Department of Neurology, University Clinic Hospital of Salamanca, Salamanca, Spain.
Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain.
J Alzheimers Dis. 2020;75(3):1061-1069. doi: 10.3233/JAD-191263.
Specific cognitive alterations could be one of the predictors that lead to the complex activities of daily living (CADL) impairment in mild cognitive impairment (MCI) and, hence, help to explain the continuum between MCI and dementia.
We aimed to reevaluate the existing uncertainty regarding the impact of memory and executive functions on CADL in patients with MCI.
Caregivers of 161 patients with amnestic multi-domain MCI and of 150 patients with incipient Alzheimer's disease as well as 100 age-, sex-, and education-matched controls, completed the Interview for Deterioration in Daily Living Activities in Dementia, a suitable instrument for the description and discrimination of CADL. In addition, all patients and controls were assessed with a neuropsychological battery to measure explicit memory and executive functions performance.
Multiple regression analyses showed that in the group of patients with amnestic multi-domain MCI, 67.4% of the variability of the CADL impairment was explained by worse performance on executive functions tests (p < 0.0001) and 41.8% by different explicit memory components impairment (p < 0.0001). Further, in patients with incipient AD, 44.0% of the variability of CADL impairment was explained by worse performance on executive functions tests (p < 0.0001) and 39.9% by different explicit memory components worsening (p < 0.0001).
Memory and executive functions alterations impact similarly on the CADL in both amnestic multi-domain MCI and incipient Alzheimer's disease. Given the continuum that exists between both conditions, we conclude that CADL impairment may be an important early step in the evolution towards Alzheimer's disease from amnestic multi-domain MCI.
特定的认知改变可能是导致轻度认知障碍（MCI）患者日常生活活动（CADL）受损的预测因素之一，从而有助于解释 MCI 和痴呆之间的连续体。
我们旨在重新评估记忆和执行功能对 MCI 患者 CADL 的影响的现有不确定性。
161 名有遗忘型多领域 MCI 的患者和 150 名早期阿尔茨海默病患者的照顾者，以及 100 名年龄、性别和教育程度匹配的对照组完成了用于描述和区分 CADL 的痴呆症日常生活活动恶化访谈。此外，所有患者和对照组均接受神经心理测试，以测量外显记忆和执行功能表现。
多元回归分析显示，在遗忘型多领域 MCI 患者组中，CADL 损害的可变性有 67.4%可以用执行功能测试表现更差来解释（p<0.0001），有 41.8%可以用不同的外显记忆成分损害来解释（p<0.0001）。此外，在早期 AD 患者中，CADL 损害的可变性有 44.0%可以用执行功能测试表现更差来解释（p<0.0001），有 39.9%可以用不同的外显记忆成分恶化来解释（p<0.0001）。
记忆和执行功能改变对遗忘型多领域 MCI 和早期阿尔茨海默病的 CADL 有相似的影响。鉴于这两种情况之间存在连续性，我们得出结论，CADL 损害可能是从遗忘型多领域 MCI 向阿尔茨海默病发展的重要早期步骤。
