Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-22T18:31:08.375Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical correlates of functional performance in community-dwelling Chinese older persons with mild cognitive impairment

Published online by Cambridge University Press:  23 May 2008

Cindy W. C. Tam ,
Linda C. W. Lam ,
Victor W. C. Lui ,
W. C. Chan ,
Sandra S. M. Chan ,
Helen F. K. Chiu  and
W. M. Chan
Cindy W. C. Tam
Affiliation:
Department of Psychiatry, Tai Po Hospital, Hong Kong SAR
Linda C. W. Lam*
Affiliation:
Department of Psychiatry, the Chinese University of Hong Kong, Shatin, Hong Kong SAR
Victor W. C. Lui
Affiliation:
Department of Psychiatry, Tai Po Hospital, Hong Kong SAR
W. C. Chan
Affiliation:
Castle Peak Hospital, Tuen Mum, Hong Kong SAR
Sandra S. M. Chan
Affiliation:
Department of Psychiatry, the Chinese University of Hong Kong, Shatin, Hong Kong SAR
Helen F. K. Chiu
Affiliation:
Department of Psychiatry, the Chinese University of Hong Kong, Shatin, Hong Kong SAR
W. M. Chan
Affiliation:
Elderly Health Service, Department of Health, Hong Kong SAR
*
Correspondence should be addressed to: Linda C. W. Lam, Department of Psychiatry, G/F, Multi-centre, Tai Po Hospital, Tai Po, NT, Hong Kong SAR. Phone: +852 26076026, Fax: +852 26671255. Email: [email protected].
Get access

Abstract

Background: Increasing evidence suggests that functional impairment can be detected in older persons with mild cognitive impairment (MCI). This study explores the functional profiles and the clinical correlates of a population-based sample of Chinese older persons with MCI in Hong Kong.

Methods: A random sample of 765 Chinese elderly subjects without dementia was recruited, of which 389 were elderly normal controls (Clinical Dementia Rating = 0), and 376 had questionable dementia (CDR = 0.5). The latter were categorized into an MCI group (n = 291) and a very mild dementia (VMD) group (n = 85). Their functional performances were measured and compared with the normal controls (NC). Multiple regression analyses investigated the associations between functional scores (Disability Assessment in Dementia) and clinical correlates (cognitive test scores, neuropsychiatric symptoms and motor signs) in the NC subjects and cognitively impaired subjects.

Results: Subjects with MCI had intermediate functional performance between the NC and those with VMD. Regression analyses revealed that lower scores of cognitive tests (delayed recall and categorical verbal fluency tests), apathy, aberrant motor symptoms and parkinsonism features were associated with lower functional scores in clinically non-demented subjects. Functional scores had no correlation with age, education and medical illness burden.

Conclusion: Neuropsychiatric symptoms and parkinsonism features were associated with functional impairment in the clinically non-demented elderly in the community. Assessment of these should be incorporated in the evaluation of older persons for early cognitive impairment.

