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. 2017 Jan-Mar;31(1):55-61.
doi: 10.1097/WAD.0000000000000160.

Impact of Functional Deficits in Instrumental Activities of Daily Living in Mild Cognitive Impairment: A Clinical Algorithm to Predict Progression to Dementia

Davangere P Devanand  1 , Xinhua Liu, Patrick J Brown
Affiliations

Impact of Functional Deficits in Instrumental Activities of Daily Living in Mild Cognitive Impairment: A Clinical Algorithm to Predict Progression to Dementia

Davangere P Devanand et al. Alzheimer Dis Assoc Disord. 2017 Jan-Mar.

Abstract

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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Conflict of interest statement

Disclosure of Financial Conflicts of Interest

Dr. D.P. Devanand has received consulting fees from AbbVie, Lundbeck, Astellas and Intracellular Therapeutics. Drs. Brown and Liu report no conflicts of interest.

Figures

Figure 1
Figure 1
ROC curves for age, MMSE, and FAQ measures for progression to dementia (validation set, n=1174).
See this image and copyright information in PMC

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