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BACKGROUND: Declining ability to independently perform instrumental activities of daily living (IADL) is a hallmark of early-stage Alzheimer's disease (AD). Financial capacity, an aspect of IADL, includes financial skills such as balancing a checkbook and making change and is potentially sensitive to early decline in cognitive abilities, raising the question of how financial capacity is affected by buildup of cerebral tau and amyloid-hallmarks of AD pathology. OBJECTIVES: This study aimed to examine the relationship between cerebral tau, amyloid, and their interaction with change in financial capacity over time. DESIGN: Participants were selected from the Alzheimer's Disease Neuroimaging Initiative (ADNI) to have at least one yearly follow-up Financial Capacity Instrument-Short Form (FCI-SF) exam and a flortaucipir (tau) PET scan within 6 months of baseline (and in a subset, a florbetapir (amyloid) PET scan within a year of baseline). SETTING: Multi-center international cohort study. PARTICIPANTS: Sample size was 507-322 cognitively normal (CN) and 185 with amnestic mild cognitive impairment (MCI). Sixty-two percent (N=316) had amyloid data. MEASUREMENTS: Linear mixed-effects models predicted FCI-SF total score from baseline tau, age, gender, premorbid intelligence, executive function, memory, and the interaction of each with time. Regions of interest included inferior temporal, entorhinal cortex, precuneus, posterior cingulate, supramarginal, and dorsolateral prefrontal (DLPF). Additional models examined amyloid and its interaction with tau. Results were adjusted for multiple comparisons. RESULTS: Among the whole sample and in CN participants alone, higher baseline tau in all regions, most prominently in the inferior temporal, entorhinal cortex, and supramarginal regions, was significantly associated with worse performance on the FCI-SF over time. Among MCI participants alone, this relationship was significant in the entorhinal cortex (unstandardized b = 0.27, t = 3.71, adjusted p = 0.001), inferior temporal (b = 0.27, t = 3.96, p < 0.001), precuneus (b = 0.27, t = 3.04, p = 0.01), and supramarginal (b = 0.27, t = 2.74, p = 0.02) regions. Amyloid alone was significantly associated with worse FCI-SF performance in only the whole sample (b = 0.15, t = 2.37, p = 0.04), and a three-way interaction between tau, amyloid, and time was only present for entorhinal cortex tau in CN individuals (b = -1.61, t = -2.61, p = 0.03). CONCLUSIONS: Early tau accumulation is linked to worsening financial capacity over time in CN older adults and MCI. Declining financial capacity may signal pathological buildup and serve as an early warning sign for AD, and future research should continue to investigate the longitudinal relationship between tau, financial capacity, and other IADL.
Subject(s)
Activities of Daily Living , Cognitive Dysfunction , Positron-Emission Tomography , tau Proteins , Humans , Cognitive Dysfunction/metabolism , Female , Aged , Male , tau Proteins/metabolism , Longitudinal Studies , Cognition/physiology , Aged, 80 and over , Brain/metabolism , Brain/diagnostic imaging , Aniline Compounds , Carbolines , Amyloid beta-Peptides/metabolism , Ethylene Glycols , Alzheimer Disease/metabolism , Alzheimer Disease/diagnostic imagingABSTRACT
Background: Changes in everyday functioning constitute a clinically meaningful outcome, even in the early stages of Alzheimer's disease. Performance-based assessments of everyday functioning might help uncover these early changes. We aimed to investigate how changes over time in everyday functioning relate to tau and amyloid in cognitively unimpaired older adults. Methods: Seventy-six cognitively unimpaired participants (72 ± 6 years old, 61% female) completed multiple Harvard Automated Phone Task (APT) assessments over 2.0 ± 0.9 years. The Harvard APT consists of three tasks, performed through an automated phone system, in which participants refill a prescription (APT-Script), select a new primary care physician (APT-PCP), and transfer money to pay a bill (APT-Bank). Participants underwent Pittsburgh compound-B and flortaucipir positron emission tomography scans at baseline. We computed distribution volume ratios for a cortical amyloid aggregate and standardized uptake volume ratios for medial temporal and neocortical tau regions. In separate linear mixed models, baseline amyloid by time and tau by time interactions were used to predict longitudinal changes in performance on the Harvard APT tasks. Three-way amyloid by tau by time interactions were also investigated. Lastly, we examined associations between tau and change in Harvard APT scores in exploratory voxel-wise whole-brain analyses. All models were adjusted for age, sex, and education. Results: Amyloid [unstandardized partial regression coefficient estimate (ß) = -0.007, 95% confidence interval (95% CI) = (-0.013, -0.001)], and medial temporal tau [ß = -0.013, 95% CI = (-0.022, -0.004)] were associated with change over time in years on APT-PCP only, i.e., higher baseline amyloid and higher baseline tau were associated with steeper rate of decline of APT-PCP. Voxel-wise analyses showed widespread associations between tau and change in APT-PCP scores over time. Conclusion: Even among cognitively unimpaired older adults, changes over time in the performance of cognitively complex everyday activities relate to cortical amyloid and widespread cerebral tau burden at baseline. These findings support the link between Alzheimer's disease pathology and function and highlight the importance of measuring everyday functioning in preclinical disease stages.
