Alzheimer's Disease Cooperative Study: detailed assessment of activities of daily living in moderate to severe Alzheimer's disease

Department of Neurology, V127, University of California, San Diego, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
Journal of the International Neuropsychological Society (Impact Factor: 2.96). 08/2005; 11(4):446-53. DOI: 10.1017/S1355617705050502
Source: PubMed


Patients with Alzheimer's Disease (AD) who have reached a stage of moderate to severe dementia are capable of completing a restricted range of cognitive tests and performing a limited range of activities of daily living (ADL). As part of an initiative to develop instruments to evaluate AD, we analyzed data describing the performance of a large number of ADL and scores on cognitive and global assessment measures in a cohort of patients with AD with moderate to severe cognitive impairment, defined as a Mini-Mental State Examination score ranging from 0-15 (out of 30). From the large pool of ADL, 19 met criteria of applicability, reliability, good scaling, concordant validity, and sensitivity to detect change in performance over 6-12 months. A total score derived from these 19 ADL ratings, comprising a scale termed the Alzheimer Disease Cooperative Study ADL-sev, correlated strongly with measures of cognition and of global dementia severity. Patients with moderate to severe AD showed a decline on the ADL-sev and cognitive measures over 6 and 12 months, consistent with the progression of AD. Detailed evaluation of ADL may provide a useful index to evaluate patients with moderate to severe AD and may complement cognitive assessment, especially for characterizing change in interventional or therapeutic studies.

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    • "One study suggested that basic ADL performance deteriorated predominantly during the later stages of dementia (Pocnet et al., 2013). In the absence of comparable literature that investigates each stage of dementia separately (Ostbye et al., 1997; Galasko et al., 2005), understanding how individual ADL performance varies across the course of the degenerative disease is important as the basis for developing non-pharmacological interventions that are specific to each dementia stage, with different foci. Interventions that assist community-dwelling PwD to retain their independence and which help alleviate carer stress could be beneficial and may also reduce care costs by delaying long-term care admission. "
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    ABSTRACT: Background: Performing basic activities of daily living (ADLs) is one of the major difficulties encountered in dementia, which can have considerable negative impacts on the quality of life (QoL) of people with dementia (PwD). However, the extent to which basic ADL performance deteriorates across mild, moderate, and severe dementia is little examined and its impact, together with depression and neuropsychiatric behavior, upon QoL, is of considerable relevance across European countries. Methods: Data were drawn from people living in the community who were participants in a large-scale European study on transition from community living to care homes of PwD. PwD completed measures on cognitive functioning and QoL, and informal carers reported upon QoL, depressive symptomatology, psychopathology, and functional ability of the PwD. Results: ADL performance deteriorated differently for each activity. In particular, toileting, transfer, and feeding remained relatively intact throughout, whereas performance on bathing and dressing deteriorated to a greater extent from mild to severe dementia. It appears that continence was not affected by the stage of dementia with similar levels of impairment. Basic ADL performance impacted to different degrees on QoL across dementia stages and countries. Conclusions: Interventions aimed at maintaining independence or QoL need to target different ADLs across different dementia stages and perhaps also tailor interventions to the context of different countries. Findings contribute to the development of non-pharmaceutical interventions and governmental pledges to promote independence in dementia.
    International Psychogeriatrics 05/2014; 26(8):1283-1293. DOI:10.1017/S1041610214000775 · 1.93 Impact Factor
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    • "The moderate-severe AD subjects show that cognitive and functional abilities and social interactions are severely reduced, their capacity to perform instrumental activities of daily life (IADLs) is impaired, and only some ADLs may be still carried out. Bathing and toileting usually need aid [34] and obviously these subjects are those requiring more care and resources. For treating AD at this stage the only approved treatments are memantine (worldwide) and donepezil (in the USA). "
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    ABSTRACT: Background: Acetylcholinesterase (AChE)/cholinesterase (ChE) inhibitors (Is) and memantine are licensed for symptomatic treatment of mild-moderate and moderate-severe forms of Alzheimer's disease (AD), respectively. High doses of the AChE-I donepezil were licensed in the USA for moderate-severe AD, and the association AChE/ChE-Is plus memantine was proposed for AD at this stage. Objectives: This paper has reviewed evidence from clinical trials of the effectiveness of memantine, donepezil, or the two drugs in association in managing moderate-severe AD. Method: Double-blind, placebo-controlled randomized trials (RCTs) using memantine or donepezil alone or in association versus placebo in moderate-severe AD were reviewed. Analysis done in January 2013 considered the years 2007-2012. Results and conclusion: Only 83 of the 941 papers selected were considered relevant, and only 13 met the criterion of "adequacy and representativeness." Memantine and donepezil lead to improvements in moderate-to-severe AD and the choice between the compounds should be based on their contraindications more than on disease severity. No evidence was found of advantages of the association of memantine-donepezil. The heterogeneity of conditions explored by RCTs, the relatively short time of observation (24-52 weeks), and the different cognitive assessment tools used did not allow comparing properly different trials.
    The Scientific World Journal 10/2013; 2013(1):925702. DOI:10.1155/2013/925702 · 1.73 Impact Factor
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    • "During the moderate to severe stages of AD, the patients’ language declines and deficits often result in a loss of ability to express their needs, which in turn affects their quality of life, prognosis, and social relationships, and can contribute significantly to patient and caregiver burden.4,15 Indeed, with progressive loss of language and other cognitive abilities, these patients lose their autonomy, and quality of life worsens as they become unable to sustain normal daily activities; as has been demonstrated in a study showing that several cognitive abilities, including expressive language, are required to maintain function in activities of daily living.16 Emotional distress/depression, severity of language deficit, and communication disability are some predictors of health-related quality of life in patients with language impairments.17 "
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    ABSTRACT: Alzheimer's disease is characterized by progressively worsening deficits in several cognitive domains, including language. Language impairment in Alzheimer's disease primarily occurs because of decline in semantic and pragmatic levels of language processing. Given the centrality of language to cognitive function, a number of language-specific scales have been developed to assess language deficits throughout progression of the disease and to evaluate the effects of pharmacotherapy on language function. Trials of acetylcholinesterase inhibitors, used for the treatment of clinical symptoms of Alzheimer's disease, have generally focused on overall cognitive effects. However, in the current report, we review data indicating specific beneficial effects of acetylcholinesterase inhibitors on language abilities in patients with Alzheimer's disease, with a particular focus on outcomes among patients in the moderate and severe disease stages, during which communication is at risk and preservation is particularly important.
    Clinical Interventions in Aging 08/2013; 8:1007-14. DOI:10.2147/CIA.S39959 · 2.08 Impact Factor
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