Acurácia do desempenho funcional em idosos saudáveis, com comprometimento cognitivo leve e doença de Alzheimer

Abstract

Estabelecer o continuum de declínio cognitivo e funcional no envelhecimento normal para o patológico é desafi ador. Nesta transição está o Comprometimento Cognitivo Leve (CCL), defi nido por prejuízo sutil na cognição e funcionalidade. Quando o prejuízo funcional aumenta preenche critérios para demência. Assim, determinar a acurácia diagnóstica da avaliação funcional é imprescindível. Com isso o objetivo foi comparar o desempenho funcional através da avaliação direta versus indireta e avaliar a acurácia do desempenho destas avaliações entre controles, pacientes com CCL e com doença de Alzheimer (DA). Participaram 90 indivíduos (n=27 controles, n=35 pacientes com CCL e n=28 com DA). Foram utilizadas a Activities of Daily Living Questionnaire (ADL-Q) e a Direct Assessment of Functional Status (DAFS-R). Foram realizadas MANCOVA para comparar o desempenho funcional direto entre os participantes e curvas ROC para verifi car a acurácia diagnóstica das escalas entre os grupos. O desempenho da avaliação direta demonstrou diferenciar controles de CCL e CCL de DA. Ambas as escalas mostraram diferenciar CCL e DA, e a DAFS-R controles de CCL. Assim, a DAFS-R evidenciou melhor acurácia do desempenho funcional nestes grupos.

Nursing diagnoses of impaired memory and chronic confusion for older adults: diagnostic content validation

“…The processes of retaining and recalling information or skills are critical parts of the memory, that might be related to several chronic diseases other than dementia (9,(28)(29) and directly interfere with the ability of elders to learn and keep new information and competencies (3) . This inability may pose the necesssity to start taking notes and increasing focus in attention to maintain activities independently (30) .Thus, the impairment of these abilities constitutes critical attributes for IM and further justifies the relevance of these DC.…”

“…Although it was not observed in previous diagnosis validation studies (9)(10) , this has been considered one of the main characteristics to differentiate IM from CC. This preserved capacity occurs because the elder, in this case, is able to apply different cognitive strategies that will help to perform the required activity (28,30) . While literature usually indicates DC are constituted by problems evidenced (8) , "preserved capacity to perform daily activities (IADL & ADL) independently" was not a problem; rather it was a "normal" pattern.…”

“…However, if there are permanent difficulties (after treatment of reversible causes), the diagnosis is IM (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) . Finally, if the problems reach other cognitive areas, added to demonstration of dependency, the diagnosis is CC (30,(33)(34) . These clarifications were submited to NANDA-I and approved to inclusion in the 11 edition, specially regarding the topic related to dependency and development of daily activities (35) .…”

Cross-cultural adaptation of functioning evaluation Routine Task Inventory - Extended (RTI-E) for use in elderly people with dementia in Brazil

“…Assessment instruments by direct observation of performance require preparation that make them less accessible for everyday clinical practice, where there is often a high demand for care and limited material resources 11 . Assessment instruments by indirect observation based on the report of a caregiver are widely used 12 , considering that the lack of awareness of the deficit is a characteristic of the dementia condition 13 . Such instruments can bring information bias, underestimating or overestimating 14 the performance capacity of the person with dementia 12 .…”

Loss of functional capacity in elderly individuals with Alzheimer disease

“…5 After diagnosis of this condition, cognitive deficits emerge in the prodromal phase, characterized by mild cognitive deficits that become more evident, even interfering with the activities of daily living in the dementia stage. 6 The first problems reported in everyday life typically involve more challenging activities, such as cooking, managing finances, and operating devices, which are generally referred to as instrumental activities of daily living (IADL) and are cognitively more complex. 7,8 These progressive deficits in cognitive function(s) lead to impaired reasoning and planning, functional and social losses, as well as changes in behavior, with a consequent loss of functional independence.…”