Awareness of Functional Difficulties in Mild Cognitive Impairment: A Multidomain Assessment Approach

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Abstract
OBJECTIVES: To determine whether patients with mild cognitive impairment (MCI) are fully aware of and provide reliable estimates of their functional status. DESIGN: Controlled, matched‐samples, cross‐sectional study. SETTING: University medical and research centers. PARTICIPANTS: Fifty‐seven persons with amnestic MCI and 68 normal controls. MEASUREMENTS: The study examined accuracy of self‐report in MCI across five functional domains (driving, financial abilities, medication management, grocery shopping, and telephone use) by comparing patients' report of functioning with their performance on laboratory‐based measures of function. RESULTS: The discrepancy between self‐report and objective performance was significantly higher in patients with MCI than in their cognitively normal peers only on financial abilities. Patients with MCI overestimated their abilities on this functional domain. Patients with MCI also tended to overestimate their driving abilities, although this was not statistically significant. CONCLUSION: These findings provide evidence that awareness of functional difficulties is not a unitary construct; rather, it varies across functional domains. They also suggest that self‐report of functional abilities in MCI may be, on the whole, as accurate as in cognitively intact older adults. Even so, the self‐objective discrepancies noted for both study groups suggest that supplementing self‐reported information with objective functional assessment might improve detection of older adults who have begun to experience more functional restriction than is normal for age. In turn, timely identification would permit the targeted implementation of interventions that delay or forestall further deterioration in function.

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