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Functional Disability in Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

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Abstract

Accumulating evidence suggests that the pre-dementia syndrome mild cognitive impairment (MCI) is characterized by decrements in instrumental activities of daily living (IADL). The current review was a quantitative synthesis of the available literature to objectively characterize IADL disability in MCI while clarifying inconsistencies in findings across studies. It was hypothesized that individuals with MCI would display significantly greater functional impairment relative to cognitively intact controls. Candidate moderators specified a priori included functional assessment approach, MCI subtype, depressive symptoms, and language conducted. Online databases (PubMed/MEDLINE and PsycINFO) and reference lists were searched to identify peer-reviewed publications assessing IADL in MCI compared to normal aging. A total of 151 effect sizes derived from 106 studies met inclusionary criteria (N = 62,260). Random effects models yielded a large overall summary effect size (Hedges’ g = 0.76, 95 % confidence interval: 0.68 − 0.83, p < .001) confirmed in multi-level analyses adjusted for nesting of effect sizes within studies (g = 0.78, 95 % confidence interval: 0.69 − 0.87). Functional assessment strategy and MCI subtype were significant moderators of effect size, whereas depressive symptoms and language were not. Results convincingly demonstrate that MCI is associated with significant difficulties in the performance of complex everyday tasks. It appears that functional decline, like cognitive decline, exists on a continuum from healthy aging to dementia onset. Implications for clinical practice and research priorities are discussed.

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Acknowledgments

We would like to express our sincere gratitude to all of the researchers whose work forms the basis for our meta-analytic review. In particular, we thank those individuals who generously responded to our requests for unpublished data.

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Authors and Affiliations

  1. Department of Psychology, University of Georgia, Athens, GA, 30602, USA

    Cutter A. Lindbergh & L. Stephen Miller

  2. Department of Kinesiology, University of Georgia, Athens, GA, 30602, USA

    Rodney K. Dishman

  3. Bio-Imaging Research Center, Paul D. Coverdell Center, University of Georgia, Athens, GA, 30602, USA

    L. Stephen Miller

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  1. Cutter A. Lindbergh
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Lindbergh, C.A., Dishman, R.K. & Miller, L.S. Functional Disability in Mild Cognitive Impairment: A Systematic Review and Meta-Analysis. Neuropsychol Rev 26, 129–159 (2016). https://doi.org/10.1007/s11065-016-9321-5

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