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The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 56:M638-M643 (2001)
© 2001 The Gerontological Society of America

The Hierarchy of Functional Loss Associated With Cognitive Decline in Older Persons

Vesna Njegovana, Malcolm Man-Son-Hinga,b,c, Susan L. Mitchella,b and Frank J. Molnara,b,c

a Geriatric Assessment Unit, Ottawa Hospital, Ottawa, Ontario, Canada
b Department of Medicine, University of Ottawa
c Institute on Health of the Elderly, Sisters of Charity Health Service, Ottawa, Canada

Malcolm Man-Son-Hing, Geriatric Assessment Unit, Ottawa Hospital–Civic Campus, 1053 Carling Avenue, Ottawa, Ontario, Canada K1Y 4E9 E-mail: mhing{at}ottawahospital.on.ca.

Decision Editor: John E. Morley, MB, BCh

Objectives. We studied a representative cohort of community-dwelling elderly persons to (i) examine the relationship between the loss of specific functional activities and cognitive status at the time of these losses, (ii) compare the cognitive status of participants who have and have not lost independence in these functional activities, and (iii) determine whether a hierarchical scale of functional loss is associated with declining cognitive status.

Methods. A cohort of 5874 community-dwelling persons aged 65 years and older from the Canadian Study of Health and Aging I and II were analyzed. At baseline and 5 years later, cognitive status with the Modified Mini-Mental State Examination (3MS) and functional status with 14 Older American Resources and Services (OARS) items were measured. For each OARS functional item, the mean 3MS scores for persons who lost independence during the 5-year period versus those who did not were compared.

Results. For each functional item, the 5-year decline in 3MS scores of persons who lost independence were significantly greater than those who remained independent (e.g., ability to do finances), with an 18-point decline for those who lost independence and a 2-point decline for those who retained independence. A hierarchy of functional items existed, with instrumental activities of daily living (ADLs) (e.g., shopping, banking, and cooking) being lost at higher cognitive scores than basic ADL items (e.g., eating, dressing, and walking), although there was some overlap.

Conclusions. This is the first prospective study using a large representative cohort of elderly persons to demonstrate that progressive cognitive decline is associated with a specific pattern of loss of functional tasks. Clear cognitive thresholds at which development of dependency in OARS functional items occurred. By providing estimates of the cognitive status of persons at the time at which they developed dependency in specific functional items, a natural hierarchy of functional loss associated with cognitive decline emerged. For caregivers, clinicians, and health policy makers, this information can help anticipate the pattern of functional decline and the subsequent care needs of persons with declining cognition, potentially improving the quality of life of these persons and their caregivers and playing an important part in health care planning.




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