|
© 2006 American Academy of Neurology Restriction in complex activities of daily living in MCIImpact on outcomeFrom INSERM U593 the French Institute of Health and Medical Research, University Victor Segalen, (K.P., V.C., C.F., J.M.O., J.F.D., P.B.-G.) and University Hospital Center (J.M.O., J.F.D., P.B.-G.), Bordeaux, France. Address correspondence and reprint requests to Dr. Karine Pérès, INSERM U593-PAQUID, Case 11, 146 rue Léo Saignat, 33076 Bordeaux Cedex, France; e-mail: Karine.Peres{at}isped.u-bordeaux2.fr Objective: To describe the restriction in instrumental activities of daily living (IADL) in mild cognitive impairment (MCI) and to assess the impact of IADL restriction on the progression to dementia and on MCI reversibility. Methods: The study sample included 1,517 participants of the PAQUID cohort, visited at 8- and 10-year follow-ups. Subjects classified as having MCI had no dementia but a cognitive deficit according to five neuropsychological tests. Four IADL (telephone, transports, medication, finances) were assessed and considered restricted if at least two of them were not performed at the highest level of performance. Cross-sectional and longitudinal analyses were conducted. Results: A total of 285 subjects were classified as having MCI at baseline, and 15.2% developed dementia within 2 years. MCI subjects were more frequently IADL restricted (34.3%) than controls (5.4%) but less than those with dementia (91.1%). The IADL-restricted MCI subjects were more likely to develop dementia over 2 years (30.7%) than the nonrestricted ones (7.8%). In multivariate analyses, the odds ratio for dementia was 7.4 (CI: 3.3 to 16.5) in the IADL-restricted MCI and 2.8 (CI: 1.3 to 6.0) in the non–IADL-restricted MCI compared with the non–IADL-restricted controls. IADL restriction also lowered the chance of reversibility to normal, observed in 10.7% of the restricted MCI and 34.7% of the nonrestricted MCI. Conclusions: Inclusion of instrumental activities of daily living restriction in the criteria of mild cognitive impairment improves the prediction of dementia and the stability of this status over time. Conversely, its exclusion results in inappropriate selection of subjects with a low probability of short-term progression to dementia.
The PAQUID project was funded by ARMA (Bordeaux); Caisse Nationale d’Assurance Maladie des Travailleurs Salariés (CNAMTS); Conseil Général de la Dordogne; Conseil Général de la Gironde; Conseil Régional d’Aquitaine; Fondation de France; France Alzheimer (Paris); GIS Longévité; Institut National de la Santé et de la Recherche Médicale (INSERM); Mutuelle Générale de l’Education Nationale (MGEN); Mutualité Sociale Agricole (MSA); NOVARTIS Pharma (France); and SCOR Insurance (France). Disclosure: The authors report no conflicts of interest. Received October 7, 2005. Accepted in final form April 5, 2006.
This article has been cited by other articles:
Correspondence:Read all Correspondence
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
