Early identification of cognitive impairment in older adults from Advanced Activities of Daily Living (AADL): A scoping review

Abstract

Objectives: Rapid technological advancements and societal shifts have reshaped older adults’ daily lives. Emerging evidence suggests that Advanced Activities of Daily Living (AADL)—complex tasks beyond basic Activities of Daily Living (ADL) and Instrumental ADL (IADL)—may signal cognitive impairment earlier than traditional measures. This scoping review aims to identify AADL that could serve as early indicators of cognitive impairment. Study design: Scoping review. Methods: This review followed Arksey and O'Malley's framework and adhered to the PRISMA-ScR guideline. We systematically searched Web of Science, PubMed, and PsycINFO for relevant studies published between 2013 and 2023. Results: From 16,185 initially identified articles, 45 studies conducted across 11 countries were included after thorough screening and eligibility assessment. These studies examined eight domains of AADL (e.g., digital technology use, social engagement, cultural activities, naturalistic driving), across cognitive impairment stages from mild cognitive impairment (MCI) to dementia. Findings highlighted that frequent engagement in certain leisure, social, and intellectually stimulating activities (e.g., reading, playing board games, volunteering) was consistently associated with a reduced risk of cognitive decline. Digital behavioural indicators (e.g., computer usage patterns, naturalistic driving metrics, survey response times) showed promising predictive potential for early cognitive impairment identification, with several studies reporting good predictive accuracy (e.g., AUC >0.80). Conclusions: AADL indicators hold promise for early detection and potential prevention of cognitive impairment among older adults. Future research should explore the feasibility, acceptability, and clinical integration of AADL assessments into routine geriatric care and public health practice, particularly in low- and middle-income countries.