@article{3b062dca455142ccb4c3030e45ff6948,
title = "Cognitive impairment as a strong predictor of incident disability in specific ADL-IADL tasks among community-dwelling elders: The Azuchi study",
abstract = "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.",
keywords = "ADL, Caregiving needs, Hasegawa Dementia Scale, IADL, Population attributable risk",
author = "Dodge, {Hiroko H.} and Takashi Kadowaki and Takehito Hayakawa and Masanobu Yamakawa and Akira Sekikawa and Hirotugu Ueshima",
note = "Funding Information: This research was supported in part by Grants-in-Aid for Scientific Research (B) 07457106 and 02454211 from the Japan Ministry of Education, Culture, Sports, Science and Technology in Japan and by Grant K01AG023014-01 from the National Institute on Aging in the United States. Funding Information: To investigate functional disabilities, quality of life, family structures, and other issues relevant to the elderly population, the Department of Health Science at the Shiga University of Medical Science (in Shiga, Japan), with funding from the Japan Ministry of Education, Culture, Sports, Science and Technology, conducted a survey of all noninstitutionalized residents aged 65 and older living in Azuchi (total population approximately 12,000). Azuchi is located near the middle of the Shiga prefecture, and 82% of households engage in farming as supplemental employment. In 1990, the proportion of elderly persons aged 65 and older living in Azuchi was 12%, very similar to the 11.6% national level. Among 1,398 community dwellers, data were collected from 1,289 (92.2%) during the 1990–1992 period (baseline). Thirty-four individuals could not be contacted (2.4%), and 75 individuals refused to participate (5.4%). After undergoing intensive training for assessment reliability, a certified nurse and a medical student conducted the interview in pairs. The survey was self-reported, supplemented by information from proxies; if a person was unable to answer the questionnaire or could not fully remember the past events, a family member or caregiver was asked to respond. For 115 out of 1,289 participants (8.9%), information was obtained from proxies for at least part of the survey. The follow-up survey was conducted 3 years later (1993–1995). The gathered information included the Hasegawa Dementia Scale (HDS; Hasegawa, 1983; baseline only), demographic variables, health conditions, and quality of life. Informed consent was obtained from each participant.",
year = "2005",
month = apr,
doi = "10.1093/geront/45.2.222",
language = "English (US)",
volume = "45",
pages = "222--230",
journal = "Gerontologist",
issn = "0016-9013",
publisher = "Oxford University Press",
number = "2",
}