Skip to main content
Download PDF

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

Alzheimer's Research & Therapy volume 7, Article number: 17 (2015) Cite this article

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.

Introduction

Mild cognitive impairment (MCI) is a controversial clinical entity, initially conceptualized as a transitional zone between normal aging and dementia. The most commonly used criteria for MCI—also known as Mayo criteria—were proposed by Petersen et al. [1,2]. These criteria require (1) a memory complaint, (2) normal activities of daily living, (3) normal general cognitive function, (4) abnormal memory for age and (5) absence of dementia. These criteria have been modified to expand the original MCI concept, including impairments in cognitive domains other than memory. Thus, the clinical phenotypes of amnestic MCI and nonamnestic MCI have been developed, which can both be further classified as single-domain or multiple-domain [3]. Discussion about the MCI criteria and their operationalization is ongoing [4], as the criteria neither specify methods to assess cognitive or functional capacity nor provide cutoff points for cognitive or functional scales to differentiate MCI from mild dementia.

Another important point of discussion is the existence of deficits in activities of daily living (ADL). ADL are divided into basic activities of daily living (BADL) and instrumental activities of daily living (IADL). BADL include self-maintenance skills such as bathing, getting dressed or eating, and IADL consist of more complex activities such as using public transportation, managing finances, or shopping [5]. The assessment of ADL is usually done by using rating scales, which are administered either to the patient or a proxy. Controversy exists about the ability of patients with MCI to adequately rate themselves, as they lack awareness of IADL deficits and overestimate their functional capacity [6-8]. Farias et al., however, reported no lack of awareness in patients with MCI compared with healthy controls [9]. There is evidence that proxies are not always a reliable source of information, as they have a tendency to over- or underestimate IADL deficits [8,10,11]. In some cases, a proxy is not available or has massive knowledge gaps. Direct measures requiring the patient to solve specific IADL-related tasks have better validity and do not have reporter bias. However, they allow observation of only a small excerpt of real-world performance and are quite time-consuming.

It is assumed that IADL require more complex neuropsychological processing capacity than BADL and therefore are more prone to deterioration triggered by cognitive decline [12,13]. Functional deficits have been observed early in the course of decline [14-16]. In an analysis of studies with a focus on BADL and IADL in subjects with MCI, dementia or no cognitive deficits, Nygård [17] suggested that IADL can be impaired before the onset of dementia and should therefore be included in the diagnosis of MCI.

These findings were taken into account by Winblad et al. [18], who proposed the following criteria for MCI: (1) not normal, not demented; (2) cognitive decline; and (3) preserved BADL and/or minimal impairment in complex instrumental functions. Thus, the criterion of “normal activities of daily living” has been revised to a less stringent one allowing for discrete IADL deficits in patients with MCI.

Over the last 15 years, a large amount of research has been conducted on IADL deficits in MCI. The aim of the present review is to summarize research results regarding the performance of patients with MCI in specific IADL (sub)domains compared with persons who are cognitively normal and/or patients with dementia. In addition, sample characteristics and applied IADL assessment methods—performance-based instruments versus self- and/or informant-reported questionnaires or interviews—are investigated.

Methods

Data sources

To identify relevant published papers, the electronic databases PubMed, Web of Science and PsycINFO were searched in December 2013. Publication dates were set from January 1999 to December 2013. This restriction was chosen to identify only papers that were published after the introduction of Petersen’s MCI definition [2]. The search terms “mild cognitive impairment” (MeSH term) or “MCI” were used in combination with the terms “activities of daily living” (MeSH term) or “ADL” or “instrumental activities of daily living” or “IADL” or “everyday functioning” or “functional ability” or “functional capability” or “functional deficits” or “functional impairment.” After removal of duplicates, 497 articles were retrieved from the 3 searched databases.

Selection criteria

Titles and abstracts of the retrieved articles were screened by two authors (KJ and MD) independently and were rated to assess their relevance to the research question. If inconsistencies occurred, a third author (LH) was consulted. The following selection criteria were applied. (1) The abstract indicated that the focus of the study was the investigation of IADL in MCI versus healthy controls and/or dementia patients. (2) General IADL and/or specific subdomains were investigated. (3) The method of IADL assessment was standardized. (4) MCI was defined according to Petersen and/or Winblad criteria [2,3,18]. (5) No other concepts, such as cognitive impairment, no dementia [19,20], aging-associated cognitive decline [21] or age-associated memory impairment [22], were used. (6) The original article was written in English.

Articles that met the outlined criteria were included in the present review. Reference lists of the selected articles were searched to retrieve further relevant articles. Effect sizes (Cohen’s d) were calculated to allow a better evaluation of clinical relevance.

Results

In total, 34 of the 497 papers were selected for review. Owing to the broad focus of the search terms to ensure retrieval of all relevant articles, the majority of articles did not meet the inclusion criteria (that is, no definition of MCI criteria, use of concepts other than Petersen and/or Winblad criteria). A further three articles were selected from among the reference lists of the selected papers. Thus, the content of the present review is formed from a total of 37 articles.

Mild cognitive impairment sample characteristics

For the diagnosis of MCI, the criteria of Petersen or Winblad were applied across studies; their operationalization, however, varied. One-third of the studies used the original Petersen criteria supplemented by cutoffs on specific neuropsychological tests [15,23-34]. In the remaining studies, the use of the original clinical criteria published by Petersen et al. [2] was reported without specific cutoff values or with a combination of Petersen and Winblad criteria. Mean Mini Mental State Examination (MMSE) [35] scores ranged from 23.1 [36] to 28.7 points [37] for MCI samples, from 26.5 [36] to 29.4 points [30,38] for normal control samples and from 16.4 [39] to 25.5 points [40] for Alzheimer’s disease (AD) samples. In each examined study, however, the MMSE score for the MCI group was lower than that for the comparative control group and higher than that for the dementia sample.

Study types and/or designs

The majority of the reported studies followed a cross-sectional design (29 studies [15,23-26,29,30,33,34,36-38,40-56]), and eight studies applied a longitudinal design [27,28,32,57-61]. In five of the longitudinal studies, risk of conversion to AD depending on IADL impairment was also assessed [27,28,32,58,60].

Assessment instruments used

Altogether, 31 different instruments were used to assess IADL in patients with MCI (see Table 1 for details), including performance-based instruments, self- and informant-report rating questionnaires, and structured interviews. Of the 37 studies, 15 relied solely on informant-report rating questionnaires [23,28,29,31,33,40-43,45-48,54,58], 10 relied solely on performance-based assessments [24,26,30,32,38,50-53,57] and 6 relied solely on self-report rating instruments [27,36,55,56,59,61]. Three studies used both informant-report questionnaires and performance-based assessments [25,34,60]. Interestingly (and inconsistently), in three studies [15,25,44], the IADL of patients with MCI were rated by informants, whereas normal control subjects rated their IADL functioning themselves.

Table 1 Instruments used for instrumental activities of daily living assessment a
Full size table

Mild cognitive impairment subtypes

According to Petersen et al. [1], MCI has two major subtypes: amnestic and nonamnestic. Both can be further divided into single-domain and multidomain types. Among the 37 studies included in this review, IADL performance was analyzed between MCI subtypes in 8 studies [23,31,33,37,40,48,58,61].

Instrumental activities of living in patients with mild cognitive impairment

Among the 37 studies included in this review, all but 2 studies [38,42] found IADL deficits in patients with MCI compared with control subjects without cognitive impairment on at least one applied instrument. In the following sections, we first report results of studies investigating global IADL (see Table 2), then results of studies in which informant-report measures were used and studies using self-report measures (see Table 3).

