The Relationship Between Cognitive Impairment and Upper Extremity Function in Older Primary Care Patients

BACKGROUND Individuals with mild cognitive impairment (MCI), often a precursor to dementia, experience limitations in completing daily activities. These limitations are particularly important to understand, as they predict risk for dementia. Relations between functional changes and both cognitive decline and upper extremity motor impairments have been reported, but the contribution of motor function to relations between cognitive function and functional independence remains poorly understood. We examined the relationship between cognition and upper extremity activities, and whether this relation was mediated by motor function. METHODS A total of 430 community-dwelling primary care patients aged at least 65 years from the Boston Rehabilitative Impairment Study of the Elderly completed self-report measures of upper extremity function, tests of neuromuscular attributes to measure motor function (reaction time, pronosupination of the hands), and neuropsychological measures. Participants were classified based on cognitive performance into groups: MCI and without MCI, with MCI further classified by cognitive subtype. Regression and mediation analyses examined group differences and relations between cognitive function, upper extremity function, and neuromuscular attributes. RESULTS MCI participants demonstrated poorer neuromuscular attributes and self-reported upper extremity function, and neuromuscular attributes significantly mediated positive relations between cognitive status and self-reported upper extremity function. Poorer self-reported upper extremity function was most prominent for groups with executive dysfunction. CONCLUSIONS Together with previous research, results suggest that the relationship between cognitive function, motor function, and functional activities is not confined to mobility tasks but universally related to body systems and functional activities. These findings inform new approaches for dementia risk screening and rehabilitative care.

[1]  J. Bobes,et al.  Functional impairment as a defining feature of: amnestic MCI cognitive, emotional, and demographic correlates , 2012, International Psychogeriatrics.

[2]  L. Ferrucci,et al.  A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. , 1994, Journal of gerontology.

[3]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[4]  E. Scherder,et al.  Higher-Level Hand Motor Function in Aging and (Preclinical) Dementia: Its Relationship with (Instrumental) Activities of Daily Life – A Mini-Review , 2008, Gerontology.

[5]  Philip D. Harvey,et al.  Administration and interpretation of the Trail Making Test , 2006, Nature Protocols.

[6]  R. Dishman,et al.  Functional Disability in Mild Cognitive Impairment: A Systematic Review and Meta-Analysis , 2016, Neuropsychology Review.

[7]  D. Mackinnon,et al.  Equivalence of the Mediation, Confounding and Suppression Effect , 2000, Prevention Science.

[8]  R. Jung.  Neuropsychological Assessment, 4th ed. , 2005 .

[9]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[10]  P. Strick,et al.  Basal ganglia and cerebellar loops: motor and cognitive circuits , 2000, Brain Research Reviews.

[11]  A. Jette,et al.  Validation of the Late‐Life Function and Disability Instrument , 2004, Journal of the American Geriatrics Society.

[12]  Jeffrey M. Hausdorff,et al.  Gait and Cognition: A Complementary Approach to Understanding Brain Function and the Risk of Falling , 2012, Journal of the American Geriatrics Society.

[13]  S. Greenland,et al.  Simulation study of confounder-selection strategies. , 1993, American journal of epidemiology.

[14]  E. Tucker-Drob,et al.  Neurocognitive functions and everyday functions change together in old age. , 2011, Neuropsychology.

[15]  D. Delis,et al.  Quantification of five neuropsychological approaches to defining mild cognitive impairment. , 2009, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[16]  R. Petersen.  Mild cognitive impairment as a diagnostic entity , 2004, Journal of internal medicine.

[17]  A. Jette,et al.  Performance-Based Versus Patient-Reported Physical Function: What Are the Underlying Predictors? , 2011, Physical Therapy.

[18]  S. Lord,et al.  Postural stability and associated physiological factors in a population of aged persons. , 1991, Journal of gerontology.

[19]  Lisa Delano-Wood,et al.  Complex activities of daily living vary by mild cognitive impairment subtype , 2010, Journal of the International Neuropsychological Society.

[20]  Ralph H. B. Benedict,et al.  Hopkins Verbal Learning Test—Revised: Normative data and analysis of inter-form and test–retest reliability. , 1998 .

