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An explorative study of the relationship between functional and cognitive decline in older persons with mild cognitive impairment and Alzheimer's disease
- Authors:
- VERMEERSCH Sophie, et al
- Journal article citation:
- British Journal of Occupational Therapy, 78(3), 2015, pp.166-174.
- Publisher:
- Sage
Introduction: This study explored the relationship between functional decline on three advanced activities of daily living and cognitive decline in elderly persons. The use of everyday technology, driving a vehicle, and performing complex economic activities are advanced activities of daily living domains presumed to be sensitive to early cognitive decline and therefore of interest for the profession of occupational therapy. Method: The study included 45 persons with mild cognitive impairment, 48 persons with Alzheimer’s disease, and 50 cognitively healthy controls. Functional impairment due to cognitive decline was evaluated by the advanced activities of daily living tool. Cognitive disability indices were computed for the investigated advanced activities of daily living domains and correlated with the Mini Mental State Examination and the Cambridge Examination for Mental Disorders of the Elderly, Cognitive Part. Results The cognitive disability index for performing complex economic activities and the cognitive disability index for the three advanced activities of daily living domains together differed significantly between the three groups. For the whole sample, the advanced activity of daily living cognitive disability indices correlated strongly with the cognitive measures. Within each separate group, few correlations were found. Conclusion: This study contributes to the field of knowledge for occupational therapy by emphasizing the value of assessment of advanced activities of daily living in early cognitive decline. For the occupational therapy profession, further research is required in the interaction between functional decline and cognition in early cognitive decline. (Edited publisher abstract)
Activity involvement and quality of life of people at different stages of dementia in long term care facilities
- Authors:
- SMIT Dieneke, et al
- Journal article citation:
- Aging and Mental Health, 20(1), 2016, pp.100-109.
- Publisher:
- Taylor and Francis
Objectives: Involvement in activities is assumed to positively influence the quality of life of people with dementia, yet activity provision in long-term care remains limited. This study aims to provide more insight into the value of activity involvement for domains of the quality of life of long-term dementia care residents, taking resident characteristics and cognitive status into account. Method: Data were derived from 144 long-term care facilities participating in the second measurement (2010/2011) of the living arrangements for dementia study. Amongst 1144 residents, the relationship between time involved in activities (activity pursuit patterns; RAI-MDS) and quality of life (Qualidem) was studied using multilevel linear regression analyses. Analyses were adjusted for residents’ age, gender, neuropsychiatric symptoms, ADL dependency and cognition. To check for effect modification of cognition, interactions terms of the variables activity involvement and cognitive status were added to the analyses. Results: Despite resident's cognitive status, their activity involvement was significantly related to better scores on care relationship, positive affect, restless tense behaviour, social relations, and having something to do. A negative relationship existed between the activity involvement and positive self-image. The explained variance in the quality of life between residents caused by the activity involvement was small. Conclusion: Activity involvement seems to be a small yet important contributor to higher well-being in long-term care resident at all stages of dementia. Adjusting activities to individual preferences and capabilities might enlarge this relationship. Further research is needed to confirm this hypothesis, using measurement instruments less sensitive to recall bias and differentiating between the active and passive activity involvement. (Publisher abstract)
Functional outcomes of drug treatment in Alzheimer’s disease: a systematic review and meta-analysis
- Authors:
- HANSEN Richard A., et al
- Journal article citation:
- Drugs and Aging, 24(2), 2007, pp.155-167.
- Publisher:
- Wolters Kulwer
Data from 14 randomised controlled trials comparing four drugs (donepezil, galantamine, rivastigmine and memantine) with placebo were meta-analysed to identify their impact on functional outcomes. The overall standardised effect size was small (d = 0.1-0.4) but consistently favoured drug treatment over placebo and was consistent in short (less than 24 weeks) and long (24 weeks or more) trials. Adverse side effects were generally limited to gastro-intestinal problems, weight loss and dizziness, all of which were reported in less than 20% of patients on average. Given the current lack of other effective treatments for Alzheimer’s disease, the authors conclude that their findings support the view that these drugs have clinical benefits with respect to functional outcomes.
Cognitive training in Alzheimer’s disease: a meta-analysis of the literature
- Authors:
- SITZER D.I., TWAMLEY E.W., JESTE C.V.
- Journal article citation:
- Acta Psychiatrica Scandinavica, 114(2), August 2006, pp.75-90.
- Publisher:
- Blackwell Publishing
Effect sizes (Cohen’s d) were calculated for 19 controlled studies, and an overall effect size of 0.47 was observed for all cognitive training (CT) strategies across all measured outcomes. Mean effect sizes were higher for restorative strategies (designed to return functioning in specific domains to pre-disease levels) than for compensatory strategies (to teach new ways of performing tasks by ‘working round’ the cognitive deficit). Primarily medium effect sizes were observed for learning, memory, executive functioning, activities of daily living, general cognitive problems and self-rated general functioning. Several limitations of the published literature are discussed, including small sample sizes and the fact that most studies combine multiple treatment strategies, making it difficult to evaluate the efficacy of individual components.