Table 2 Studies investigating global instrumental activities of daily living functioning a
Full size table
Table 3 Studies investigating specific instrumental activities of daily living domains a
Full size table

Global instrumental activities of daily living rating instruments

Performance-based instruments

Schmitter-Edgecombe et al. [34] designed the Day-Out Task (DOT), which requires multitasking in a real-world setting. Participants have to prepare for a day out and complete related tasks such as planning a bus route or packing specific items in a picnic basket. Patients with MCI required more time to complete the DOT than healthy controls and made more errors while solving the subtasks. By means of the Timed IADL, Wadley et al. [50] investigated both the speed and accuracy of patients with MCI in solving tasks related to shopping, finances, medication, telephone use and locating information on food labels. Patients with MCI took significantly longer than normal controls to solve the tasks and were less accurate. Using the Direct Assessment of Functional Status (DAFS), Pereira et al. [60] found that patients with MCI performed significantly worse than healthy controls and better than AD patients. Financial and shopping skills were the items that differentiated patients with MCI from healthy controls. Binegar et al. [57] applied the Texas Functional Living Scale and detected a significant but small difference between patients with MCI and controls. Interestingly, they mentioned that the performance of patients with MCI on this direct measure was much better (47 points) than that of patients with mild AD (31 points) in a previously conducted study [65].

Using the Naturalistic Action Task, Giovanetti et al. [24] found that patients with MCI performed significantly worse than healthy controls, but better than persons with mild AD, on all three assessed tasks: preparing toast and coffee, wrapping a gift and preparing a lunch box. When cutoff scores were applied, no controls, but 24% of the patients with MCI and 76% of the AD group, fell within the impaired range. Goldberg et al. found a similar pattern of results when they applied a novel performance-based assessment (the University of California San Diego Performance-Based Skills Assessment): The cognitively normal control group outperformed the MCI group, which in turn performed better than the mild to moderate AD group [25]. Interestingly, using the informant-report Alzheimer’s Disease Cooperative Study/Activities of Daily Living Inventory (ADCS-ADL), they detected no significant differences between patients with MCI and persons who were cognitively normal.

All of the performance-based instruments detected significant differences in IADL functioning between patients with MCI and healthy controls, as well as between patients with MCI and patients with dementia, respectively. Furthermore, patients with MCI needed more time to complete tasks than healthy controls and less time than patients with dementia. Calculated effect sizes were medium to large. In terms of effect sizes, the DAFS was the best measure for detecting differences in global IADL functioning between MCI and healthy controls (Cohen’s d = 1.58) and between MCI and AD (Cohen’s d = 2.18).

Informant-report rating instruments

Using the Seoul-IADL, Ahn et al. [41] found deficits in patients with MCI compared with healthy controls in the domains of telephone use, meal preparation, medication intake, management of belongings, keeping appointments, talking about recent events and performing leisure activities and/or hobbies. They concluded that IADL requiring memory or frontal cortex executive functioning are at particular risk of decline in MCI. Jefferson et al. [43] applied an error-based questionnaire of functional capacity (FC-IADL). The FC-IADL measures specific behaviors such as “getting lost in familiar places” and “does not use tools for the proposed use.” On this questionnaire, patients with MCI scored more than 1.5 standard deviations (SD) worse than normal controls. In contrast, no statistically or clinically significant differences were found for the informant-report Lawton and Brody IADL scale.

In contrast, two other studies applying Lawton and Brody’s IADL scale [44,45] showed that patients with MCI had deficits compared with controls regarding shopping, taking medications and handling finances.

Using the Record of Independent Living, Boeve et al. [42] found no significant differences between patients with MCI and healthy controls, but they did observe differences between patients with MCI and controls compared with dementia patients. This study is exceptional within this review because the participants were 90 to 100 years of age. Furthermore, the MCI group was very small (n = 13, compared with 56 healthy controls and 42 patients with dementia). Perneczky et al. [47] applied a questionnaire specifically designed for measuring IADL in MCI—the ADCS-MCI-ADL [69]—and found greater informant-reported impairments for the MCI group than among the age- and sex-matched cognitively normal controls. Pedrosa et al. [45] also reported better ADCS-MCI-ADL scores for healthy controls than for patients with MCI. Consistent observations—that is, differences between patients with MCI and healthy controls—in both studies were observed for finding personal belongings, balancing a checkbook, keeping appointments, using a telephone and talking about recent events. Furthermore, Pedrosa et al. compared the original ADCS-MCI-ADL scale with an extended version. (The authors added six items that they considered useful for MCI populations.) The 24-item version distinguished patients with MCI and healthy controls more reliably than the 18-item version [45]. Reppermund et al. [29], using the Bayer-ADL scale, found significant differences between patients with MCI and healthy controls. This effect was due to deficits of patients with MCI in the domains of observing important dates or events, reading, describing recent events, taking part in a conversation, taking a message, doing two tasks at a time, coping with unfamiliar situations and performing a task while under pressure. Conducting a factor analysis, the authors further subdivided the items into IADL with high or low cognitive demands. Group differences emerged only for the high cognitive demand factor, which consisted mainly of the items mentioned above, which in turn were responsible for the group differences between healthy controls and MCI subjects. The low cognitive demand factor consisted of items such as shopping, using transportation and preparing food. The same work group [28] gathered longitudinal data and again found differences in the Bayer-ADL scale between patients with MCI and healthy controls at baseline and at 2-year follow-up. For healthy controls, Bayer-ADL items with high cognitive demand predicted conversion to MCI and dementia at follow-up. Using the Functional Activities Questionnaire (FAQ), Brown et al. [15] detected significant differences between patients with MCI and healthy controls, and patients with MCI showed more deficits than healthy controls regarding financial skills and remembering events.

With the exception of one study [42], differences between patients with MCI and healthy controls were consistently detected. Deficits regarding financial abilities and memory-related IADL such as keeping appointments or remembering events were common themes across studies. With large effect sizes and consistent results across studies, the informant-reported ADCS-MCI-ADL seems to be a useful tool for global IADL assessment. The Lawton and Brody IADL scale delivered mixed results. Jefferson et al. detected no significant differences between MCI and healthy controls [43], whereas Pedrosa et al. found large effects [45] and Mariani et al. discovered small effects [44]. The same holds true for the Bayer-ADL. Large effects were seen in the two studies by Perneczky et al. [46,47], but only small effects were reported in the studies by Reppermund et al. [28,29].

Self-report rating instruments

Using the Seoul-IADL in a self-rating version, Kim et al. [36] found patients with MCI to be significantly impaired in using a telephone, keeping appointments, talking about recent events and using household appliances, thus replicating the findings of Ahn et al. with the Seoul-IADL in an informant-rating version [41]. In addition, Kim et al. also reported worse performance of the MCI group for transportation and finances. Peres et al. [27] investigated restriction to four IADL items from the Lawton and Brody IADL scale in a self-rating version: telephone use, mode of transport, medication responsibility and handling finances. Patients with MCI were more often restricted in IADL (34.3%) than controls (5.4%) and were less restricted than patients with dementia (91.1%). Interestingly, within a 2-year period, IADL-restricted patients with MCI converted to dementia more frequently than IADL-nonrestricted patients with MCI (30.7% versus 7.8%).

Global instrumental activities of daily living and mild cognitive impairment subtypes

When we analyzed MCI subtypes, differences between MCI subtypes and normal controls were reported for all applied measures except of the Lawton and Brody IADL scale. Looking at effect sizes, the IADL deficits tended to be more pronounced in multiple-domains MCI than in single-domain MCI and also in amnestic MCI than in nonamnestic MCI.

Informant-report rating instruments

Focusing on MCI subtypes, Tam et al. [48] found that the multiple-domains MCI subgroup had an intermediate IADL performance level between those of normal controls and patients with mild dementia on the Disability Assessment for Dementia (DAD) scale. Using the DAD, IADL performance, as well as subjects’ performance regarding initiation or planning and organizing of the IADL subtasks, can be evaluated. The amnestic MCI group had significantly better IADL scores than the multiple-domains MCI group, and their scores were similar to those of the cognitively normal controls. The IADL subscales most frequently impaired in the multiple-domains MCI group were those connected to planning and organizing IADL tasks; initiation of tasks was unaffected.

