Think about your morning routine: maybe you check your phone, brew coffee, shower, and head out the door. These seemingly simple tasks actually require different levels of brain power. Some are complex (managing your calendar or paying bills online), others are more routine (making breakfast), and some are so automatic you barely think about them (brushing your teeth). What many people don’t realize is that Alzheimer’s disease affects these different types of daily activities in a surprisingly predictable order.
What Are the Three Types of Daily Activities?
A recent study by Henríquez and colleagues (2024) gives us fascinating insights into this pattern by following 138 older adults in Latin America through different stages of cognitive decline. The researchers wanted to understand not just how daily living skills change as Alzheimer’s progresses, but also which parts of the brain are responsible for these changes.
The team looked at three categories of daily activities. Advanced activities include things like managing finances, using technology, or handling complex social situations — the mentally demanding stuff that requires planning and problem-solving. Instrumental activities cover practical skills like cooking, shopping, or taking medications — tasks that keep you independent but aren’t quite as cognitively complex. Basic activities are the fundamental self-care skills like bathing, dressing, or eating.
How Alzheimer’s Daily Activities Decline Over Time
Here’s what they discovered: these skills decline in a specific hierarchy. Advanced activities go first, then instrumental ones, and finally basic self-care abilities. People in the earliest stages — those with mild memory concerns or what doctors call mild cognitive impairment — mainly struggled with the advanced tasks. They might have trouble figuring out a new smartphone app or managing their investment portfolio, but they could still cook dinner and take care of their personal hygiene just fine. Only when Alzheimer’s progressed to full dementia did people need help with all three types of activities.
The violin plots below show impairment scores across three groups — those with subjective cognitive complaints (SCC), mild cognitive impairment (MCI), and Alzheimer’s disease dementia (ADD) — for each type of daily activity. A wider shape means more people scored at that level. Notice how basic self-care (BADL) stays near zero for SCC and MCI, while advanced activities (AADL) show decline much earlier.
Figure 1. Total and domain-specific T-ADLQ scores across groups, showing basic (BADL), instrumental (IADL), advanced (AADL), and total daily living activity impairment scores for SCC, MCI, and ADD groups (n = 138).
Source: Henríquez F, Riquelme P, Forno G, et al. Activities of daily living and their neural correlates across the Alzheimer’s disease continuum: Evidence from a Latin American cohort. Alzheimer’s & Dementia. 2026;22:e71445. https://doi.org/10.1002/alz.71445. Licensed under CC BY 4.0.
Which Brain Regions Control Daily Activities?
What makes this study particularly compelling is that the researchers also used brain imaging to see which areas of gray matter (the brain tissue packed with nerve cells) were linked to each type of skill. They found that different but overlapping brain regions support each category of daily activities, which helps explain why they decline in this predictable order.
This isn’t entirely surprising to those of us who work in neuropsychology, but it’s the first time someone has mapped out this progression so clearly in a Latin American population. Most research on Alzheimer’s has focused on North American or European groups, so understanding how these patterns show up across different cultures and backgrounds is crucial for providing better care worldwide.
What This Means for Caregivers
So why does this matter for you and your family? If you’re caring for someone with memory concerns, this research suggests you can expect certain changes before others. Early on, you might notice your loved one having trouble with complex tasks like online banking or learning new technology, while their ability to cook familiar meals or maintain their personal care remains intact. This knowledge can help you plan ahead and focus your support where it’s most needed.
The study also highlights something important for healthcare providers: assessing advanced daily living skills might help identify cognitive problems earlier than traditional memory tests. When someone starts struggling with complex tasks but can still handle routine activities, it might be an early warning sign worth investigating.
Understanding this progression can actually be empowering. Instead of feeling overwhelmed by uncertainty, families can anticipate what types of support might be needed and when. It also reminds us that even as some abilities decline, others remain strong for quite some time — preserving dignity and independence in the areas that matter most.
The brain’s remarkable complexity means that Alzheimer’s doesn’t flip a switch and suddenly take everything away. Instead, it follows patterns we’re beginning to understand, giving us valuable time to adapt, plan, and focus on maintaining quality of life for as long as possible.
Advanced Neuropsychology and Psychology Services, PLLC (ADVNPS) offers neuropsychological evaluations to assist in identifying the nature and scope of one’s neurocognitive difficulties, as well as the functional impact of any identified deficits. For information on neuropsychological evaluations at ADVNPS, start here.
Reference
Henríquez et al. (2026). Activities of daily living and their neural correlates across the alzheimer’s disease continuum: evidence from a latin american cohort.. Alzheimer’s & dementia : the journal of the Alzheimer’s Association. https://doi.org/10.1002/alz.71445