TY - JOUR
T1 - Cognitive, extrapyramidal, and magnetic resonance imaging predictors of functional impairment in nondemented older community dwellers
T2 - The Sydney Older Person Study
AU - Bennett, Hayley P.
AU - Piguet, Olivier
AU - Grayson, David A.
AU - Creasey, Helen
AU - Waite, Louise M.
AU - Lye, Tanya
AU - Corbett, Alastair J.
AU - Hayes, Michael
AU - Broe, Ganthony
AU - Halliday, Glenda M.
PY - 2006/1
Y1 - 2006/1
N2 - OBJECTIVES: To identify the clinical correlates of functional incapacity in the community living "old-old." DESIGN: Cross-sectional. SETTING: Community-based. PARTICIPANTS: One hundred six nondemented people aged 80 to 94. MEASUREMENTS: Participants were medically and cognitively assessed, underwent magnetic resonance imaging scanning (MRI), and were interviewed regarding their functional status: activities of daily living (ADLs), instrumental ADLs (IADLs), and the complex IADL functions of reading, hobbies, and socializing. RESULTS: Dependency in IADLs, but not ADLs, was present. After controlling for age, sex, and education, extrapyramidal (EP) signs were significantly associated with two of the three IADLs, with EP signs comprising a composite score of 10 EP signs (e.g., resting tremor) and a 5-meter timed walk. Cognitive test performance on a range of tests was also associated with functional status. A hierarchical model confirmed the association between the EP signs and cognitive test performance and functional scores, but no "pattern" of cognitive association emerged. Hippocampal volume was associated with socializing. CONCLUSION: This study has shown that many nondemented very old people living in the community are losing capacity to perform IADL functions and that areas of incapacity are associated with the presence of EP signs and impaired cognition. These results highlight the need for health workers to include an assessment of EP and cognitive status in their evaluation of older persons living in the community, even in the context of a lack of dementia diagnosis. Furthermore, it signifies the need to directly evaluate IADL function to identify need for intervention and support if required. This group of old-old individuals may now be considered the "survivors" of their cohort, and early detection of the difficulties they are experiencing will enable clinicians to respond appropriately, thus providing them a higher quality of life for their years to come.
AB - OBJECTIVES: To identify the clinical correlates of functional incapacity in the community living "old-old." DESIGN: Cross-sectional. SETTING: Community-based. PARTICIPANTS: One hundred six nondemented people aged 80 to 94. MEASUREMENTS: Participants were medically and cognitively assessed, underwent magnetic resonance imaging scanning (MRI), and were interviewed regarding their functional status: activities of daily living (ADLs), instrumental ADLs (IADLs), and the complex IADL functions of reading, hobbies, and socializing. RESULTS: Dependency in IADLs, but not ADLs, was present. After controlling for age, sex, and education, extrapyramidal (EP) signs were significantly associated with two of the three IADLs, with EP signs comprising a composite score of 10 EP signs (e.g., resting tremor) and a 5-meter timed walk. Cognitive test performance on a range of tests was also associated with functional status. A hierarchical model confirmed the association between the EP signs and cognitive test performance and functional scores, but no "pattern" of cognitive association emerged. Hippocampal volume was associated with socializing. CONCLUSION: This study has shown that many nondemented very old people living in the community are losing capacity to perform IADL functions and that areas of incapacity are associated with the presence of EP signs and impaired cognition. These results highlight the need for health workers to include an assessment of EP and cognitive status in their evaluation of older persons living in the community, even in the context of a lack of dementia diagnosis. Furthermore, it signifies the need to directly evaluate IADL function to identify need for intervention and support if required. This group of old-old individuals may now be considered the "survivors" of their cohort, and early detection of the difficulties they are experiencing will enable clinicians to respond appropriately, thus providing them a higher quality of life for their years to come.
KW - Cognition
KW - Functional impairment
KW - Mild cognitive impairment
KW - Normal elderly
UR - http://www.scopus.com/inward/record.url?scp=33645112906&partnerID=8YFLogxK
U2 - 10.1111/j.1532-5415.2005.00532.x
DO - 10.1111/j.1532-5415.2005.00532.x
M3 - Article
C2 - 16420192
AN - SCOPUS:33645112906
VL - 54
SP - 3
EP - 10
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
SN - 0002-8614
IS - 1
ER -