Mild Cognitive Impairment and 10‐Year Trajectories of Disability in the Iowa Established Populations for Epidemiologic Studies of the Elderly Cohort

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Abstract
Objectives: To apply diagnostic criteria for mild cognitive impairment (MCI) to a geographically representative sample, to estimate the prevalence of MCI, and to estimate 10‐year trajectories of incident disability for cognitively intact participants and subgroups with MCI. Design: Prospective cohort; 10 years of follow‐up. Setting: Community‐based survey of noninstitutionalized population aged 65 and or older in two rural Iowa counties (Washington and Iowa). Participants: Iowa Established Populations for Epidemiologic Studies of the Elderly (aged ≥65; N=3,673; 61.3% female; 99.9% white). Measurements: Age, sex, education, Short Portable Mental Status Questionnaire (SPMSQ), 20‐item word recall, activities of daily living (ADLs), instrumental activities of daily living (IADLs), chronic medical conditions. Results: MCI was prevalent in 24.7% of participants at baseline. Most participants in the overall cohort remained stable or changed slowly (≤1 new limitations) over 10 years (63.1% for SPMSQ, 89.3% for word recall, and 61.7% for ADL disability). For MCI/no prevalent IADL disability (Stage 1 MCI), disability progression was similar to that in the cognitively intact subgroup (median=0.08 vs 0.05 disabilities per year). For MCI plus prevalent IADL disability (Stage 2 MCI), the median rate of change was equivalent to that of the severely impaired (0.23 disabilities per year; interquartile range=0.12–0.36). Conclusion: Unlike participants with MCI who reported no IADL limitations, those with such limitations were more likely to develop ADL disability—a prerequisite for a diagnosis of dementia.

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