Correlation and adaptation among functional and cognitive instruments for staging and monitoring Alzheimer?s disease in advanced stages

Abstract

Background: Although Alzheimer's disease (AD) is the most prevalent form of dementia, little is known about cognitive and functional aspects in its advanced stages. Objective: This study aimed the adaptation and correlation among specific instruments for AD in advanced stages with regard to cognition objectively weighted, besides the comparison between static and ecological aspects of functional capacity. Methods: 95 moderate, moderatly severe and severe AD patients (33 men and 62 women) underwent the scales CDR (Clinical for Dementia Rating), FAST (Functional Assessment Scale), MMSE (Mini-Mental State Exame), MMSEsev (Severe Mini-Mental State Examination), SIB-8 (Severe Impairment Battery) and TSI (Test for Severe Impairment), for the comparison with a golden-standard ecological scale the PADL (Performance Activities of Daily Living). Results: The evidence suggests an increasing and statistically significant linear correlation between the ecological functional scale and cognitive tests according to the stratification of AD stages once weighted by static functional scale. Discussion: The results indicate that for patients in advanced stages of AD, appropriate cognitive tests and performance-based functional scales are useful in more accurate assessment of disease staging and monitoring its progression.

Family dynamics in face of Alzheimer's in one of its members

“…The family of the person with Alzheimer goes through several phases, from diagnosis to the advanced stage of the disease, with feelings of denial and acceptance in face of the excessive involvement (3,8) . Usually, for the family is difficult to have dimension of the changes that will occur in their daily lives, especially when they do not have much knowledge about the disease, the care to be performed and the care management.…”

“…Subsequently, there is deterioration of cognitive functions such as constructive apraxia, agnosia and aphasic disorders. It has a clinical picture of slow, variable and irreversible evolution, moving towards a vegetative state within 10 to 15 years from the onset of symptoms (3) . The symptoms of AD can be described in three stages, namely: the initial, intermediate and terminal phases.…”

“…The terminal phase is characterized by bed confinement, silence, intestinal or urinary retention, and adoption of the fetal position due to contractures. These progressive, cognitive and behavioral symptoms influence the probability of performing the Activities of Daily Living, making patients increasingly dependent on their families (3) . Regarding the care of the person with AD, the current trend is to recommend that the elderly remain in their homes under the care of their families, aiming for their comfort and dignity.…”

Clinical Trial Endpoints and Their Clinical Meaningfulness in Early Stages of Alzheimer’s Disease

“…In the assessment of cognition, multiple domains are evaluated, including attention, memory, executive function, language, visuospatial processing, and praxis ( Table 1 ), but there is limited consensus on the discreteness of these functions ( 11 ). Cognitive decline impacts all cognitive domains to a variable extent and is associated with increasing functional impairment over time ( Table 1 ; Figure 1A , 1B ) ( 11 – 14 ).…”

Review on Alzheimer's Disease: Diagnosis, Evolution and Cares

“…Por meio da análise dessa classe é possível identificar a relação estabelecida entre a Doença de Alzheimer em si e o avanço das pesquisas sobre como avaliar e controlar a doença. Alguns trechos das UCIs apontam essa associação: "(...) em fases avançadas da Doença de Alzheimer, testes cognitivos apropriados e escalas funcionais baseadas no desempenho são uteis na avaliação mais acurada do estadiamento da doença e acompanhamento de sua progressão" (Wajman, Schultz, Marin, & Bertolucci, 2014). "(...) este é o primeiro estudo que demonstrou que o volume do cerebelo pode estar reduzido na fase pré-demência e reforça o papel dessa estrutura na progressão da Doença de Alzheimer" (Baldaçara et al, 2011).…”