Skip to main content
    • Aa
    • Aa

Executive dysfunction correlates with impaired functional status in older adults with varying degrees of cognitive impairment

  • F. S. Pereira (a1), M. S. Yassuda (a1) (a2), A. M. Oliveira (a1) and O. V. Forlenza (a1)

Background: Previous studies have reported an association between executive dysfunction and the ability to perform activities of daily living (ADL)s among older adults. This study aims to examine the association between executive functions and functional status in a cross-section of older adults with varying degrees of cognitive impairment.

Methods: 89 individuals (mean age 73.8 years) were recruited at a memory clinic in São Paulo, Brazil. Subjects underwent evaluation, and were allocated into three diagnostic groups according to cognitive status: normal controls (NC, n = 32), mild cognitive impairment (MCI, n = 31) and mild Alzheimer's disease (AD, n = 26). Executive functions were assessed with the 25-item Executive Interview (EXIT25), and functional status was measured with the Direct Assessment of Functional Status test (DAFS-R).

Results: Significantly different total DAFS-R scores were observed across the three diagnostic groups. Patients with AD performed significantly worse in EXIT25 compared with subjects without dementia, and no significant differences were detected between NC and MCI patients. We found a robust negative correlation between the DAFS-R and the EXIT25 scores (r =–0.872, p < 0.001). Linear regression analyses suggested a significant influence of the EXIT-25 and the CAMCOG on the DAFS-R scores.

Conclusion: Executive dysfunction and decline in general measures of cognitive functioning are associated with a lower ability to undertake instrumental ADLs. MCI patients showed worse functional status than NC subjects. MCI patients may show subtle changes in functional status that may only be captured by objective measures of ADLs.

