Prediction of incident dementia: impact of impairment in instrumental activities of daily living and mild cognitive impairment-results from the German study on ageing, cognition, and dementia in primary care patients.
OBJECTIVE
There is an increasing call for a stronger consideration of impairment in instrumental activities of daily living (IADL) in the diagnostic criteria of Mild Cognitive Impairment (MCI) to improve the prediction of dementia. Thus, the aim of the study was to determine the predictive capability of MCI and IADL impairment for incident dementia.


METHODS
Longitudinal cohort study with four assessments at 1.5-year intervals over a period of 4.5 years.


METHODS
: Primary care medical record registry sample.


METHODS
As part of the German Study on Ageing, Cognition, and Dementia in Primary Care Patients, a sample of 3,327 patients from general practitioners, aged 75 years and older, was assessed.


METHODS
The predictive capability of MCI and IADL impairment for incident dementia was analysed using receiver operating characteristics, Kaplan-Meier survival analyses, and Cox proportional hazards models.


RESULTS
MCI and IADL impairment were found to be significantly associated with higher conversion to, shorter time to, and better predictive power for future dementia. Regarding IADL, a significant impact was particularly found for impairment in responsibility for one's own medication, shopping, and housekeeping, and in the ability to use public transport.


CONCLUSIONS
Combining MCI with IADL impairment significantly improves the prediction of future dementia. Even though information on a set of risk factors is required to achieve a predictive accuracy for dementia in subjects with MCI being clinically useful, IADL impairment should be a very important element of such a risk factor set.
Insitute of Social Medicine, Occupational Health and Public Health, University of Leipzig, D-04103 Leipzig, Germany. tobias.luck@medizin.uni-leipzig.de
Tobias
T
Luck
Melanie
M
Luppa
Birgit
B
Wiese
Wolfgang
W
Maier
Hendrik
H
van den Bussche
Marion
M
Eisele
Frank
F
Jessen
Dagmar
D
Weeg
Siegfried
S
Weyerer
Michael
M
Pentzek
Hanna
H
Leicht
Mirjam
M
Koehler
Franziska
F
Tebarth
Julia
J
Olbrich
Sandra
S
Eifflaender-Gorfer
Angela
A
Fuchs
Hans-Helmut
HH
Koenig
Steffi G
SG
Riedel-Heller
D000203:Activities of Daily Living / Q000145:classification* / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000523:psychology; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000523:psychology*; D003704:Dementia / Q000175:diagnosis* / Q000523:psychology; D015161:Dementia, Multi-Infarct / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D058006:General Practice; D005858:Germany; D006306:Health Surveys; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011320:Primary Health Care; D011594:Psychometrics