Identifying factors of activities of daily living important for cost and caregiver outcomes in Alzheimer's disease

Abstract

Background:We aimed to obtain a better understanding of how different aspects of patient functioning affect key cost and caregiver outcomes in Alzheimer's disease (AD).Methods: Baseline data from a prospective observational study of community-living AD patients (GERAS) were used. Functioning was assessed using the Alzheimer's Disease Cooperative Study -Activities of Daily Living Scale. Generalized linear models were conducted to analyze the relationship between scores for total activities of daily living (ADL), basic ADL (BADL), instrumental ADL (IADL), ADL subdomains (confirmed through factor analysis) and individual ADL questions, and total societal costs, patient healthcare and social care costs, total and supervision caregiver time, and caregiver burden.Results: Four distinct ADL subdomains were confirmed: basic activities, domestic/household activities, communication, and outside activities. Higher total societal costs were associated with impairments in all aspects of ADL, including all subdomains; patient costs were associated with total ADL and BADL, and basic activities subdomain scores. Both total and supervision caregiver hours were associated with total ADL and IADL scores, and domestic/household and outside activities subdomain scores (greater hours associated with greater functional impairments). There was no association between caregiver burden and BADL or basic activities subdomain scores. The relationship between total ADL, IADL, and the outside activities subdomain and outcomes differed between patients with mild and moderate-to-severe AD.Conclusions: Identification of ADL subdomains may lead to a better understanding of the association between patient function and costs and caregiver outcomes at different stages of AD, in particular the outside activities subdomain within mild AD.

Relationship Between Brain Amyloid Deposition and Instrumental Activities of Daily Living in Older Adults: A Longitudinal Study from the Multidomain Alzheimer Prevention Trial

“…Brain amyloid deposition may be a biological signature of AD, even though it is detectable in other subtypes of dementia and in individuals who never progress to dementia . One of the main challenges for clinicians is to better understand the pattern of deterioration in daily functioning during the preclinical phase of dementia in order to offer the earliest, most‐specific treatment . Furthermore, this asymptomatic stage might be the only window of opportunity for antiamyloid therapies, which have failed to slow the progression of cognitive symptoms significantly, in individuals with symptomatic or prodromal AD.…”

“…4,22 One of the main challenges for clinicians is to better understand the pattern of deterioration in daily functioning during the preclinical phase of dementia in order to offer the earliest, most-specific treatment. 23,24 Furthermore, this asymptomatic stage might be the only window of opportunity for antiamyloid therapies, 25 which have failed to slow the progression of cognitive symptoms significantly, in individuals with symptomatic 26 or prodromal 27 AD. Better identification of individuals at risk of dementia might also be of great interest for intervention trials aiming to delay the onset of clinical symptoms.…”

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

“…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].…”

“…Patients with dementia have been shown to exhibit an increasing decline in activities of daily living (ADL) as their cognition deteriorates [2,3]. Moreover, this decline in ADL has been associated with a higher total societal cost and caregiver time [4]. The management of ADL therefore appears to be an important clinical issue, for both a therapeutic and humane care aspect.…”

“…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].…”