Corresponding author
Correspondence should be addressed to: Dr. Orestes V. Forlenza, Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, Rua Dr. Ovídio Pires de Campos, 785, 3rd floor, 05403-010 – São Paulo, S.P., Brazil. Phone: +55 11 3069–7924; Fax: +55 11 3085-5412. Email:
Hide All
American Psychiatric Association (1994). Diagnostic and Statistic Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association.
Argüelles S., Loewenstein D. A., Eisdorfer C. and Argüelles T. (2001). Caregivers’ judgments of the functional abilities of the Alzheimer's disease patient: impact of caregivers’ depression and perceived burden. Journal of Geriatric Psychiatry and Neurology, 14, 9198.
Army Individual Test Battery (1944). Manual of Directions and Scoring. Washington, DC: War Department.
Backman L., Jones S., Berger A. K., Laukka E. J. and Small B. J. (2004). Multiple deficits during the transition to Alzheimer's disease. Journal of Internal Medicine, 256, 195204.
Bell-McGinty S., Podell K., Franzen M., Baird A. D. and Williams M. J. (2002). Standard measures of executive function in predicting instrumental activities of daily living in older adults. International Journal of Geriatric Psychiatry, 17, 828834.
Binetti G., Magni E., Padovani A., Cappa S. F., Bianchetti A. and Trabucchi M. (1996). Executive dysfunction in early Alzheimer's disease. Journal of Neurology, Neurosurgery and Psychiatry, 60, 9193.
Blessed G., Tomlinson B. E. and Roth M. (1968). The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. British Journal of Psychiatry, 114, 797811.
Bottino C. M. C., Almeida O. P. and Tamai S. (1999). Entrevista Estruturada para Diagnóstico de Transtornos Mentais em Idosos. São Paulo: PROTER do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da USP.
Cahn-Weiner D. A., Malloy P. F., Boyle P. A., Marran M. and Salloway S. (2000). Prediction of functional status from neuropsychological tests in community-dwelling elderly individuals. Clinical Neuropsychologist, 14, 187195.
Cahn-Weiner D. A., Boyle P. A. and Malloy P. F. (2002). Tests of executive function predict instrumental activities of daily living in community-dwelling elderly individuals. Applied Neuropsychology, 9, 187191.
DeBettignies B. H., Mahurin R. K. and Pirozzolo F. J. (1990). Insight for impairment in independent living skills in Alzheimer's disease and multi-infarct dementia. Journal of Clinical and Experimental Neuropsychology, 12, 355363.
Diniz B. S. O. et al. (2007). Clinical and neuropsychological characterization of community-dwelling elderly patients assessed at a university based memory clinic. International Conference on Prevention of Dementia. Alzheimer's and Dementia, 3 (Suppl.), S138.
Erzigkeit H. (1991). The development of the SKT Project. In Hindmarch I., Hippius H. and Wilcock G. K. (eds.), Dementia: Molecules, Methods and Measures (pp. 101108). Chichester: Wiley.
Farias S. T., Mungas D., Reed B., Harvey D., Cahn-Weiner D. and DeCarli C. (2006). MCI is associated with deficits in everyday functioning. Alzheimer Disease and Associated Disorders, 20, 217223.
Flaks M. K. et al. (2006). The Short Cognitive Performance Test (SKT): a preliminary study of its psychometric properties in Brazil. International Psychogeriatrics, 18, 121133.
Folstein M. F., Folstein S. E. and McHugh P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Fuld P. (1980). Guaranteed stimulus processing in the evaluation of memory and learning. Cortex, 16, 255271.
Gill T. M., Richardson E. D. and Tinetti M. E. (1995). Evaluating the risk of dependence in activities of daily living among community-living older adults with mild to moderate cognitive impairment. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 50, 235241.
Hachinski V. C. et al. (1975). Cerebral blood flow in dementia. Archives of Neurology, 32, 632637.
Hamilton M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 5662.
Jorm A. F. and Jacomb P. A. (1989). The Informant Questionnaire on Cognitive Decline in the Elderly: sociodemographic correlates, reliability, validity and some norms. Psychological Medicine, 19, 10151022.
Lezak M. D., Howieson D. B. and Loring D. W. (2004). Neuropsychological Assessment, 4th edn. New York: Oxford University Press.
Lindeboom R., Vermeulen M., Holman R. and De Hann R. J. (2003). Activities of daily living instruments: optimizing scales for neurologic assessment. Neurology, 60, 738742.
Loewenstein D. A. and Bates C. B. (2006). The Direct Assessment of Functional Status Revised (DAFS-R). Manual for Administration and Scoring. Miami: Neuropsychological Laboratories and The Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center.
Loewenstein D. A., Amigo E. and Duara R. (1989). A new scale for the assessment of functional status in Alzheimer's disease and related disorders. Journal of Gerontology, 4, 114121.
Loewenstein D. A. et al. (2001). Caregivers’ judgments of the functional abilities of the Alzheimer's disease patient: a comparison of proxy reports and objective measures. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 56, 7884.
Loewenstein D. A. et al. (2006). Cognitive profiles on Alzheimers disease and mild cognitive impairment on different etiologies. Dementia and Geriatric Cognitive Disorders, 21, 309315.
Mann U. M., Mohr E., Gearing M. and Chase T. N. (1992). Heterogeneity in Alzheimer's disease: progression rate segregated by distinct neuropsychological and cerebral metabolic profiles. Journal of Neurology, Neurosurgery and Psychiatry, 55, 956959.
McKhann G., Drachman D., Folstein M., Katzman R., Price D. and Stadlan E. M. (1984). Clinical diagnosis of Alzheimer disease: Report of NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Service Task Force on Alzheimer Disease. Neurology, 34, 939944.
Nunes P. V. et al. (2008). CAMCOG as a screening tool for diagnosis of mild cognitive impairment and dementia in a Brazilian clinical sample of moderate to high education. International Journal of Geriatric Psychiatry, e-published ahead of print.
Oliveira R. and Schmidt S. L. (1999). Teste Comportamental de Memória de Rivermead. Rio de Janeiro: Cognição.
Peres K., Chrysostome V., Fabrigoule C., Orgogozo J. M., Dartigues J. F. and Barberger-Gateau P. (2006). Restriction in complex activities of daily living in MCI. Impact on outcome. Neurology, 67, 461466.
Perneczky R. et al. (2006). Complex activities of daily living in mild cognitive impairment: conceptual and diagnostic issues. Age and Ageing, 35, 240245.
Perry R. J. and Hodges J. R. (2000). Relationship between functional and neuropsychological performance in early Alzheimer disease. Alzheimer Disease and Associated Disorders, 14, 110.
Petersen R. C. (2004). Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 256, 183194.
Petersen R. C. and Negash S. (2008). Mild cognitive impairment: an overview. CNS Spectrums, 13, 4553.
Petersen R. C., Smith G. E., Waring S. C., Ivnik R. J., Tangalos E. G. and Kokmen E. (1999). Mild cognitive impairment: clinical characterization and outcome. Archives of Neurology, 56, 303308.
Roth M. et al. (1986). CAMDEX: a standardized instrument for the diagnosis of mental disorders in the elderly with special reference to early detection of dementia. British Journal of Psychiatry, 149, 698709.
Royall D. R., Mahurin R. K. and Gray K. (1992). Bedside assessment of executive cognitive impairment: the Executive Interview (EXIT25). Journal of the American Geriatrics Society, 40, 12211226.
Royall D. R., Palmer R., Chiodo L. K. and Polk J. M. (2005). Executive control mediates memory's association with change in instrumental activities of daily living: the Freedom House Study. Journal of the American Geriatrics Society, 53, 1117.
Royall D. R., Lauterbach E. C., Kaufer D., Malloy P., Coburn K. L. and Black K. J. (2007). The cognitive correlates of functional status: a review from the Committee on Research of the American Neuropsychiatric Association. Journal of Neuropsychiatry and Clinical Neurosciences, 19, 249265.
Rozzini L. et al. (2007).Conversion of amnestic Mild Cognitive Impairment to dementia of Alzheimer type is independent of memory deterioration. International Journal of Geriatric Psychiatry, 22, 12171222.
Sunderland T. et al. (1989). Clock drawing in Alzheimer's disease: a novel measure of disease severity. Journal of the American Geriatrics Society, 37, 725729.
Tabert M. H. et al. (2006). Neuropsychological prediction of conversion to Alzheimer disease in patients with mild cognitive impairment. Archives of General Psychiatry, 63, 916.
Teri L., Larson E. B. and Reifler B. V. (1988). Behavioral disturbance in dementia of the Alzheimer's type. Journal of the American Geriatrics Society, 36, 16.
van Hooren S. A., Van Boxtel M. P., Valentijn S. A., Bosma H., Ponds R. W. and Jolles J. (2005). Influence of cognitive functioning on functional status in an older population: 3- and 6-year follow-up of the Maastricht Aging Study. International Journal of Geriatric Psychiatry, 20, 883888.
Wechsler D. I. (1981). Examiner's Manual: Wechsler Adult Intelligence Scale-Revised. New York: Psychological Corporation.
Wilson B., Cockburn J. and Baddeley A. D. (1985). Rivermead Behavioural Memory Test. Suffolk: Thames Valley.
Yassuda M. S. et al. (2006). Preliminary analyses of the psychometric characteristics of the Rivermead Behavioral Memory Test (RBMT) as an early detection instrument for AD in Brazil, paper presented at Alzheimer's Association 10th International Conference on AD and Related Disorders. Alzheimer's and Dementia, 2 (Suppl.), S387.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 2
Total number of PDF views: 29 *
Loading metrics...

Abstract views

Total abstract views: 204 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st October 2017. This data will be updated every 24 hours.