Aretouli et al. [23] found significant differences between healthy controls and patients with MCI for 12 of 15 items on the Activities of Daily Living-Prevention Instrument. Major difficulties were reported for keeping appointments, using the telephone, remembering current events and finding things at home, and minor difficulties were reported for driving and using transportation, managing finances, organizing and completing activities, and taking medication. An analysis of the MCI subtypes revealed that all four subgroups showed deficits compared with normal controls. However, patients with multiple-domains MCI were not significantly different from those with single-domain MCI, and the amnestic groups did not differ significantly from the nonamnestic groups.

Using the DAD, Yeh et al. [33] reported more IADL deficits for both single-domain amnestic MCI und multiple-domains amnestic MCI than for healthy controls. Both MCI groups had better DAD scores than the mild AD group. When they looked at the DAD scores in detail, though, multiple-domains amnestic patients with MCI had deficits on a larger number of items than single-domain amnestic patients with MCI. Applying the DAD-6 (a shortened version of the DAD), de Rotrou et al. [40] reported similar findings. Using the FAQ, Teng et al. [31] reported better results for normal controls than for patients with MCI. In analyzing the subgroups, they found better results for normal controls than for the amnestic MCI group on all investigated IADL items and better scores than the nonamnestic group on managing bills, preparing taxes, keeping up with current events, attending to media, remembering dates and traveling outside the neighborhood. Luck et al. [58] investigated performance on nine IADL items and detected worse performance of patients with MCI compared with healthy controls. Analyses of MCI subtypes revealed that this effect was stronger for amnestic MCI subtypes.

Self-report rating instruments

Investigating MCI subtypes and normal controls, Wadley et al. [61] found all MCI subgroups reported significantly greater IADL difficulty and worse everyday functioning scores than normal controls at baseline. Over a 3-year period, all MCI groups also showed a significantly steeper decline on the everyday-functioning composite score and IADL performance compared with the cognitively normal group.

One study comparing all three assessment modalities

In a study by Burton et al. [37], three different IADL measures were used that revealed differences between MCI subtypes and healthy controls on the Scales of Independent Behavior–Revised (on both the self- and informant-report version) and the performance-based Everyday Problems Test. No differences between groups emerged with the use of Lawton and Brody’s IADL scale with either the self-report or the informant-report version.

Specific instrumental activities of daily living domains

Financial capacity performance-based instruments

Financial capacity is the best-studied IADL subdomain. The Financial Capacity Instrument (FCI) has been used in three studies [26,30,32]. The FCI assesses financial capacity in seven domains, including monetary skills, financial concepts and bank statement management. All three studies revealed that the overall financial capacity (total score) of patients with MCI was worse than that of healthy controls. The activity “bank statement management” was consistently affected across studies. Griffith et al. [26] additionally found group differences regarding bill payment and financial concepts. Moreover, Triebel et al. [32] reported longitudinal data showing that, at baseline, MCI participants were significantly worse than normal controls on all financial domains and on total scores. Furthermore, the MCI group had been divided into converters and nonconverters to dementia. At baseline, the MCI nonconverter group performed better than the converter group in the domains of financial conceptual knowledge, cash transactions, bank statement management, bill payment and both total scores. No differences were observed for the domains of basic monetary skills, checkbook management, financial judgment and investment decision-making. Over a 1-year period, declines in the domain checkbook management and the total score were observed for the converters, but not for the nonconverters or controls [32].

Management of everyday technology

Performance-based instruments

In 2010, Malinowsky et al. [53] used a standardized observation-based tool (Management of Everyday Technology Assessment) to evaluate ability to manage everyday technology (ET; for example, electronic household appliances, remote controls, cell phones) in patients with mild AD or MCI and controls. They found significant differences between all three groups. Patients with MCI performed worse in using technology than healthy controls did, but better than patients with dementia. In a more recent analysis of the same sample by the same work group [38], significant differences were observed only between healthy controls and patients with dementia when intrapersonal and environmental features were controlled for. They reasoned that what influences a person’s ability to use ET—besides cognitive level or diagnosis—is within-person variability in intrapersonal characteristics and environmental influence (that is, the design of the ET and the context in which it is used).

Informant-rating instruments

Muñoz-Neira et al. [54] added a technology subscale to a Spanish ADL questionnaire. They found significant group differences between healthy controls, patients with MCI and patients with dementia for the total score. Patients with AD had worse scores than patients with MCI and healthy controls on all seven subscales. Comparing patients with MCI and healthy controls, only the recreation and travel subscales differed significantly; no difference was observed for the technology subscale.

Self-report rating instruments

Applying the Everyday Technology Use Questionnaire, Rosenberg et al. [56] investigated the perceived difficulty in use of everyday technologies in samples with AD, MCI and controls. They found significant differences between groups, as well as in the amount of technologies that were considered relevant in each group. Using the same instrument, Nygård et al. [55] could replicate the above-mentioned findings. Furthermore, they found a moderately strong association between engagement in everyday life activities and perceived difficulty in ET use in these three samples.

Driving capacity

Performance-based instruments

Wadley et al. [51] investigated driving ability, which revealed that patients with MCI were significantly more likely than participants who were cognitively normal to be given “less than optimal” ratings for left-hand turns, lane control and the global driving rating. Furthermore, they tended to receive more “less than optimal” ratings on gap judgment and maintaining proper speed. No differences were found for right-hand turns or steering steadiness. The authors noted, however, that the magnitude of difference between MCI participants’ driving performance and that of controls was small, and that, as a group, MCI drivers were not sufficiently impaired to have their driving ability rated as unsafe or unsatisfactory.

Self-report rating instruments

O’Connor et al. [59] investigated 5-year trajectories of mobility indicators, including driving frequency and perceived driving difficulty. The study revealed that driving frequency had a steeper decline in the MCI group compared with healthy controls. Furthermore, driving in both normal and demanding situations was perceived as more difficult by patients with MCI than controls.

Shopping capacity performance-based instruments

Werner et al. [52] directly assessed the IADL domain of shopping by means of a virtual reality supermarket scenario (the Virtual Action Planning Supermarket). They found that patients with MCI covered a significantly higher mean distance, had longer pauses and accordingly took longer to complete their shopping than normal controls. However, the number of purchases, correct or wrong actions, stops and mean time to pay did not differ between groups.

Discussion

This review impressively illustrates that deficits in IADL are consistently present in MCI. Of the 37 included studies, 35 revealed deficits in global IADL or in specific IADL subdomains such as finances, shopping, keeping appointments, driving or ET use. Furthermore, compared with healthy controls, patients with MCI needed longer to complete tasks and tended to be less accurate. Effect sizes were predominantly moderate to large. In analyzing the MCI subtypes, we observed that the IADL deficits tended to be more pronounced in multiple-domains MCI than in single-domain MCI and in amnestic MCI than in nonamnestic MCI, respectively.

In general, patients with MCI had intermediate functional performance between healthy controls and patients with mild AD, particularly in more complex tasks with high cognitive demand. Financial capacity, particularly, was affected in a vast majority of studies. On the general IADL questionnaires, telephone use, responsibility for medication and keeping appointments were the domains most often affected. Nevertheless, there were studies that revealed no deficits in these domains [37,42]. Even when comparing studies in which researchers used the same instrument, such as the Seoul-IADL [36,41], only three matching domains emerged: telephone use, keeping appointments and using household appliances. Similar inconsistencies were observed for Lawton and Brody’s IADL Scale [5]. In two studies in which this instrument was used, investigators did not find any differences between patients with MCI and persons who were cognitively normal [37,43], supporting the argument that this scale is not sensitive enough to detect subtle deficits in MCI. However, researchers in two other studies [44,45] used the same scale and identified impairments in patients with MCI regarding the domains of shopping, medication and finances. One possible explanation for these inconsistencies is the very heterogeneous operationalization of the MCI criteria. Some studies relied solely on a clinical decision, and others used cutoff scores to determine the magnitude of cognitive impairment, but even the cutoff scores varied between 1 SD and 1.5 SD below age- and education-adjusted norms. Furthermore, the mean MMSE scores of MCI subjects ranged from 23.1 [36] to 28.7 points [37], and mean MMSE scores of normal controls ranged from 26.5 [36] to 29.4 points [30]. The problem with studies including patients with MCI with very low MMSE scores is that IADL deficits may be due to already present, but not yet diagnosed, dementia. In a long-term study of patients with mild AD (MMSE score range, 20 to 26), 45% to 65% could not perform usual IADL tasks at baseline, and 70% to 85% of the remaining patients needed assistance with IADL after 3 years [81]. For future research, it would be helpful to conduct (sub)analyses with patients with MCI who have a MMSE score of 27 points or higher to ensure that they have not already converted to dementia. Another possibility is to use cutoff scores of 1 SD, instead of 1.5 SD, below age- and education-adjusted norms in neuropsychological tests [82]. Moreover, it should be taken into consideration that the MMSE is a rather insensitive measure for cognitive functioning, as it is not adjusted for age and education. In general, the use of MMSE cutoff scores to define MCI should be scrutinized.

