Assessment of Instrumental Activities of Daily Living in Preclinical Alzheimer Disease.
Audrey A Keleman, Rebecca M Bollinger, Julie K Wisch and 4 others
PMID 35708011WHAT IT FOUND
In cognitively normal older adults, a performance-based IADL test did not separate those with and without preclinical AD.
It showed wider score spread than a proxy questionnaire, and poorer checkbook and medication tasks were associated with brain volume and network connection measures.
Key findings
01Most scorable FAQ responses showed full independence: 106 of 117 participants scored 0, indicating independence for all 10 IADL categories.
02PASS tasks produced score ranges and cue counts: shopping cues 0-11, checkbook cues 0-17, medication cues 0-7; independence means were 2.67-2.90 out of 3.00.
03PASS performance did not differ by preclinical AD status or amyloid level, but poorer medication adequacy was associated with smaller hippocampal volume and poorer checkbook adequacy was associated with weaker brain network connections.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
This was a cross-sectional baseline analysis, so it cannot show that PASS performance predicts future decline or that neurodegeneration caused the poorer task performance. The cohort was high-functioning: all participants were cognitively normal (Clinical Dementia Rating 0) and had a mean MMSE score of 29.21 out of 30, so PASS scores were very high and may miss subtle impairment. FAQ data were incomplete for some participants: 150 had proxy ratings, but only 117 had all responses within a scorable range. Tau biomarkers were not analysed because few participants had suitable tau measurement. This prevented comparison across preclinical AD stages. The associations between PASS performance and neurodegeneration markers could be explained by factors other than preclinical AD, and other causes were not examined. Functional MRI analyses were based on 66 participants, a smaller sample than the amyloid PET and structural MRI analyses. The sample was mostly White and highly educated, so findings may not generalize to other populations. Longitudinal research with a larger cohort is planned, so the study did not report follow-up outcomes.
Declared interests
Most authors declared no conflicts of interest. Dr. Benzinger reported investigator-initiated research funding from NIH, the Alzheimer’s Association, the Barnes-Jewish Hospital Foundation, and Avid Radiopharmaceuticals, a wholly owned subsidiary of Eli Lilly; site-investigator roles in clinical trials sponsored by Avid Radiopharmaceuticals, Eli Lilly, Biogen, Eisai, Jaansen, and Roche; paid consulting, advisory, and speaking work for Biogen; and unpaid consulting for Eisai and Siemens. The article also lists NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not conclude that the PASS identifies preclinical AD. It did not separate those with and without preclinical AD, was not associated with amyloid, and only cross-sectional links to hippocampal volume and brain network connections were found, which could reflect other causes.