The Assessment of Functional Competence in a Clinical Sample of Older Adults along the Alzheimer’s Continuum

Aneela Rahman, Nadia Pare, Maureen Schmitter-Edgecombe, Reanne Cunningham, Lillian Behm, Ved Patel, Erica Schmidt, David E. Warren, Laura Rabin

Research output: Contribution to journalComment/debatepeer-review


Background: Difficulties in performing “Instrumental Activities of Daily Living” (IADL) such as managing finances and medications can lead to loss of independence among older adults. Performance-based assessments allow for an objective and systematic quantification of IADLs utilizing real life paradigms. In an ongoing NIA-funded study, we evaluated the association of a recently developed performance-based assessment of functional ability (Night Out Task, NOT, Schmitter-Edgecombe, 2021) with a performance-based measure of financial capacity and an informant-based measure of functional and decision-making capacity in non-demented older adults with varying degrees of cognitive impairment. Method: Participants (n = 22; mean age = 76) were classified as healthy control (HC, n = 4), subjective cognitive decline (SCD, n = 9), or mild cognitive impairment (MCI, n = 9) based on clinical criteria. The NOT was used to evaluate the ability to efficiently and accurately plan, multitask and complete eight activities in preparation for a night out. The primary outcome variable for the NOT was completion time. Additionally, participants completed the Financial Capacity Instrument (FCI-SF-short form), which assesses financial knowledge and problem-solving skills (Marson, 2015). Meanwhile, informants completed the Assessment of Functional Capacity Interview (AFCI; Pare et al., 2020) which captures decision making related to home safety, financial, medical, and social competence. Result: NOT scores were normally distributed, as assessed by Shapiro-Wilk’s test (p > 0.05). We observed a statistical trend for group on NOT completion time such that greater clinical impairment was associated with greater completion time: MCI (M = 916.38s, SD = 218.54) > SCD (M = 741.83s, SD = 212) > HC (M = 728.05s, SD = 167.45). Similar trends were observed for other NOT variables. Correct sequencing and overall efficiency of NOT tasks were negatively correlated with AFCI Financial domain, r(21) = -0.606 and r(21) = -0.487, both P <0.05, respectively. Overall NOT task accuracy was negatively correlated with FCI-SF Total Score, r(21) = -0.528, P <0.05. Conclusion: The NOT showed impressive associations with informant reports of functional and decision-making capacity and objectively assessed financial capacity. The NOT can potentially distinguish among healthy controls and preclinical dementia groups, offering promise for early detection and characterization of cognitive changes.

Original languageEnglish (US)
Article numbere067774
JournalAlzheimer's and Dementia
Issue numberS8
StatePublished - Dec 2022

ASJC Scopus subject areas

  • Epidemiology
  • Health Policy
  • Developmental Neuroscience
  • Clinical Neurology
  • Geriatrics and Gerontology
  • Cellular and Molecular Neuroscience
  • Psychiatry and Mental health


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