Activities of Daily Living in Patients with Dementia

Abstract

Disability, characterised by the loss of ability to perform activities of daily living (ADL), is a defining feature of dementia that results in growing caregiver burden and the eventual need for alternative care or nursing home placement. Functional decline in patients with dementia can also result from causes other than dementia, such as comorbid medical and psychiatric illnesses and sensory impairment. ADL consists of instrumental ADL (IADL) [complex higher order skills, such as managing finances] and basic ADL (BADL) [self-maintenance skills, such as bathing]. Assessment of IADL and BADL is recommended to establish a diagnosis of dementia. Functional assessment also helps the healthcare provider to offer appropriate counselling regarding safety concerns and need for custodial care. Functional capacity measures have been used increasingly in pharmacological trials of patients with Alzheimer's disease (AD) and related dementias, although at the present time these measures are generally not primary outcome measures. Functional impairment is not a uniform construct; rather, it is multifaceted and can be measured with various clinical instruments. Many scales have been validated for use in patients with AD for characterising functional impairment and evaluating the efficacy of treatment. Research to date indicates that cholinesterase inhibitors have the potential for modest but meaningful beneficial effects on ADL in patients with mild-to-moderate AD. Memantine also has promising beneficial effects on functional abilities in persons with moderate-to-severe AD. Assessment of ADL as a primary efficacy measure using a validated scale that is non-gender biased and cross-nationally relevant is recommended in new treatment trials of patients with AD and related dementias.

Disability in Instrumental Activities of Daily Living in Elderly Patients with Mild Cognitive Impairment and Alzheimer‘s Disease

“…IADL as a supplement in the diagnostic process is therefore an interesting topic to discuss since the criteria regarding IADL disability necessary to constitute dementia are not very strict. The available evidence suggests that mild dementia is rarely diagnosed in clinical practice, and even moderately severe dementia is underrecognized [1]. Results of this study may support that the diagnostic process regarding MCI and dementia is challenging [34].…”

“…The scale is generic, has been used in many previous studies on dementia and has been tested for reliability and validity [13,22]. Information was given by a family carer [1]. The Lawton and Brody IADL scale consists of 8 items, listed in table 2.…”

“…Decline in functional abilities is one of the most troubling aspects of dementia and may be experienced in early stages of dementia [1,2]. The number of lost functions in activities of daily living is shown to be the most important predictor of short-term mortality in patients with Alzheimer‘s disease (AD) [3].…”

“…There seem to be no strict criteria and clear consensus concerning the extent of IADL disability in persons with MCI diagnosis compared to persons with mild dementia in AD [7,11]. The use of standardized scales assessing IADL in elderly persons experiencing cognitive impairment may be useful in addition to commonly used cognitive tests for an earlier, more accurate diagnosis of MCI and prediction of dementia [1]. There is a large variability in measuring IADL and more research is needed regarding the relationship between IADL and cognitive processes [12,13].…”

Validation of the Amsterdam IADL Questionnaire©, a New Tool to Measure Instrumental Activities of Daily Living in Dementia

“…It leads to a progressive loss of cognitive functions, causing interference with social and occupational functioning [1]. This interference in everyday functioning is generally measured using informant-based questionnaires aimed at instrumental activities of daily living (IADL) [2]. However, the psychometric quality of these questionnaires has been questioned in several reviews and improvements in IADL questionnaires were recommended [3,4,5].…”