Abstract
OBJECTIVES. This study investigated the role of low normal cognitive function in the subsequent loss of independence in activities of daily living. METHODS. Of the 678 elderly nuns who-completed cognitive and physical function assessments in 1992/93, 575 were reassessed in 1993/94. Mini-Mental State Examination scores were divided into three categories and related to loss of independence in six activities of daily living. RESULTS. Participants with low normal cognitive function at first assessment had twice the risk of losing independence in three activities of daily living by second assessment relative to those with high normal cognitive function. This relationship was largely due to a progression from low normal cognitive function at first assessment to impaired cognitive function at second assessment and was associated with an elevated risk of losing independence in the six activities. CONCLUSIONS. Progression from low normal to impaired cognitive function was associated with loss of independence in activities of daily living. Thus low normal cognitive function could be viewed as an early warning of impending cognitive impairment and loss of physical function.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Blessed G., Tomlinson B. E., Roth M. The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry. 1968 Jul;114(512):797–811. doi: 10.1192/bjp.114.512.797. [DOI] [PubMed] [Google Scholar]
- Boult C., Kane R. L., Louis T. A., Boult L., McCaffrey D. Chronic conditions that lead to functional limitation in the elderly. J Gerontol. 1994 Jan;49(1):M28–M36. doi: 10.1093/geronj/49.1.m28. [DOI] [PubMed] [Google Scholar]
- Ensrud K. E., Nevitt M. C., Yunis C., Cauley J. A., Seeley D. G., Fox K. M., Cummings S. R. Correlates of impaired function in older women. J Am Geriatr Soc. 1994 May;42(5):481–489. doi: 10.1111/j.1532-5415.1994.tb04968.x. [DOI] [PubMed] [Google Scholar]
- Fillenbaum G. G., Hughes D. C., Heyman A., George L. K., Blazer D. G. Relationship of health and demographic characteristics to Mini-Mental State examination score among community residents. Psychol Med. 1988 Aug;18(3):719–726. doi: 10.1017/s0033291700008412. [DOI] [PubMed] [Google Scholar]
- Folstein M. F., Folstein S. E., McHugh P. R. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6. [DOI] [PubMed] [Google Scholar]
- Fratiglioni L., Grut M., Forsell Y., Viitanen M., Grafström M., Holmén K., Ericsson K., Bäckman L., Ahlbom A., Winblad B. Prevalence of Alzheimer's disease and other dementias in an elderly urban population: relationship with age, sex, and education. Neurology. 1991 Dec;41(12):1886–1892. doi: 10.1212/wnl.41.12.1886. [DOI] [PubMed] [Google Scholar]
- Ganguli M., Seaberg E., Belle S., Fischer L., Kuller L. H. Cognitive impairment and the use of health services in an elderly rural population: the MoVIES project. Monongahela Valley Independent Elders Survey. J Am Geriatr Soc. 1993 Oct;41(10):1065–1070. doi: 10.1111/j.1532-5415.1993.tb06453.x. [DOI] [PubMed] [Google Scholar]
- Guralnik J. M., Simonsick E. M. Physical disability in older Americans. J Gerontol. 1993 Sep;48(Spec No):3–10. doi: 10.1093/geronj/48.special_issue.3. [DOI] [PubMed] [Google Scholar]
- Harris T., Kovar M. G., Suzman R., Kleinman J. C., Feldman J. J. Longitudinal study of physical ability in the oldest-old. Am J Public Health. 1989 Jun;79(6):698–702. doi: 10.2105/ajph.79.6.698. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Heeren T. J., Lagaay A. M., von Beek W. C., Rooymans H. G., Hijmans W. Reference values for the Mini-Mental State Examination (MMSE) in octo- and nonagenarians. J Am Geriatr Soc. 1990 Oct;38(10):1093–1096. doi: 10.1111/j.1532-5415.1990.tb01371.x. [DOI] [PubMed] [Google Scholar]
- Kaplan G. A., Seeman T. E., Cohen R. D., Knudsen L. P., Guralnik J. Mortality among the elderly in the Alameda County Study: behavioral and demographic risk factors. Am J Public Health. 1987 Mar;77(3):307–312. doi: 10.2105/ajph.77.3.307. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kruiansky J., Gurland B. The performance test of activities of daily living. Int J Aging Hum Dev. 1976;7(4):343–352. doi: 10.2190/x45l-tww7-wxxy-ka6k. [DOI] [PubMed] [Google Scholar]
- Lammi U. K., Kivelä S. L., Nissinen A., Punsar S., Puska P., Karvonen M. Predictors of disability in elderly Finnish men--a longitudinal study. J Clin Epidemiol. 1989;42(12):1215–1225. doi: 10.1016/0895-4356(89)90120-0. [DOI] [PubMed] [Google Scholar]