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BACKGROUND: Adherence to the transition from oral agents to insulin injections in Type 2 Diabetes Mellitus therapy varies among patients and is not uniformly successful, leading to suboptimal glycemic control in certain cases. This study aims to investigate the potential correlation between cognitive and daily functional capabilities and glycemic control in middle-aged to older adults (40-74 years old) diagnosed with Type 2 Diabetes Mellitus for less than 10 years, specifically those who have recently transitioned to insulin injections and have lower education levels within the context of a developing country. METHODS: A case-control study was conducted with 30 poorly controlled diabetes mellitus (PCDM) patients recognized by HbA1c levels > 8% compared to 30 fairly controlled diabetes mellitus (FCDM) patients with HbA1c levels ≤ 8%. Basic Montreal Cognitive Assessment (MoCA-B) score of less than 27 was investigated as the exposure among two groups. Additionally, intra- and inter-battery correlations were assessed among MoCA-B and Instrumental Activities of Daily Living (IADL) domains using Pearson's r. RESULTS: The primary outcomes showed no crude difference between MoCA-B scores in the two diabetic groups (p-value = 0.82). However, after adjusting for age, education, and IADL scores, cognitive decline in the less-educated younger elderly with high IADL scores demonstrated an unexpected protective effect against PCDM (p-value < 0.0001, OR 95% CI = 0-0.26). In linear regression analysis among MoCA-B and IADL scores, "delayed recall" and "orientation" domains from MoCA-B, and "managing medications" and "using the phone" from IADL were negatively associated with HbA1c levels (p-values of < 0.01, 0.043, 0.015, and 0.023, respectively). Intra- and inter-battery correlations further illustrated a strong association between MoCA-B's "orientation" with IADL's "using the phone" and "managing medications" (p-values < 0.0001). CONCLUSION: Superior performance in certain cognitive domains is linked to better glycemic control. Still, since assessing cognitive domains may be timely in clinical routine, a potential rapid approach might be taken by assessing patients' instrumental abilities to use cell phone or manage medications. Future studies including a larger sample size and a broader spectrum of psychosocial factors are needed to elaborate on our findings.
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Activities of Daily Living , Cognition , Diabetes Mellitus, Type 2 , Humans , Diabetes Mellitus, Type 2/psychology , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/blood , Middle Aged , Male , Case-Control Studies , Female , Aged , Cognition/physiology , Cognition/drug effects , Adult , Hypoglycemic Agents/therapeutic use , Hypoglycemic Agents/administration & dosage , Glycated Hemoglobin/analysis , Cognitive Dysfunction/etiologyABSTRACT
BACKGROUND: Social inactivity after a stroke leads to adverse outcomes, making social activity after discharge important for chronic stroke survivors. This study aimed to investigate the effects of early rehabilitation services after discharge on social activity among chronic stroke survivors. METHODS: The participants were prospectively recruited from 3 convalescent hospitals. Receipt of early rehabilitation services after discharge for chronic stroke survivors was defined as the utilization of day care or home-based rehabilitation services by the Japanese long-term care insurance system. Social activity was assessed using the Frenchay Activities Index (FAI) premorbid and at 3, 6, and 12 months after discharge. In this study, the outcome was defined as the change in the FAI score from 3 to 12 months after discharge. Multivariate regression analysis was performed to examine the effect of access to rehabilitation on changes in FAI. RESULTS: Ninety stroke survivors (age 67.2±11.6 years, 52 male) were enrolled. The FAI showed improvements by 27.4% and 1.4% from 3 to 12 months after discharge in the rehabilitation and nonrehabilitation groups, respectively. Multivariate regression analysis showed that access to rehabilitation after discharge was positively associated with the FAI change from 3 to 12 months after discharge (B=30.3, ß=0.38, 95% confidence interval=11.13-49.47, P=0.002). CONCLUSIONS: Early rehabilitation services after discharge were significantly associated with increased social activity.
