Impact of frontal white matter hyperintensity on instrumental activities of daily living in elderly women with Alzheimer disease and amnestic mild cognitive impairment

PLoS One. 2017 Mar 2;12(3):e0172484. doi: 10.1371/journal.pone.0172484. eCollection 2017.

Abstract

Background: Instrumental activities of daily living (IADL) start to decline during the progression of amnestic mild cognitive impairment (aMCI) to Alzheimer disease (AD). Cognitive and physical decline are involved in the loss of functional independence. However, little is known about AD-related neural change that leads to IADL impairment. The purpose of this study was to clarify the effects of regional white matter hyperintensity (WMH) on IADL impairment in persons with AD and aMCI.

Methods: The participants were 347 female subjects aged 65-85 years diagnosed with AD (n = 227), aMCI (n = 44) or normal cognition (n = 76). IADL was assessed by the Lawton Index. Cognition, mood and mobility function were evaluated by comprehensive geriatric assessment batteries. WMH and brain atrophy were analyzed with brain magnetic resonance imaging, using an automatic segmentation program. Regional WMH was measured in the frontal, temporal, occipital and parietal lobes.

Results: Ability to carry out IADL of shopping, food preparation, mode of transportation, responsibility for own medication, and ability to handle finances was obviously impaired in the early stage of AD. Frontal WMH was specifically associated with disability to do shopping and food preparation even after adjusting for several confounders including brain atrophy.

Conclusions: IADL subcategories were differentially impaired along with cognitive status in persons with AD and aMCI. Frontal WMH was an important predictor of impaired ability to do shopping and food preparation. A preventive strategy for WMH might lead to suppression of IADL disability and slow the progression of AD.

MeSH terms

  • Activities of Daily Living*
  • Aged
  • Aged, 80 and over
  • Alzheimer Disease / complications*
  • Alzheimer Disease / diagnostic imaging
  • Alzheimer Disease / pathology
  • Alzheimer Disease / physiopathology*
  • Amnesia / complications*
  • Atrophy / complications
  • Cognition
  • Cognitive Dysfunction / complications*
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Risk Factors
  • White Matter / diagnostic imaging
  • White Matter / pathology*
  • White Matter / physiopathology*

Grants and funding

T.S discloses a research grant from Research Funding of Longevity Sciences (25-6, 27-21) from National Center for Geriatrics and Gerontology (http://www.ncgg.go.jp/ncgg-kenkyu/index.html). N.S discloses a research grant from Research Funding of Longevity Sciences (28-15) from the National Center for Geriatrics and Gerontology (http://www.ncgg.go.jp/ncgg-kenkyu/index.html), and Grants-in-Aid for Scientific Research (B) (No. 26870765) from the Japanese Society for the Promotion of Science (https://www.jsps.go.jp/j-grantsinaid/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.