Comparisons of Daily Functional Performance and Relevant Factors in Patients with Alzheimer’s Disease and Subcortical Ischemic Vascular Disease

Abstract

ObjectiveTo compare daily functional performance and potential predictive factors in patients with Alzheimer's disease (AD) and subcortical ischemic vascular disease (SIVD). MethodsSixty-eight community patients with AD and 39 with SIVD were evaluated using the informantbased Barthel Index of Activities of Daily Living (B-ADL) and Instrumental Activities of Daily Living (IADL). Motor function, cognition, and white matter hyperintensities (WMHs) were assessed using the modified Rankin Scale (mRS), Cognitive Abilities Screening Instrument (CASI)/Clinical Dementia Rating (CDR), and Scheltens scale, respectively. ResultsAfter controlling for systemic diseases and medications, toilet use was the only B-ADL subset in which the patients with SIVD performed worse than those with AD in overall comparisons and CDR0.5-1. Additionally, the SIVD group with CDR0.5-1 performed worse in bathing, mobility, and climbing stairs. Regarding IADL performance, the SIVD group had worse performances than the AD group in mode of transportation during CDR2. In WMHs analysis, periventricular WMHs (PWMHs) was the only factor showing significant inverse correlations with both CASI and B-ADL/IADL. Hierarchical regression of all patients suggested that the best models including age, education, PWMHs, CASI, and mRS accounted for 71% and 78% of the variances in B-ADL and IADL, respectively. While mRS accounted for a significant effect in both B-ADL and IADL, CASI accounted for a significant effect only in IADL. Subgroup analysis suggested that the effects of CASI and PWMHs were confined within B-ADL/IADL and IADL in the AD group, respectively. ConclusionsMotor function was the major factor in both B-ADL and IADL, and cognition had a significant effect on IADL. Although PWMH load had inverse associations with both motor and cognitive functions, this radiological marker better predicted IADL in AD than in SIVD. The variation in daily functional profiles with dementia stage and subtypes highlights the need to assess motor function for preventive interventions. Keywords Subcortical ischemic vascular disease; Alzheimer's disease; Cognition; Motor function; Activities of daily life; Instrumental activities of daily life; White matter hyperintensities Neuropsychiatry (London) (2018) 8(2) 558Research Yen-Hsuan Hsu care strategy [14].Several studies have reported ADL profiles and their relevant impact among patients with AD [15][16][17]. However, the functional profiles and determining factors in individuals with SIVD have yet to be fully elucidated [18][19][20], and comparisons of these two prevalent subtypes of dementia are even more limited [19][20]. Therefore, the aims of the current study were to compare the profiles of ADL performance between patients with SIVD and AD subtypes, and to analyze predictors of daily functional performance in different subtypes of dementia by examining the associations between clinical factors, cognitive/motor function, and WMHs. Materials and MethodsSixty-eight community patients with AD and 39 with SIVD who visited the...

Attention and Functional Connectivity Among Patients With Early-Stage Subcortical Ischemic Vascular Disease and Alzheimer’s Disease

“…Based on the inverse correlation between mean ReHo values in the left ACG and the Trail Making Test A, lower ReHo values were linked with dampened neuronal activity that may consequently affect attention. This hypothesis could be further extrapolated to the mechanisms contributing to apathy (Tu et al, 2017a), executive dysfunction (Hsu et al, 2016), and gait problems (Tu et al, 2018a) commonly identified in patients with SIVD. An increase in ReHo values within the right ORB among the patients with AD provided an interesting parallel compared with the aforementioned distinct findings among the patients with SIVD.…”