Subject(s)
Patient Discharge , Stroke Rehabilitation , Stroke , Humans , Male , Female , Aged , Patient Discharge/statistics & numerical data , Prospective Studies , Middle Aged , Stroke/psychology , Chronic Disease , Survivors , Aged, 80 and over , Treatment OutcomeABSTRACT
The evaluation of Activities of Daily Living (ADL) has become a critical issue in neuropsychology, but existing instruments for evaluating ADL have some limitations. This work aims to propose a new instrument to evaluate ADL, the ADL Inventory (ADLI), for which we present preliminary data.The ADLI was developed based on a comprehensive model of the stages of test development and following a combined framework of the World Health Organization's International Classification of Functioning, Disability, and Health and the American Occupational Therapy Association models.Besides sociodemographic information, ADLI includes 144 items, organized into four sections: (a) basic ADL; (b) IADL; (c) advanced ADL; and (d) factors influencing functionality. The main characteristics of ADLI are: having self- and informant-report forms; including items focused on different sensory and neurocognitive functions; individualizing the progression along items considering the person's functionality; considering the impact of several factors on functionality; and using a large response scale. Preliminary data of predictive and convergent validity for ADLI are presented. The preliminary study comprised 15 older adults. The Addenbrooke's Cognitive Examination - III, the Barthel Index, and the Instrumental Activities of Daily Living (IADL) Scale were applied to determine the predictive and convergent validity of ADLI.
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Amnestic mild cognitive impairment (aMCI) is a transitional stage between normal aging and Alzheimer's disease, making early screening imperative for potential intervention and prevention of progression to Alzheimer's disease (AD). Therefore, there is a demand for research to identify effective and easy-to-use tools for aMCI screening. While behavioral tests in virtual reality environments have successfully captured behavioral features related to instrumental activities of daily living for aMCI screening, further investigations are necessary to establish connections between cognitive decline and neurological changes. Utilizing electroencephalography with steady-state visual evoked potentials, this study delved into the correlation between behavioral features recorded during virtual reality tests and neurological features obtained by measuring neural activity in the dorsal stream. As a result, this multimodal approach achieved an impressive screening accuracy of 98.38%.
Subject(s)
Cognitive Dysfunction , Electroencephalography , Evoked Potentials, Visual , Virtual Reality , Humans , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/physiopathology , Electroencephalography/methods , Aged , Male , Female , Evoked Potentials, Visual/physiology , Alzheimer Disease/physiopathology , Neuropsychological Tests , Activities of Daily Living , Middle AgedABSTRACT
Introduction: The aging population in South Korea faces numerous health challenges, one of which is the decline in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). This study aims to investigate the patterns of change in ADL and IADL among older adults and examines how these patterns vary between individuals with and without dementia. Methods: We conducted an analysis of data collected from the Korea Longitudinal Study of Ageing (KLoSA) between 2006 and 2022. Our cohort consisted of individuals aged 45 and older with non-dementia conditions, including mild cognitive impairment (N=6042), and a smaller group with dementia (N=91). Using Latent Growth Curve Models, we explored the developmental trajectories of ADL and IADL among our sample. Results: Our findings indicate a linear decline in both ADL and IADL scores as individuals age. The decline in IADL was more pronounced in the dementia group, suggesting a greater sensitivity to sociocultural factors within this domain. The data revealed that individuals with dementia had consistently lower ADL and IADL scores. Notably, the variance in scores within the dementia group increased with age, signifying a worsening in daily living performance and an increase in individual variation (F=226.630, p<.001). Discussion: The results of this study underscore the impact of dementia on both the self-regulation function and the social and cultural aspects of daily living performance, particularly reflected in IADL scores. These findings point to the necessity for comprehensive care strategies that address the multifaceted needs of older adults with dementia, including support for complex daily activities that are influenced by sociocultural factors.
