Supplementary Material for: Increasing the Sensitivity of Functional Status Assessment in the Preclinical Range (Normal to Mild Cognitive Impairment): Exploring the IADL-Extended Approach
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<b><i>Background/Aims:</i></b> Dementia exhibits an insidious onset consisting of cognitive, behavioral, and functional impairment. We explored a functional continuum that extends assessment beyond the clinical instrumental activities of daily living (IADL) range and into advanced activities of daily living. <b><i>Methods:</i></b> We examined the predictive power (Cox regression; <i>n</i> = 2,471) of a unidimensional IADL-extended (IADL-x) scale for incident mild cognitive impairment (MCI). We also examined “time to MCI” as an outcome measure. <b><i>Results:</i></b> Each additional task endorsed on the IADL-x hierarchy (e.g., endorsing participation in 6 vs. 5 activities) resulted in a 10% reduction in MCI risk (HR 0.90, 95% CI 0.85–0.94, <i>p</i> < 0.001). For the fully adjusted model the risk reduction dropped to 6%. The odds of incident MCI within 2 years (for those below the median IADL-x total score) was 2.5 times higher (OR 2.60, 95% CI 1.52–4.4, <i>p</i> < 0.001) and 2 times higher for incident MCI within the next 5 years (OR 1.93, 95% CI 1.76–3.2, <i>p</i> < 0.01). <b><i>Conclusion:</i></b> The IADL-x metric appears to be a valid approach for determining the risk of MCI based on one’s position along a formal hierarchy of function.
<b><i>背景与目的：</i></b> 痴呆起病隐匿，表现为认知、行为及功能损害。本研究旨在探索一种功能连续体，将评估范围从临床工具性日常生活活动（IADL）范畴拓展至高级日常生活活动领域。 <b><i>方法：</i></b> 本研究采用Cox回归分析（样本量n=2471），评估单维度扩展IADL（IADL-x）量表对新发轻度认知障碍（MCI）的预测效能，并以“至MCI发生时间”作为结局指标。 <b><i>结果：</i></b> IADL-x等级量表中每多勾选一项活动（例如勾选参与6项而非5项活动），MCI发生风险即降低10%（风险比HR=0.90，95%置信区间0.85~0.94，p<0.001）。在完全校正模型中，该风险降幅降至6%。对于IADL-x总分低于中位数的受试者，2年内新发MCI的发病风险较对照组高2.5倍（比值比OR=2.60，95%置信区间1.52~4.40，p<0.001）；5年内新发MCI的发病风险较对照组高2倍（OR=1.93，95%置信区间1.76~3.20，p<0.01）。 <b><i>结论：</i></b> IADL-x评分量表可基于受试者在正式功能等级中的位次，有效评估MCI发生风险，是一种可靠的评估手段。
