Background: Activities of daily living (ADL) impairment is a hallmark of Alzheimer’s disease (AD) dementia,
but impairment in instrumental ADL (IADL) has been reported in mild cognitive impairment (MCI). The Structured Interview
and Scoring Tool-Massachusetts Alzheimer’s Disease Research Center (MADRC)-Informant Report (SIST-MIR)
includes 60 graded items that assist in scoring the Clinical Dementia Rating; it assesses the spectrum of cognitive and
ADL changes relevant to early AD. Of the 60 SIST-M-IR items, 41 address IADL; we aimed to determine which of these
best discriminate individuals with MCI from clinically normal (CN) elderly. Methods: We assessed 447 subjects participating
in the MADRC longitudinal cohort (289 CN, 158 MCI). We performed logistic regression analyses predicting the
probability of CN vs. MCI diagnosis using the SIST-M-IR items. Analyses were adjusted for demographic characteristics.
Results: We found that 4 SIST-M-IR items best discriminated between CN and MCI subjects (MCI performing worse
than CN): “participating in games that involve retrieving words” (p=0.0001), “navigating to unfamiliar areas” (p=0.001),
“performing mental tasks involved in a former primary job” (p=0.002), and “fixing things or finishing projects”
(p=0.002). Conclusions: Our results point to the earliest functional changes seen in elderly at risk for AD, which could be
captured by a few simple questions. Honing the sensitivity of clinical assessment tools will help clinicians differentiate
those individuals with normal aging from those who are developing cognitive impairment.
Keywords: Activities of daily living, Alzheimer's disease, clinical assessment, clinically normal elderly, daily functioning,
mild cognitive impairment.
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