[21]  Rachael D. Seidler,et al.  Bimanual coordination and aging: Neurobehavioral implications , 2010, Neuropsychologia.

[22]  R. Mccaffrey,et al.  Motor Tests and Cognition in Healthy Older Adults , 2009, Applied neuropsychology.

[23]  G. Fillenbaum,et al.  Mild Cognitive Impairment and 10‐Year Trajectories of Disability in the Iowa Established Populations for Epidemiologic Studies of the Elderly Cohort , 2005, Journal of the American Geriatrics Society.

[24]  Jean-François Dartigues,et al.  Natural History of Decline in Instrumental Activities of Daily Living Performance over the 10 Years Preceding the Clinical Diagnosis of Dementia: A Prospective Population‐Based Study , 2008, Journal of the American Geriatrics Society.

[25]  A. Kubo,et al.  Exploring the factor on sensory motor function of upper limb associated with executive function in communitydwelling older adults , 2016, Nagoya journal of medical science.

[26]  O. Okonkwo,et al.  Cognitive Correlates of Financial Abilities in Mild Cognitive Impairment , 2006, Journal of the American Geriatrics Society.

[27]  Suzanne G. Leveille,et al.  The Boston Rehabilitative Impairment Study of the Elderly: a description of methods. , 2013, Archives of physical medicine and rehabilitation.

[28]  Alan M Jette,et al.  Late Life Function and Disability Instrument: II. Development and evaluation of the function component. , 2002, The journals of gerontology. Series A, Biological sciences and medical sciences.

[29]  G. Jarnlo,et al.  Slowing of Alternating Forearm Movements Is Associated with Cognitive Impairment in Community-Dwelling Older People , 2010, Dementia and Geriatric Cognitive Disorders.

[30]  Dawn Iacobucci,et al.  Methods Dialogue Mediation analysis and categorical variables: The final frontier ☆ , 2012 .

[31]  Alan M Jette,et al.  Late life function and disability instrument: I. Development and evaluation of the disability component. , 2002, The journals of gerontology. Series A, Biological sciences and medical sciences.

[32]  A. Kurz,et al.  Progression to Dementia in Clinical Subtypes of Mild Cognitive Impairment , 2006, Dementia and Geriatric Cognitive Disorders.

[33]  D. Harvey,et al.  Longitudinal Changes in Memory and Executive Functioning are Associated with longitudinal change in instrumental activities of daily living in older Adults , 2009, The Clinical neuropsychologist.

[34]  J. Brandt,et al.  Construct and concurrent validity of the Hopkins Verbal Learning Test-revised. , 1999, The Clinical neuropsychologist.

[35]  T. Goldberg,et al.  Utility of combinations of biomarkers, cognitive markers, and risk factors to predict conversion from mild cognitive impairment to Alzheimer disease in patients in the Alzheimer's disease neuroimaging initiative. , 2011, Archives of general psychiatry.

[36]  M. Mittner,et al.  Association Between Executive Functions, Working Memory, and Manual Dexterity in Young and Healthy Older Adults , 2016, Perceptual and motor skills.

[37]  E. Tangalos,et al.  Mild Cognitive Impairment Clinical Characterization and Outcome , 1999 .

[38]  P. Mecocci,et al.  Influence of comorbidity and cognitive status on instrumental activities of daily living in amnestic mild cognitive impairment: results from the ReGAl project , 2008, International journal of geriatric psychiatry.

[39]  J. Touchon,et al.  Disability and mild cognitive impairment: a longitudinal population‐based study , 2001, International journal of geriatric psychiatry.

[40]  A. Hofman,et al.  Simple Test of Manual Dexterity Can Help to Identify Persons at High Risk for Neurodegenerative Diseases in the Community , 2017, The journals of gerontology. Series A, Biological sciences and medical sciences.

[41]  K. Ritchie.  Mild cognitive impairment: an epidemiological perspective , 2004, Dialogues in clinical neuroscience.

[42]  Suzanne G. Leveille,et al.  Mild cognitive impairment status and mobility performance: an analysis from the Boston RISE study. , 2014, The journals of gerontology. Series A, Biological sciences and medical sciences.

[43]  R. Petersen.  Clinical practice. Mild cognitive impairment. , 2011, The New England journal of medicine.