title: Impact of frontal white matter hyperintensity on instrumental activities of daily living in elderly women with Alzheimer disease and amnestic mild cognitive impairment.
abstract: BACKGROUND
  Instrumental activities of daily living (IADL) start to decline during the progression of amnestic mild cognitive impairment (aMCI) to Alzheimer disease (AD). Cognitive and physical decline are involved in the loss of functional independence. However, little is known about AD-related neural change that leads to IADL impairment. The purpose of this study was to clarify the effects of regional white matter hyperintensity (WMH) on IADL impairment in persons with AD and aMCI.
  
  
  METHODS
  The participants were 347 female subjects aged 65-85 years diagnosed with AD (n = 227), aMCI (n = 44) or normal cognition (n = 76). IADL was assessed by the Lawton Index. Cognition, mood and mobility function were evaluated by comprehensive geriatric assessment batteries. WMH and brain atrophy were analyzed with brain magnetic resonance imaging, using an automatic segmentation program. Regional WMH was measured in the frontal, temporal, occipital and parietal lobes.
  
  
  RESULTS
  Ability to carry out IADL of shopping, food preparation, mode of transportation, responsibility for own medication, and ability to handle finances was obviously impaired in the early stage of AD. Frontal WMH was specifically associated with disability to do shopping and food preparation even after adjusting for several confounders including brain atrophy.
  
  
  CONCLUSIONS
  IADL subcategories were differentially impaired along with cognitive status in persons with AD and aMCI. Frontal WMH was an important predictor of impaired ability to do shopping and food preparation. A preventive strategy for WMH might lead to suppression of IADL disability and slow the progression of AD.
authors.affiliation: Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.|Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Ogama
authors.affiliation: Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakurai
authors.affiliation: NeuroImaging and Informatics, National Center for Geriatrics and Gerontology, Obu, Japan.
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Nakai
authors.affiliation: Medical Genome Center, National Center for Geriatrics and Gerontology, Obu, Japan.
authors.forename: Shumpei
authors.initials: S
authors.lastname: Niida
authors.affiliation: Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Saji
authors.affiliation: Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Toba
authors.affiliation: Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Umegaki
authors.affiliation: Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kuzuya
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D000647:Amnesia / Q000150:complications*; D001284:Atrophy / Q000150:complications; D003071:Cognition; D060825:Cognitive Dysfunction / Q000150:complications*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D012307:Risk Factors; D066127:White Matter / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*