Cognitive, extrapyramidal, and magnetic resonance imaging predictors of functional impairment in nondemented older community dwellers: the Sydney Older Person Study.
OBJECTIVE
To identify the clinical correlates of functional incapacity in the community living "old-old."


METHODS
Cross-sectional.


METHODS
Community-based.


METHODS
One hundred six nondemented people aged 80 to 94.


METHODS
Participants were medically and cognitively assessed, underwent magnetic resonance imaging scanning (MRI), and were interviewed regarding their functional status: activities of daily living (ADLs), instrumental ADLs (IADLs), and the complex IADL functions of reading, hobbies, and socializing.


RESULTS
Dependency in IADLs, but not ADLs, was present. After controlling for age, sex, and education, extrapyramidal (EP) signs were significantly associated with two of the three IADLs, with EP signs comprising a composite score of 10 EP signs (e.g., resting tremor) and a 5-meter timed walk. Cognitive test performance on a range of tests was also associated with functional status. A hierarchical model confirmed the association between the EP signs and cognitive test performance and functional scores, but no "pattern" of cognitive association emerged. Hippocampal volume was associated with socializing.


CONCLUSIONS
This study has shown that many nondemented very old people living in the community are losing capacity to perform IADL functions and that areas of incapacity are associated with the presence of EP signs and impaired cognition. These results highlight the need for health workers to include an assessment of EP and cognitive status in their evaluation of older persons living in the community, even in the context of a lack of dementia diagnosis. Furthermore, it signifies the need to directly evaluate IADL function to identify need for intervention and support if required. This group of old-old individuals may now be considered the "survivors" of their cohort, and early detection of the difficulties they are experiencing will enable clinicians to respond appropriately, thus providing them a higher quality of life for their years to come.
Bennett
Hayley P
HP
Prince of Wales Medical Research Institute and University of New South Wales, Sydney, Australia. hayley.bennett@unsw.edu.au
Piguet
Olivier
O
Grayson
David A
DA
Creasey
Helen
H
Waite
Louise M
LM
Lye
Tanya
T
Corbett
Alastair J
AJ
Hayes
Michael
M
Broe
G Anthony
GA
Halliday
Glenda M
GM
D000203:Activities of Daily Living; D000369:Aged, 80 and over / Q000502:physiology* / Q000523:psychology*; D001315:Australia; D001921:Brain / Q000473:pathology* / Q000503:physiopathology*; D003071:Cognition / Q000502:physiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D011998:Recreation; D012111:Residence Characteristics; D012919:Social Behavior