In reviewing the selected articles, we found that the variety of assessment instruments applied to assess IADL in MCI was impressive; 31 different instruments were identified (see Table 1), which complicates comparisons among studies. Another problem is that few of these instruments were constructed and validated for IADL assessment in patients with MCI. The majority of the instruments used were originally designed for studies with patients with dementia, and thus the items are not calibrated to detect subtle differences from normal. Moreover, data on psychometric properties are mainly insufficient; for an overview of IADL scales in dementia where the need for validation studies is explicated, see the article by Sikkes et al. [83]. Measures specifically designed for MCI populations are required. This may be exemplified by the failure of the ADCS-ADL scale to reveal differences between patients with MCI and healthy controls [25], whereas the ADCS-MCI-ADL scales definitely detected differences [46,47]. The problem could be solved by constructing more sensitive item scoring for MCI-specific scales and/or by investigating in detail only those domains that have been shown to be impaired consistently in MCI, such as financial capacity. When the domain of financial capacity was thoroughly analyzed by an interview or a performance-based assessment procedure, differences between patients with MCI and control participants with cognitive impairment were persistently observed [26,32,39] and invariably revealed large effect sizes.

Furthermore, the majority of assessment instruments do not investigate computer skills or the handling of “new” technology in general. The instruments targeting ET use are examples of scales that focus on a particular domain that proved to be sensitive to subtle impairment, and significant differences were detected through both self-reports and observations [53-56].

Performance-based assessment methods seem to be a promising tool, especially for patients without proxies to provide information about the patient’s IADL. Moreover, performance-based methods would overcome another methodological issue related to self- and/or informant-report measures. In three reviewed studies [15,25,44], healthy controls rated their IADL capacity themselves, whereas MCI subjects were rated by their proxies. This inconsistency could lead to biased results, as rating procedures differed. All assessment methods have their limitations. When using self-report, patients tend to over- or underestimate their abilities and may not have full insight into the impairments caused by the disease. Informant-based methods rely on the informant’s knowledge about the patient, which might be affected by the amount of care provided. In addition, family members tend to misjudge the patient’s capacity. Performance-based instruments also have limitations, such as a higher degree of training needed by assessors, a more time-consuming evaluation and an unfamiliar environment that might bias the functional performance [84].

Furthermore, this review revealed some main problems of MCI definition. The operationalization of MCI is not clearly specified, which leads researchers to define cutoff points and choose assessment instruments of their own. The new criteria for prodromal AD/MCI due to AD may overcome this problem by including biomarkers for the diagnosis of the condition [85]. Nevertheless, the differentiation between MCI and dementia, as described in the new National Institute on Aging and Alzheimer’s Association criteria, rests on the determination of whether there is significant interference in the ability to function at work or in usual daily activities [86]. Therefore, the identification of IADL deficits in MCI as an early phase of AD is absolutely essential for clinical practice. Regarding the effect sizes, the differences between MCI subjects and healthy controls are not only statistically significant but also clinically relevant and can be considered quite robust. Defining a threshold of functional impairment, however, remains a difficult task. MCI is primarily a neuropsychologically defined construct. To give recommendations on exact thresholds, IADL measures which are specifically designed for and/or validated in MCI populations are needed first. If this is achieved, future criteria for MCI could postulate mild deficits in IADL functioning (that is, more than 1.5 standard deviations below healthy controls) in at least one of the following domains: financial abilities, keeping appointments, task completion time, task accuracy or remembering recent events.

It appears evident on the basis of this review that patients with MCI with IADL deficits are more likely to convert to dementia than are patients with MCI without IADL restrictions [27,32]. In fact, the presence of acquired IADL disability not due to a concomitant physical condition seems to be in itself a valid marker of prodromal AD. Studies assessing structural brain functioning and IADL impairment in MCI simultaneously [87] can help to identify relevant biomarkers of IADL deficits and at-risk individuals. Failure to detect an individual’s functional impairments might preclude training of these activities by occupational therapy or lead to neglecting needs and providing an inadequate amount of care from community-based services. Deterioration in IADL abilities, rather than cognition impairments, predicted a greater need of home help services in AD [88].

Conclusions

Although there was no uniform agreement about which IADL domains are typically—that is, characteristically and/or specifically—impaired in MCI and which types of instruments may detect those best, a clear tendency nevertheless emerged, with activities requiring higher cognitive processes being consistently affected. Also, the use of performance-based measures and technology-related items seems to be promising.

Future research should concentrate on both the thorough validation of established instruments and the development of new ones. As new instruments for IADL functioning in MCI are being developed, researchers should include items measuring the domains of financial capacities, keeping appointments, task completion time and task accuracy. Moreover, studies comparing the three assessment modalities—that is, self-report, informant-report rating and performance-based—in the same sample are needed. In the long run, this could lead to a more precise definition of functional impairment in MCI in terms of quantifiable cutoff scores.

Abbreviations

AD:

Alzheimer’s disease

ADCS-ADL:

Alzheimer’s Disease Cooperative Study/Activities of Daily Living Inventory

ADCS-MCI-ADL-18:

18-item Alzheimer’s Disease Cooperative Study/Activities of Daily Living Inventory adapted for patients with mild cognitive impairment

ADCS-MCI-ADL-24:

24-item Alzheimer’s Disease Cooperative Study/Activities of Daily Living Inventory adapted for patients with mild cognitive impairment

ADL:

Activities of daily living

ADL-PI:

Activities of Daily Living-Prevention Instrument

am:

Amnestic multiple domain

aMCI:

Amnestic mild cognitive impairment

as:

Amnestic single domain

BADL:

Basic activities of daily living

Bayer-ADL:

Bayer Activities of Daily Living Scale

CDR:

Clinical dementia rating

DAD:

Disability Assessment for Dementia

DAD-6:

6-item Disability Assessment for Dementia

DAFS:

Direct Assessment of Functional Status

DHQ:

Driving Habits Questionnaire

DOT:

Day-Out Task

EPT:

Everyday Problems Test

ETUQ:

Everyday Technology Use Questionnaire

FAQ:

Functional Activities Questionnaire

FC-ADL:

Functional Capacities for Activities of Daily Living

FCI:

Financial Capacity Instrument

FC-IADL:

Functional Capacities for Instrumental Activities of Daily Living

IADL:

Instrumental activities of daily living

4-IADL:

4-item Instrumental Activities of Daily Living scale items chosen from Lawton and Brody

9-IADL:

9-item Instrumental Activities of Daily Living scale

ICC:

Intraclass correlation coefficient

IQCODE:

Informant Questionnaire on Cognitive Decline in the Elderly

KI-IADL:

Knowledgeable Informant report about Instrumental Activities of Daily Living

L&B IADL:

Lawton and Brody’s Instrumental Activities of Daily Living

MCI:

Mild cognitive impairment

md:

Multiple domain

META:

