EVERYDAY FUNCTIONAL PERFORMANCE IN MCI

很少有人直接评估轻度认知障碍(MCI)认知改变对日常任务表现的影响。由于发展为痴呆症的高风险，MCI患者也面临着在社会中有效和独立运作所需能力下降的高风险。他们可能会经历功能技能的丧失，介于与正常衰老相关的微妙减退和与阿尔茨海默病等痴呆症相关的明显缺陷之间。MCI概念化的一个关键问题是，在2到4年的时间里，记忆和其他认知能力的变化如何影响日常任务的表现--对许多人来说，这段时间将标志着从MCI到痴呆症的转变。更清楚地了解认知能力和现实世界任务绩效之间的关系，不仅将提供有关MCI功能变化的潜在机制的信息，还将针对特定区域 用于未来的多组分干预研究。这项拟议研究的目的是检验特定认知能力与一系列现实世界任务之间的关系，这些任务与自主功能、生活质量、健康和避免住院和死亡率等不良后果密切相关，并评估相对于正常对照组，这些关系如何随着时间的推移而变化。这些目标将通过比较具有良好特征的、基于临床的75至90名MCI患者的样本与同样具有良好特征的、基于临床的、年龄匹配的、认知正常的75至90名个体的功能能力来实现。具体目标是：(1)比较确诊为MCI的个体与年龄和教育程度匹配的正常对照组在各种日常功能指数上的表现，主要侧重于驾驶和财务技能；(2)比较MCI个体的功能表现的纵向变化与对照组的纵向变化，每隔2至4年进行年度评估；(3) 检查MCI患者和正常对照组的功能表现和功能随时间变化的认知预测因子；以及(4)通过检查与正常对照组相比功能能力的下降，并通过比较每个功能领域的损失幅度和被评估的一系列功能能力的损失，来探索MCI功能变化的层级，无论是在基线还是随时间。

Little has been done to directly evaluate the impact of cognitive changes in Mild Cognitive Impairment (MCI) on the performance of everyday tasks. By virtue of their high risk for progression to dementia, individuals with MCI also are at high risk for decline in the abilities needed to function effectively and independently in society. They are likely to experience a loss of functional skills that lies somewhere between the subtle decrements associated with normal aging and the frank deficits associated with a dementia such as Alzheimer's disease. A critical question in the conceptualization of MCI is how changes in memory and other cognitive abilities influence the performance of everyday tasks over a 2 to 4 year period of time--a period that for many individuals will mark the transition from MCI to dementia. A clearer understanding of the relationship between cognitive abilities and real world task performance will not only provide information about potential mechanisms for functional change in MCI but also will target areas for future multi-component intervention studies. The objectives of the proposed research are to examine the relationships between specific cognitive abilities and a spectrum of real world tasks that are strongly tied to autonomous functioning, quality of life, health, and avoidance of adverse outcomes such as hospitalization and mortality, and to evaluate how these relationships change over time among individuals with MCI relative to normal controls. These objectives will be achieved by comparing over time the functional abilities of a well-characterized, clinic-based sample of 75 to 90 individuals with MCI to those of an equally well- characterized, clinic-based sample of 75 to 90 age-matched, cognitively normal individuals. Specific aims are to: (1) compare the performance of individuals diagnosed with MCI to that of age- and education-matched normal controls on a variety of indices of everyday function, with primary emphasis on driving and financial skills; (2) compare longitudinal changes in functional performance in individuals with MCI to longitudinal changes in controls with annual assessments over intervals of 2 to 4 years; (3) examine cognitive predictors of functional performance and functional change over time in individuals with MCI and in normal controls; and (4) explore the hierarchy of functional change in MCI by examining decrements in functional abilities compared to those of normal controls and by comparing the magnitude of loss in each functional domain to losses across the range of functional abilities under evaluation, both at baseline and over time.