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BACKGROUND: In recent years cognitive frailty has emerged as an important predictor of adverse health outcomes in older adults. Herein, we aimed to investigate the prevalence and associated factors of cognitive frailty in a population of community-dwelling older adults in Iran. METHOD: This cross-sectional study was conducted as part of the second cycle of the Amirkola Health and Aging Project (AHAP). Physical frailty and cognitive impairment were evaluated using the FRAIL questionnaire and the mini-mental state examination (MMSE) respectively. Cognitive frailty was defined as co-existence of frailty and cognitive impairment without presence of dementia. Depression and disability were assessed using the Persian version of geriatric depression scale (GDS) and instrumental activities of daily living (IADL) questionnaire. RESULTS: Overall 1775 individuals (47.1% female) with mean age of 69.7 ± 7.3 years were included in the final analysis. The prevalence of cognitive frailty was 12.0%. The prevalence of cognitive frailty among males and females was 4.3% and 20.7%, respectively. After adjusting for all possible confounders through binary logistic regression analysis, factors such as older age (OR 1.06, CI 1.03-1.09), female gender (OR 2.25, CI 1.42-3.57), illiteracy (OR 3.84, CI 2.03-8.29), more comorbidities (OR 1.21, CI 1.12-1.31), depression (OR 2.01, CI 1.40-2.86), and greater IADL disability (OR 1.68, CI 1.44-3.96), were independently and significantly associated with cognitive frailty. CONCLUSION: In this population of Iranian older adults, prevalence of cognitive frailty was consistent with its estimated mean global prevalence. Age, gender, illiteracy, comorbidities, depression and IADL disability were associated with cognitive frailty. Further research is required to develop screening tools and prevention strategies.
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Cognitive Dysfunction , Frailty , Humans , Male , Female , Aged , Iran/epidemiology , Prevalence , Cross-Sectional Studies , Cognitive Dysfunction/epidemiology , Frailty/epidemiology , Middle Aged , Aged, 80 and over , Frail Elderly/psychology , Frail Elderly/statistics & numerical data , Geriatric Assessment , Depression/epidemiology , Activities of Daily Living , Risk Factors , Independent Living , Cognition/physiologyABSTRACT
Cognitive stimulation therapy (CST) was found to significantly improve cognitive function and quality of life (QOL) in patients with mild-to-moderate dementia in the UK. However, indigenous research on older adults with dementia in Taiwan is scarce. Therefore, this study developed and investigated the effects of a Taiwan version of group CST (CST-T) through a quasi-experimental trial. Excluding the dropouts, there were 13 experimental participants (M = 78.9 ± 9.0) and 13 control participants (77.9 ± 5.6). The results indicated significant improvements in cognitive function, QOL, and daily life functioning in the experimental group compared with the control group, and these effects remained evident at a 3-month follow-up.
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INTRODUCTION: Declines in instrumental activities of daily living (IADLs) have been proposed as a prodromal marker of Parkinson's disease (PD). The Cleveland Clinic Virtual Reality Shopping (CC-VRS) platform combines an omnidirectional treadmill with a virtual reality headset to create a virtual grocery store that a user physically walks through and completes a shopping task. The primary aim of this project was to determine the known-group validity of the CC-VRS platform in discriminating IADL performance and to characterize specific motor and cognitive declines responsible for PD-related IADL impairments. METHODS: Sixteen individuals with PD and 15 healthy adults completed traditional motor, cognitive, and IADL assessments and the CC-VRS task. Group differences were evaluated using Welch's t-test. RESULTS: There were no between-group differences in traditional performance measures of motor, cognitive, or IADL function. Regarding CC-VRS performance, participants in the PD group completed the task significantly slower than controls (690 vs. 523 sec, respectively). Participants with PD spent 25 % more time walking and turning and were stopped 46 % longer than controls. Average gait speed when viewing the shopping list, a measure of dual-task performance, was significantly slower in the PD group compared to controls (0.26 vs. 0.17 m/s, respectively). CONCLUSION: Unlike traditional performance measures of motor, cognitive, and IADL function, the CC-VRS discriminated participants with PD from healthy older adults. For the PD group, motor and dual-task declines contributed to diminished CC-VRS performance. Identifying underlying contributors to IADL declines supports using ecological assessments, such as the CC-VRS, for the routine clinical evaluation of IADLs.
