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Study finds older adults with mild cognitive impairment may also have some functional impairment

The JAMA Network Journals

Difficulty remembering important dates and medications, and gathering paperwork, is more common in older individuals with mild cognitive impairment than in those with no cognition problems, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

According to background information in the article, mild cognitive impairment is a condition that includes some difficulty with cognition and, in the amnestic subtype (aMCI), difficulty with memory, but does not include considerable problems with daily tasks, work, or social activities. In some patients, this condition progresses to Alzheimer's disease (AD) or another form of dementia. So understanding the level of impairment a patient has is important, note the authors: "Identifying the extent and severity of functional deficits that typically occur in each disorder can aid in early diagnosis, help in estimating prognosis, and improve treatment strategies."

Patrick J. Brown, Ph.D., from the New York State Psychiatric Institute, and colleagues examined data from the Alzheimer's Disease Neuroimaging Initiative (ADNI). The authors evaluated 229 individuals with no cognitive problems, 394 who had a diagnosis of aMCI, and 193 who had a diagnosis of mild AD. The data included neuropsychological test results, participants' performance on the Pfeffer Functional Activities Questionnaire (FAQ), and brain-imaging studies.

Compared with the control group of those with no cognitive difficulty, most of the participants in the aMCI group and the AD group had difficulty with at least one type of function (7.9% vs. 72.3% and 97.4%, respectively). Two items that seemed to give the cognition-impaired participants significant problems were "assembling tax records, business affairs, or other papers" and "remembering appointments, family occasions, holidays, and medications." In the aMCI and AD groups, individuals who had the most difficulty functioning also tended to score worse on cognition tests, have smaller hippocampal volumes, and express the apolipoprotein ε4 allele.

The results, write the researchers, may help physicians better recognize whether patients with aMCI are likely to advance to dementia. "These findings show that even mild disruptions in daily functioning may be an important clinical indicator of disease and represent the latter phases of disease progression within the MCI classification system for cognitive impairment," they explain. More research into when and how trouble with functioning happens is needed, add the authors.

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(Arch Gen Psychiatry. 2011;68[6]:617-626. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: Data collection and sharing for this project were funded by the Alzheimer's Disease Neuroimaging Initiative (ADNI). Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

To contact Patrick J. Brown, Ph.D., call Dacia Morris at 212-543-5421 or e-mail morrisd@pi.cpmc.columbia.edu.

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.

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