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Alzheimers Res Ther. 2015 Mar 18;7(1):17. doi: 10.1186/s13195-015-0099-0. eCollection 2015.

Mild cognitive impairment and deficits in instrumental activities of daily living: a systematic review.

Author information

1
Network Aging Research, Heidelberg University, Bergheimer Str. 20, 69115 Heidelberg, Germany ; Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Square J 5, 68159 Mannheim, Germany.
2
Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Square J 5, 68159 Mannheim, Germany.
3
Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, 20502 Malmö, Sweden.
4
Kingshill Research Centre, Victoria Hospital, 53 Downs Way, Swindon, SN3 6BW UK.
5
Hon Senior Lecturer in Psychiatry at the University of Dundee, Murray Royal Hospital, Perth, PH2 7BH UK.
6
Centre des Maladies Cognitives et Comportementales (IM2A), Institut du Cerveau et de la Moelle épinière (ICM), UMR-S975, Université Pierre et Marie Curie- Paris6, AP-HP, Hôpital de la Salpêtrière, 47 boulevard de l'Hôpital, 75013 Paris, France.
7
Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Alfred Nobels allé 23, 14183 Huddinge, Sweden.
8
Institute of Health and Nursing Science, Charité Center 1 for Health and Human Sciences, Augustenburger Platz 1, 13353 Berlin, Germany.
9
Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
10
Department of Neurology, Centre for Cognitive Impairments, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia.
11
Scottish Dementia Clinical Research Network, Murray Royal Hospital, Perth, PH2 7BH UK.
12
Institute of Gerontology and Geriatrics, University of Perugia, via Brunamonti 51, 06122 Perugia, Italy.
13
Alzheimer's Disease and Other Cognitive Disorders Unit, ICN, Hospital Clínic i Universitari, IDIBAPS, Villarroel 170, Barcelona, 08036 Spain.
14
Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Fack 23200, 14183 Huddinge, Sweden.
15
Department of Geriatrics, Radboud University Nijmegen Medical Centre, Reinier Postlaan 4, 6525 GC Nijmegen, the Netherlands.
16
Department of Clinical Neurosciences, University Hospital Pellegrin, Place Amélie Raba-Léon, 33000 Bordeaux, France.
17
INSERM U1171, CHU, Memory Clinic, University of Lille, rue Emile Laine, 59037 Lille, France.
18
University of Bordeaux, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, 33000 Bordeaux, France ; INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, 33000 Bordeaux, France.
19
Memory Clinic, Department of Neurology, University of Liège, allée du 6 Août 8, 4000 Liège, Belgium.
20
Alzheimer Center and Department of Epidemiology and Biostatistics, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
21
Department of Medical Psychology, Medical University of Lodz, 5 Sterling St, 90-425 Lodz, Poland.
22
Memory Clinic, University Center for Medicine of Aging Basel, Felix Platter Hospital, Schanzenstr. 55, CH-4031 Basel, Switzerland.
23
3rd Department of Neurology, Aristotle University, Despere 3, Thessaloniki, 54621 Greece.
24
Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Center for Alzheimer Research, Karolinska Institutet, 14157 Huddinge, Sweden.

Abstract

INTRODUCTION:

There is a growing body of evidence that subtle deficits in instrumental activities of daily living (IADL) may be present in mild cognitive impairment (MCI). However, it is not clear if there are IADL domains that are consistently affected across patients with MCI. In this systematic review, therefore, we aimed to summarize research results regarding the performance of MCI patients in specific IADL (sub)domains compared with persons who are cognitively normal and/or patients with dementia.

METHODS:

The databases PsycINFO, PubMed and Web of Science were searched for relevant literature in December 2013. Publications from 1999 onward were considered for inclusion. Altogether, 497 articles were retrieved. Reference lists of selected articles were searched for potentially relevant articles. After screening the abstracts of these 497 articles, 37 articles were included in this review.

RESULTS:

In 35 studies, IADL deficits (such as problems with medication intake, telephone use, keeping appointments, finding things at home and using everyday technology) were documented in patients with MCI. Financial capacity in patients with MCI was affected in the majority of studies. Effect sizes for group differences between patients with MCI and healthy controls were predominantly moderate to large. Performance-based instruments showed slight advantages (in terms of effect sizes) in detecting group differences in IADL functioning between patients with MCI, patients with Alzheimer's disease and healthy controls.

CONCLUSION:

IADL requiring higher neuropsychological functioning seem to be most severely affected in patients with MCI. A reliable identification of such deficits is necessary, as patients with MCI with IADL deficits seem to have a higher risk of converting to dementia than patients with MCI without IADL deficits. The use of assessment tools specifically designed and validated for patients with MCI is therefore strongly recommended. Furthermore, the development of performance-based assessment instruments should be intensified, as they allow a valid and reliable assessment of subtle IADL deficits in MCI, even if a proxy is not available. Another important point to consider when designing new scales is the inclusion of technology-associated IADL. Novel instruments for clinical practice should be time-efficient and easy to administer.

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