Review: Impairment of Instrumental ADL in Mild Cognitive Impairment

The paper reviewed here is ‘Impairment of Instrumental Activities of Daily Living in Patients with Mild Cognitive Impairment’ by Ahn and colleagues and freely available here. In the conclusion, the authors write that

The patients with MCI showed impairments in the ability to perform complex ADL in comparison to healthy controls. IADLS’s related to memory and frontal/executive functioning were particularly affected in MCI

The study was carried out in South Korea. The researchers have selected

  • 66 subjects with MCI (mean age 70.76 years)
  • 61 health controls (mean age 64 years)

Controls were recruited by advertisement whilst the recruitment method for the MCI group was unclear. The criterion used for MCI are clearly stipulated and include

  • Cognitive performance of 1.5 SD below the age and education norm in one or more of the following domains: memory, language, visuoconstruction, and frontal/executive function
  • Cognitive decline by self and/or informant reporting

The subjects were also administered a battery of neuropsychological tests including

  • Digit span forwards and backwards
  • Korean-Boston Naming Test
  • Rey-Kim Complex Figure TEST
  • Clock Drawing TEST
  • Contrasting Program, Go-no-go Test

amongst others. The study focused on the performance of MCI subjects on two measures of functioning – The Seoul Instrumental Activities of Daily Living (SIADL) and the Seoul Activities of Daily Living. About the SIADL, the researchers write that it assesses a number of functions and that

These include the ability to prepare a balanced meal, remember appointments, keep financial records, remember to take medication and so on

and is composed of 15 items. The primary research questions seems to be fairly straightforward – is there a difference between the MCI and control groups on the ADL’s? The researchers used a multivariate logistical regression analysis to investigate this relationship. They also wanted to find the optimal cut-off point for MCI and used a ROC curve for this purpose.

The MCI group scored significantly higher on the S-IADL than the control group (4.47 v 1.44) and this difference remained after controlling for variables including age. The S-IADL discriminated well between the control and MCI groups with a sensitivity and specificity of 82%. The researchers write that the

MCI patients showed significantly more impairment in the areas of ‘using the telephone’, ‘preparing meals’, ‘taking medication’, ‘managing belongings’, ‘keeping appointment’, ‘talking about recent events’, and ‘leisure/hobbies’ than normal elderly controls


Although these results are extremely encouraging I’m not sure if they generalise to the english version of the IADL and maybe another study with the English version needs to be undertaken. However the MCI group have a mean age of just over 70 years of age and again it would be unclear if this would generalise to a group in their early 60’s or late 50’s although the correction for age indicated that a significant difference between the groups remained.

There is an interesting question here which is about the precise nature of the relationship between the memory and executive components of the neuropsychological test battery and the performance on the IADL. Making a telephone call presumably involves a number of cognitive functions – motor cognition, working memory, episodic memory, auditory processing, attention and executive functions at the very least. Therefore if we could see which areas of the brain light up, during a telephone conversation (i.e fMRI) on the basis of the above we might expect to see the corresponding areas in the relevant order although it is never that simple. It might be expected that if some tasks require more cognitive functions they would be more susceptible to the effects of MCI – thus there might be a  hierarchy (although the individual tasks will vary in complexity).

More importantly from this study, this has implications for the workplace. If people have MCI and are working then this study suggests that it may interfere with a number of tasks around the workplace. If that is the case, then it would mean that assistive technologies may be useful. Furthermore the need for assistive technologies could be estimated from performance on a paper and pen test given the effective discrimination between the MCI and control groups (as MCI was assessed using the neuropsychological tests discussed above). It will be interesting to see if this study is replicated using an English version of the IADL.



You can find an index of the site here. The page contains links to all of the articles in the blog in chronological order.


You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link


You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast).

TAWOP Channel

You can follow the TAWOP Channel on YouTube by clicking on this link


If you have any comments, you can leave them below or alternatively e-mail


The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.


  1. You have an affecting point of view on this subject. I am happy you shared your thoughts and ideas and I find that I agree. I enjoy your clear writing and the effort you have put into this article. Thank you for the fine work and good luck with the site, I am looking forward to more updates.


  2. I love this website, the information is great and I have bookmarked it in my favorites. This is a well organized and informative website. Great Job!


  3. TWhen I first landed on the site, i was impressed by the layout and design. Once I started looking around, i found the information to be even better. Great Website.


  4. I appears that you’ve put a good amount of effort into your article and I require a lot more of these on the web these days. I sincerely got a kick out of your post. I do not have a bunch to to say in reply, I only wanted to register to say tremendous work.


  5. Incredibly practical post. Me and my neighbor were planning to perform a bit of study concerning that. We recieved a valuable guide on that matter via our own nearby library and most publications are not as descriptive as your info. I’m very grateful to see such information which I was searching for a while.


  6. Some of the points of this post are generally high-quality however had me wondering, did they truly imply that? One point I have to say is your publishing expertise are very very good and I will probably be returning back for any fresh post you make, you may well have a new enthusiast. I saved the web page for reference.


  7. My brother and I were just discussing this very topic, he’s invariably trying to prove me incorrect. Your view on this is perfect and just how I really feel. I just sent my brother this page to show him your view. After looking over your web site I book marked and will be returning to read your posts!


  8. I’ve been looking around on the web trying to find some ideas on how to get my personal blog coded, your overall style together with style are amazing. Did you actually code it your self or did you recruit a coder to do it on your behalf?


  9. Excellent blog site , I’ve discovered this insightful. A great deal of helpful information from it. I’m really considering the data on unhealthy weight. As well as tried taking lipobind intended for reducing fat ingestion? In any other case, do give it a shot. It’s effective to do. I’ve resulted in a url to. Thanks.


  10. I’ve been surfing online more than 3 hours today, yet I never found any interesting article like yours. It is pretty worth enough for me. Personally, if all site owners and bloggers made good content as you did, the internet will be a lot more useful than ever before.


  11. I think some other websites masters must consider this blog as an model, very clean and even terrific user friendly design and style, let alone the content. You can be an expert in this topic!


  12. Hi there! Someone in my Myspace group shared this website with us so I came to take a look. I’m definitely enjoying the information. I’m bookmarking and will be tweeting this to my followers! Terrific blog and fantastic design and style.


  13. This blog post gives the light in which we can observe the reality. this is very great one and gives indepth information. thank you for this great post! Yours trully, Zelma.


  14. I’ve been exploring for a little bit for any high-quality articles or blog posts on this kind of area . Exploring in Yahoo I ultimately stumbled upon this site. Reading this information So i am happy to exhibit that I have a very good uncanny feeling I discovered just what I needed.


  15. […] I run my own removals company and i must say i love your blog. i found your blog from google, one of my friends posted a link to this blog and thought i would view it. great stuff […]


  16. This is like my sixth time coming by your site. You should write more please, this information will help me and others. Try proof reading a couple of times before publishing. Keep writing though.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s