Cognitive Correlates of Instrumental Activities of Daily Living Performance in Parkinson Disease Without Dementia

Arch Rehabil Res Clin Transl. 2021 Jul 3;3(3):100138. doi: 10.1016/j.arrct.2021.100138. eCollection 2021 Sep.

Abstract

Objective: To investigate cognitive correlates of instrumental activities of daily living (IADL) performance among people with Parkinson disease (PD) without dementia.

Design: Cross-sectional.

Setting: Academic medical center.

Participants: Volunteer sample (N=161) comprising participants with PD without dementia (n=102) and healthy comparison (HC) participants (n=59).

Interventions: Not applicable.

Main outcome measures: Performance-based assessment of cognitively-demanding IADL (meal preparation, bill paying, shopping, medication management, small home repair), neuropsychological tests (attentional control/flexibility, planning, working memory, memory, crystallized intelligence), and measures of motor function and other characteristics (eg, depressive symptoms).

Results: There were no group differences in neuropsychological test performance (P>.06). The PD group performed more poorly than the HC group on a number of cognitive IADL tasks (P<.04). After accounting for the effects of motor impairment and other disease-related characteristics, neuropsychological test performance accounted for a small but unique portion of the variance in performance of all cognitive IADL combined, meal preparation, shopping, and medication management in the PD group (R 2=4%-13%; P≤.01).

Conclusions: The PD group had cognitive IADL performance limitations despite being unimpaired on neuropsychological tests. Within PD, neuropsychological test performance accounted for a small but significant portion of the variance in cognitive IADL performance over and above the effects of motor and other impairments. These results support the added value of using performance-based IADL assessments in functional evaluations of individuals with early and mild PD without dementia.

Keywords: Activities of daily living, Cognition; CANTAB, Cambridge Neuropsychological Test Automated Battery; HC, healthy comparison; IADL, instrumental activities of daily living; IED, Intra-Extra Dimensional Set Shift test; MMSE, Mini Mental Status Examination; PAL, Paired Associates Learning; PASS, Performance Assessment of Self-care Skills; PD, Parkinson disease; Parkinson disease; Rehabilitation; SOC, Stockings of Cambridge; SWM, spatial working memory; UPDRS, Unified Parkinson's Disease Rating Scale; WTAR, Wechsler Test of Adult Reading.