Subject(s)
Activities of Daily Living , Parkinson Disease , Virtual Reality , Humans , Parkinson Disease/physiopathology , Male , Female , Aged , Middle Aged , Cognitive Dysfunction/etiology , Cognitive Dysfunction/physiopathologyABSTRACT
BACKGROUND: There is good evidence that elevated amyloid-ß (Aß) positron emission tomography (PET) signal is associated with cognitive decline in clinically normal (CN) individuals. However, it is less well established whether there is an association between the Aß burden and decline in daily living activities in this population. Moreover, Aß-PET Centiloids (CL) thresholds that can optimally predict functional decline have not yet been established. METHODS: Cross-sectional and longitudinal analyses over a mean three-year timeframe were performed on the European amyloid-PET imaging AMYPAD-PNHS dataset that phenotypes 1260 individuals, including 1032 CN individuals and 228 participants with questionable functional impairment. Amyloid-PET was assessed continuously on the Centiloid (CL) scale and using Aß groups (CL < 12 = Aß-, 12 ≤ CL ≤ 50 = Aß-intermediate/Aß± , CL > 50 = Aß+). Functional abilities were longitudinally assessed using the Clinical Dementia Rating (Global-CDR, CDR-SOB) and the Amsterdam Instrumental Activities of Daily Living Questionnaire (A-IADL-Q). The Global-CDR was available for the 1260 participants at baseline, while baseline CDR-SOB and A-IADL-Q scores and longitudinal functional data were available for different subsamples that had similar characteristics to those of the entire sample. RESULTS: Participants included 765 Aß- (61%, Mdnage = 66.0, IQRage = 61.0-71.0; 59% women), 301 Aß± (24%; Mdnage = 69.0, IQRage = 64.0-75.0; 53% women) and 194 Aß+ individuals (15%, Mdnage = 73.0, IQRage = 68.0-78.0; 53% women). Cross-sectionally, CL values were associated with CDR outcomes. Longitudinally, baseline CL values predicted prospective changes in the CDR-SOB (bCL*Time = 0.001/CL/year, 95% CI [0.0005,0.0024], p = .003) and A-IADL-Q (bCL*Time = -0.010/CL/year, 95% CI [-0.016,-0.004], p = .002) scores in initially CN participants. Increased clinical progression (Global-CDR > 0) was mainly observed in Aß+ CN individuals (HRAß+ vs Aß- = 2.55, 95% CI [1.16,5.60], p = .020). Optimal thresholds for predicting decline were found at 41 CL using the CDR-SOB (bAß+ vs Aß- = 0.137/year, 95% CI [0.069,0.206], p < .001) and 28 CL using the A-IADL-Q (bAß+ vs Aß- = -0.693/year, 95% CI [-1.179,-0.208], p = .005). CONCLUSIONS: Amyloid-PET quantification supports the identification of CN individuals at risk of functional decline. TRIAL REGISTRATION: The AMYPAD PNHS is registered at www.clinicaltrialsregister.eu with the EudraCT Number: 2018-002277-22.
Subject(s)
Activities of Daily Living , Amyloid beta-Peptides , Positron-Emission Tomography , Humans , Positron-Emission Tomography/methods , Female , Male , Cross-Sectional Studies , Longitudinal Studies , Aged , Amyloid beta-Peptides/metabolism , Cognitive Dysfunction/diagnostic imaging , Cognitive Dysfunction/metabolism , Middle Aged , Brain/diagnostic imaging , Brain/metabolism , Aged, 80 and overABSTRACT
Introduction: Although the overall quality of medicine has improved in recent decades, the functional capacity in many hip fracture patients remains insufficient. The goal of the present study was to identify significant predictors of Instrumental Activities of Daily Living (IADL) measured by the Lawton-Brody scale at 3- and 6-month follow-up in patients with hip fractures admitted to a hospital. Methods: This observational cohort study included 191 patients with acute hip fractures. IADL was measured at baseline and after 3 and 6 months using the Lawton-Brody scale. Multivariable logistic regression analysis was carried out using pre-fracture functional status, sociodemographic variables, hand grip strength (HGS), surgical procedure, complications, and length of hospital stay, Short Physical Performance Battery, and Barthel Index (BI) on the fifth postoperative day as potential predictors for IADL after a hip fracture surgery. Results: The mean age of the participants was 80.3 ± 6.8 years, and 77.0% of our cohort were women. Multivariate regression analysis revealed that pre-fracture functional status and early functional recovery were independent predictors of IADL after hip fracture surgery. Conclusions: Clinicians should take steps to improve functional outcomes by changing how patients are rehabilitated in the first days after hip fracture surgery, especially for the group of patients with a lower functional status before the fracture.