Diagnostic accuracy of Instrumental Activities of Daily Living for dementia in community-dwelling older adults
- Authors:
- MAO Hui-Fen, et al
- Journal article citation:
- Age and Ageing, 47(4), 2018, p.551–557.
- Publisher:
- Oxford University Press
Background: many people living with dementia remain underdiagnosed and unrecognised. Screening strategies are important for early detection. Objective: to examine whether the Lawton’s Instrumental Activities of Daily Living (IADL) scale, compared with other cognitive screening tools—the Mini-Mental State Examination (MMSE), and the Ascertain Dementia 8-item Informant Questionnaire (AD8)—can identify older (≥ 65 years) adults with dementia. Design: population-based cross-sectional observational study. Setting: all 19 counties in Taiwan. Participants: community-dwelling older adults (n = 10,340; mean age 74.87 ± 6.03). Methods: all participants underwent a structured in-person interview. Dementia was identified using National Institute on Aging-Alzheimer’s Association core clinical criteria for all-cause dementia. Receiver operator characteristic curves were used to determine the discriminant abilities of the IADL scale, MMSE and AD8 to differentiate participants with and without dementia. Results: 917 (8.9%) participants with dementia were identified, and 9,423 (91.1%) participants without. The discriminant abilities of the MMSE, AD8 and IADL scale (cutoff score: 6/7; area under curve = 0.925; sensitivity = 89%; specificity = 81%; positive likelihood ratio = 4.75; accuracy = 0.82) were comparable. Combining IADL with AD8 scores significantly improved overall accuracy: specificity = 93%; positive likelihood ratio = 11.74; accuracy = 0.92. Conclusions: the findings support using IADL scale to screen older community-dwelling residents for dementia: it has discriminant power comparable to that of the AD8 and MMSE. Combining the IADL and the AD8 improves specificity. (Edited publisher abstract)
Taking a positive spin: preserved initiative and performance of everyday activities across mild Alzheimer's, vascular and mixed dementia
- Authors:
- GIEBEL Clarissa M., BURNS Alistair, CHALLIS David
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(9), 2017, pp.959-967.
- Publisher:
- Wiley
Objectives: The literature commonly evaluates those daily activities which are impaired in dementia. However, in the mild stages, people with dementia (PwD) are still able to initiate and perform many of those tasks. With a lack of research exploring variations between different dementia diagnoses, this study sought to investigate those daily activities with modest impairments in the mild stages and how these compare between Alzheimer's disease (AD), vascular dementia (VaD) and mixed dementia. Methods: Staff from memory assessment services from nine National Health Service trusts across England identified and approached informal carers of people with mild dementia. Carers completed the newly revised Interview for Deteriorations in Daily Living Activities in Dementia 2 assessing the PwD's initiative and performance of instrumental activities of daily living (IADLs). Data were analysed using analysis of variance and Chi-square tests to compare the maintenance of IADL functioning across AD, VaD, and mixed dementia. Results: A total of 160 carers returned the Interview for Deteriorations in Daily Living Activities in Dementia 2, of which 109, 21, and 30 cared for someone with AD, VaD, and mixed dementia, respectively. There were significant variations across subtypes, with AD showing better preserved initiative and performance than VaD for several IADLs. Overall, PwD showed greater preservation of performance than initiative, with tasks such as preparing a hot drink and dressing being best maintained. Conclusion: Findings can help classify dementia better into subtypes in order to receive bespoke support. It suggests that interventions should primarily address initiative to improve overall functioning. (Publisher abstract)
Learning and using technology in intertwined processes: a study of people with mild cognitive impairment or Alzheimer’s disease
- Authors:
- ROSENBERG Lena, NYGARD Louise
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 13(5), 2014, pp.662-677.
- Publisher:
- Sage
People with mild cognitive impairment and Alzheimer’s disease are likely to be challenged by the multitude of everyday technology in today’s society. The aim of this study was to explore how they try to prohibit, avoid or solve problems in everyday technology use, maintain skills, and learn to use new technology. To explore how the participants applied and reasoned about using everyday technology in real-life situations interviews were conducted while the participants used their own technology in their homes. Interviews were conducted with 20 participants with mild cognitive impairment (n = 10) or Alzheimer’s disease (n = 10). The analyses were inspired from grounded theory and resulted in one core category and three sub-categories that represent sub-processes in the core. The core finding presents a continuous, intertwined process of learning and using everyday technology, highlighting how the context was interwoven in the processes. The participants used a rich variety of management strategies when approaching technology, including communication with the everyday technologies on different levels. The findings underscore that it is important to support continued use of everyday technology as long as it is valued and relevant to the person with mild cognitive impairment or Alzheimer’s disease. The intertwined process of learning and using everyday technology suggests how support could target different sub-processes. (Publisher abstract)
Everyday functioning in mild cognitive impairment and its relationship with executive cognition
- Authors:
- ARETOULI Eleni, BRANDT Jason
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(3), March 2010, pp.224-233.
