BackgroundAssessment of activities of daily living (ADL) is paramount to determine impairment in everyday functioning and to ensure accurate early diagnosis of neurocognitive disorders. Unfortunately, most common ADL tools are limited in their use in a diagnostic process. This study developed a new evaluation by adopting the items of the Katz Index (basic [b-] ADL) and Lawton Scale (instrumental [i-] ADL), defining them with the terminology of the International Classification of Human Functioning, Disability and Health (ICF), adding the scoring system of the ICF, and adding the possibility to identify underlying causes of limitations in ADL.Methods and findingsThe construct validity, interrater reliability, and discriminative validity of this new evaluation were determined. From 2015 until 2016, older persons (65–93 y) with normal cognitive ageing (healthy comparison [HC]) (n = 79), mild cognitive impairment (MCI) (n = 73), and Alzheimer disease (AD) (n = 71) underwent a diagnostic procedure for neurocognitive disorders at the geriatric day hospital of the Universitair Ziekenhuis Brussel (Brussels, Belgium). Additionally, the ICF-based evaluation for b- and i-ADL was carried out. A global disability index (DI), a cognitive DI (CDI), and a physical DI (PDI) were calculated. The i-ADL-CDI showed high accuracy and higher discriminative power than the Lawton Scale in differentiating HC and MCI (area under the curve [AUC] = 0.895, 95% CI .840–.950, p = .002), MCI and AD (AUC = 0.805, 95% CI .805–.734, p = .010), and HC and AD (AUC = 0.990, 95% CI .978–1.000, p < .001). The b-ADL-DI showed significantly better discriminative accuracy than the Katz Index in differentiating HC and AD (AUC = 0.828, 95% CI .759–.897, p = .039). This study was conducted in a clinically relevant sample. However, heterogeneity between HC, MCI, and AD and the use of different methods of reporting ADL might limit this study.ConclusionsThis evaluation of b- and i-ADL can contribute to the diagnostic differentiation between cognitively healthy ageing and neurocognitive disorders in older age. This evaluation provides more clarity and nuance in assessing everyday functioning by using an ICF-based terminology and scoring system. Also, the possibility to take underlying causes of limitations into account seems to be valuable since it is crucial to determine the extent to which cognitive decline is responsible for functional impairment in diagnosing neurocognitive disorders. Though further prospective validation is still required, the i-ADL-CDI might be useful in clinical practice since it identifies impairment in i-ADL exclusively because of cognitive limitations.

Background:

Abstract:Objectives Assessment of advanced activities of daily living (a-ADL) can be of interest in establishing the diagnosis of Alzheimer's disease (AD) in an earlier stage, since these activities demand high cognitive functioning and are more responsive to subtle changes. In this study we tested a new a-ADL tool, developed according to the International Classification of Functioning, Disability and Health (ICF). The a-ADL tool is based on the total number of activities performed (TNA) by a person and takes each subject as his own reference. It distinguishes a total Disability Index (a-ADL-DI), a Cognitive Disability Index (a-ADL-CDI), and a Physical Disability Index (a-ADL-PDI), with lower score representing more independency. We explored whether these indices allow distinction between cognitively 2 healthy persons, patients with Mild Cognitive Impairment (MCI) and patients with mild AD. MethodsParticipants were on average 80 years old (SD 4.6;, were community dwelling, and were diagnosed as (1) cognitively healthy subjects (n=26); (2) patients with MCI (n = 17), or (3) mild AD (n = 25), based upon extensive clinical evaluation and a set of global, cognitive, mood and functional assessments. The a-ADL-tool was not part of the clinical evaluation. ResultsThe a-ADL-CDI was significantly different between the three groups (p<.01). The a-ADL-DI was significantly different between MCI and AD (p<.001). The tool had good psychometrical properties (inter-rater reliability; agreement between patient and proxy; correlations with cognitive tests). Although the sample size was relatively small, ROC curves were computed for the a-ADL-DI and a-ADL-CDI with satisfactory and promising results. ConclusionThe a-ADL-CDI and a-ADL-DI might offer a useful contribution to the identification and follow up of patients with mild cognitive disorders in an older population. Conflict of interest declaration: noneAcknowledgements:

