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From the Memory Disorders Clinic and Department of Biological Psychiatry (Drs. Tabert, Pelton, Liu, and Devanand, L. Borukhova-Milov, and Y. Camacho), New York State Psychiatric Institute, Taub Alzheimer’s Disease Research Center; and Departments of Psychiatry and Neurology and Gertrude H. Sergievsky Center (Drs. Tabert, Albert, Pelton, Stern, and Devanand), College of Physicians and Surgeons, Columbia University, New York, NY.
Address correspondence and reprint requests to Dr. M.H. Tabert, Columbia University/NYSPI, 1051 Riverside Dr., Unit 126, New York, NY 10032; e-mail: mht35{at}columbia.edu
Objective: To evaluate the predictive utility of self-reported and informant-reported functional deficits in patients with mild cognitive impairment (MCI) for the follow-up diagnosis of probable AD.
Methods: The Pfeffer Functional Activities Questionnaire (FAQ) and Lawton Instrumental Activities of Daily Living (IADL) Scale were administered at baseline. Patients were followed at 6-month intervals, and matched normal control subjects (NC) were followed annually.
Results: Self-reported deficits were higher for patients with MCI than for NC. At baseline, self- and informant-reported functional deficits were significantly greater for patients who converted to AD on follow-up evaluation than for patients who did not convert, even after controlling for age, education, and modified Mini-Mental State Examination scores. While converters showed significantly more informant- than self-reported deficits at baseline, nonconverters showed the reverse pattern. Survival analyses further revealed that informant-reported deficits (but not self-reported deficits) and a discrepancy score indicating greater informant- than self-reported functional deficits significantly predicted the development of AD. The discrepancy index showed high specificity and sensitivity for progression to AD within 2 years.
Conclusions: These findings indicate that in patients with MCI, the patient’s lack of awareness of functional deficits identified by informants strongly predicts a future diagnosis of AD. If replicated, these findings suggest that clinicians evaluating MCI patients should obtain both self-reports and informant reports of functional deficits to help in prediction of long-term outcome.
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