Impact of Functional Deficits in Instrumental Activities of Daily Living in Mild Cognitive Impairment: A Clinical Algorithm to Predict Progression to Dementia.
BACKGROUND
The utility of functional deficits in patients with mild cognitive impairment is not established.


METHODS
In 3886 individuals with mild cognitive impairment evaluated and followed at 34 National Alzheimer Coordinating Center sites, informant-reported Pfeffer Functional Activities Questionnaire (FAQ) items associated with progression to dementia were derived in a training set (n=1943) and tested in the validation set (n=1943).


RESULTS
In the training set, the optimal combination comprised 6 FAQ items (FAQ6): difficulties with finances (2 items), remembering events/appointments, playing games of skill, current events, and travel. In the validation set, hazard ratio for dementia increased from 2.00 for 1 FAQ6 deficit to 5.56 for 6 FAQ6 deficits. In patients 50 to 67 years old with high Mini Mental State Exam scores, dementia risk rose from 12.06% for no FAQ6 deficits to 56.75% for 6 functional deficits. Likelihood of progression to dementia reached 80% to 89% in older age groups with low Mini Mental State Exam and severe FAQ6 deficits.


CONCLUSIONS
Specific functional deficits increased dementia risk and, with age and global cognition, constituted a validated clinical algorithm to estimate dementia risk. Clinicians can use this clinically important algorithm to personalize decision-making about further investigation and identify high-risk patients for early treatment or inclusion in clinical trials.
*Department of Psychiatry, Division of Geriatric Psychiatry, New York State Psychiatric Institute and Columbia University Medical Center †Division of Biostatistics in the Mailman School of Public Health, Columbia University, New York, NY.
Davangere P
DP
Devanand
Xinhua
X
Liu
Patrick J
PJ
Brown
D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000465:Algorithms; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000523:psychology; D003704:Dementia; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011795:Surveys and Questionnaires