Institute of Social Medicine, Occupational Health and Public Health (ISAP) Medical Faculty, University of Leipzig, Leipzig, Germany.
LIFE-Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany.
Int J Geriatr Psychiatry. 2019 Jan;34(1):193-203. doi: 10.1002/gps.5010. Epub 2018 Nov 9.
Subjective cognitive decline (SCD), the earliest symptom in preclinical Alzheimer's disease (AD), is insufficient to identify individuals at risk for AD dementia. Therefore, we aimed to investigate whether function in instrumental activities of daily living (IADL) contributes to identification.
We analysed data of cognitively unimpaired participants of the prospective German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe) and its extension, the Study on Needs, Health Service Use, Costs and Health-related Quality of Life in a Large Sample of Oldest-old Primary Care Patients (AgeQualiDe), collected over 10.5 years. Development of AD dementia was quantified as incidence rates (IRs) per 1000 person-years. Cox regression was used to assess the association of SCD and IADL function in regard to incident AD dementia.
Of 1467 included individuals, 792 (54.0%) reported SCD at baseline. Impaired IADL were present in 50 (3.4%) individuals. IR for AD dementia was highest in individuals with SCD and impaired IADL (49.7; 95% CI, 24.8-99.3). Unadjusted and adjusted Cox analyses revealed an increased AD dementia risk for individuals with SCD and impaired IADL (uHR = 6.1; 95% CI, 2.9-13.0; P < 0.001; aHR = 2.5; 95% CI, 1.1-5.7; P < 0.05).
Consistent with the SCD concept, IADL function was largely well preserved in the majority of individuals with SCD. However, if difficulties in IADL were present, risk for AD dementia was increased. Therefore, screening for IADL impairment could serve as an economically viable indicator to assess AD dementia risk above and beyond SCD.
主观认知下降（SCD）是临床前阿尔茨海默病（AD）的最早症状，但不足以识别 AD 痴呆的风险个体。因此，我们旨在研究工具性日常生活活动（IADL）功能是否有助于识别。
我们分析了前瞻性德国初级保健患者认知老化、认知和痴呆研究（AgeCoDe）及其扩展研究，即大型老年初级保健患者需求、卫生服务利用、成本和健康相关生活质量研究（AgeQualiDe）中认知未受损参与者的数据，这些数据收集时间超过 10.5 年。AD 痴呆的发展被量化为每 1000 人年的发病率（IR）。Cox 回归用于评估 SCD 和 IADL 功能与 AD 痴呆的发病风险之间的关系。
在纳入的 1467 名个体中，792 名（54.0%）在基线时报告了 SCD。50 名（3.4%）个体存在 IADL 受损。AD 痴呆的 IR 在 SCD 和 IADL 受损的个体中最高（49.7；95%CI，24.8-99.3）。未调整和调整后的 Cox 分析显示，SCD 和 IADL 受损的个体 AD 痴呆风险增加（uHR=6.1；95%CI，2.9-13.0；P<0.001；aHR=2.5；95%CI，1.1-5.7；P<0.05）。
与 SCD 概念一致，SCD 患者中大多数的 IADL 功能基本保持完好。然而，如果存在 IADL 困难，则 AD 痴呆的风险增加。因此，筛查 IADL 损伤可以作为一种经济可行的指标，在 SCD 之外评估 AD 痴呆的风险。