Keywords

functional performancemild cognitive impairmentChinese
Type
Research Article
Information
International Psychogeriatrics , Volume 20 , Issue 5 , October 2008 , pp. 1059 - 1070
Copyright
Copyright © International Psychogeriatric Association 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Albert, S. M., Michaels, K., Padilla, M., Pelton, G., Bell, K. and Marder, K. (1999). Functional significance of mild cognitive impairment in elderly patients without a dementia diagnosis. American Journal of Geriatric Psychiatry, 7, 213–220.CrossRefGoogle ScholarPubMed
Artero, S., Touchon, J. and Ritchie, K. (2002). Disability and mild cognitive impairment: a longitudinal population-based study. International Journal of Geriatric Psychiatry, 16, 1092–1097.CrossRefGoogle Scholar
Barberger-Gateau, P., Fabrigoule, C., Helmer, C., Rouch, I. and Dartigues, J. F. (1999). Functional impairment in instrumental activities of daily living: an early clinical sign of dementia. Journal of the American Geriatrics Society, 47, 456–462.CrossRefGoogle ScholarPubMed
Bennett, H. P. et al. (2006). Cognitive, extrapyramidal, and magnetic resonance imaging predictors of functional impairment in nondemented older community dwellers: the Sydney Older Person Study. Journal of the American Geriatrics Society, 54, 3–10.CrossRefGoogle ScholarPubMed
Boyle, P. A., Malloy, P. F., Salloway, S., Cahn-Weiner, D. A., Cohen, R. and Cummings, J. L. (2003). Executive dysfunction and apathy predicts functional impairment in Alzheimer Disease. American Journal of Geriatric Psychiatry, 11, 214–221.CrossRefGoogle ScholarPubMed
Cahn-Weiner, D. A., Boyle, P. A. and Malloy, P. F. (2002). Tests of executive function predict instrumental activities of daily living in community-dwelling older individuals. Applied Neuropsychology, 9, 187–191.CrossRefGoogle ScholarPubMed
Chiu, H. F., Lee, H. C., Chung, W. S. and Kwong, P. K. (1994). Reliability and validity of the Cantonese version of the Mini-mental State Examination – a preliminary study. Hong Kong Journal of Psychiatry, 2, 25–28.Google Scholar
Chu, L. W., Chiu, K. C., Hui, S. L., Yu, G. K. K., Tsui, W. J. C. and Lee, P. W. H. (2000). The reliability and validity of the Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-Cog) among the elderly Chinese in Hong Kong. Annals, Academy of Medicine, Singapore, 29, 474–485.Google ScholarPubMed
Conwell, Y., Forbes, N. T., Cox, C. and Caine, E. D. (1993). Validation of a measure of physical illness burden at autopsy: the Cumulative Illness Rating Scale. Journal of the American Geriatrics Society, 41, 38–41.CrossRefGoogle ScholarPubMed
Copeland, M. et al. (2003) Psychiatric symptomatology and prodromal Alzheimer's disease. Alzheimer Disease and Associated Disorders, 17, 1–8.CrossRefGoogle ScholarPubMed
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
Grigsby, J., Kaye, K. and Baxter, J. (1998) Executive cognitive abilities and functional status among community-dwelling older persons in the San Luis Valley Health and Aging Study. Journal of the American Geriatrics Society, 46, 590–596.CrossRefGoogle Scholar
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. and Martin, R. L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 556–572.CrossRefGoogle ScholarPubMed
Lam, L. C. W., Lui, V. W. C., Chiu, H. F. K., Chan, S. S. M. and Tam, C. W. C. (2005a) Executive function impairment in community elderly subjects with questionable dementia. Dementia and Geriatric Cognitive Disorders, 19, 86–90.CrossRefGoogle ScholarPubMed
Lam, L. C., Lui, V. W., Tam, C.W. and Chiu, H.F. (2005b). Subjective memory complaints in Chinese subjects with mild cognitive impairment and early Alzheimer's disease. International Journal of Geriatric Psychiatry, 20, 876–882.CrossRefGoogle ScholarPubMed
Lam, L. C. W., Tam, C. W. C., Chiu, H. F. K. and Lui, V. W. C. (2007). Depression and apathy affect functioning in community active subjects with questionable dementia and mild Alzheimer's disease. International Journal of Geriatric Psychiatry, 22, 431–437.CrossRefGoogle ScholarPubMed
Lam, L. C. W. et al. (2008). Prevalence of very mild and mild dementia in community dwelling Chinese older persons in Hong Kong. International Psychogeriatrics, 20, 135–148.CrossRefGoogle ScholarPubMed
