{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T01:45:32Z","timestamp":1785807932523,"version":"3.56.0"},"reference-count":55,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"NIHR Exeter Biomedical Research Centre"},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["BCA527734"],"award-info":[{"award-number":["BCA527734"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Gordie Howe Cares"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Alzheimer\u2019s Disease"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Functional independence is crucial for healthy aging, and its loss is a diagnostic criterion for dementia, including Alzheimer's disease. However, functional impairment (FI) can emerge before dementia diagnosis. Early and accurate characterization of FI may help identify individuals at elevated risk of cognitive decline and dementia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Exploring the utility of capturing persistent versus impersistent FI, to identify a higher-risk group for incident cognitive decline and dementia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      Data from 11,793 cognitively normal (CN) older adults from the National Alzheimer's Coordinating Center were analyzed. Exploratory factor analysis identified four Functional Activities Questionnaire items\u2014preparing hot drinks, preparing balanced meals, shopping, and traveling\u2014representing primarily functional abilities. An FI composite score was calculated as the sum of these items. Persistent FI was operationalized as FI present (composite score\u2009\u2265\u20092) at more than two-thirds of all visits prior to cognitive decline and dementia. Comparator groups were impersistent\/transient FI and no FI. Time-dependent covariate Cox models compared incidence of cognitive decline and dementia across time-dependent FI groups, adjusted for demographics,\n                      <jats:italic toggle=\"yes\">APOE<\/jats:italic>\n                      \u03b54 status, presence of neuropsychiatric symptoms, CDR sum of boxes, and informant characteristics (age, sex, relationship, cohabitation status).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The CN sample comprised 164 Persistent-FI (age\u2009=\u200975.7\u2009\u00b1\u200912.2; 59.1% female), 522 Transient-FI (age\u2009=\u200973.7\u2009\u00b1\u20099.5; 62.8% female), and 11,107 No-FI participants (age\u2009=\u200970.9\u2009\u00b1\u20098.9; 66.0% female). Persistent-FI was associated with a 2.12-fold greater incidence of cognitive decline and dementia versus No-FI (CI:1.80\u20132.51, p\u2009&lt;\u20090.001). Transient-FI showed no significant difference (HR\u2009=\u20091.14, CI:0.97\u20131.33, p\u2009=\u20090.107).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Operationalizing FI-related risk based on persistence is a promising approach to incorporation of FI into dementia prognostication.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13872877251406661","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T17:29:49Z","timestamp":1766424589000},"page":"1415-1427","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Persistent functional impairment as an early indicator of cognitive decline and dementia in cognitively normal older adults"],"prefix":"10.1177","volume":"109","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8063-713X","authenticated-orcid":false,"given":"Maryam","family":"Ghahremani","sequence":"first","affiliation":[{"name":"Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada"},{"name":"Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3956-1668","authenticated-orcid":false,"given":"Eric E.","family":"Smith","sequence":"additional","affiliation":[{"name":"Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada"},{"name":"Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada"},{"name":"Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5529-3731","authenticated-orcid":false,"given":"Zahinoor","family":"Ismail","sequence":"additional","affiliation":[{"name":"Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada"},{"name":"Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada"},{"name":"Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada"},{"name":"Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada"},{"name":"O\u2019Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada"},{"name":"Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2018.02.018"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/9.3_Part_1.179"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2007.01499.x"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13195-015-0099-0"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2010.04.005"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11065-016-9321-5"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1080\/13803395.2023.2249626"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000228228.70065.f1"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/JGP.0b013e31825c09bc"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1017\/S003329171000142X"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/gps.3865"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-170903"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2015.05.017"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000201517"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13024-023-00631-6"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.wad.0000213865.09806.92"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/WAD.0b013e318142774e"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/WAD.0b013e318191c7dd"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/geronj\/37.3.323"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/1073191121991215"},{"key":"e_1_3_3_22_2","article-title":"Persistence of neuropsychiatric symptoms and dementia prognostication: a comparison of three operational case definitions of mild behavioral impairment","volume":"15","author":"Guan DX","year":"2023","unstructured":"Guan DX, Smith EE, Pike GB, et al. 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