Is there correlation between cognition and functionality in severe dementia? The value of a performance-based ecological assessment for Alzheimer’s disease

Abstract

Objective: Besides significant cognitive decline, patients in later stages of Alzheimer's disease (AD) also present global functional impairment, usually reported by their caregivers. This study searched for preserved activities of daily living by investigating correlations among specific instruments for severe dementia with a performance-based functional scale. Method: A sample of 95 moderate to severe AD patients and their caregivers underwent a neuropsychological battery consisting of screening tools, the Functional Assessment Staging Test (FAST), the Severe Mini-Mental State Examination (MMSEsev) and a performance-based ecological scale, the Performance Test of Activities of Daily Living (PADL). Results: Consistent findings emerged from the comparisons among tests. PADL showed significant statistical correlation with MMSEsev (r,0.001), according to FAST subdivisions. Conclusion: Upon suspicion of unreliable caregiver reports, ecological scales may be useful for disease staging. Variable degrees of functionality and cognition may be present even in later stages of AD, requiring proper assessment.Keywords: Alzheimer disease, neuropsychology, activities of daily living. RESUMOObjetivo: Além do significativo declínio cognitivo, pacientes em estágios avançados da doença de Alzheimer (DA) também apresentam prejuízo funcional global. Este estudo investigou atividades de vida diária correlacionando teste específico para a demência grave, com escala funcional baseada no desempenho. Método: 95 pacientes com DA foram submetidos a uma bateria neuropsicológica composta por instrumentos de rastreio, a escala Functional Assessment Staging Test (FAST), o Mini-exame do Estado Mental grave (MEEMg) e escala ecológica baseada no desempenho: a Performance Test of Activities of Daily Living (PADL). Resultados: Achados consistentes emergiram da comparação entre os instrumentos. De acordo com as subdivisões da escala FAST, a PADL apresentou significativa correlação estatística com o MEEMg (r,0.001). Conclusão: Na suspeita de relato pouco confiável por parte do cuidador, escalas ecológicas podem ser úteis no estadiamento da doença. Igualmente à cognição, variados graus de funcionalidade estão presentes mesmo em fases avançadas da DA, exigindo avaliação adequada.Palavras-chave: doença de Alzheimer, neuropsicologia, atividades de vida diária.Dementias are a worldwide burden to public health systems. Given the demographic changes with a global aging trend ( faster in developing countries), estimates on the rising prevalence of these disorders are discouraging, considering associated costs in primary, secondary and tertiary levels of care . As suggested by current guidelines 2 , the progressive course of dementia might be classified in three main stages: mild -there is still some aptitude for independent life, despite the impact on instrumental activities of daily living; moderate -the abilities for independent living are limited and supervision is needed in many activities; severerestricted independence for all activities, incl...

Relationships between Cognition and Activities of Daily Living in Alzheimer’s Disease During a 5-Year Follow-Up: ALSOVA Study

“…The moderate stage shows almost a comparable decline in both IADL and BADL, differing from the mild stage when deficits in only IADL are prevalent [21]. A study using the total scores from a neuropsychological battery and performance-based measure of ADL found a significant relationship between the two scores in a sample of persons with moderate or severe AD [22]; however, the specifics of cognitive and functional impairment in the later stages are yet to be elucidated.…”

Cognitive and physical factors affecting daily function in Alzheimer's disease: A cross‐sectional analysis

“…There is some evidence to suggest that three factors – cognition, physical performance, and behavioral and psychological symptoms of dementia (BPSD) – directly affect ADL and mediates the effects of other factors, such as aerobic fitness on ADL (Figure ). Studies have demonstrated a positive association between global cognition and ADL well into the severe stage of AD (Allain et al, ; Delva et al, ; Wajman, Oliveira, Marin, Schultz, & Bertolucci, ), and the association is stronger as AD progresses over time (Liu‐Seifert et al, ). Quantitatively, a one point worsening in global cognition, as measured by the Mini‐Mental State Examination (MMSE), is associated with a three point decline in ADL, as measured by the Disability for AD (DAD) scale (Arrighi et al, ).…”

Funcionalidade e função executiva em idosos saudáveis e portadores de demência na doença de Alzheimer: estudo de validação do Executive Function Performance Test-Br

“…Na demência moderada, a memória remota começa a ser acometida, o prejuízo no funcionamento social é mais visível e, em relação à funcionalidade, nota-se que as atividades instrumentais de vida diária (AIVD) em geral tornam-se mais limitadas, apresentando já algum declínio/dificuldade em atividades básicas de vida diária (ABVD), tornando a pessoa mais dependente. Quando na fase grave, a memória já está gravemente acometida, ocorrendo desorientação temporal e espacial; nessa fase, o paciente requer cuidados intensos para as AVD, necessitando de ajuda para comer, vestir-se, sendo que muitas vezes já não consegue executar comandos simples, apresenta incontinência esfincteriana e comumente encontra-se acamado (Negrouschi, 2000;Oliveira, 2014).…”

“…A avaliação direta oferece informações mais precisas em termos de desempenho do que a indireta (Royall et al, 2007). Até mesmo em fases avançadas, as avaliações diretas e ecológicas podem ser de grande valia, uma vez que variados graus de funcionalidade estão presentes (Wajman et al, 2014 (Baum, 2008;. (Beaton, 2000).…”