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Global clinical dementia rating of 0.5 in MCI masks variability related to level of function

Y-L Chang1, M W Bondi, L K McEvoy

  • 1Department of Psychology, National Taiwan University, Taipei, 10617 Taiwan. ychang@ntu.edu.tw

Neurology
|February 16, 2011
PubMed
Abstract

Insights

Instrumental activities of daily living (IADL) impairment in mild cognitive impairment (MCI) is linked to significant brain changes and faster progression to Alzheimer disease (AD). This highlights the need to better utilize IADL data in MCI assessments.

Area of Science:

  • Neurology
  • Gerontology
  • Neuroscience

Background:

  • Mild cognitive impairment (MCI) is a transitional stage between normal aging and dementia.
  • The Clinical Dementia Rating (CDR) scale assesses cognitive and functional status.
  • Instrumental activities of daily living (IADL) are crucial for independent living.

Purpose of the Study:

  • To determine if CDR IADL item ratings correlate with cognitive and brain characteristics in MCI patients with a global CDR score of 0.5.
  • To investigate the association between IADL performance and brain morphometry in MCI.
  • To compare the rate of progression to Alzheimer disease (AD) based on IADL status.

Main Methods:

  • Analysis of baseline cognitive and morphometric data from 283 individuals with MCI.
  • Participants were categorized into 'impaired' and 'intact' IADL groups based on CDR IADL item scores.
  • Comparison of Alzheimer disease (AD) progression rates over two years between the two IADL groups.

Main Results:

  • The MCI group with impaired IADL showed greater gray matter loss in frontal and parietal regions.
  • Worse episodic memory and executive functions were observed in the impaired IADL group.
  • A higher percentage of individuals in the impaired IADL group progressed to AD.

Conclusions:

  • Functional information from CDR IADL items is vital for evaluating MCI, even if not heavily weighted in global scores.
  • IADL impairment in MCI is associated with broader brain region involvement beyond the mesial temporal lobe.
  • Relying solely on the global CDR score may delay the identification of high-risk MCI individuals.

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