Conventional dichotomous classifications of cognitive status in older adults (normal vs impaired) may obscure distinct domain-specific deficits. Identifying nuanced cognitive profiles could enable personalized interventions, particularly when tailored to instrumental activities of daily living (IADLs).

To identify distinct cognitive profiles in older adults without dementia and assess their associations with overall and domain-specific IADL performance.

Cross-sectional data from 2,219 adults aged ≥65 years without dementia in the nationally representative National Health and Aging Trends Study.

Latent profile analysis classified participants across six cognitive domains: episodic memory, executive function, orientation, psychomotor function, visual attention, and working memory. Logistic and linear regression models with Holm-Bonferroni corrections evaluated relationships between cognitive profiles and IADL performance.

Five profiles emerged: Profile 1: Overall intact (50.5% of participants); Profile 2: Isolated moderate orientation impairment (15.6%); Profile 3: Mild global impairment with preserved orientation (22.0%); Profile 4: Mild global impairment with significant orientation impairment (5.5%); Profile 5: Moderate global impairment (6.2%). Compared with Profile 1, all other profiles exhibited significantly higher overall IADL difficulty and were more likely to experience challenges with shopping, medication management, meal preparation, and banking (all adjusted p < 0.05). Profile 4 had the highest odds for difficulties with shopping (OR, 2.19; 95% CI, 1.41-3.38; adjusted p = 0.005) and banking (OR, 3.98; 95% CI, 2.62-6.04; adjusted p < 0.001), whereas Profile 5 showed the greatest risk for medication management (OR, 2.55; 95% CI, 1.66-3.90; adjusted p < 0.001) and meal preparation (OR, 2.22; 95% CI, 1.49-3.31; adjusted p = 0.001).

Nearly half of older adults without dementia exhibit distinct cognitive profiles warranting tailored interventions. Profile 5 requires comprehensive strategies, whereas Profiles 2, 3, and 4 may benefit from orientation-targeted and intensity-varied training in other cognition domain. Incorporating specific IADL tasks (e.g., meal preparation, medication management for Profile 5 and shopping, banking for Profile 4) into cognitive interventions may concurrently enhance cognitive health and functional independence.