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Clinical Manifestations.

Peter J Morin1, Ying Wang2, Joel Reisman3

  • 1Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|December 26, 2025
PubMed
Summary
This summary is machine-generated.

This study established Instrumental Activities of Daily Living (IADL) score thresholds to stage Alzheimer's disease (AD) progression, correlating them with Montreal Cognitive Assessment (MoCA) scores for clinical staging. These findings offer a novel method for assessing AD severity using IADL measures.

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Area of Science:

  • Gerontology
  • Neurology
  • Clinical Diagnostics

Background:

  • Alzheimer's disease (AD) staging traditionally relies on cognitive assessments.
  • Instrumental Activities of Daily Living (IADL) offer a functional measure of disease progression.
  • A validated crosswalk between cognitive (MoCA) and functional (IADL) scores is needed for comprehensive AD staging.

Purpose of the Study:

  • To define clinical stages of Alzheimer's disease (AD) using Instrumental Activities of Daily Living (IADL) scores.
  • To establish a crosswalk between Montreal Cognitive Assessment (MoCA) scores and IADL performance.
  • To provide IADL score thresholds that correspond to different stages of AD, from normal cognition to severe dementia.

Main Methods:

  • Retrospective analysis of patient data from the Veteran's Affairs Healthcare System (VAHS) database (2020-2024).
  • Inclusion of patients diagnosed with mild cognitive impairment (MCI) or Alzheimer's dementia (AD).
  • Paired analysis of Montreal Cognitive Assessment (MoCA) and Lawton-Brody IADL scores using linear, repeated measures, and categorical regression models.

Main Results:

  • A total of 1,327 patients (mean age 80.1 years, 97.4% male) were analyzed.
  • Specific MoCA score cut-offs were defined for normal cognition, MCI, and mild, moderate, and severe AD.
  • Corresponding IADL score ranges and means were identified for each cognitive stage, with categorical regression showing better discrimination across mild to severe AD stages.

Conclusions:

  • Instrumental Activities of Daily Living (IADL) score thresholds were successfully identified for staging Alzheimer's disease (AD) from normal to severe.
  • The established crosswalk between MoCA and IADL scores provides a functional metric for AD clinical staging.
  • Categorical regression analysis demonstrated utility in accommodating non-linear relationships between MoCA and IADL scores for improved staging accuracy.