- Publisher:
- Wiley
Older people with mild cognitive impairment (MCI), a clinical syndrome with multiple etiologies and outcomes that range from normal aging to dementia, are at increased risk of dementia and functional impairments. This study investigates the contribution of three domains of executive cognition to everyday functioning among older people with MCI. 124 MCI patients and 68 cognitively normal elderly participants underwent a cognitive screening battery. The tests were used to divide patients into four subgroups: amnestic single domain; amnestic multiple domain; non-amnestic single domain; and non-amnestic multiple domain. Subjects were then administered 18 executive function tests that assessed planning and problem-solving, working memory and judgment. Performance of everyday activities and everyday cognitive ability was rated with two informant-reported measures. The findings showed that all MCI subtypes had more difficulties in everyday activities than cognitively normal older participants. Multiple domain MCI patients had more functional impairments than single domain MCI patients. Contrary to the authors’ expectations, only one executive function component - working memory - contributed significantly to functional status after controlling for demographic, health-related and other cognitive factors. In conclusion, this paper noted that functional abilities were compromised in all MCI subtypes, and working memory may be associated with functional impairments, but general cognitive measures account for more unique variance.
The relationship between non-cognitive symptoms and functional impairment in Alzheimer's disease
- Authors:
- MOK W. Y. W., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(11), November 2004, pp.1040-1046.
- Publisher:
- Wiley
Cognitive impairment is an important determinant for functional impairment in Alzheimer's disease. The role of non-cognitive symptom is uncertain. The objective of this study was to investigate the role of non-cognitive symptoms as predictive factors for functional outcome in A.D. This was a retrospective study. Subjects were recruited from the Memory Clinic in Queen Mary Hospital over a two years period. Patients with diagnosis of probable A.D. by NINCDS-ADRDA were identified. Demographic data, Folstein Mini-Mental Status Examination (MMSE), Clinical Dementia Rating (CDR), Neuropsychiatric inventory (NPI), Barthel activities of daily living (ADL) as well as Lawton's Instrumental activities of daily living (IADL) were retrieved. 100 patients were identified. Univariate analysis identified statistically significant correlation between hallucination and disinhibition score with Barthel Index (r = -0.43, p < 0.001; r = -0.30, p = 0.002 respectively); hallucination and aberrant motor act score with Lawton's IADL (r = -0.21, p = 0.038; r = -0.21, p = 0.038). MMSE was statistical significantly correlated with the above two functional scores. NPI was not statistical significantly correlated with any one of the functional measures. Multivariate regression analyses showed that hallucination score was an independent predictive factors for the Barthel index but not for the Lawton's IADL. MMSE score was identified to be independent predictive factor for all functional measures. Global cognitive impairment and hallucination was an important independent predictive factor for functional outcomes. Screening hallucination during the course of A.D. would be helpful. Further studies are needed to show the benefit of treatment of hallucination on the improvement of functional outcomes.
Role of behavioural disturbance in the loss of autonomy for activities of daily living in Alzheimer patients
- Author:
- LECHOWSKI L.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(11), November 2003, pp.977-982.
- Publisher:
- Wiley
Cognitive impairment is associated with functional impairment in patients with Alzheimer's disease (AD). Behavioural disturbance is very common in these patients. Nevertheless, there has been very little research into the relations between behavioural disturbance and functional status in AD. The purpose of this study is to investigate the relationship between behavioural disturbance and functional status after taking account of cognitive impairment. 579 patients were prospectively evaluated at 16 French hospitals, all referents for AD, and were diagnosed with possible or probable AD. These patients were assessed with NeuroPsychiatric Inventory (NPI), cognitive subscales of the Alzheimer's Disease Assessment Scale (ADAS-cog), Clinical Dementia Rating scale (CDR) and Instrumental Activities of Daily Living scale (IADL). The number of men with available data for IADL total score was too small to make any analysis. Group A gathered 256 women for whom the relation between autonomy for Activities of Daily Living (ADL) and the other variables were determined. Group B, pooled 85 women for whom relations found were verified. Linear regression was used for the analysis. With age, cognitive impairment allows us to explain best (38%) the loss of autonomy for ADL. The role of behavioural disturbances in the loss of autonomy for ADL was not determinant in our study, whereas cognitive impairment and age were better able to determine the loss of autonomy for ADL. Further study is needed to explain the decline of functional status in AD patients