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

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.