Questionnaire May Help Discern Mild Cognitive Impairment From Early Alzheimer's Disease

Paula Moyer, MA

October 11, 2006

October 11, 2006 (Chicago) — Patients with mild cognitive impairment who need help with key activities of daily living may be more likely to progress to Alzheimer's disease, according to investigators who presented their findings here at American Neurological Association (ANA) 131st Annual Meeting.

"Our findings show that analyses of individual assessments of activities of daily living, such as the Functional Activities Questionnaire [FAQ], may be useful for diagnosing mild cognitive impairment," said principal investigator Edmond Teng, MD, PhD, at his presentation. Dr. Teng is a fellow at the Alzheimer Disease Center at the David Geffen School of Medicine at the University of California, Los Angeles.

The assessment tool used in the study, the FAQ, is administered to the patient's caregiver and assesses the patient's ability to participate in 10 categories of instrumental activities of daily living (IADLs). Although the FAQ scores in some domains overlapped between those with mild cognitive impairment and those with Alzheimer's disease, the ability or inability to travel independently out of one's own neighborhood most effectively discriminated between the 2 conditions (P = .001), he said.

The 10 domains addressed by the FAQ include:

  1. Writing checks and maintaining other financial records.

  2. Assembling tax or business records.

  3. Shopping alone.

  4. Playing a game of skill.

  5. Making coffee or tea.

  6. Preparing a balanced meal.

  7. Keeping track of current events.

  8. Attending to and understanding a television program, book, or magazine.

  9. Remembering appointments, family occasions, and medications.

  10. Traveling out of the neighborhood.


The caregiver gave the patient a score of zero to 3 on each activity, with zero equaling normal independent participation in the activity; 1 indicating the patient's ability to do the activity alone but with difficulty; 2 indicating that the patient requires assistance; and 3 indicating that the patient depends on others to conduct the activity.

The investigators conducted the study because other research had shown that people with mild cognitive impairment continue to have essentially intact functional abilities. However, other research has shown that such patients have declines in IADLs. Therefore, they wanted to know whether they could use the FAQ to distinguish subjects with mild cognitive impairment and those with mild Alzheimer's disease.

They analyzed the FAQ responses for 65 normal control subjects, 42 with mild cognitive impairment, and 22 with mild Alzheimer's disease. They further categorized those with mild cognitive impairment as those with memory deficits in a single domain, in multiple domains, or not having memory deficits; and subdivided mild Alzheimer's disease into possible and probable disease.

The total FAQ scores in patients with mild cognitive impairment were similar across subtypes but significantly different from the controls and the mild Alzheimer's disease groups ( P < .001 for each). As Dr. Teng indicated, the ability to manage transportation and travel outside of one's neighborhood most effectively discriminated between mild cognitive impairment and Alzheimer's disease. A cutoff of greater than 1 on this item yielded classification rates of 86% between all mild cognitive impairment and all Alzheimer's disease subjects; further, on this score, there was a classification rate of 87% between those with mild cognitive impairment who had memory deficits across multiple domains and subjects with probable Alzheimer's disease.

"Any neuropsychological instrument that was truly reliably predictive of the subpopulation of patients with mild cognitive impairment destined to convert to Alzheimer's disease within a defined period of time would be an enormous advance, not only in providing for planning . . . but for testing the newest generation of Alzheimer's medicines," Sam Gandy, MD, PhD, told Medscape in an interview. Dr. Gandy, who was not involved in the study, is the director of the Farber Institute for Neurosciences at Thomas Jefferson University, in Philadelphia, Pennsylvania, and the chair of the National Medical and Scientific Advisory Council of the Alzheimer's Association.

"These drugs are largely aimed at the buildup of amyloid. . . . We believe that amyloid buildup is a very, very early event in Alzheimer's, and the earlier in the process we can assess these new drugs in clinical trials, the better," he added. "Otherwise, we might get 'false-negative' results of medicines if we tested them too late in the disease when, in fact, these very medicines might be fabulously effective if only administered early enough. The extreme example of 'early enough,' of course, is primary, preclinical prevention, which is where we eventually want to be: we want to know who is at risk before any impairment is present, and 'head amyloid off at the pass.' "

Another expert agreed that the FAQ is useful in this setting. "Impairments in complex IADLs are often the earliest functional impairment seen in individuals with mild cognitive impairment," wrote Leon Thal, MD, chair of neurosciences at the University of California, San Diego, in an e-mail. "The FAQ is a useful instrument for measuring IADLs."

ANA 131st Annual Meeting: Abstract S-20. Presented October 8, 2006.

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