Objective: Although many studies explored the relationship between executive functions (EF) and activities of daily living (ADLs) in cognitive disorders, previous studies used measurements without well-defined levels of ADLs. This study explored the relationship between EF and the threefold classification of everyday functioning (basic or b-, instrumental or i-, and advanced or a-ADLs) and examined how EF account for the variance in this triad of everyday functioning. Methods:A sample of 44 cognitively healthy persons, 41 persons with mild cognitive impairment, and 35 persons with Alzheimer disease were assessed with comprehensive measures of EF and the b-, i-, and a-ADL tools. Results: Correlations demonstrated that subjects with higher executive dysfunctions have more limitations in b-, i-, and a-ADLs. The highest significant correlations with measures of EF were seen in i-and a-ADLs (ranging from r = −0.193 to r = −0.559, P < 0.05). However, correlations with a-ADLs were not stronger than with i-ADLs. The multivariate analyses revealed Trail Making Test A (TMT-A) as a significant contributor of everyday functioning in b-ADLs, as well as i-and a-ADLs, and Clock Drawing Test (CDT) and Animal Fluency Test (AFT) seemed to contribute significantly to variance in i-and a-ADLs. Conclusions: EF are less related to b-ADLs than i-and a-ADLs and contribute to the same amount of variance to limitations in both i-and a-ADLs. This study recommends using the TMT-A, CDT, and AFT as screening tools to indicate the need for profound evaluation of ADLs in older persons with neurocognitive disorders.

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: We 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.

Introduction: This study determined whether the multicomponent rehabilitation programme of a memory clinic had positive outcomes on ameliorating everyday functioning, quality of life, mood and behavioural disturbances of persons with dementia and reducing distress and burden of caregivers. Method: A retrospective pre-test-post-test study without control group was conducted on the first cohort of persons with dementia (n ¼ 30) and their caregivers (n ¼ 30), who participated in a programme lasting for a maximum of 1 year with 25 1-hour counselling sessions. The assessment contained an evaluation of everyday functioning in basic, instrumental and advanced activities of daily living, cognition, mood, emotional and behavioural disturbances, quality of life and caregiver burden. Results: Eight participants dropped out prematurely. For persons with dementia (n ¼ 22), participating in the programme did not improve everyday functioning and cognition but ameliorated quality of life significantly (Z ¼-2.7, p ¼ 0.006, 95% CI (.003-.005)) and stabilized mood, emotional and behavioural disturbances for 60% or more of them. For caregivers (n ¼ 22), the mild to moderate burden of care remained stable or got better for 63.6% of the caregivers. Conclusion: This programme appears to be promising and valuable, and might reduce institutionalization rates. Future explorations are recommended to research how participants evolve and to investigate which participants responded in a positive way.

Introduction: Meaningful activities of daily living promote the quality of life of residents of long-term care facilities. This project aimed to develop an approach to enable meaningful activities of daily living and to guide long-term care facilities in a creative and innovative attitude towards residents' meaningful activities of daily living. Method: The approach was developed in six steps: (1) in-depth-interviews with 14 residents; (2) a survey with 171 residents; (3) a systematic map and synthesis review on interventions enriching meaningful activities of daily living; (4) qualitative analysis of 24 'good examples' and, to support future implementation, (5) focus groups with staff (n ¼ 69). Results determined the components of the new approach which was (6) pilot-tested in one long-term care facility. Quantitative and qualitative data were gathered concerning benefits for the residents and feasibility for the staff. Results: A client-and activity-oriented approach was developed, characterised by an active participatory attitude of residents and staff and a systematic iterative process. Significant positive effects were found for the number of activities, the satisfaction with the leisure offered, the social network, medication use, but not for quality of life. The approach appeared to be feasible. Conclusion: This approach stimulates residents' meaningful activities of daily living and social life. Further investigation is needed to evaluate its outcome and implementation potentials.

In contrast to prior studies comparing report-based and performance-based methods of assessing ADL, this study indicates that the NAT and the a- and i-ADL tools have strong convergent and concurrent validity, and appear to have similar discriminatory power in differentiating between HCs, MCI, and AD.