European geriatric medicine · 2026
Prognostic factors for functional decline in community-dwelling older adults with dementia: a systematic review and meta-analysis.
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Riis Johannes, Melgaard Dorte, Gunmalm Victoria, Petersen Kirsten Schultz, Jørgensen Martin Grønbech, Andersen Stig
Аннотация
BACKGROUND: Identifying prognostic factors of ADL decline in community-dwelling older adults with dementia may clarify individual variability and support person-centered prognostication. This systematic review and meta-analysis aimed to review independent prognostic factors for ADL decline in this population.
METHODS: We searched PubMed, EMBASE, Cochrane CENTRAL, CINAHL, and PsycINFO from inception to October 2025. Eligible longitudinal studies enrolled community-dwelling adults ≥65 years with dementia. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Risk of bias was assessed using the Quality in Prognostic Studies tool. Meta-analyses and GRADE were applied to predictors reported in ≥3 studies with sufficient heterogeneity.
RESULTS: We screened 6,915 records; reviewed 100 full texts and included 19 reports from 13 studies (9,490 participants). Risk of bias was frequently high for selection (16/19) and attrition (14/19), often due to poor reporting. A wide range of prognostic factors were reported but only age, global cognitive function by MMSE, sex, education, and living alone were examined consistently enough to allow meta-analysis. Age and education showed no significant effect (SMD: 0.0, 95% CI 0.0-0.1 for age, 0.00, 95% CI: -0.02 to 0.02 for years of education; moderate certainty for both). Better baseline cognition predicted slower ADL decline (SMD -0.05, 95% CI -0.06 to -0.04; moderate certainty). Confidence in results for sex and living alone was very low and inconsistent.
CONCLUSION: In community-dwelling older adults with dementia, baseline cognition-but not age or education-predicts ADL decline. The limited and heterogeneous evidence highlights the need for more high-quality longitudinal research.
PROTOCOL REGISTRATION: PROSPERO: CRD42024502839.
METHODS: We searched PubMed, EMBASE, Cochrane CENTRAL, CINAHL, and PsycINFO from inception to October 2025. Eligible longitudinal studies enrolled community-dwelling adults ≥65 years with dementia. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Risk of bias was assessed using the Quality in Prognostic Studies tool. Meta-analyses and GRADE were applied to predictors reported in ≥3 studies with sufficient heterogeneity.
RESULTS: We screened 6,915 records; reviewed 100 full texts and included 19 reports from 13 studies (9,490 participants). Risk of bias was frequently high for selection (16/19) and attrition (14/19), often due to poor reporting. A wide range of prognostic factors were reported but only age, global cognitive function by MMSE, sex, education, and living alone were examined consistently enough to allow meta-analysis. Age and education showed no significant effect (SMD: 0.0, 95% CI 0.0-0.1 for age, 0.00, 95% CI: -0.02 to 0.02 for years of education; moderate certainty for both). Better baseline cognition predicted slower ADL decline (SMD -0.05, 95% CI -0.06 to -0.04; moderate certainty). Confidence in results for sex and living alone was very low and inconsistent.
CONCLUSION: In community-dwelling older adults with dementia, baseline cognition-but not age or education-predicts ADL decline. The limited and heterogeneous evidence highlights the need for more high-quality longitudinal research.
PROTOCOL REGISTRATION: PROSPERO: CRD42024502839.