CLINICAL DIAGNOSES AND DISABILITY IN COGNITIVELY IMPAIRED OLDER PERSONS

A sample of 126 elderly persons with cognitive impairment who were liv ing in the community were clinically assessed for severity on a range of illnesses: somatic, psychiatric, neurodegenerative. At the same tim e, their disability was examined by self-report and via informant repo rt. The domains of disability that were investigated were personal car e, instrumental activities and social functioning. The key findings we re that most of the variation in disability in each domain was account ed for by the clinical diagnoses. Analysis of informant data (N = 90) showed that social functioning was affected by behavioural impairment and depression, performance in instrumental activities was affected by extrapyramidal gait disorder, cognitive impairment, behavioural impai rment and depression, while personal care was affected by extrapyramid al gait disorder, cognitive impairment, depression and arthritis. Simi lar results were obtained with subject data (N = 126) on scales of ins trumental activities and personal care: disability in instrumental act ivities was associated with diagnoses of extrapyramidal gait disorder, cognitive impairment, behavioural impairment and stroke, while person al care was affected by extrapyramidal gait disorder, peripheral vascu lar disease and stroke. In this population, neuropsychiatric disturban ces (disorders of cognition, behaviour and mood) and extrapyramidal ga it disorders are major independent predictions of disability. Somatic disorders have a lesser impact.