title: Cognitive impairment as a strong predictor of incident disability in specific ADL-IADL tasks among community-dwelling elders: the Azuchi Study.
abstract: OBJECTIVE
  We examined differential effects of cognitive impairment on each of the activities of daily living (ADL) and instrumental activities of daily living (IADL) tasks.
  
  
  METHODS
  In a 3-year follow-up of community-dwelling elderly persons in Azuchi, Japan, we assessed cognition by using the Hasegawa Dementia Scale. We examined (a) the cross-sectional association between cognitive impairment and functional disability in each ADL-IADL item; (b) cognitive impairment as a risk factor for incident disability in each ADL-IADL item, through logistic regression models; and (c) probabilities of incident loss of ADL-IADL abilities or death in 3 years, using multinomial logistic regression models. We also calculated the population attributable risk (PAR%) of cognitive impairment on incident loss of task-specific ADL-IADL abilities.
  
  
  RESULTS
  Cross-sectionally, the severity of cognitive impairment was associated with disability in each ADL-IADL task, with larger effects shown for ADL items. Longitudinally, minimally or mildly cognitively impaired individuals had a significantly higher risk of losing functional abilities compared with those with intact cognition. The PAR% indicated that cognitive impairment accounts for 11% to 36% of incident disability in ADL-IADL tasks, with the highest PAR% shown for the ability to feed oneself.
  
  
  CONCLUSIONS
  Cognitively impaired subjects are heterogeneous; the severity of cognitive impairment has a different impact on incident loss of task-specific ADL-IADL abilities, and comorbidities could affect disabilities differently. Consideration of these heterogeneities will enrich future studies on the impact of cognitive impairment on ADL-IADL abilities.
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15261, USA. Dodge@edc.pitt.edu
authors.forename: Hiroko H
authors.initials: HH
authors.lastname: Dodge
authors.forename: Takashi
authors.initials: T
authors.lastname: Kadowaki
authors.forename: Takehito
authors.initials: T
authors.lastname: Hayakawa
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yamakawa
authors.forename: Akira
authors.initials: A
authors.lastname: Sekikawa
authors.forename: Hirotugu
authors.initials: H
authors.lastname: Ueshima
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D003072:Cognition Disorders / Q000175:diagnosis* / Q000503:physiopathology; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male