Functional Reserve: Experience Participating in Instrumental Activities of Daily Living is Associated with Gender and Functional Independence in Mild Cognitive Impairment
Functional Reserve: Experience Participating in Instrumental Activities of Daily Living is Associated with Gender and Functional Independence in Mild Cognitive Impairment
复制标题
DOI：
10.3233/jad-161227
复制
发表时间：
2017-01-01
影响因子：
4
通讯作者：
Black, Sandra E.
中科院分区：
文献类型：
--
作者：
Berezuk, Courtney;Zakzanis, Konstantine K.;Black, Sandra E.
背景：轻度认知障碍（MCI）和阿尔茨海默病患者日常生活工具活动（IADLs）的性别差异可以通过IADL参与的性别差异来解释。目的：我们引入了一个新的理论结构，称为功能储备，并实证研究了性别差异在IADL经验中作为该储备的代理。方法：我们横断面检查了来自阿尔茨海默病神经影像学倡议（ADNI）的MCI男性（n = 502）和女性（n = 340）。以人口统计学因素、抑郁症状、神经心理评分和IADL经历为自变量，以功能活动问卷（FAQ）总分为因变量。对整个队列进行回归分析，并按性别分层，以确定男性和女性的差异预测关系。结果：性别与总FAQ相关（p < 0.05），直到调整IADL经验。此外，尽管IADL经验是最重要的单一变量（解释4.8%,p < 0.001），但认知测量的组合在功能依赖中占最大方差（12%,p < 0.001）。按性别分层显示，IADL经历占男性常见问题评分方差的6.6% (p < 0.001)，但在女性中仅占2.4% (p = 0.001)；然而，性别和经验之间的交互作用没有统计学意义。讨论：男性在轻度认知损伤中表现出更大的功能依赖的小影响可能是由于较低的IADL经验。此外，在所有分析中，IADL经验与优越的功能有关，可能通过增加功能储备。这种功能储备的概念可能对识别有IADL依赖风险的个体、预防或延缓衰退以及潜在的功能损伤治疗具有重要意义。
Background: Gender differences in instrumental activities of daily living (IADLs) in mild cognitive impairment (MCI) and Alzheimer's disease may be explained by gender differences in IADL involvement.Objective: We introduce a novel theoretical construct, termed functional reserve, and empirically examine gender differences in IADL experience as a proxy of this reserve.Methods: We cross-sectionally examined men (n = 502) and women (n = 340) with MCI from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Demographic factors, depressive symptoms, neuropsychological scores, and IADL experience were included as independent variables and total Functional Activities Questionnaire (FAQ) scores as the dependent variable. Regression analyses were performed on the full cohort and stratified by gender to identify differential predictive relationships for men and women.Results: Gender was associated with total FAQ (p < 0.05) until adjusting for IADL experience. Furthermore, the combination of cognitive measures accounted for the most variance in functional dependence (12% explained, p < 0.001), although IADL experience was the most important single variable (4.8% explained, p < 0.001). Stratification by gender revealed that IADL experience accounted for 6.6% of the variance in FAQ score in men (p < 0.001) but only 2.4% in women (p = 0.001); however, the interaction between gender and experience was not statistically significant.Discussion: A small effect of men showing greater functional dependence in MCI may be explained by lower IADL experience. Additionally, IADL experience was associated with superior functioning in all analyses, potentially through increased functional reserve. This concept of functional reserve may have implications for identifying individuals at risk for IADL dependence, preventing or delaying decline, and potentially treating functional impairment.