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. 2021 Feb;36(2):314-323.
doi: 10.1002/gps.5426. Epub 2020 Sep 17.

Trajectories of decline on instrumental activities of daily living prior to dementia in persons with mild cognitive impairment

Simon Cloutier  1 , Howard Chertkow  2 , Marie-Jeanne Kergoat  1 , Isabelle Gélinas  3 , Serge Gauthier  4 , Sylvie Belleville  1
Affiliations

Trajectories of decline on instrumental activities of daily living prior to dementia in persons with mild cognitive impairment

Simon Cloutier et al. Int J Geriatr Psychiatry. 2021 Feb.

Abstract

Objectives: The main objective was to determine the trajectory of instrumental activities of daily living (iADL) decline in persons with mild cognitive impairment (MCI) who progressed towards dementia relative to persons with MCI who remained stable.

Methods/design: At study entry, 121 participants met criteria for MCI. Based on the follow-up, 47 participants later converted to dementia and were identified as progressors. Sixteen participants, identified as decliners, presented a significant cognitive decline but did not reach the criteria for dementia within the study timeframe. Stable MCI remained cognitively stable during the 5-year follow-up; n = 58. Participants completed a yearly assessment using clinical tests/questionnaires, neuropsychological measures, and functional autonomy assessment until they met criteria for dementia. The average number of months for the follow-up was 34.

Results: Many years of stable performance followed by an accelerated decline just prior to diagnosis, was observed for complex activities for progressors. No change was found for stable MCI and a gradual linear decline characterized decliners. The housekeeping-related activities component showed a linear decline in progressors and did not change in stable and decliner MCI. We found a predictive model that includes significant predictors of dementia conversion with a high diagnostic accuracy the following year (area under the curve = 0.94 [95% confidence level; lower bound: 0.87, upper bound: 1]).

Conclusions: It is critical to assess iADL that reflect complex activities in the evaluation of MCI individuals as their impairment, combined with change on cognitive markers, indicates a higher risk of dementia progression 1 or 2 years later.

Keywords: Alzheimer's disease; activities of daily living; mild cognitive impairment; trajectories.

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Conflict of interest statement

The authors have no relevant conflict of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Trajectories of decline in stable (dotted lines), decliners (broken line), and progressors (full line) as a function of time to diagnosis on (A) total iADL, (B) housekeeping, and (C) complex iADL. (A) Score on SMAf total (sum of the eight items) as a function of time to diagnosis (for progressors) or on the last five cognitive assessments (for the decliners and stable). Note that a higher score represents more functional impact. A quadratic function best describes the distribution for the progressors: black line. A linear function best describes the distribution for the decliners: big dots line. No significant model for stable: small dots line. (B) Score on the housekeeping‐related iADL items as a function of time to diagnosis (for progressors) or on the last five cognitive assessments (for the decliners and stable). Note that a higher score represents more functional impact. A linear function best describes the distribution for the progressors: black line. No significant model for the declines (big dots line) and the stable: small dots line. (C) Score on the complex iADL items as a function of time to diagnosis (for progressors) or on the last five cognitive assessments (for the decliners and stable). Note that a higher score represents more functional impact. A quadratic function best describes the distribution for the progressors: black line. A linear function best describes the distribution for the decliners: big dots line. No significant model for stable: small dots line. iADL, instrumental activities of daily living
FIGURE 2
FIGURE 2
Prediction model of progression from MCI to dementia (left) and diagnostic accuracy of this model (right). The grey area represents the significant predictors of conversion, based on the logistic regression analysis. ROC curve analysis indicated a good accuracy 3 years prior the diagnosis (AUC = 0.88 [95% confidence level; lower bound: 0.76, upper bound: 1]) and an excellent accuracy 2 years (AUC = 0.92 [95% confidence level; lower bound: 0.84, upper bound: 1]) and 1 year (AUC = 0.94 [95% confidence level; lower bound: 0.87, upper bound: 1]) before diagnosis. AUC, area under the curve; MCI, mild cognitive impairment; ROC, receive operating characteristic
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