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The Cognitive Correlates of Functional Status: A Review From the Committee on Research of the American Neuropsychiatric Association

Received July 26, 2006; accepted August 7, 2006. Dr. Royall is affiliated with the Department of Psychiatry, University of Texas Health Science Center, San Antonio, Texas. Drs. Lauterbach and Coburn are affiliated with the Mercer University School of Medicine, Macon, Georgia. Dr. Kaufer is affiliated with the Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, North Carolina. Dr. Malloy is affiliated with Butler Hospital, Providence, Rhode Island. Dr. Black is affiliated with Washington University School of Medicine, St. Louis, Missouri. Address correspondence to Dr. Royall, Department of Psychiatry, UTHSCSA, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900; royall{at}uthscsa.edu (e-mail).

This report reviews the state of the literature and opportunities for research related to the cognitive correlates of functional status. The prediction of functional capacity on the basis of cognitive test performance is an important aspect of neuropsychological assessment. Moreover, functional impairment or "disability" is an essential part of dementia case finding. Nevertheless, relatively little attention has been given to the empirical study of the specific cognitive correlates of functional outcomes. What literature is available suggests that 1) the variance in functional status that can be specifically attributed to cognition is surprisingly modest; 2) some cognitive domains may be more relevant to functional capacity than others; 3) some measures of executive control function are relatively strong correlates of functional capacities, particularly medical or financial decision-making; and 4) "general" cognitive screening tests are surprisingly strong correlates of functional status. These findings are of particular significance to dementia case finding, epidemiology, and treatment. The extensive literature on functional status has yet to be integrated with the equally extensive literature on cognitive assessment. Better integration of cognitive and functional assessments would offer greater clinical utility. However, psychometric batteries may have to be redesigned to maximize their capacity to capture the variance in functional outcomes.

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