Li Jiaying, Szanton Sarah L, Li Junxin
School of Nursing, Johns Hopkins University, Baltimore, United States; School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.
School of Nursing, Johns Hopkins University, Baltimore, United States.
J Prev Alzheimers Dis. 2025 Jun;12(6):100162. doi: 10.1016/j.tjpad.2025.100162. Epub 2025 Apr 9.
Conventional dichotomous classifications of cognitive status in older adults (normal vs impaired) may obscure distinct domain-specific deficits. Identifying nuanced cognitive profiles could enable personalized interventions, particularly when tailored to instrumental activities of daily living (IADLs).
To identify distinct cognitive profiles in older adults without dementia and assess their associations with overall and domain-specific IADL performance.
DESIGN/SETTING/PARTICIPANTS: Cross-sectional data from 2219 adults aged ≥65 years without dementia in the nationally representative National Health and Aging Trends Study.
Latent profile analysis classified participants across six cognitive domains: episodic memory, executive function, orientation, psychomotor function, visual attention, and working memory. Logistic and linear regression models with Holm-Bonferroni corrections evaluated relationships between cognitive profiles and IADL performance.
Five profiles emerged: Profile 1: Overall intact (50.5 % of participants); Profile 2: Isolated moderate orientation impairment (15.6 %); Profile 3: Mild global impairment with preserved orientation (22.0 %); Profile 4: Mild global impairment with significant orientation impairment (5.5 %); Profile 5: Moderate global impairment (6.2 %). Compared with Profile 1, all other profiles exhibited significantly higher overall IADL difficulty and were more likely to experience challenges with shopping, medication management, meal preparation, and banking (all adjusted p < 0.05). Profile 4 had the highest odds for difficulties with shopping (OR, 2.19; 95 % CI, 1.41-3.38; adjusted p = 0.005) and banking (OR, 3.98; 95 % CI, 2.62-6.04; adjusted p < 0.001), whereas Profile 5 showed the greatest risk for medication management (OR, 2.55; 95 % CI, 1.66-3.90; adjusted p < 0.001) and meal preparation (OR, 2.22; 95 % CI, 1.49-3.31; adjusted p = 0.001).
Nearly half of older adults without dementia exhibit distinct cognitive profiles warranting tailored interventions. Profile 5 requires comprehensive strategies, whereas Profiles 2, 3, and 4 may benefit from orientation-targeted and intensity-varied training in other cognition domain. Incorporating specific IADL tasks (e.g., meal preparation, medication management for Profile 5 and shopping, banking for Profile 4) into cognitive interventions may concurrently enhance cognitive health and functional independence.
老年人认知状态的传统二分法分类（正常与受损）可能会掩盖不同领域特定的缺陷。识别细微的认知特征有助于进行个性化干预，尤其是针对日常生活工具性活动（IADL）进行定制时。
识别无痴呆症老年人的不同认知特征，并评估它们与整体及特定领域IADL表现之间的关联。
设计/地点/参与者：来自具有全国代表性的国家健康与老龄化趋势研究中2219名年龄≥65岁无痴呆症成年人的横断面数据。
潜在类别分析将参与者按六个认知领域分类：情景记忆、执行功能、定向、心理运动功能、视觉注意力和工作记忆。采用带有霍尔姆 - 邦费罗尼校正的逻辑回归和线性回归模型评估认知特征与IADL表现之间的关系。
出现了五种特征：特征1：整体完好（50.5%的参与者）；特征2：孤立的中度定向障碍（15.6%）；特征3：轻度整体受损但定向保留（22.0%）；特征4：轻度整体受损且有明显定向障碍（5.5%）；特征5：中度整体受损（6.2%）。与特征1相比，所有其他特征在整体IADL难度上均显著更高，并且在购物、药物管理、 meal preparation和银行业务方面更有可能遇到困难（所有调整后p < 0.05）。特征4在购物困难方面的几率最高（OR，2.19；95% CI，1.41 - 3.38；调整后p = 0.005）和银行业务（OR，3.98；95% CI，2.62 - 6.04；调整后p < 0.001），而特征5在药物管理方面显示出最大风险（OR，2.55；95% CI，1.66 - 3.90；调整后p < 0.001）和meal preparation（OR，2.22；95% CI，1.49 - 3.31；调整后p = 0.001）。
近一半无痴呆症的老年人表现出不同的认知特征，需要进行定制干预。特征5需要全面的策略，而特征2、3和4可能受益于针对其他认知领域的定向和强度可变的训练。将特定的IADL任务（例如，针对特征5的meal preparation、药物管理，以及针对特征4的购物、银行业务）纳入认知干预可能同时增强认知健康和功能独立性。
