Patterns of Loss of Basic Activities of Daily Living in Alzheimer Patients: A Cross-Sectional Study of the French REAL Cohort

Abstract

Background/Aims: To characterize loss of basic activities of daily living (BADL) in 687 Alzheimer’s disease (AD) community-dwelling patients included in the French REAL cohort. Methods: Patients had mild to moderately severe AD, and the mean age was 77.8 years. Patterns of loss of the 6 BADL were described at inclusion using the Lawton scale. Results: With 6 binary BADL scores, each patient presented at inclusion a set of losses. For 53% of women, the sets of losses were included within each other or were identical, adding losses in physical ambulation, grooming, bathing, dressing, toilet and feeding, respectively. For 47% of men, a similar sequence was identified, with loss of dressing occurring secondly. A global cohesion of sets of losses was found for 87% of women and 86% of men. The Lawton scale is very useful for the assessment of AD patients.

Factors affecting independence in eating among elderly with Alzheimer's disease

“…Furthermore, this result suggests that vital functions assessed by BI and VI decline earlier than eating ability. The data from specific groups of AD in the present study are in agreement with previous reports that referred to empirically supported strategies for feeding patients with dementia 3,8,12 …”

“…In addition, we found that the presence of dysphagia signs significantly contributed to the decrease in independence in eating. This is in agreement with some clinical reports that showed that dysphagia is the most common factor in advanced AD 3,8,12 . At the time when dysphagia becomes evident in AD, worsening of the severity of dementia, impairment of the basic physical functions, 33 such as the defense reflexes, 4 and pseudobulbar paralysis 37 are usually present.…”

“…The data from specific groups of AD in the present study are in agreement with previous reports that referred to empirically supported strategies for feeding patients with dementia. 3,8,12 Our findings showed that RIE decreased as the severity of dementia increased, and that E-BPSD and the presence of dysphagia signs were significantly related with RIE in general over the range of moderate to severe Eating in the elderly with AD © 2012 Japan Geriatrics Society ͉ 487…”

“…Therefore, there have been some studies on assessment and caregiving methods for patients with these symptoms. One paper reported that even when dementia becomes severe and there is a decrease in independence for activities of daily life, such as excretory functions, taking a bath and walking, many patients still show interest in food and feed themselves 8 . In contrast, other reports have noted the manifestation of eating changes and eating‐related BPSD (E‐BPSD), 9–11 such as failure to begin eating, suspension of eating, eating with the hands rather than utensils, eating non‐food items such as flowers and attempting to eat another person's food 6,12,13 .…”

Early diagnosis of mild cognitive impairment and mild dementia through basic and instrumental activities of daily living: Development of a new evaluation tool

“…Basic ADL (b-ADL), which includes personal hygiene, dressing, and eating, remain stable the longest [27]. Only in major NCD does one need the support of others in performing b-ADL [23,28,29]. Consequently, assessment of ADL is paramount to determine the degree of impairment in everyday functioning and to underpin accurate diagnostic classification in NCD [9,12,15,30].…”