- Mahurin R. K., DeBettignies B. H., Pirozzolo F. J. Structured assessment of independent living skills: preliminary report of a performance measure of functional abilities in dementia. J Gerontol. 1991 Mar;46(2):P58–P66. doi: 10.1093/geronj/46.2.p58. [DOI] [PubMed] [Google Scholar]
- Mor V., Murphy J., Masterson-Allen S., Willey C., Razmpour A., Jackson M. E., Greer D., Katz S. Risk of functional decline among well elders. J Clin Epidemiol. 1989;42(9):895–904. doi: 10.1016/0895-4356(89)90103-0. [DOI] [PubMed] [Google Scholar]
- Morris J. C., Heyman A., Mohs R. C., Hughes J. P., van Belle G., Fillenbaum G., Mellits E. D., Clark C. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology. 1989 Sep;39(9):1159–1165. doi: 10.1212/wnl.39.9.1159. [DOI] [PubMed] [Google Scholar]
- Palmore E. B., Nowlin J. B., Wang H. S. Predictors of function among the old-old: a 10-year follow-up. J Gerontol. 1985 Mar;40(2):244–250. doi: 10.1093/geronj/40.2.244. [DOI] [PubMed] [Google Scholar]
- Patten B. M. The history of memory arts. Neurology. 1990 Feb;40(2):346–352. doi: 10.1212/wnl.40.2.346. [DOI] [PubMed] [Google Scholar]
- Pinsky J. L., Leaverton P. E., Stokes J., 3rd Predictors of good function: the Framingham Study. J Chronic Dis. 1987;40 (Suppl 1):159S-167S, 181S-2. doi: 10.1016/s0021-9681(87)80045-0. [DOI] [PubMed] [Google Scholar]
- Potvin A. R., Tourtellotte W. W., Dailey J. S., Alberts J. W., Walker J. E., Pew R. W., Henderson W. G., Snyder D. N. Simulated activities of daily living examination. Arch Phys Med Rehabil. 1972 Oct;53(10):476–passim. [PubMed] [Google Scholar]
- Raskin N. H. Acute and prophylactic treatment of migraine: practical approaches and pharmacologic rationale. Neurology. 1993 Jun;43(6 Suppl 3):S39–S42. [PubMed] [Google Scholar]
- Roos N. P., Havens B. Predictors of successful aging: a twelve-year study of Manitoba elderly. Am J Public Health. 1991 Jan;81(1):63–68. doi: 10.2105/ajph.81.1.63. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rubin E. H., Storandt M., Miller J. P., Grant E. A., Kinscherf D. A., Morris J. C., Berg L. Influence of age on clinical and psychometric assessment of subjects with very mild or mild dementia of the Alzheimer type. Arch Neurol. 1993 Apr;50(4):380–383. doi: 10.1001/archneur.1993.00540040042011. [DOI] [PubMed] [Google Scholar]
- Seeman T. E., Charpentier P. A., Berkman L. F., Tinetti M. E., Guralnik J. M., Albert M., Blazer D., Rowe J. W. Predicting changes in physical performance in a high-functioning elderly cohort: MacArthur studies of successful aging. J Gerontol. 1994 May;49(3):M97–108. doi: 10.1093/geronj/49.3.m97. [DOI] [PubMed] [Google Scholar]
- Snowdon D. A., Ostwald S. K., Kane R. L. Education, survival, and independence in elderly Catholic sisters, 1936-1988. Am J Epidemiol. 1989 Nov;130(5):999–1012. doi: 10.1093/oxfordjournals.aje.a115433. [DOI] [PubMed] [Google Scholar]
- Snowdon D. A., Ostwald S. K., Kane R. L., Keenan N. L. Years of life with good and poor mental and physical function in the elderly. J Clin Epidemiol. 1989;42(11):1055–1066. doi: 10.1016/0895-4356(89)90047-4. [DOI] [PubMed] [Google Scholar]
- Stern Y., Gurland B., Tatemichi T. K., Tang M. X., Wilder D., Mayeux R. Influence of education and occupation on the incidence of Alzheimer's disease. JAMA. 1994 Apr 6;271(13):1004–1010. [PubMed] [Google Scholar]
- Uhlmann R. F., Larson E. B. Effect of education on the mini-mental state examination as a screening test for dementia. J Am Geriatr Soc. 1991 Sep;39(9):876–880. doi: 10.1111/j.1532-5415.1991.tb04454.x. [DOI] [PubMed] [Google Scholar]
- Wallace R. B., Colsher P. L. Conceptual problems in identifying risk factors for functional decline in the elderly: a commentary. Ann Epidemiol. 1992 Nov;2(6):835–839. doi: 10.1016/1047-2797(92)90077-4. [DOI] [PubMed] [Google Scholar]
- Wernicke T. F., Reischies F. M. Prevalence of dementia in old age: clinical diagnoses in subjects aged 95 years and older. Neurology. 1994 Feb;44(2):250–253. doi: 10.1212/wnl.44.2.250. [DOI] [PubMed] [Google Scholar]
- Zhang M. Y., Katzman R., Salmon D., Jin H., Cai G. J., Wang Z. Y., Qu G. Y., Grant I., Yu E., Levy P. The prevalence of dementia and Alzheimer's disease in Shanghai, China: impact of age, gender, and education. Ann Neurol. 1990 Apr;27(4):428–437. doi: 10.1002/ana.410270412. [DOI] [PubMed] [Google Scholar]