Sex Differences in the Rate of Decline in Activities of Daily Living in Individuals Diagnosed with Mild Cognitive Impairment and Alzheimer’s Disease

Nanako Hawley, University of South Alabama, Mobile, United States
Kaitlyn Kauzor, San Francisco VA Medical Center, San Francisco, United States
Jill Razani, California State University, Northridge, Northridge, United States


Neurocognitive disorders such as Alzheimer’s disease (AD), and those with mild cognitive impairment (MCI), result in declines in the ability to perform activities necessary for maintaining an independent lifestyle known as activities of daily living (ADL). Conversion rates from MCI to dementia have been found to be higher in individuals with baseline ADL impairment relative to individuals with typical functioning. Mixed results have been discovered pertaining to sex differences in performance of ADL with some studies finding greater deficits in men and others finding greater ADL impairment in women. The current project aims to examine the rates of decline in AD and MCI relative to healthy controls as well as sex differences in ADL decline in individuals diagnosed with MCI and AD.

Participants and Methods:

58 patients, 26 of whom were diagnosed with AD and 36 of whom were diagnosed with MCI were recruited from research medical centers in the greater Los Angeles area.  AD patients met the diagnostic criteria National Institute of Neurological and Communicative Diseases and Stroke-Alzheimer’s Disease and Related Disorders Association (NINCDS- ADRDA) criteria and those with MCI were diagnosed in accordance with Petersen et al. (2014) criteria.

Participants were administered the Direct Assessment of Functional Status (DAFS), an observation-based functional measure for the assessment of daily functional abilities. The DAFS examines 7 subscales/domains of functional abilities including time orientation, communication skills, transportation skills, financial skills, shopping skills, grooming skills, and eating skills. The DAFS reportedly has a Cohen’s kappa test-retest reliability for subscales ranging from .57- .92 and interrater reliability of .90 (Loewenstein et al., 1998). The DAFS was administered at baseline and again approximately one year later. The DAFS subscales were summed to form a total score and a rate of decline was calculated as percentage lost between year-1 and year-2 performance.  ANOVAs for both diagnostic groups were conducted to compare DAFS performance between males and females.


Univariate analyses were performed in which diagnosis (AD and MCI) and sex (males and females) were used as independent variables and the DAFS subscales were used as the dependent variables for each analysis. The results revealed that for the shopping subscale, the decline over the one-year period was greater for AD relative to the MCI patients, F (1, 54) = 4.64, p < .05.  For the financial subscale, a significant interaction between diagnosis x sex was found, F (1, 54) = 6.62, p < .01, such that the AD males’ performance on the financial task declined at a greater rate than that of MCI males. No other differences in a one-year decline were found for the other DAFS subscales.


The findings of the current study indicate that of all of the daily tasks, those which require memory functioning, such as shopping, a more rapid rate can be expected for AD relative to MCI patients.  Additionally, it appears that the ability to carry out functional tasks declines faster in males relative to females with AD, but this sex difference was not found for MCI.

Category: Dementia (Alzheimer's Disease)

Keyword 1: activities of daily living
Keyword 2: aging disorders