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Performance-based measures of everyday function in mild cognitive impairment.

Terry E Goldberg1, Jeremy Koppel, Lynda Keehlisen

  • 1Litwin Zucker Center for Research in Alzheimer's Disease and Memory Disorders, Feinstein Institute for Medical Research, 350 Community Dr., Manhassett, NY 11030, USA. tgoldber@nshs.edu

The American Journal of Psychiatry
|April 3, 2010
PubMed
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Everyday function is impaired in mild cognitive impairment, as shown by the sensitive UCSD Performance-Based Skills Assessment (UPSA). This performance-based measure is superior to informant-based tools for detecting early functional decline in Alzheimer's disease research.

Area of Science:

  • Neurology
  • Gerontology
  • Cognitive Science

Background:

  • Everyday function is often considered preserved in mild cognitive impairment (MCI).
  • This assumption may underestimate the functional impact of early neurodegenerative changes.
  • Sensitive measures are needed to accurately assess functional deficits in MCI and Alzheimer's disease (AD).

Purpose of the Study:

  • To quantify everyday functional impairment in MCI and AD using the UCSD Performance-Based Skills Assessment (UPSA).
  • To compare the sensitivity of the UPSA with the Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory (ADCS-ADL).
  • To model the relationship between cognitive performance and functional outcomes in MCI.

Main Methods:

  • Assessed 50 cognitively normal elders, 26 with MCI, and 22 with mild-to-moderate AD.

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  • Administered the UPSA, ADCS-ADL, and a neurocognitive test battery.
  • Utilized multiple regression models to analyze cognitive-functional relationships.

    • Main Results:

    • MCI patients showed significant impairments on the UPSA, but not the ADCS-ADL.
    • A large effect size (d=0.86) was found for UPSA in differentiating MCI from controls.
    • Cognitive speed, episodic memory, and semantic processing significantly predicted UPSA scores.

    Conclusions:

    • Performance-based measures like the UPSA are sensitive tools for detecting functional deficits in MCI and AD.
    • Findings suggest a need to reconceptualize the cognition-function relationship in MCI.
    • Accurate functional assessment is crucial for aligning cognitive and functional changes in neurodegenerative disease research.