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: 3.01). 08/2005; 11(4):446-53. DOI: 10.1017/S1355617705050502
Source: PubMed

ABSTRACT 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: 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 · 1.89 Impact Factor
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    • "A subset of 19 items rate the patient's ability to eat, dress, bathe, telephone, travel, shop, and perform other household chores. The ADCS-ADL 19 total score is the sum of the 19 subscores with a range of 0–54 (low scores indicate functional impairment) [8] [9]. "
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    ABSTRACT: The present study evaluated the effects of once-daily memantine (20 mg) treatment on cognition and communication in patients with moderate to severe Alzheimer's disease (AD). In a multicenter, single-arm open-label study, outpatients diagnosed with AD (MMSE < 20; n = 97) were titrated from 5 mg to 20 mg once-daily memantine over 4 weeks. Once-daily memantine treatment (20 mg) was then continued for 8 weeks, followed by a 4-week wash-out period. The primary efficacy endpoint was the change from baseline in the Consortium to Establish a Registry for Alzheimer's Disease -Neuropsychological Battery (CERAD-NP) total score. Secondary efficacy endpoints included change from baseline in Functional Communication Language Inventory (FLCI) and ADCS-ADL19 total score, and the response from baseline in Clinical Global Impression of Change (CGI-C). The CERAD-NP total score improved significantly after 12 weeks of once-daily memantine treatment compared with baseline (5.9 ± 8.8; p < 0.0001). The FLCI total score improved significantly after 12 weeks compared with baseline (4.4 ± 6.8; p < 0.0001). These significant improvements were already observed after 4 and 8 weeks of once-daily memantine treatment and persisted after a 4-week wash-out period. ADCS-ADL19 total scores showed only slight increases from baseline, and CGI-C indicated that the majority of patients experienced an improvement or stabilization of the disease after 12 weeks. At least one Treatment-Emergent Adverse Event was reported by 38 (39.2%) patients. In patients with moderate to severe AD, once-daily memantine (20 mg) treatment significantly improved cognition and functional communication and was found to have a favorable safety and tolerability profile.
    Journal of Alzheimer's disease: JAD 04/2011; 25(3):463-75. DOI:10.3233/JAD-2011-101929 · 4.15 Impact Factor
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    • "Las AVD son un elemento clave para medir la calidad de vida y el estatus funcional en los AM (Acosta, 2009) y se refieren a un conjunto de tareas cotidianas comunes que se necesitan para el autocuidado personal y una vida independiente (Wiener, Hanley, Clark y Van Nostrand, 1990). Existen diversos instrumentos para medir las AVD, desarrollados originalmente para la valoración geriátrica general (Galasko, Schmitt, Thomas y cols., 2005) y el deterioro funcional en los AM, definido este como el declive en la capacidad de ejecutar una o más de las AVD (Naik, Burnett, Pickens- Pace y Dyer, 2008). En el caso de la valoración de las actividades básicas de la vida diaria (ABVD), las cuales están altamente correlacionadas con funciones y coordinación motoras (Cahn-Weiner, Tomaszewski , Julian y cols., 2007), el ejemplo clásico es el Índice de Katz de Independencia en Actividades de la Vida Diaria (Katz, Ford, Moskowitz , Jackson y Jaffe, 1963), que mide la independencia de los AM en la alimentación, continencia , movilidad, uso del excusado, vestido y aseo corporal. "
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    ABSTRACT: El presente estudio tuvo como objetivo obtener una muestra de ejemplos de actividades recreativas mentales, recreativas físicas, sociales, de independencia y de protección a la salud, para la propuesta inicial de un inventario de actividades de la vida diaria en adultos mayores, esto a través del desarrollo de dos grupos focales de ancianos organizados alrededor del tema de actividades cotidianas. Los resultados reflejan una amplia variedad de actividades en la vida diaria en los participantes, consecuencia de la heterogeneidad en el proceso del envejecimiento, y establecen las bases para estudios posteriores sobre mecanismos de adaptación en adultos mayores ante los cambios asociados en la vejez, donde se atiendan las necesidades que exige este sector de la población.
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