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ARTICLES: K. Pérès, V. Chrysostome, C. Fabrigoule, J. M. Orgogozo, J. F. Dartigues, and P. Barberger-Gateau Restriction in complex activities of daily living in MCI: Impact on outcome Neurology 2006; 67: 461-466 [Abstract] [Full text] [PDF]

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Restriction in complex activities of daily living in MCI: Impact on outcome

Hadi Hussain   (31 October 2006)

Reply from the Authors

Karine Pérès, Virginie Chrysostome, Colette Fabrigoule, Jean-Marc Orgogozo, Jean-François Dartigues, and Pascale Barberger-Gateau   (31 October 2006)

Restriction in complex activities of daily living in MCI: Impact on outcome 31 October 2006
Hadi Hussain, Military Hospital, Rawalpindi House No 59,Street No 40, Gunj Moghal Pura Lahore,Pakistan Send Correspondence to journal: Re: Restriction in complex activities of daily living in MCI: Impact on outcome hadimeeran{at}yahoo.com Hadi Hussain	Pérès et al conclude that inclusion of IADL restriction, particularly for the four items known to be most sensitive to early dementia, improved the prediction of dementia and the stability of this status (e.g. no reversal back to normal) over a period of time as short as 2 years. [1] This study is important because it helps define the MCI population most at risk of progression to dementia usually Alzheimer’s disease (AD), and may facilitate the evaluation of disease-modifying treatments. These clinical observations can be supplemented by apolipoprotein E (APOE å4) genotyping; results from the Cache County Study confirm the very high risk of progression to AD in MCI subjects with at least one APOE å4 allele. [2] [11C]PIB scanning also appears promising in detecting subjects with abnormal amyloid loading in asymptomatic individuals. [3] It is possible to predict that persons with cognitive complaints found to have some abnormal neuropsychological tests but not clinically demented will be offered a combination of clinical and biological predictors for progression to dementia. This strategy will make sense if there are specific disease-modifying treatments such as the amyloid-specific therapies under study (tramiprosate or Alzhemed, R-flurbiprofen or Flurizan, bapineuzumab or AAB-001). This promising research must not detract from the daily reality of dealing with persons with memory complaints--most will not have dementia. These patients should be made aware of their risk state and their vascular risk factors treated appropriately. [4] References: 1. Pérès K, Chrysostome V, Fabrigoule C, Orgogozo JM, Dartigues JF, Barberger-Gateau P. Restriction in complex activities of daily living in MCI: Impact on outcome Neurology 2006; 67: 461-466. 2. Tschanz JT, Welsh-Bohmer KA, Lyketsos CG, et al. Conversion to dementia from mild cognitive disorder: the Cache County Study. Neurology 2006;67: 229-234 3. Mintun MA, Larossa GN, Sheline YI, et al. [11C] PIB in a nondemented population: potential antecedent marker of Alzheimer disease. Neurology 2006;67: 446-452 4. Gauthier S, Reisberg B, Zaudig M, Petersen et al. Mild cognitive impairment. Lancet 2006;367: 1262-1270. Disclosure: The author reports no conflicts of interest.
Reply from the Authors 31 October 2006
Karine Pérès, Inserm U593, the French Institute of Health and Medical Research, University Bordeaux 2 146 rue Léo Saignat 33076 Bordeaux Cedex France, Virginie Chrysostome, Colette Fabrigoule, Jean-Marc Orgogozo, Jean-François Dartigues, and Pascale Barberger-Gateau Send Correspondence to journal: Re: Reply from the Authors Karine.Peres{at}isped.u-bordeaux2.fr Karine Pérès, et al.	We thank Dr. Hussain for his interest in our article. [1] In the PAQUID study, restriction of complex activities in daily living seemed to capture other information than those identified on the sole basis of neuropsychological testing. This additional information could predict subsequent dementia in population-based studies. Dr. Hussain suggests that other factors could be added to the diagnostic criteria of MCI, such as genetics [2] or imaging. [3] Better identification of patients involved in the dementia process is essential, especially at the stage of the evaluation of disease-modifying treatments. If patients are not targeted at an early stage, evaluations of disease-modifying treatments will never be probative. Restriction in complex ADL greatly improves the prediction of subsequent dementia. we found that cognitively normal people restricted in IADL are more likely to develop dementia than those with MCI but non-restricted in these activities. Such an evaluation may identify difficulties experienced in daily life but might be not captured in neuropsychological testing. On the other hand, people with low cognitive performance (maybe low performers since ever) but functioning independently in daily life might not be involved in the dementia process despite poor cognitive performances on experimental testing. These latter would thus be misclassified as MCI and wrongly considered at higher risk of dementia. Functional assessment should put emphasis on change, decline, and adaptation of activities because of incipient cognitive problems. The concomitant or differential evolution of abilities in IADL and cognitive functioning needs to be further investigated years before dementia. The PAQUID cohort with its 17 years of hindsight provides the data required for such analyses. Dr. Hussain concludes that most of people with cognitive complaints will not have dementia. He also concludes that patients should be aware of their risk state. If no efficient treatment will be available, the statement of over-risk of dementia at the MCI stage--with the consequences involved with such an announcement--should be approached more cautiously. However, we fully agree with an optimal prevention of vascular risk factors. [4] Disclosure: The authors report no conflicts of interest.