Dodge Hiroko H, Kadowaki Takashi, Hayakawa Takehito, Yamakawa Masanobu, Sekikawa Akira, Ueshima Hirotugu
Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15261, USA.
Gerontologist. 2005 Apr;45(2):222-30. doi: 10.1093/geront/45.2.222.
We examined differential effects of cognitive impairment on each of the activities of daily living (ADL) and instrumental activities of daily living (IADL) tasks.
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.
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.
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.
我们研究了认知障碍对日常生活活动（ADL）和工具性日常生活活动（IADL）各项任务的不同影响。
在对日本阿苏市社区居住老年人进行的为期3年的随访中，我们使用长谷川痴呆量表评估认知情况。我们研究了：（a）认知障碍与每个ADL - IADL项目中功能残疾之间的横断面关联；（b）通过逻辑回归模型，将认知障碍作为每个ADL - IADL项目中发生残疾的风险因素；以及（c）使用多项逻辑回归模型计算3年内ADL - IADL能力丧失或死亡的发生概率。我们还计算了认知障碍对特定任务的ADL - IADL能力丧失的人群归因风险（PAR%）。
横断面来看，认知障碍的严重程度与每个ADL - IADL任务中的残疾相关，ADL项目显示出更大的影响。纵向来看，与认知完好的个体相比，轻度或中度认知障碍个体丧失功能能力的风险显著更高。PAR%表明，认知障碍占ADL - IADL任务中发生残疾的11%至36%，其中自我进食能力的PAR%最高。
认知障碍患者具有异质性；认知障碍的严重程度对特定任务的ADL - IADL能力丧失有不同影响，合并症对残疾的影响也可能不同。考虑这些异质性将丰富未来关于认知障碍对ADL - IADL能力影响的研究。