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Background Aging has an impact on women's quality of life and is closely correlated with deteriorating social support systems and cognitive abilities. This project intends to improve women's performance, independence, and quality of life by using meta-cognitive strategy-based activities to improve executive functioning and their capacity to maintain social networks. The ultimate objective is to keep older women's cognitive abilities from declining and to give them more independence in carrying out essential everyday tasks. By enhancing their executive functioning skills, women will be better equipped to navigate daily challenges and maintain their autonomy. Additionally, the project aims to provide a supportive environment for older women to engage in social activities and strengthen their social connections, ultimately leading to a more fulfilling and enriched quality of life. Aims and objectives The study aims to evaluate the impact of meta-cognitive strategy-based activities on executive functioning, social networking, and instrumental activities of daily living. This study is specifically for women. Materials and method This is a quasi-experimental design with convenience sampling and selected samples (n=70), who were then split into two groups: an experimental group (n=35) and a control group (n=35) based on the inclusion and exclusion criteria. The experimental group received intervention based on meta-cognitive strategies through various activities, while the control group did not receive any specific intervention except health education. Pre- and post-tests were conducted to measure the changes. Executive functioning was assessed using the Brief Executive Function Assessment Tool (BEAT), social networking was assessed using the Lubben Social Networking Scale, and instrumental activities of daily living were assessed using the Lawton Brody Instrumental Activities of Daily Living Scale. The duration of the study was six months, three sessions per week, lasting 45 minutes to an hour each. The statistical analysis was done with significance at a 5% alpha level using IBM SPSS version 29.0 (Armonk, NY: IBM Corp). Results The pre-test and post-test data were analyzed using the Wilcoxon signed-rank test and the Mann-Whitney test. Since the p-value of the experimental group was 0.00 for the Lubben Social Networking Scale, the BEAT, and the Lawton Brody Instrumental Activities of Daily Living Scale, the alternate hypothesis was accepted. Thus, the results showed significant improvement in executive functioning, social networking, and instrumental daily living activities in the experimental group compared to the control group. Conclusion The clinically significant finding of this study was that the participants were enthusiastic and motivated to engage in meta-cognitive strategy-based activities; furthermore, there was a significant improvement in the experimental group when compared with the control group in executive functioning and social networking abilities. This will enhance functions like instrumental activities of daily living and occupational performance. Meta-cognitive strategy-based activities appeared beneficial for improving the cognitive functions and quality of life of women. Although the findings from the studies are positive for therapeutic and health benefits, more clinical trials are needed in order to prove the effect of meta-cognitive strategy-based activities as a therapeutic approach.
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Objective: Frailty and activities of daily living (ADL) disability are common conditions among older population. Studies on the bidirectional relationship between frailty and ADL are limited. The current study examined the cross-sectional and longitudinal associations between frailty and ADL in middle-aged and older Chinese individuals. Methods: The data was collected through the China Health and Retirement Longitudinal Study (CHARLS), conducted in 2011, 2013, and 2015, encompassing 17,284 individuals aged ≥45 years. We excluded individuals without follow-up data. 2,631 participants finished the baseline survey. The definition of ADL disability encompasses difficulty in engaging in either basic activities of daily living (BADL) or instrumental activities of daily living (IADL). Frailty was assessed according to the Fried criteria. Logistic regression was utilized to examine odds ratios (ORs) and 95% confidence intervals (CIs) for assessing the cross-sectional relationships between ADL with frailty at baseline. The prediction effects were explored using Cox proportional hazards analysis, testing hazard ratios (HRs) and 95%CIs. Results: In cross-sectional analysis, BADL [OR = 6.660 (4.519-9.815)], IADL [OR = 5.950 (4.490-7.866)], and ADL [OR = 5.658 (4.278-7.483)] exhibited significant associations with frailty; frailty demonstrated significant associations with BADL [OR = 6.741 (4.574-9.933)], IADL [OR = 6.042 (4.555-8.016)] and ADL [OR = 5.735 (4.333-7.591)]. In longitudinal analysis, IADL and ADL were significantly associated with frailty in participants without baseline frailty in the short-term period [IADL: HR = 1.971 (1.150-3.379), ADL: HR = 1.920 (1.146-3.215)], IADL exhibited a significant association with frailty in the long-term period [HR = 2.056 (1.085-3.895)]. There was no significant link observed between frailty and an elevated risk of disability onset in BADL, IADL and ADL during the short-term period. When considering the long-term perspective, frailty exhibited a significant association with an elevated risk of disability onset in BADL [HR= 1.820 (1.126-2.939)] and IADL [HR = 1.724 (1.103-2.694)]. Conclusion: In middle-aged and older adults, ADL and IADL disability predicted frailty after 2-year follow-up, IADL disability predicted frailty after 4-year follow-up. Moreover, frailty did not predict BADL, IADL and ADL disability after 2-year follow-up. However, frailty predicted BADL and IADL disability after 4-year follow-up.
