Can community‐based cognitive screening identify individuals with MCI associated changes in complex instrumental activities of daily living?

Abstract Background Unrecognized deficits in complex instrumental activities of daily living, termed “preclinical disability”, have been identified in individuals experiencing mild cognitive impairment (MCI: Fieo & Stern, 2018; Peterson et al., 2017). Screening for difficulties in the performance of cognitively demanding complex IADLs may facilitate earlier identification of people on the threshold of MCI and can facilitate earlier intervention (Rodakowski et al., 2014). We examined the ability of three cognitive screening tests to identify individuals reporting IADL problems on the ADCS‐ADL‐MCI scale. Methods A sample of 87 adults living independently in the community were assessed with the Menu Task, Mini‐Cog, Montreal Cognitive Assessment (MoCA), the ADCS‐ADL, and the 18 and 24 item versions of the ADCS‐MCI‐ADL scale. Established cut‐off scores for each cognitive screen identified impaired and unimpaired groups. Mann‐Whitney U tests compared differences between unimpaired and impaired groups for each cognitive screen on the 18 and 24 item ADCS‐MCI‐ADL composite scores. Between group differences were also examined for each of the ADCS‐MCI‐ADL‐24 individual items. Results Sample demographics are presented in Table 1. Individuals impaired on the Menu Task had significantly lower composite scores on both the ADCS‐MCI‐ADL‐18 and the ADCS‐MCI‐ADL‐24 (p < .01), although no significant composite score differences were found for the Mini‐Cog (p = .061, p = .155) or the MoCA (p = .053, p = .099). Individual ADCS MCI items were also analyzed to explore the types of IADL impairments identified by each of the three cognitive screens scales. Different patterns of IADL impairment emerged for each of the cognitive screening measures. Individuals impaired on the Mini‐Cog had significantly lower ADCS‐ADL composite scores (p < .05). Conclusion Individuals living in the community who score as impaired on the Menu Task demonstrated significantly lower ADCS‐MCI‐ADL‐18 and ADCS‐MCI‐ADL‐24 composite scores, but no significant difference on ADCS‐ADL. Impairment on each of the cognitive screening measures was associated with lower scores on individual ADCS‐ADL‐MCI complex IADL items. Cognitive screening measures that detect early and subtle changes in function may lead to earlier diagnosis and interventions for cognitively complex IADL deficits.

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