Journal of the International Neuropsychological Society



Cognitive and neuroimaging predictors of instrumental activities of daily living


DEBORAH A.  CAHN-WEINER  a1 c1 , SARAH TOMASZEWSKI  FARIAS  a2 , LAURA  JULIAN  a3 , DANIELLE J.  HARVEY  a4 , JOEL H.  KRAMER  a1 , BRUCE R.  REED  a2 a5 , DAN  MUNGAS  a2 , MARGARET  WETZEL  a1 and HELENA  CHUI  a6
a1 Department of Neurology, University of California, San Francisco, California
a2 Department of Neurology, School of Medicine, University of California, Davis, California
a3 Department of Medicine, University of California, San Francisco, California
a4 Division of Biostatistics, School of Medicine, University of California, Davis, California
a5 Veterans Administration Northern California Health Care System, Davis, California
a6 Department of Neurology, School of Medicine, University of Southern California, Los Angeles, California

Article author query
cahn-weiner da   [PubMed][Google Scholar] 
farias st   [PubMed][Google Scholar] 
julian l   [PubMed][Google Scholar] 
harvey dj   [PubMed][Google Scholar] 
kramer jh   [PubMed][Google Scholar] 
reed br   [PubMed][Google Scholar] 
mungas d   [PubMed][Google Scholar] 
wetzel m   [PubMed][Google Scholar] 
chui h   [PubMed][Google Scholar] 

Abstract

Impaired ability to conduct daily activities is a diagnostic criterion for dementia and a determinant of healthcare services utilization and caregiver burden. What predicts decline in instrumental activities of daily living (IADLs) is not well understood. This study examined measures of episodic memory, executive function, and MRI brain volumes in relation to baseline IADLs and as predictors of rate of IADL change. Participants were 124 elderly persons with cognitive function between normal and moderate dementia both with and without significant small vessel cerebrovascular disease. Random effects modeling showed that baseline memory and executive function (EXEC) were associated with baseline IADL scores, but only EXEC was independently associated with rate of change in IADLs. Whereas hippocampal and cortical gray matter volumes were significantly associated with baseline IADL scores, only hippocampal volume was associated with IADL change. In a model including cognitive and neuroimaging predictors, only EXEC independently predicted rate of decline in IADL scores. These findings indicate that greater executive dysfunction at initial assessment is associated with more rapid decline in IADLs. Perhaps executive function is particularly important with respect to maintaining IADLs. Alternatively, executive dysfunction may be a sentinel event indicating widespread cortical involvement and poor prognosis. (JINS, 2007, 13, 747–757.)

(Received August 22 2006)
(Revised February 28 2007)
(Accepted March 1 2007)


Key Words: Alzheimer's disease; Vascular dementia; Memory; Everyday function; Neuroimaging; Frontal lobe.

Correspondence:
c1 Correspondence and reprint requests to: Deborah Cahn-Weiner, Ph.D., University of California, San Francisco, Department of Neurology, 400 Parnassus Avenue, San Francisco, CA 94143-0138. E-mail: Deborah.Cahn-Weiner@ucsf.edu