Performance-Based vs Informant-Reported Instrumental Activities of Daily Living in Predicting Dementia.

Abstract Objectives Identifying individuals at risk of developing dementia may be aided by early detection of functional impairments. The aims of the present study were to examine differences in informant-reported and performance-based measures of instrumental activities of daily living (IADL) and to assess whether a performance-based IADL measure contributes additional unique variance over informant reports in predicting incident dementia over 4 years. Design Prospective cohort study (Sydney Memory and Ageing Study). Setting Eastern Suburbs, Sydney, Australia. Participants 307 community-dwelling individuals (60.6% female) aged between 76 and 96 years with normal cognition (NC; n = 190) or mild cognitive impairment (MCI; n = 117). Methods IADL ability was assessed with the performance-based Sydney Test of Activities of Daily Living in Memory Disorders (STAM) and the Bayer-Activities of Daily Living (B-ADL) informant report, at baseline and 4-year follow-up. Covariates included age, sex, education, Mini-Mental State Examination and Geriatric Depression Scale scores, arthritis, vision impairment, cardiovascular risk, and number of medications. Logistic regressions were conducted to examine the longitudinal association between the 2 types of IADL measures and incident dementia. Results Logistic regressions showed that performance-based IADL impairment at baseline [odds ratio (OR) = 0.83, 95% confidence interval (CI) 0.77, 0.90; P Conclusions and Implications Performance-based measures of IADL can predict progression to dementia over 4 years beyond that provided by an informant report of IADL. Performance-based IADL measures are promising tools for clinical practice to identify individuals at greater risk of developing dementia.