elderly Patients With Mild Cognitive Impairment and Mild Alzheimer Disease
Arch Gen Psychiatry. 2011;68(6):617-626

The mild cognitive impairment (MCI) criteria require reports of subjective memory deficits and a score 1.5 SDs below age-adjusted norms on a memory test (amnestic MCI) and require no “substantial interference with work, usual social activities, or other activities of daily living.”
However, research has shown that individuals with aMCI commonly have deficits in instrumental activities
of daily living (IADLs).

Objectives of this study is:
(a) to examine the number, type, and severity of functional impairments across patients with aMCI and those with mild Alzheimer Disease, comparing them with healthy, cognitively intact control individuals.
(b) to identify the clinical characteristics that explain functional impairment in individuals with aMCI and mild AD.
(c) to explore the neuropsychological and neuroanatomical profiles in relation to functional deficits in individuals with aMCI.

Patients:
- 229 control individuals,
- 394 patients with aMCI
- 193 patients with AD

NEUROPSYCHOLOGICAL ASSESSMENT:
- Trail Making Test, parts A and B
- Digit Symbol Substitution Test of the Wechsler Adult Intelligence Scale–Revised
- Auditory Verbal Learning Test

FUNCTIONAL ASSESSMENT
- Pfeffer Functional Activities Questionnaire:
This questionnaire includes following questions-
1. Writing checks, paying bills, or balancing checkbook
2. Assembling tax records, business affairs, or other papers
3. Shopping alone for clothes, household necessities, or groceries
4. Playing a game of skill such as bridge or chess or working on a hobby
5. Heating water, making a cup of coffee, or turning off the stove
6. Preparing a balanced meal
7. Keeping track of current events
8. Paying attention to and understanding a television program, book, or magazine
9. Remembering appointments, family occasions, holidays, and medications
10. Traveling outside the neighborhood, driving, or arranging to take public transportation

IMAGING VOLUME DERIVATIONS
- Hippocampal volume
- Entorhinal volume
- Intracranial volumes

Results & Conclusions:
- Two FAQ items were specific in differentiating the control group from the combined aMCI and AD groups:-
(a) remembering appointments, family occasions, holidays, and medications and
(b) assembling tax records, business affairs, or other papers.
- 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.
- 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 scores compared with individuals with moderate or severe FAQdeficits.
- Patients with a high number of deficits were more likely to express the apolipoprotein ε4 allele compared with patients with no or few functional deficits.