title: Can performance on daily activities discriminate between older adults with normal cognitive function and those with mild cognitive impairment?
abstract: OBJECTIVE
  To examine whether preclinical disability in performance of cognitively focused instrumental activity of daily living (C-IADL) tasks can discriminate between older adults with normal cognitive function and those with mild cognitive impairment (MCI) and, secondarily, to determine the two tasks with the strongest psychometric properties and assess their discriminative ability so as to generate diagnosis-relevant information about cognitive changes associated with MCI and mild neurocognitive disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria.
  
  
  METHODS
  Secondary analyses of cross-sectional data from a cohort of individuals diagnosed with normal cognitive function or MCI.
  
  
  METHODS
  Pittsburgh, Pennsylvania.
  
  
  METHODS
  Older adults with remitted major depression (N = 157).
  
  
  METHODS
  Diagnosis of cognitive status was made at the Alzheimer's Disease Research Center, University of Pittsburgh. Performance on eight C-IADLs was measured using the criterion-referenced, observation-based Performance Assessment of Self-Care Skills (PASS).
  
  
  RESULTS
  Ninety-six older adults with normal cognitive function (mean age 72.5 ± 5.9) and 61 with MCI (mean age 75.5 ± 6.3) participated. The eight C-IADLs demonstrated 81% accuracy in discriminating cognitive status (area under the receiver operating characteristic curve (AUC) = 0.81, P < .001). Two tasks (shopping and checkbook balancing) were the most discriminating (AUC = 0.80, P < .001); they demonstrated similar ability as all eight C-IADLs in determining cognitive status. Assessing performance on these two C-IADLs takes 10 to 15 minutes.
  
  
  CONCLUSIONS
  This is the first demonstration of the discriminative ability of preclinical disability to distinguish older adults with MCI from cognitively normal older adults. These findings highlight potential tasks that, when measured using the observation-based PASS, demonstrate greater effort for individuals with MCI. These tasks may be considered when attempting to diagnose MCI or mild neurocognitive disorder in clinical practice and research.
authors.affiliation: Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Juleen
authors.initials: J
authors.lastname: Rodakowski
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Skidmore
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.forename: Meryl A
authors.initials: MA
authors.lastname: Butters
authors.forename: Margo B
authors.initials: MB
authors.lastname: Holm
authors.forename: Oscar L
authors.initials: OL
authors.lastname: Lopez
authors.forename: Joan C
authors.initials: JC
authors.lastname: Rogers
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D060825:Cognitive Dysfunction / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: activities of daily living; cognitive function; instrumental activities of daily living; mild cognitive impairment; mild neurocognitive disorder