Longitudinal changes in functional disability in Alzheimer's disease patients

Janssen Alzheimer Immunotherapy Research & Development, LLC, South San Francisco, California, USA.
International Psychogeriatrics (Impact Factor: 1.93). 02/2013; 25(6):1-9. DOI: 10.1017/S1041610212002360
Source: PubMed


Functional impairment is a core symptom of Alzheimer's disease (AD) often measured by loss of ability to perform activities of daily living (ADL). The objective is to describe the progressive loss of specific ADL functional capabilities expressed by AD patients' cognitive ability.

Data are from ELN-AIP-901, an observational study of cognitive progression in participants aged 50-85 with AD (n = 196), mild cognitive impairment (n = 70), or cognitively normal (n = 75). Participants were evaluated using the Mini-Mental Status Exam (MMSE) and the Disability Assessment for Dementia (DAD) every six months for ≤2 years. Hierarchical regression was used to estimate annual change in DAD and MMSE; first, by individuals' rate of change using linear regression, then controlling for baseline diagnosis.

Over a two-year period, in AD participants, a 1-point change in MMSE was associated with a 3-point change in DAD (2.79, 95% CI: 1.97-3.63); DAD items within the finance, medication, and outings subdomains were impacted earlier than other subdomains; a hierarchy of functional impairment was observed, with instrumental ADL generally impaired prior to basic ADL.

ADL are impacted in a progressive and hierarchical manner associated with cognitive decline, but substantial variability remains among individuals, as well as in the relative order of items affected.