Management of Everyday Technology Assessment

MMSE:

Mini Mental State Examination

nam:

Nonamnestic multiple domain

naMCI:

Nonamnestic mild cognitive impairment

nas:

Nonamnestic single domain

NAT:

Naturalistic action task

NC:

Normal control

NIA-AA:

National Institute on Aging and Alzheimer’s Association

ns:

nonsignificant

ROIL:

Record of Independent Living

sd:

Single domain

SD:

Standard deviation

S-IADL:

Seoul-Instrumental Activities of Daily Living

SIB-R:

Scales of Independent Behavior–Revised

SR-IADL:

Self-report Instrumental Activities of Daily Living

TADL-Q:

Technology–Activities of Daily Living Questionnaire

TFLS:

Texas Functional Living Scale

TIADL:

Timed Instrumental Activities of Daily Living

UAB-DA:

University of Alabama at Birmingham Driving Assessment

UCSD-UPSA:

University of California San Diego Performance-Based Skills Assessment

VAPS:

Virtual Action Planning Supermarket

References

  1. Petersen RC, Doody R, Kurz A, Mohs RC, Morris JC, Rabins PV, et al. Current concepts in mild cognitive impairment. Arch Neurol. 2001;58:1985–92.

    Article  CAS  PubMed  Google Scholar 

  2. Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol. 1999;56:303–8.

    Article  CAS  PubMed  Google Scholar 

  3. Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med. 2004;256:183–94. doi:10.1111/j.1365-2796.2004.01388.x.

    Article  CAS  PubMed  Google Scholar 

  4. Ritchie K, Touchon J. Mild cognitive impairment: conceptual basis and current nosological status. Lancet. 2000;355:225–8. doi:10.1016/S0140-6736(99)06155-3.

    Article  CAS  PubMed  Google Scholar 

  5. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–86.

    Article  CAS  PubMed  Google Scholar 

  6. Albert SM, Michaels K, Padilla M, Pelton G, Bell K, Marder K, et al. Functional significance of mild cognitive impairment in elderly patients without a dementia diagnosis. Am J Geriatr Psychiatry. 1999;7:213–20.

    Article  CAS  PubMed  Google Scholar 

  7. Tabert MH, Albert SM, Borukhova-Milov L, Camacho Y, Pelton G, Liu X, et al. Functional deficits in patients with mild cognitive impairment: prediction of AD. Neurology. 2002;58:758–64.

    Article  CAS  PubMed  Google Scholar 

  8. Okonkwo OC, Wadley VG, Griffith HR, Belue K, Lanza S, Zamrini EY, et al. Awareness of deficits in financial abilities in patients with mild cognitive impairment: going beyond self-informant discrepancy. Am J Geriatr Psychiatry. 2008;16:650–9. doi:10.1097/JGP.0b013e31817e8a9d.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Farias ST, Mungas D, Jagust W. Degree of discrepancy between self and other-reported everyday functioning by cognitive status: dementia, mild cognitive impairment, and healthy elders. Int J Geriatr Psychiatry. 2005;20:827–34. doi:10.1002/gps.1367.

    Article  PubMed Central  PubMed  Google Scholar 

  10. DeBettignies BH, Mahurin RK, Pirozzolo FJ. Insight for impairment in independent living skills in Alzheimer’s disease and multi-infarct dementia. J Clin Exp Neuropsychol. 1990;12:355–63. doi:10.1080/01688639008400980.

    Article  CAS  PubMed  Google Scholar 

  11. Zanetti O, Geroldi C, Frisoni GB, Bianchetti A, Trabucchi M. Contrasting results between caregiver’s report and direct assessment of activities of daily living in patients affected by mild and very mild dementia: the contribution of the caregiver’s personal characteristics. J Am Geriatr Soc. 1999;47:196–202.

    CAS  PubMed  Google Scholar 

  12. Njegovan V, Man-Son-Hing M, Mitchell SL, Molnar FJ. The hierarchy of functional loss associated with cognitive decline in older persons. J Gerontol A Biol Sci Med Sci. 2001;56:M638–43. doi:10.1093/gerona/56.10.M638.

    Article  CAS  PubMed  Google Scholar 

  13. Agüero-Torres H, Thomas Versus, Winblad B, Fratiglioni L. The impact of somatic and cognitive disorders on the functional status of the elderly. J Clin Epidemiol. 2002;55:1007–12.

    Article  PubMed  Google Scholar 

  14. Amieva H, Le Goff M, Millet X, Orgogozo JM, Pérès K, Barberger-Gateau P, et al. Prodromal Alzheimer’s disease: successive emergence of the clinical symptoms. Ann Neurol. 2008;64:492–8. doi:10.1002/ana.21509.

    Article  PubMed  Google Scholar 

  15. Brown PJ, Devanand DP, Liu X, Caccappolo E, Alzheimer’s Disease Neuroimaging Initiative. Functional impairment in elderly patients with mild cognitive impairment and mild Alzheimer disease. Arch Gen Psychiatry. 2011;68:617–26. doi:10.1001/archgenpsychiatry.2011.57.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Pérès K, Helmer C, Amieva H, Orgogozo JM, Rouch I, Dartigues JF, et al. Natural history of decline in instrumental activities of daily living performance over the 10 years preceding the clinical diagnosis of dementia: a prospective population-based study. J Am Geriatr Soc. 2008;56:37–44. doi:10.1111/j.1532-5415.2007.01499.x.

    Article  PubMed  Google Scholar 

  17. Nygård L. Instrumental activities of daily living: a stepping-stone towards Alzheimer’s disease diagnosis in subjects with mild cognitive impairment? Acta Neurol Scand Suppl. 2003;179:42–6.

    Article  PubMed  Google Scholar 

  18. Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, et al. Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med. 2004;256:240–6.

    Article  CAS  PubMed  Google Scholar 

  19. Ebly EM, Hogan DB, Parhad IM. Cognitive impairment in the nondemented elderly: results from the Canadian Study of Health and Aging. Arch Neurol. 1995;52:612–9. doi:10.1001/archneur.1995.00540300086018.

    Article  CAS  PubMed  Google Scholar 

  20. Graham JE, Rockwood K, Beattie BL, Eastwood R, Gauthier S, Tuokko H, et al. Prevalence and severity of cognitive impairment with and without dementia in an elderly population. Lancet. 1997;349:1793–6.

    Article  CAS  PubMed  Google Scholar 

  21. Levy R. Aging-associated cognitive decline: Working Party of the International Psychogeriatric Association in collaboration with the World Health Organization. Int Psychogeriatr. 1994;6:63–8.

    Article  CAS  PubMed  Google Scholar 

  22. Crook T, Bartus RT, Ferris SH, Whitehouse P, Cohen GD, Gershon S. Age-associated memory impairment: proposed diagnostic criteria and measures of clinical change—report of a National Institute of Mental Health work group. Dev Neuropsychol. 1986;2:261–76. doi:10.1080/87565648609540348.

    Article  Google Scholar 

  23. Aretouli E, Brandt J. Everyday functioning in mild cognitive impairment and its relationship with executive cognition. Int J Geriatr Psychiatry. 2010;25:224–33. doi:10.1002/gps.2325.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Giovannetti T, Bettcher BM, Brennan L, Libon DJ, Burke M, Duey K, et al. Characterization of everyday functioning in mild cognitive impairment: a direct assessment approach. Dement Geriatr Cogn Disord. 2008;25:359–65. doi:10.1159/000121005.

    Article  PubMed  Google Scholar 

  25. Goldberg TE, Koppel J, Keehlisen L, Christen E, Dreses-Werringloer U, Conejero-Goldberg C, et al. Performance-based measures of everyday function in mild cognitive impairment. Am J Psychiatry. 2010;167:845–53. doi:10.1176/appi.ajp.2010.09050692.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Griffith HR, Belue K, Sicola A, Krzywanski S, Zamrini E, Harrell L, et al. Impaired financial abilities in mild cognitive impairment: a direct assessment approach. Neurology. 2003;60:449–57.

