Direct and indirect assessment of functional abilities in patients with Parkinson’s disease transitioning to dementia

Abstract

<jats:p>ABSTRACT. Cognitive impairment is common in patients with Parkinson’s disease (PD), and evaluation of functional abilities is crucial for diagnosis of dementia. Objective: We evaluated differences between direct and indirect functional assessment methods to evaluate functional abilities in PD patients. Methods: We evaluated 32 patients with PD and suspected mild dementia using direct and indirect assessment methods. Results: There was a significant difference between the scores of direct and indirect methods of assessment. Patients and close informants usually overestimated their abilities in many ADL. However, all functional assessment tools used in this study had a relatively good accuracy to predict abnormal performance in a global cognitive scale. Patients with normal cognition according to scores in a global cognitive scale may have some functional impairment in ADL. Direct Assessment of Functional Ability (DAFA) scores correlated linearly with scores in global cognitive scales, and especially with scores in the domains of memory and concentration. Conclusion: Patients and close informants usually overestimate their instrumental abilities in ADL. The direct assessment of daily functioning was more reliable than indirect tools to assess functional losses in patients with PD. Finally, some patients with PD but no dementia may present functional losses in ADL.</jats:p>

Diagnóstico e manejo da demência da doença de Parkinson e demência com corpos de Lewy: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia

“…Corroborando com esses dados, dois estudos brasileiros sugeriram que o questionário da pílula é menos sensível do que outros instrumentos para detectar comprometimento funcional 15,33 . Estudos prévios avaliando pacientes brasileiros com DDP utilizaram alguns instrumentos para avaliar habilidades funcionais, incluindo o questionário de atividades funcionais de Pfeffer, Avaliação de Incapacidade em Demência (DAD), Questionário de Informante sobre Declínio Cognitivo em Idosos (IQCODE), Pill Questionnaire, teste de telefone e Avaliação Direta da Capacidade Funcional (DAFA) 15,[33][34][35][36][37] . Dois estudos avaliaram a precisão do Pfeffer para detectar comprometimento funcional em pacientes com DP 33,37 .…”

Inclusion of Potentially Inappropriate Medicines for the Older Adults in the Brazilian Consensus in Accordance with International Criteria

“…Functional changes and homeostasis usually appear naturally due to the senescence physiology and impact on pharmacokinetics and pharmacodynamics, with the potential to influence the drug therapy safety and effectiveness. 1,2 One of the senility processes designs, characterized by a gradual and pathological decline in all body systems functioning, has determined the highest frequency of frailty and comorbidities and, by consequence, the polypharmacy in the older adults. The long-lived population is one of the largest consumers of drugs 3 and studies have shown that the use of inappropriate medications is prevalent in older adults patients, as well as adverse reactions and drug interactions.…”

“…Functional changes and homeostasis usually appear naturally due to the senescence physiology and impact on pharmacokinetics and pharmacodynamics, with the potential to influence the drug therapy safety and effectiveness. 1 , 2…”

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

“…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 . Although the combined use of instruments for direct and indirect observation of performance is recommended 13 , those available in our environment do not allow observation of the same items of routine tasks, making it difficult to compare perceptions and identify discrepancies between different sources.…”