Functional Impairment in Instrumental Activities of Daily Living: An Early Clinical Sign of Dementia?

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Abstract
OBJECTIVE: To estimate the predictive value of four IADLs on 3‐ and 5‐year incident dementia. DESIGN: Prospective cohort study. SETTING: A community survey in 37 randomly selected parishes. SUBJECTS: A random sample of French community dwellers aged 65 and older included in the PAQUID study followed‐up at 3 (1582 subjects) and 5 years (1283 subjects). MAIN OUTCOME MEASURES: Incidence of dementia at 3 and 5 years, diagnosed by two‐step screening: (1) MMS and DSM‐III‐R; (2) diagnosis of dementia confirmed by a neurologist. RESULTS: A score summing up the number of dependencies at baseline on four IADLs is a predictor of 3‐year but not of 5‐year incident dementia. Increase in the level of dependence between baseline and 3‐year follow‐up is associated with an increased risk of incident dementia at 5‐year follow‐up. CONCLUSION: These four IADLs can help to identify older subjects at high risk of dementia who should then undergo neuropsychological testing.