Leung, V. P. Y., Lam, L. C. W., Chiu, H. F. K., Cummings, J. L. and Chen, Q. L. (2001). Validation study of the Chinese version of the Neuropsychiatric Inventory (NPI). International Journal of Geriatric Psychiatry, 16, 789–793.CrossRefGoogle Scholar
Louis, E., Tang, M., Schupf, N. and Mayeux, R. (2005). Functional correlates and prevalence of mild Parkinsonian signs in a community population of older people. Archives of Neurology, 62, 297–302.CrossRefGoogle Scholar
Mok, C. C. M., Siu, A. M. H., Chan, W. C., Yeung, K. M., Pan, P. C. and Li, S. W. (2005). Functional disabilities profile of Chinese version of the Disability Assessment for Dementia (CDAD). Dementia and Geriatric Cognitive Disorders, 20, 112–119.CrossRefGoogle Scholar
Mok, E. H., Lam, L. C. and Chiu, H. F. (2004). Category verbal fluency test performance in Chinese elderly with Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 18, 120–124.CrossRefGoogle ScholarPubMed
Norton, L. E., Malloy, P. F. and Salloway, S. (2001). The impact of behavioral symptoms on activities of daily living in patients with dementia. American Journal of Geriatric Psychiatry, 9, 41–48.CrossRefGoogle ScholarPubMed
Nygard, L. (2003) Instrumental activities of daily living: a stepping-stone towards Alzheimer's disease diagnosis in subjects with mild cognitive impairment? Acta Neurologica Scandinavica, 107 (S179), 42–46.CrossRefGoogle Scholar
Perneczky, R. et al. (2006). Complex activities of daily living in mild cognitive impairment: conceptual and diagnostic issues. Age and Ageing, 35, 240–245.CrossRefGoogle ScholarPubMed
Petersen, R. C. (2003). Conceptual overview. In Petersen, R. C. (ed.), Mild Cognitive Impairment: Aging to Alzheimer's Disease (pp. 1–14). New York: Oxford University Press.CrossRefGoogle Scholar
Petersen, R. C. (2004) Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 256, 183–194.CrossRefGoogle ScholarPubMed
Rapp, M. A., Schnaider, B. M., Schmeidler, J., Sano, M., Silverman, J. M. and Haroutunian, V. (2005). Relationship of neuropsychological performance to functional status in nursing home residents and community-dwelling older adults. American Journal of Geriatric Psychiatry, 13, 450–459.CrossRefGoogle ScholarPubMed
Ready, R. E., Ott, B. R., Grace, J. and Cahn-Weiner, D. A. (2003). Apathy and executive dysfunction in mild cognitive impairment and Alzheimer Disease. American Journal of Geriatric Psychiatry, 11, 222–228.CrossRefGoogle ScholarPubMed
Reiran, R. M. and Wolfson, D. (1995). Category test and trail making test as measures of frontal lobe functions. Clinical Neuropsychology, 9, 50–56.Google Scholar
Richards, M., Touchon, J., Ledesert, B. and Ritchie, K. (2002). Mild extrapyramidal signs and functional impairment in aging. International Journal of Geriatric Psychiatry, 17, 150–153.CrossRefGoogle Scholar
Royall, D. R., Palmer, R., Chiodo, L. K. and Polk, M. J. (2004). Declining executive control in normal aging predicts change in functional status: the Freedom House Study. Journal of the American Geriatrics Society, 52, 346–352.CrossRefGoogle ScholarPubMed
Royall, D. R., Palmer, R., Chiodo, L. K. and Polk, M. J. (2005). Executive control mediates memory's association with changes in instrumental activities of daily living: The Freedom House Study. Journal of the American Geriatrics Society, 53, 11–17.CrossRefGoogle ScholarPubMed
Salmon, D. P. et al. (2002). Alzheimer disease can be accurately diagnosed in very mildly impaired individuals. Neurology, 59, 1022–1028.CrossRefGoogle ScholarPubMed
Stern, M. B. (1978). The clinical characteristics of Parkinson's disease and parkinsonian syndromes: diagnosis and assessment. In Stern, M. B. and Hurtig, I. H. (eds.), The Comprehensive Management of Parkinson's Disease (pp. 34–39). New York: PMA Publishing Corp.Google Scholar
Storandt, M., Grant, E. A., Miller, P. and Morris, J. (2002). Rates of progression in mild cognitive impairment and early Alzheimer's disease. Neurology, 59, 1034–1041.CrossRefGoogle ScholarPubMed
Tam, C. W. C., Lam, L. C. W., Chiu, H. F. K. and Lui, V. W. C. (2007). Characteristic profiles of instrumental activities of daily living in Chinese older persons with mild cognitive impairment. American Journal of Alzheimer's Disease and Other Dementias, 22, 211–217.Google ScholarPubMed
Winblad, B. et al. (2004). Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240–246.CrossRefGoogle Scholar