Subject(s)
Activities of Daily Living , Frail Elderly , Frailty , Humans , Female , Male , Aged , Middle Aged , China/epidemiology , Cross-Sectional Studies , Longitudinal Studies , Frail Elderly/statistics & numerical data , Follow-Up Studies , Aged, 80 and over , Geriatric Assessment/statistics & numerical data , East Asian PeopleABSTRACT
BACKGROUND: Dementia results from multiple neuropathologies causing cognitive impairment sufficiently severe to impact functional status. However, these pathologies and functional impairment are common in persons without dementia. We examined the association of AD and multiple other neuropathologies with instrumental and basic activities of daily living in persons with and without dementia. METHODS: Participants were 1,509 deceased from the Religious Orders Study or Rush Memory and Aging Project. Pathologic AD and three other AD indices were examined, in addition to four non-AD neurodegenerative pathologies: cerebral amyloid angiopathy (CAA), hippocampal sclerosis, TDP-43 and Lewy bodies, and four cerebrovascular pathologies: gross- and microinfarctions, athero- and arteriolosclerosis. Functional assessment included Lawton and Katz Index Instrumental and Basic Activities of Daily Living (IADL and BADL). Ordinal regression models adjusted for age, sex, and education were used to examine the association of neuropathologies with IADL and BADL. RESULTS: AD and the other neuropathologies were associated with impaired IADL (all Ps<0.001) and with impaired BADL (Ps<0.01), except for atherosclerosis and CAA which were not associated with BADL. The effects of most neuropathologies were largely affected by dementia. However, small effects on IADL remained for PHFtau tangles after adjusting models for dementia. Direct effects of gross infarcts on IADL and BADL, and of microinfarcts on BADL remained unchanged after adjusting the models for dementia. CONCLUSION: AD and all other neuropathologies are strongly associated with functional disability. The association of most neuropathologies with disability was eliminated or attenuated by dementia, except for gross infarcts and microinfarcts.
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Objective: To investigate the risk of impairment in cognitive instrumental activities of daily living (IADL) for people with Parkinson's (PwP) identifying as sexual and/or gender minorities (SGM). Method: Data were obtained from Fox Insight, an online, longitudinal study with self/informant-report questionnaires from PwP and people without Parkinson's. Groups consisted of PwP without cognitive IADL impairment at baseline, identifying as (1) SGM with female sex assigned at birth (SGM-F, n = 75); (2) cisgender, heterosexual with female sex assigned at birth (CH-F, n = 2046); (3) SGM with male sex assigned at birth (SGM-M, n = 84); (4) cisgender, heterosexual with male sex assigned at birth (CH-M, n = 2056). Impairment in cognitive IADL was based on Penn Parkinson's Daily Activities Questionnaire-15 (PDAQ-15). Group differences for PDAQ-15 and impairment likelihood during follow-up were assessed with unadjusted models and adjusting for variables that differed between the groups. Results: SGM-F were the youngest at Parkinson's diagnosis; SGM-M had the lowest PDAQ-15 at baseline (p ≤ .014 for all). Scores declined more for males than females in unadjusted and adjusted models (p < .001 for both). In unadjusted models, SGM-M had a higher impairment risk than PwP identifying as cisgender and heterosexual (p ≤ .018). In adjusted models, females had a lower impairment risk than males (p < .001). Age, education, and discrimination level were significant moderators (p < .001 for all). Conclusions: SGM-M can be at a higher risk for impairment in cognitive IADL, associated with social determinants. Female sex assigned at birth may be associated with a lower level of impairment risk, although this advantage can disappear with social determinants.
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Diminished cognitive and physical functions negatively affect the daily functions of individuals. Although combined cognitive and physical training prevents instrumental activities of daily living (IADL) disability in older adults, no predictive model or mediation analysis of IADL after combined training exists. This study aims to employ prediction and mediation analysis to identify the predictors of IADL performance and to elucidate the mediators of the association between baseline global cognition and subsequent IADL performance following combined cognitive and physical training. This study involved 177 participants aged 60 years and older who underwent combined training. Cognitive function was measured with the Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSST), Color Trails Test, Word List, and a dual task; physical function with the Timed Up and Go (TUG) test; daily function with the Lawton IADL Scale. We conducted regression analyses to identify the predictors of IADL performance, and mediation analysis to examine whether DSST and TUG mediate the relationship between MoCA and IADL. The pre-intervention DSST and TUG were significant independent predictors of post-intervention IADL. The association between the pre-intervention MoCA and post-intervention IADL was mediated by pre-intervention DSST and TUG. This study highlighted the importance of measuring and improving processing speed and functional mobility before and during interventions to enhance IADL outcomes.Trial registration: NCT03619577, 23/07/2018; NCT04689776, 29/12/2020.
