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Cognitive Impairment as a Strong Predictor of Incident Disability in Specific ADL–IADL Tasks Among Community-Dwelling Elders: The Azuchi Study

Correspondence: Address correspondence to Dr. Hiroko Dodge, 519 Parran Hall, 130 DeSoto Street, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15261. E-mail: Dodge{at}edc.pitt.edu

Purpose: We examined differential effects of cognitive impairment on each of the activities of daily living (ADL) and instrumental activities of daily living (IADL) tasks. Design and Methods: In a 3-year follow-up of community-dwelling elderly persons in Azuchi, Japan, we assessed cognition by using the Hasegawa Dementia Scale. We examined (a) the cross-sectional association between cognitive impairment and functional disability in each ADL–IADL item; (b) cognitive impairment as a risk factor for incident disability in each ADL–IADL item, through logistic regression models; and (c) probabilities of incident loss of ADL–IADL abilities or death in 3 years, using multinomial logistic regression models. We also calculated the population attributable risk (PAR%) of cognitive impairment on incident loss of task-specific ADL–IADL abilities. Results: Cross-sectionally, the severity of cognitive impairment was associated with disability in each ADL–IADL task, with larger effects shown for ADL items. Longitudinally, minimally or mildly cognitively impaired individuals had a significantly higher risk of losing functional abilities compared with those with intact cognition. The PAR% indicated that cognitive impairment accounts for 11% to 36% of incident disability in ADL–IADL tasks, with the highest PAR% shown for the ability to feed oneself. Implications: Cognitively impaired subjects are heterogeneous; the severity of cognitive impairment has a different impact on incident loss of task-specific ADL–IADL abilities, and comorbidities could affect disabilities differently. Consideration of these heterogeneities will enrich future studies on the impact of cognitive impairment on ADL–IADL abilities.

Key Words: Hasegawa Dementia Scale • ADL • IADL • Population attributable risk • Caregiving needs

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