Relating cognition to activities of daily living in mild dementia: establishing a basis for future interventions

The ability to perform instrumental and basic activities of daily living (IADLs and ADLs) deteriorates early in dementia and affects both the person with dementia (PwD) and their carer. In order to develop effective cognitive interventions aimed at maintaining or improving independence for as long as possible, evidence-based models of the relationship between cognition and everyday activities need to be further developed. However, little, if any, work on this has been done to date. Therefore, the objective of this study was first to determine the degree of impairment of individual ADLs and IADLs in mild dementia, in terms of initiative in and performance of these activities. Performance data on a set of key neuropsychological tasks was also obtained. Relating these two data sets can provide some much needed new information as a basis to develop models of the relationship between cognition and everyday activities. For this purpose, PwD completed a set of neuropsychological tests involving short-term, long-term, prospective and semantic memory, executive function, attention and processing speed, whilst carers completed measures of IADL and ADL performance and initiative. Data were analysed using frequency and correlation analyses. Results showed that PwD were most impaired at initiating engagement in hobbies and management of finances, and in performing the tasks of maintaining an active social life and going shopping. With respect to the relationship between cognition and individual activities, several findings emerged that distinguished between initiative and performance of an activity while others revealed performance effects across the spectrum of activities. For example, performance on an activity involving the following of familiar routes was related particularly to attention and memory, whilst preparing a meal was particularly related to processing speed. Thus acquisition of a detailed picture of the complexity of these relationships can contribute to the development of interventions promoting independence and thereby improving quality of life in dementia.