Subject(s)
Activities of Daily Living , Cognition , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cognition/physiology , Exercise Therapy/methods , Mediation Analysis , Treatment OutcomeABSTRACT
The present study aimed to examine the prediction of quality of life by frailty and disability in a baseline sample of 479 Dutch community-dwelling people aged 75 years or older using a follow-up period of 8 years. Regarding frailty, we distinguish between physical, psychological, and social frailty. Concerning physical disability, we distinguish between limitations in performing activities in daily living (ADL) and instrumental activities in daily living (IADL). The Tilburg Frailty Indicator (TFI) and the Groningen Activity Restriction Scale (GARS) were used to assess frailty domains and types of disability, respectively. Quality of life was determined by the WHOQOL-BREF containing physical, psychological, social, and environmental domains. In our study, 53.9% of participants were woman, and the mean age was 80.3 years (range 75-93). The study showed that psychological frailty predicted four domains of quality of life and physical frailty three. Social frailty was only found to be a significant predictor of social quality of life and environmental quality of life. ADL and IADL disability proved to be the worst predictors. It is recommended that primary healthcare professionals (e.g., general practitioners, district nurses) focus their interventions primarily on factors that can prevent or delay psychological and physical frailty, thereby ensuring that people's quality of life does not deteriorate.
ABSTRACT
BACKGROUND: Cognitive impairment, difficulty performing basic activities of daily living (ADLs) and instrumental ADLs (IADLs), depression, and fatigue are common among individuals with multiple sclerosis (MS). Some associations between these symptoms are known; however, many of their relationships remain unclear. This study investigated the contributions of subjective and objective cognition, depressive symptom severity, and fatigue on ADLs and IADLs. METHODS: Participants (N = 217) were individuals with MS from a comprehensive MS center, participating in a larger study characterizing upper extremity function in MS. Outcome measures of ADL and IADL abilities were the Functional Status Index-Assistance (FSI-A) and Functional Status Index-Difficulty (FSI-D) and the Test D'évaluation Des Membres Supérieurs de Personnes Âgées (TEMPA). Predictors were objective cognition (Symbol Digit Modalities Test; SDMT), subjective cognition (Performance Scales©-Cognition; PS-C), depressive symptom severity (Center for Epidemiologic Studies Depression Scale; CES-D-10), and fatigue (Modified Fatigue Impact Scale; MFIS-5). Correlations were conducted, followed by hierarchal linear regressions. The SDMT and PS-C were entered into separate models. RESULTS: After controlling for demographics, the SDMT significantly predicted the TEMPA and FSI-A, while the PS-C predicted only the FSI-D. The CES-D-10 predicted the FSI-D even after accounting for PS-C and SDMT, while the MFIS-5 only predicted the FSI-D when the SDMT was included. Neither the CES-D-10 nor MFIS-5 significantly predicted the FSI-A or TEMPA. CONCLUSIONS: The way an individual with MS perceived their symptoms significantly contributed to their reported difficulty with functional tasks, while only their objective cognitive functioning predicted ADL and IADL performance and the level of assistance they would require.
ABSTRACT
OBJECTIVES: Rich social capital is regarded as an individual's social asset, which may contribute to the maintenance of functional ability, even in a state of frailty. This study examined the moderating role of individual social capital in the association between physical frailty and functional ability among older adults. DESIGN: A cross-sectional study. SETTING AND PARTICIPANTS: In total, 522 community-dwelling older adults aged ≥60 years were recruited from among visitors to public facilities, including community cultural centers and gymnasiums in Aichi, Japan. METHODS: Functional ability was assessed using the 5-item subscale of the Tokyo Metropolitan Institute of Gerontology Index of Competence that assesses instrumental self-maintenance, including transportation, finance management, and shopping. Physical frailty was defined by the Fried Frailty Phenotype Questionnaire, including 5 items of fatigue, resistance, ambulation, inactivity, and weight loss, and the participants were classified into 3 groups: non-frailty, pre-frailty, and frailty. Individual social capital was assessed for 2 dimensions: the cognitive dimension (perceptions of community social cohesion) and the structural dimension (informal socializing and social participation). RESULTS: The participants' mean age (SD) was 74.1 (6.5) years and 78.0% were women. Among the participants, non-frailty was 46.6%, pre-frailty was 47.0%, and frailty was 6.5%. Multivariable linear regression analysis revealed that physical frailty was associated with lower levels of functional ability compared with non-frailty [pre-frailty: ß (95% CI) = -0.07 (-0.22 to 0.08), P = .374; frailty: ß = -0.67 (-0.99 to -0.35), P < .001]. However, individual structural social capital showed a negative interaction with physical frailty against low functional ability, indicating a moderating association (P = .027). CONCLUSIONS AND IMPLICATIONS: High levels of individual structural social capital mitigated the adverse association between physical frailty and functional ability. Fostering rich social capital may preserve the functional ability of frail older adults, helping their independent lives in the community.