    Article  CAS  PubMed  Google Scholar 

  27. Peres K, Chrysostome V, Fabrigoule C, Orgogozo JM, Dartigues JF, Barberger-Gateau P. Restriction in complex activities of daily living in MCI: impact on outcome. Neurology. 2006;67:461–6.

    Article  CAS  PubMed  Google Scholar 

  28. Reppermund S, Brodaty H, Crawford JD, Kochan NA, Draper B, Slavin MJ, et al. Impairment in instrumental activities of daily living with high cognitive demand is an early marker of mild cognitive impairment: the Sydney Memory and Ageing Study. Psychol Med. 2013;43:2437–45. doi:10.1017/s003329171200308x.

    Article  CAS  PubMed  Google Scholar 

  29. Reppermund S, Sachdev PS, Crawford J, Kochan NA, Slavin MJ, Kang K, et al. The relationship of neuropsychological function to instrumental activities of daily living in mild cognitive impairment. Int J Geriatr Psychiatry. 2011;26:843–52. doi:10.1002/gps.2612.

    Article  PubMed  Google Scholar 

  30. Sherod MG, Griffith HR, Copeland J, Belue K, Krzywanski S, Zamrini EY, et al. Neurocognitive predictors of financial capacity across the dementia spectrum: normal aging, mild cognitive impairment, and Alzheimer’s disease. J Int Neuropsychol Soc. 2009;15:258–67. doi:10.1017/S1355617709090365.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Teng E, Becker BW, Woo E, Cummings JL, Lu PH. Subtle deficits in instrumental activities of daily living in subtypes of mild cognitive impairment. Dement Geriatr Cogn Disord. 2010;30:189–97. doi:10.1159/000313540.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Triebel KL, Martin R, Griffith HR, Marceaux J, Okonkwo OC, Harrell L, et al. Declining financial capacity in mild cognitive impairment: a 1-year longitudinal study. Neurology. 2009;73:928–34. doi:10.1212/WNL.0b013e3181b87971.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  33. Yeh YC, Lin KN, Chen WT, Lin CY, Chen TB, Wang PN. Functional disability profiles in amnestic mild cognitive impairment. Dement Geriatr Cogn Disord. 2011;31:225–32. doi:10.1159/000326910.

    Article  PubMed  Google Scholar 

  34. Schmitter-Edgecombe M, McAlister C, Weakley A. Naturalistic assessment of everyday functioning in individuals with mild cognitive impairment: the day-out task. Neuropsychology. 2012;26:631–41. doi:10.1037/a0029352.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98. doi:10.1016/0022-3956(75)90026-6.

    Article  CAS  PubMed  Google Scholar 

  36. Kim KR, Lee KS, Cheong HK, Eom JS, Oh BH, Hong CH. Characteristic profiles of instrumental activities of daily living in different subtypes of mild cognitive impairment. Dement Geriatr Cogn Disord. 2009;27:278–85. doi:10.1159/000204765.

    Article  PubMed  Google Scholar 

  37. Burton CL, Strauss E, Bunce D, Hunter MA, Hultsch DF. Functional abilities in older adults with mild cognitive impairment. Gerontology. 2009;55:570–81. doi:10.1159/000228918.

    Article  PubMed  Google Scholar 

  38. Malinowsky C, Almkvist O, Nygård L, Kottorp A. Individual variability and environmental characteristics influence older adults’ abilities to manage everyday technology. Int Psychogeriatr. 2012;24:484–95. doi:10.1017/S1041610211002092.

    Article  PubMed  Google Scholar 

  39. Marson DC, Martin RC, Wadley V, Griffith HR, Snyder S, Goode PS, et al. Clinical interview assessment of financial capacity in older adults with mild cognitive impairment and Alzheimer’s disease. J Am Geriatr Soc. 2009;57:806–14. doi:10.1111/j.1532-5415.2009.02202.x.

    Article  PubMed Central  PubMed  Google Scholar 

  40. de Rotrou J, Wu YH, Hugonot-Diener L, Thomas-Antérion C, Vidal JS, Plichart M, et al. DAD-6: a 6-item version of the Disability Assessment for Dementia scale which may differentiate Alzheimer’s disease and mild cognitive impairment from controls. Dement Geriatr Cogn Disord. 2012;33:210–8. doi:10.1159/000338232.

    Article  PubMed  Google Scholar 

  41. Ahn IS, Kim JH, Kim S, Chung JW, Kim H, Kang HS, et al. Impairment of instrumental activities of daily living in patients with mild cognitive impairment. Psychiatry Investig. 2009;6:180–4. doi:10.4306/pi.2009.6.3.180.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Boeve B, McCormick J, Smith G, Ferman T, Rummans T, Carpenter T, et al. Mild cognitive impairment in the oldest old. Neurology. 2003;60:477–80.

    Article  CAS  PubMed  Google Scholar 

  43. Jefferson AL, Byerly LK, Vanderhill S, Lambe S, Wong S, Ozonoff A, et al. Characterization of activities of daily living in individuals with mild cognitive impairment. Am J Geriatr Psychiatry. 2008;16:375–83.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Mariani E, Monastero R, Ercolani S, Rinaldi P, Mangialasche F, Costanzi E, et al. Influence of comorbidity and cognitive status on instrumental activities of daily living in amnestic mild cognitive impairment: results from the ReGAI Project. Int J Geriatr Psychiatry. 2008;23:523–30. doi:10.1002/gps.1932.

    Article  CAS  PubMed  Google Scholar 

  45. Pedrosa H, De Sa A, Guerreiro M, Marôco J, Simões MR, Galasko D, et al. Functional evaluation distinguishes MCI patients from healthy elderly people—the ADCS/MCI/ADL scale. J Nutr Health Aging. 2010;14:703–9.

    Article  CAS  PubMed  Google Scholar 

  46. Perneczky R, Pohl C, Sorg C, Hartmann J, Komossa K, Alexopoulos P, et al. Complex activities of daily living in mild cognitive impairment: conceptual and diagnostic issues. Age Ageing. 2006;35:240–5. doi:10.1109/ageing/afj054.

    Article  PubMed  Google Scholar 

  47. Perneczky R, Pohl C, Sorg C, Hartmann J, Tosic N, Grimmer T, et al. Impairment of activities of daily living requiring memory or complex reasoning as part of the MCI syndrome. Int J Geriatr Psychiatry. 2006;21:158–62. doi:10.1002/gps.1444.

    Article  PubMed  Google Scholar 

  48. Tam CW, Lam LC, Chiu HF, Lui VW. Characteristic profiles of instrumental activities of daily living in Chinese older persons with mild cognitive impairment. Am J Alzheimers Dis Other Demen. 2007;22:211–7. doi:10.1177/1533317507301597.

    Article  PubMed  Google Scholar 

  49. Teng E, Becker BW, Woo E, Knopman DS, Cummings JL, Lu PH. Utility of the functional activities questionnaire for distinguishing mild cognitive impairment from very mild Alzheimer disease. Alzheimer Dis Assoc Disord. 2010;24:348–53. doi:10.1097/WAD.0b013e3181e2fc84.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Wadley VG, Okonkwo O, Crowe M, Ross-Meadows LA. Mild cognitive impairment and everyday function: evidence of reduced speed in performing instrumental activities of daily living. Am J Geriatr Psychiatry. 2008;16:416–24. doi:10.1097/JGP.0b013e31816b7303.

    Article  PubMed  Google Scholar 

  51. Wadley VG, Okonkwo O, Crowe M, Vance DE, Elgin JM, Ball KK, et al. Mild cognitive impairment and everyday function: an investigation of driving performance. J Geriatr Psychiatry Neurol. 2009;22:87–94. doi:10.1177/0891988708328215.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Werner P, Rabinowitz S, Klinger E, Korczyn AD, Josman N. Use of the virtual action planning supermarket for the diagnosis of mild cognitive impairment: a preliminary study. Dement Geriatr Cogn Disord. 2009;27:301–9. doi:10.1159/000204915.

