Performance-Based Measures of Executive Function through Instrumental Activities of Daily Living: Systematic Review for early detection of Mild Cognitive Impairment

Abstract Background Subtle impairments in instrumental activities of daily living (IADLs) and executive dysfunction are key features in the early stages of cognitive decline and mild cognitive impairment (MCI). Higher level cognitive functions, such as planning and decision-making, are essential for complex IADLs including driving and managing finances. Early detection of MCI enables timely intervention and planning. While traditional cognitive assessments and carer or self-reporting questionnaires provide valuable insights, performance-based IADL measures may offer greater ecological validity and earlier detection of subtle functional deficits. This systematic review aimed to (i) examine existing evidence on performance-based measures that assess executive function through IADL activities in older adults and (ii) evaluate their effectiveness in identifying MCI. Methods From an initial 378 peer reviewed articles, fifteen studies met the predefined inclusion criteria, and underwent full-text analysis. Two reviewers independently, screened studies and conducted quality assessments using the Mixed Methods Appraisal Tool. Eligible studies involved quantitative evaluations of IADL performance in community-dwelling older adults, with a focus on executive function and MCI. Results Tools such as the PASS, STAM, Home-MET, DAFS-R, and FUCAS effectively differentiated individuals with MCI from cognitively healthy peers These assessments showed moderate to strong correlations with executive function like planning, inhibition, set shifting and working memory. Error analysis during task performance also offered insight into their functional ability. Financial management, medication use, and multi-step planning were particularly sensitive indicators. However, limitations included methodological variability, high education levels and under representation of non-amnestic MCI subtypes. Conclusion Performance-based IADL tools show promise for the early identification of MCI by offering ecologically valid insights into executive dysfunction and moving beyond traditional assessments to reflect real-world cognitive demands, while also aligning with person-centred care by focusing on meaningful, everyday abilities and challenges.