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    • "Later, as cognitive decline advances in dementia, difficulties in BADL also occur. This late functional decline also follows a hierarchical order, with problems in personal hygiene and dressing generally debuting before problems in eating and transferring (Arrighi, et al., 2013; Delva, et al., 2014). "
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    ABSTRACT: The overall aim of this thesis was to provide new knowledge of everyday technology (ET) use and functioning over time, as perceived by persons with cognitive decline due to mild cognitive impairment (MCI). A secondary aim was to increase knowledge about their views on technology as part of and as potential support in everyday life. The first three studies build on longitudinal instrument-based data from a cohort of 37 older adults with MCI at inclusion. The fourth study included six participants from the same cohort to a qualitative interview study. In Study I special focus was placed on changes in the perceived ability to use ET and involvement in activities. Patterns of different aspects of functioning in everyday life were explored over two years using a person-oriented approach. Study II used a mixed-linear-effect model to examine ET use over two years. Five predefined assumptions were tested regarding factors potentially influencing the amount of ET used. In Study III longitudinal involvement over four years in 15 everyday activities was investigated using differential item functioning. Furthermore, associations over time of perceived ability in ET use and overall perceived activity involvement was examined. Study IV used a grounded theory approach to explore how persons with MCI relate to technology as a part of and potential support in present and future everyday life. The findings in Study I suggest an even distribution between a stable/ascending, a fluctuating, and a descending pattern of functioning the two first years after detection of MCI, with the highest conversion to dementia (58%) in the descending pattern. Perceived ability to use ET fluctuated or descended in 50% of the sample. Study II found a significant decrease in the overall amount of ET used over two years, but the number of users of specific ETs both decreased and increased. Less perceived ability in ET use, less activity involvement, declining cognitive state, and belonging to an older age group predicted use of less ET, while diagnostic state and length of education were non-significant factors. Study III showed that overall activity involvement decreased significantly over four years. Descending involvement was found in seven of fifteen activities. All leisure activities descended. The positive correlations between activity involvement and perceived ability in ET use became stronger over time. In Study IV the findings describe the participants’ different ways of relating to existing and potential future technology in everyday occupations as a continuum of downsizing, retaining, and updating. In connection with the participants’ actions and assumptions in relation to technology and doing, trade-offs between desired and adverse outcomes were made, challenging take-off runs were endured, and negotiations took place of the price worth paying. In conclusion, the findings show that although overall activity involvement as well as the amount of ET used decreased significantly over time on a group level in this sample with MCI at inclusion, variations across activities, individuals and time-points were present. This means that the need for support in ET use is individual and likely to alter over time in persons with MCI. Therefore repeated evaluations of activity involvement and ability to use ET is suggested to facilitate timely interventions during cognitive decline due to MCI, not forgetting the area of leisure. Already-incorporated ETs may serve as a platform for support in daily life for this group.
    05/2015, Degree: Doctoral degree (Ph.D), Supervisor: Louise Nygård, Anders Kottorp & Ove Almkvist
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    • "These five variables explained 30.8% of the ADL score for the elderly with probable dementia. Arrighi et al. (2013) concluded that ADL are impacted in a progressive and hierarchical manner associated with cognitive decline, but substantial variability remains among individuals, as well as in the relative order of items affected. In addition to demographic factors, disease duration, and depression, neuropsychological variables are valuable predictors of functional status in Alzheimer's patients in an early disease stage (Benke et al., 2013). "
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    ABSTRACT: Few studies have investigated in detail which factors influence activities of daily living (ADL) in adults with intellectual disabilities (ID) comorbid with/without dementia conditions. The objective of the present study was to describe the relation between early onset dementia conditions and progressive loss of ADL capabilities and to examine the influence of dementia conditions and other possible factors toward ADL scores in adults with ID. This study was part of the "Healthy Aging Initiatives for Persons with an Intellectual Disability in Taiwan: A Social Ecological Approach" project. We analyzed data from 459 adults aged 45 years or older with an ID regarding their early onset symptoms of dementia and their ADL profile based on the perspective of the primary caregivers. Results show that a significant negative correlation was found between dementia score and ADL score in a Pearson's correlation test (r=-0.28, p<0.001). The multiple linear regression model reported that factors of male gender (β=4.187, p<0.05), marital status (β=4.79, p<0.05), education level (primary: β=5.544, p<0.05; junior high or more: β=8.147, p<0.01), Down's syndrome (β=-9.290, p<0.05), severe or profound disability level (β=-6.725, p<0.05; β=-15.773, p<0.001), comorbid condition (β=-4.853, p<0.05) and dementia conditions (β=-9.245, p<0.001) were variables that were able to significantly predict the ADL score (R(2)=0.241) after controlling for age. Disability level and comorbidity can explain 10% of the ADL score variation, whereas dementia conditions can only explain 3% of the ADL score variation in the study. The present study highlights that future studies should scrutinize in detail the reasons for the low explanatory power of dementia for ADL, particularly in examining the appropriateness of the measurement scales for dementia and ADL in aging adults with ID.
    Research in developmental disabilities 01/2014; 35(3). DOI:10.1016/j.ridd.2013.12.015 · 4.41 Impact Factor
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    ABSTRACT: Background: Knowledge of functional evolution in dementia is crucial for the patients and their families and for clinician. Objective: This review identifies scales and outcomes used to describe the natural history of functional decline and describes the natural history of functional decline in a representative clinical and population sample of published studies of patients with Alzheimer's disease (AD). Methods: A search of three relevant databases was conducted and limited to articles published in English and French between 1998 to March 2012, using the keywords "Dementia", "Activities of Daily Living", "Instrumental Activities of Daily Living", "Functional Impairment", "Prognosis", and "Disease Progression". Results: The search strategy displayed 683 articles, 20 of which were found to be related to the functional evolution of AD. In these studies, different scales were used to describe the evolution of the functional decline, except for the decline of instrumental activities, for which the Lawton scale was used in all studies. Thus, it is difficult to represent the evolution of the functional decline from a clinical point of view. Conclusion: Relatively little data are available to estimate the functional evolution of AD. A consensus with broaden thought is required to know if the progression of the incapacities in these scales is additive or hierarchical.
    Journal of Alzheimer's disease: JAD 12/2013; 40(1). DOI:10.3233/JAD-131862 · 4.15 Impact Factor
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