Department of Neurology, University of California, Davis, California, USA.
Department of Epidemiology and Translational Science, University of California, San Francisco, California, USA.
J Gerontol B Psychol Sci Soc Sci. 2022 May 5;77(5):885-894. doi: 10.1093/geronb/gbab163.
Cognitive functioning is associated with instrumental activity of daily living (IADL) performance among older adults. The present study examines potential differences in the prevalence of IADL difficulty and association with cognition across diverse groups.
Participants included 455 non-Hispanic Whites, 395 Blacks, 370 Asians, and 296 Latinos aged 65 years and older without a current dementia diagnosis from the Kaiser Healthy Aging and Diverse Life Experience cohort. Participants' self-reported IADL functioning and cognition was measured across episodic memory and executive functioning.
Older age, male gender, and being Black were associated with more IADL difficulties. Executive functioning showed a stronger association with IADLs than memory, and it was independent of health status, whereas memory was not. In joint models including both cognitive domains, executive functioning remained a significant predictor of IADL difficulty, but memory did not. Results for both cognitive domains were attenuated with self-rated health added to the joint model. These relationships did not significantly differ across racial/ethnic groups.
Our study supports previous work suggesting that Black older adults are at increased risk for IADL disability. This is the first study we are aware of that examined the association between specific cognitive domains and IADL performance across multiple racial/ethnic groups. Findings indicate that cognitive functioning has similar associations with self-reported IADL disability across diverse groups, and that executive functioning plays a particularly important role in IADL disability among older adults without dementia; however, health status largely attenuates the relationship between IADL difficulty and cognition.
认知功能与老年人的日常生活工具性活动(IADL)表现相关。本研究旨在考察不同人群中 IADL 困难的发生率差异及其与认知功能的关联。
参与者包括来自 Kaiser 健康老龄化和多样化生活经验队列的 455 名非西班牙裔白人、395 名黑人、370 名亚洲人和 296 名拉丁裔,年龄均在 65 岁及以上且目前没有痴呆症诊断。参与者的 IADL 功能和认知通过情景记忆和执行功能进行自我报告评估。
年龄较大、男性和黑人种族与更多的 IADL 困难相关。与记忆相比,执行功能与 IADL 的关联更强,且独立于健康状况,而记忆则不然。在包括两个认知领域的联合模型中,执行功能仍然是 IADL 困难的显著预测因素,但记忆则不是。在联合模型中加入自我报告的健康状况后,两个认知领域的结果均有所减弱。这些关系在不同的种族/族裔群体中没有显著差异。
我们的研究支持了先前的工作,即黑人老年人患 IADL 残疾的风险增加。这是我们所知的第一个在多个种族/族裔群体中检验特定认知领域与 IADL 表现之间关联的研究。研究结果表明,认知功能与不同人群自我报告的 IADL 残疾具有相似的关联,并且在没有痴呆症的老年人群中,执行功能在 IADL 残疾中起着特别重要的作用;然而,健康状况在很大程度上减弱了 IADL 困难与认知之间的关系。