Trouble With Daily Activities Could Point to Alzheimer's Risk

THURSDAY Sept. 17, 2009 -- Problems carrying out daily chores or enjoying hobbies could predict which people with "mild cognitive impairment" will progress more quickly to Alzheimer's dementia, U.S. researchers report.

According to the Alzheimer's Association, mild cognitive impairment (MCI) is "a condition in which a person has problems with memory, language, or another mental function severe enough to be noticeable to other people and to show up on tests, but not serious enough to interfere with daily life." This type of mental state is considered a risk factor for dementia.

In fact, some studies have found that about 10 percent to 15 percent of those with MCI will progress to dementia each year, according to background information in the new study.

Reporting in the September issue of the Archives of Neurology, the researchers sought to determine if there were telltale signs within MCI that might spot those people who would progress more rapidly to full-blown dementia. To do so, they collected data on 111 people with mild cognitive impairment, then evaluated these individuals using brain scans and cognition tests.

Over the next two years of follow-up, 28 people did go on to develop dementia.

On their own, the tests did not predict which patients went on to develop dementia, said lead researcher Sarah Tomaszewski Farias, an associate professor of neurology at the University of California, Davis.

However, level of daily function was a key predictor, Farias said.

"So, if an older adult is starting to display problems in daily life, such as problems shopping independently, problems managing their own finances, problems performing household chores, and problems maintaining their hobbies, they are more likely to develop a dementia within several years," she said.

Farias cautioned that the study involved people visiting a clinic because they were already having memory and other problems, so the implications could be different among the general population of older adults.

"If you look at individuals in the community, you see a much slower progression to dementia in those with some mild cognitive impairment," she said. "The time to develop dementia once someone has mild cognitive impairment is probably slower in the general population of older adults than we had previously thought."

Still, any kind of early warning is helpful, and Farias believes health-care providers should ask patients and those who know them well -- a spouse or adult child -- about how they are doing in their daily lives.

"It is important to keep in mind that sometimes individuals themselves lack awareness of some of these problems. So it is important, if at all possible, to get feedback from individuals who are familiar with how the older adult is functioning in their daily life," she added.

If there is evidence or suspicion that an older adult has some mild cognitive or memory problems, and it is starting to interfere with their ability to do daily activities, there is a higher likelihood this individual is developing a dementia and they should be closely monitored, Farias said.

Greg M. Cole, a neuroscientist at the Greater Los Angeles VA Healthcare System and associate director of the Alzheimer's Center at UCLA David Geffen School of Medicine, said it is crucial to be able to identify people with early Alzheimer's disease, "if we want to test methods of preventing it."

This study illustrates the difficulties in early diagnosis of Alzheimer's disease in aging people with mild problems with memory and cognition, Cole said.

"In my view, because memory and cognitive performance vary widely in our population no matter what age, the best indications of ongoing decline are going to be seen against past individual performance rather than some cross-sectional 'normalized' standard," he said.

Dr. Ronald C. Petersen, director of the Alzheimer's Disease Research Center at the Mayo Clinic in Rochester, Minn., agreed that, despite the lack of effective treatments, spotting Alzheimer's disease early remains important.

"If people in the family start to recognize a change in memory/learning patterns, that might be sufficient to identify someone who could develop Alzheimer's disease," Peterson said. "Don't wait until the person is having trouble driving, is having trouble paying their bills or having trouble functioning in the community -- that's dementia," he said. "This study tells us that we can identify important symptoms earlier and it may be worthwhile doing so."

More information

For more information on mild cognitive impairment, visit the Alzheimer's Association.

Posted: September 2009


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