    Article  PubMed  Google Scholar 

  53. Malinowsky C, Almkvist O, Kottorp A, Nygård L. Ability to manage everyday technology: a comparison of persons with dementia or mild cognitive impairment and older adults without cognitive impairment. Disabil Rehabil Assist Technol. 2010;5:462–9. doi:10.3109/17483107.2010.496098.

    Article  CAS  PubMed  Google Scholar 

  54. Muñoz-Neira C, López OL, Riveros R, Núñez-Huasaf J, Flores P, Slachevsky A. The Technology–Activities of Daily Living Questionnaire: a version with a technology-related subscale. Dement Geriatr Cogn Disord. 2012;33:361–71. doi:10.1159/000338606.

    Article  PubMed  Google Scholar 

  55. Nygård L, Pantzar M, Uppgard B, Kottorp A. Detection of activity limitations in older adults with MCI or Alzheimer’s disease through evaluation of perceived difficulty in use of everyday technology: a replication study. Aging Ment Health. 2012;16:361–71. doi:10.1080/13607863.2011.605055.

    Article  PubMed  Google Scholar 

  56. Rosenberg L, Kottorp A, Winblad B, Nygård L. Perceived difficulty in everyday technology use among older adults with or without cognitive deficits. Scand J Occup Ther. 2009;16:216–26. doi:10.3109/11038120802684299.

    Article  PubMed  Google Scholar 

  57. Binegar DL, Hynan LS, Lacritz LH, Weiner MF, Cullum CM. Can a direct IADL measure detect deficits in persons with MCI? Curr Alzheimer Res. 2009;6:48–51.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  58. Luck T, Luppa M, Angermeyer MC, Villringer A, König HH, Riedel-Heller SG. Impact of impairment in instrumental activities of daily living and mild cognitive impairment on time to incident dementia: results of the Leipzig Longitudinal Study of the Aged. Psychol Med. 2011;41:1087–97. doi:10.1017/S003329171000142X.

    Article  CAS  PubMed  Google Scholar 

  59. O’Connor ML, Edwards JD, Wadley VG, Crowe M. Changes in mobility among older adults with psychometrically defined mild cognitive impairment. J Gerontol B Psychol Sci Soc Sci. 2010;65B:306–16. doi:10.1093/geronb/gbq003.

    Article  PubMed Central  PubMed  Google Scholar 

  60. Pereira FS, Yassuda MS, Oliveira AM, Diniz BS, Radanovic M, Talib LL, et al. Profiles of functional deficits in mild cognitive impairment and dementia: benefits from objective measurement. J Int Neuropsychol Soc. 2010;16:297–305. doi:10.1017/S1355617709991330.

    Article  PubMed  Google Scholar 

  61. Wadley VG, Crowe M, Marsiske M, Cook SE, Unverzagt FW, Rosenberg AL, et al. Changes in everyday function in individuals with psychometrically defined mild cognitive impairment in the Advanced Cognitive Training for Independent and Vital Elderly Study. J Am Geriatr Soc. 2007;55:1192–8. doi:10.1111/j.1532-5415.2007.01245.x.

    Article  PubMed Central  PubMed  Google Scholar 

  62. Loewenstein DA, Amigo E, Duara R, Guterman A, Hurwitz D, Berkowitz N, et al. A new scale for the assessment of functional status in Alzheimer’s disease and related disorders. J Gerontol. 1989;44:P114–21. doi:10.1093/geronj/44.4.P114.

    Article  CAS  PubMed  Google Scholar 

  63. Willis S, Marsiske M. Manual for the Everyday Problems Test. University Park: Pennsylvania State University; 1993.

    Google Scholar 

  64. Marson DC, Sawrie SM, Snyder S, McInturff B, Stalvey T, Boothe A, et al. Assessing financial capacity in patients with Alzheimer disease: a conceptual model and prototype instrument. Arch Neurol. 2000;57:877–84. doi:10.1001/archneur.57.6.877.

    Article  CAS  PubMed  Google Scholar 

  65. Cullum CM, Saine K, Chan LD, Martin-Cook K, Gray KF, Weiner MF. Performance-based instrument to assess functional capacity in dementia: the Texas Functional Living Scale. Neuropsychiatry Neuropsychol Behav Neurol. 2001;14:103–8.

    CAS  PubMed  Google Scholar 

  66. Owsley C, Sloane M, McGwin Jr G, Ball K. Timed instrumental activities of daily living tasks: relationship to cognitive function and everyday performance assessments in older adults. Gerontology. 2002;48:254–65.

    Article  PubMed  Google Scholar 

  67. Bowers A, Peli E, Elgin J, McGwin Jr G, Owsley C. On-road driving with moderate visual field loss. Optom Vis Sci. 2005;82:657–67.

    Article  PubMed  Google Scholar 

  68. Patterson TL, Goldman S, McKibbin CL, Hughs T, Jeste DV. UCSD Performance-Based Skills Assessment: Development of a new measure of everyday functioning for severely mentally ill adults. Schizophr Bull. 2001;27:235–45.

    Article  CAS  PubMed  Google Scholar 

  69. Galasko D, Bennett D, Sano M, Ernesto C, Thomas R, Grundman M, et al. An inventory to assess activities of daily living for clinical trials in Alzheimer’s disease. Alzheimer Dis Assoc Disord. 1997;11 Suppl 2:S33–9.

    Article  PubMed  Google Scholar 

  70. Galasko D, Bennett DA, Sano M, Marson D, Kaye J, Edland SD, et al. ADCS Prevention Instrument Project: assessment of instrumental activities of daily living for community-dwelling elderly individuals in dementia prevention clinical trials. Alzheimer Dis Assoc Disord. 2006;20(4 Suppl 3):S152–69.

    Article  PubMed  Google Scholar 

  71. Hindmarch I, Lehfeld H, de Jongh P, Erzigkeit H. The Bayer Activities of Daily Living Scale (B-ADL). Dement Geriatr Cogn Disord. 1998;9 Suppl 2:20–6.

    Article  PubMed  Google Scholar 

  72. Gelinas I, Gauthier L, McIntyre M, Gauthier S. Development of a functional measure for persons with Alzheimer’s disease: the disability assessment for dementia. Am J Occup Ther. 1999;53:471–81.

    Article  CAS  PubMed  Google Scholar 

  73. Pfeffer RI, Kurosaki TT, Harrah Jr CH, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol. 1982;37:323–9.

    Article  CAS  PubMed  Google Scholar 

  74. Glosser G, Gallo J, Duda N, de Vries JJ, Clark CM, Grossman M. Visual perceptual functions predict instrumental activities of daily living in patients with dementia. Neuropsychiatry Neuropsychol Behav Neurol. 2002;15:198–206.

    PubMed  Google Scholar 

  75. Jorm AF, Jacomb PA. The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): socio-demographic correlates, reliability, validity and some norms. Psychol Med. 1989;19:1015–22. doi:10.1017/S0033291700005742.

    Article  CAS  PubMed  Google Scholar 

  76. Weintraub S. The record of independent living: an informant-completed measure of activities of daily living and behavior in elderly patients with cognitive impairment. Am J Alzheimers Dis Other Demen. 1986;1:35–9. doi:10.1177/153331758600100210.

    Article  Google Scholar 

  77. Morris JN, Fries BE, Steel K, Ikegami N, Bernabei R, Carpenter GI, et al. Comprehensive clinical assessment in community setting: applicability of the MDS-HC. J Am Geriatr Soc. 1997;45:1017–24.

    CAS  PubMed  Google Scholar 

  78. Ku H, Kim J, Lee H, Ko H, Kwon E, Jo S. A study on the reliability and validity of Seoul-Activities of Daily Living (S-ADL). J Korean Geriatr Soc. 2004;8:206–14.

    Google Scholar 

  79. Bruininks R, Woodcock R, Weatherman R, Bradley B. Scales of Independent Behavior–Revised: comprehensive manual. Itasca, IL: Riverside; 1996.

