{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T09:03:05Z","timestamp":1780390985551,"version":"3.54.1"},"reference-count":13,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Alzheimer\u2019s Disease"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>Early identification of Alzheimer's disease remains restricted due to overreliance on cognitive testing and biomarker accessibility. The study by Ghahremani et al. demonstrates that persistent, however not transient, functional impairment in cognitively normal older adults robustly predicts incident cognitive decline and dementia. This commentary positions their findings within social, behavioral, and public-health frameworks, emphasizing functional trajectories as ecologically valid, scalable markers of preclinical disease. By operationalizing function through persistence over time, this work advances dementia projections beyond cross-sectional assessment and supports integration of functional monitoring into population-level prevention, clinical trials, and equity-focused early detection strategies.<\/jats:p>","DOI":"10.1177\/13872877261438521","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T14:44:17Z","timestamp":1775486657000},"page":"985-987","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Persistent functional impairment as a preclinical signal of Alzheimer's disease: Advancing dementia prognostication through the natural history of function"],"prefix":"10.1177","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6989-8941","authenticated-orcid":false,"given":"Donna","family":"de Levante Raphael","sequence":"first","affiliation":[{"name":"Alzheimer's Foundation of America (AFA) Department: Research"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,6]]},"reference":[{"key":"e_1_3_3_2_2","first-page":"11","article-title":"An examination of instrumental activities of daily living assessment in older adults and mild cognitive impairment","volume":"37","author":"Gold DA","year":"2015","unstructured":"Gold DA. An examination of instrumental activities of daily living assessment in older adults and mild cognitive impairment. J Clin Exp Neuropsychol 2015; 37: 11\u201334.","journal-title":"J Clin Exp Neuropsychol"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13195-015-0099-0"},{"key":"e_1_3_3_4_2","first-page":"2737","article-title":"Impairment in instrumental activities of daily living with high cognitive demand is an early marker of mild cognitive impairment","volume":"46","author":"Reppermund S","year":"2016","unstructured":"Reppermund S, Brodaty H, Crawford JD, et al. Impairment in instrumental activities of daily living with high cognitive demand is an early marker of mild cognitive impairment. Psychol Med 2016; 46: 2737\u20132748.","journal-title":"Psychol Med"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/13872877251406661"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2019.04.001"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2014.10.038"},{"key":"e_1_3_3_8_2","first-page":"1136","article-title":"Toward a theory-based specification of functional decline in Alzheimer\u2019s disease","volume":"16","author":"Sikkes SAM","year":"2020","unstructured":"Sikkes SAM, Tang Y, Jutten RJ, et al. Toward a theory-based specification of functional decline in Alzheimer\u2019s disease. Alzheimers Dement 2020; 16: 1136\u20131145.","journal-title":"Alzheimers Dement"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13024-023-00631-6"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2018.02.018"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000004826"},{"key":"e_1_3_3_12_2","article-title":"Alzheimer\u2019s disease neuroimaging initiative. Adding cognition to AT(N) models improves prediction of cognitive and functional decline","volume":"13","author":"O'Shea DM","year":"2021","unstructured":"O'Shea DM, Thomas KR, Asken B, et al. Alzheimer\u2019s disease neuroimaging initiative. Adding cognition to AT(N) models improves prediction of cognitive and functional decline. Alzheimers Dement 2021; 13: e12174.","journal-title":"Alzheimers Dement"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/braincomms\/fcae043"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1041610224000590"}],"container-title":["Journal of Alzheimer\u2019s Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13872877261438521","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/13872877261438521","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13872877261438521","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T08:14:51Z","timestamp":1780388091000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/13872877261438521"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,6]]},"references-count":13,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1177\/13872877261438521"],"URL":"https:\/\/doi.org\/10.1177\/13872877261438521","relation":{},"ISSN":["1387-2877","1875-8908"],"issn-type":[{"value":"1387-2877","type":"print"},{"value":"1875-8908","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,6]]}}}