    Google Scholar 

  80. Schneekloth U, Potthoff P. Help and need of care of community dwelling elderly: results of the representative research project. Potentials and limitations of independent living. Stuttgart, Germany: Kohlhammer; 1993. German.

  81. Wattmo C, Wallin AK, Minthon L. Progression of mild Alzheimer’s disease: knowledge and prediction models required for future treatment strategies. Alzheimers Res Ther. 2013;5:44. doi:10.1186/alzrt210.

    Article  PubMed Central  PubMed  Google Scholar 

  82. Larrieu S, Letenneur L, Orgogozo JM, Fabrigoule C, Amieva H, Le Carret N, et al. Incidence and outcome of mild cognitive impairment in a population-based prospective cohort. Neurology. 2002;59:1594–9. doi:10.1212/01.WNL.0000034176.07159.F8.

    Article  CAS  PubMed  Google Scholar 

  83. Sikkes SAM, de Lange-de Klerk ESM, Pijnenburg YAL, Scheltens P, Uitdehaag BMJ. A systematic review of Instrumental Activities of Daily Living scales in dementia: room for improvement. J Neurol Neurosurg Psychiatry. 2009;80:7–12. doi:10.1136/jnnp.2008.155838.

    Article  CAS  PubMed  Google Scholar 

  84. Desai AK, Grossberg GT, Sheth DN. Activities of daily living in patients with dementia: clinical relevance, methods of assessment and effects of treatment. CNS Drugs. 2004;18:853–75.

    Article  PubMed  Google Scholar 

  85. Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, et al. The diagnosis of mild cognitive impairment due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7:270–9. doi:10.1016/j.jalz.2011.03.008.

    Article  PubMed Central  PubMed  Google Scholar 

  86. McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack Jr CR, Kawas CH, et al. The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7:263–9. doi:10.1016/j.jalz.2011.03.005.

    Article  PubMed Central  PubMed  Google Scholar 

  87. Farias ST, Park LQ, Harvey DJ, Simon C, Reed BR, Carmichael O, et al. Everyday cognition in older adults: associations with neuropsychological performance and structural brain imaging. J Int Neuropsychol Soc. 2013;19:430–41. doi:10.1017/S1355617712001609.

    Article  PubMed  Google Scholar 

  88. Wattmo C, Paulsson E, Minthon L, Londos E. A longitudinal study of risk factors for community-based home help services in Alzheimer’s disease: the influence of cholinesterase inhibitor therapy. Clin Interv Aging. 2013;8:329–39. doi:10.2147/CIA.S40087.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

KJ received a scholarship from the Robert-Bosch Stiftung, Germany. MEw is supported by the European Commission Marie Curie Training Grant (PCIG12-GA-2012-334259) and the LMUexcellent Investment Fund. FP thanks LabEx DISTALZ (Development of Innovative Strategies for a Transdisciplinary approach to ALZheimer’s disease) for their support. The work of SAMS is part of a fellowship project of Alzheimer Nederland, WE.15-2012-02. CW is currently receiving an ALF young researcher grant from Region Skåne, Sweden.

Author information

Authors and Affiliations

  1. Network Aging Research, Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany

    Katrin Jekel

  2. Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Square J 5, 68159, Mannheim, Germany

    Katrin Jekel, Marinella Damian, Lucrezia Hausner & Lutz Frölich

  3. Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, 20502, Malmö, Sweden

    Carina Wattmo

  4. Kingshill Research Centre, Victoria Hospital, 53 Downs Way, Swindon, SN3 6BW, UK

    Roger Bullock

  5. Hon Senior Lecturer in Psychiatry at the University of Dundee, Murray Royal Hospital, Perth, PH2 7BH, UK

    Peter J Connelly

  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

    Bruno Dubois

  7. Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Alfred Nobels allé 23, 14183, Huddinge, Sweden

    Maria Eriksdotter

  8. Institute of Health and Nursing Science, Charité Center 1 for Health and Human Sciences, Augustenburger Platz 1, 13353, Berlin, Germany

    Michael Ewers

  9. Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany

    Elmar Graessel

  10. Department of Neurology, Centre for Cognitive Impairments, University Medical Centre Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia

    Milica G Kramberger

  11. Scottish Dementia Clinical Research Network, Murray Royal Hospital, Perth, PH2 7BH, UK

    Emma Law

  12. Institute of Gerontology and Geriatrics, University of Perugia, via Brunamonti 51, 06122, Perugia, Italy

    Patrizia Mecocci

  13. Alzheimer’s Disease and Other Cognitive Disorders Unit, ICN, Hospital Clínic i Universitari, IDIBAPS, Villarroel 170, Barcelona, 08036, Spain

    José L Molinuevo

  14. Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Fack 23200, 14183, Huddinge, Sweden

    Louise Nygård

  15. Department of Geriatrics, Radboud University Nijmegen Medical Centre, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands

    Marcel GM Olde-Rikkert

  16. Department of Clinical Neurosciences, University Hospital Pellegrin, Place Amélie Raba-Léon, 33000, Bordeaux, France

    Jean-Marc Orgogozo

  17. INSERM U1171, CHU, Memory Clinic, University of Lille, rue Emile Laine, 59037, Lille, France

    Florence Pasquier

  18. University of Bordeaux, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, 33000, Bordeaux, France

    Karine Peres

  19. INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, 33000, Bordeaux, France

    Karine Peres

  20. Memory Clinic, Department of Neurology, University of Liège, allée du 6 Août 8, 4000, Liège, Belgium

    Eric Salmon

  21. Alzheimer Center and Department of Epidemiology and Biostatistics, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands

    Sietske AM Sikkes

  22. Department of Medical Psychology, Medical University of Lodz, 5 Sterling St, 90-425, Lodz, Poland

    Tomasz Sobow

  23. Memory Clinic, University Center for Medicine of Aging Basel, Felix Platter Hospital, Schanzenstr. 55, CH-4031, Basel, Switzerland

    René Spiegel

  24. 3rd Department of Neurology, Aristotle University, Despere 3, Thessaloniki, 54621, Greece

    Magda Tsolaki

  25. Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Center for Alzheimer Research, Karolinska Institutet, 14157, Huddinge, Sweden

    Bengt Winblad

Authors
  1. Katrin Jekel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marinella Damian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carina Wattmo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lucrezia Hausner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roger Bullock
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peter J Connelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bruno Dubois
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Maria Eriksdotter
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Michael Ewers
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Elmar Graessel
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Milica G Kramberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Emma Law
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Patrizia Mecocci
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. José L Molinuevo
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Louise Nygård
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Marcel GM Olde-Rikkert
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Jean-Marc Orgogozo
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Florence Pasquier
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Karine Peres
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Eric Salmon
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Sietske AM Sikkes
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Tomasz Sobow
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. René Spiegel
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Magda Tsolaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Bengt Winblad
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Lutz Frölich
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katrin Jekel.

Additional information

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

KJ conducted the literature search with support from MD, LH and LF and wrote the first draft of the manuscript. MEr, FP and LN added and analyzed literature regarding technology use. PJC, KP, EL and SAMS provided valuable input for restructuring parts of the manuscript. CW, RB, BD, MEw, EG, MGK, PM, JLM, MGMOR, JMO, ES, TS, RS, MT and BW were involved in revising the manuscript. All authors read and approved the final manuscript.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jekel, K., Damian, M., Wattmo, C. et al. Mild cognitive impairment and deficits in instrumental activities of daily living: a systematic review. Alz Res Therapy 7, 17 (2015). https://doi.org/10.1186/s13195-015-0099-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13195-015-0099-0

Keywords

  • Mild Cognitive Impairment
  • Mini Mental State Examination Score
  • Amnestic Mild Cognitive Impairment
  • Mild Cognitive Impairment Subject
  • Mild Cognitive Impairment Group

Alzheimer's Research & Therapy

ISSN: 1758-9193