The advanced activities of daily living: A tool allowing the evaluation of subtle functional decline in mild cognitive impairment

Abstract

Abstract:Objectives Assessment of advanced activities of daily living (a-ADL) can be of interest in establishing the diagnosis of Alzheimer's disease (AD) in an earlier stage, since these activities demand high cognitive functioning and are more responsive to subtle changes. In this study we tested a new a-ADL tool, developed according to the International Classification of Functioning, Disability and Health (ICF). The a-ADL tool is based on the total number of activities performed (TNA) by a person and takes each subject as his own reference. It distinguishes a total Disability Index (a-ADL-DI), a Cognitive Disability Index (a-ADL-CDI), and a Physical Disability Index (a-ADL-PDI), with lower score representing more independency. We explored whether these indices allow distinction between cognitively 2 healthy persons, patients with Mild Cognitive Impairment (MCI) and patients with mild AD. MethodsParticipants were on average 80 years old (SD 4.6;, were community dwelling, and were diagnosed as (1) cognitively healthy subjects (n=26); (2) patients with MCI (n = 17), or (3) mild AD (n = 25), based upon extensive clinical evaluation and a set of global, cognitive, mood and functional assessments. The a-ADL-tool was not part of the clinical evaluation. ResultsThe a-ADL-CDI was significantly different between the three groups (p<.01). The a-ADL-DI was significantly different between MCI and AD (p<.001). The tool had good psychometrical properties (inter-rater reliability; agreement between patient and proxy; correlations with cognitive tests). Although the sample size was relatively small, ROC curves were computed for the a-ADL-DI and a-ADL-CDI with satisfactory and promising results. ConclusionThe a-ADL-CDI and a-ADL-DI might offer a useful contribution to the identification and follow up of patients with mild cognitive disorders in an older population. Conflict of interest declaration: noneAcknowledgements:

Atividades avançadas de vida diária e incidência de declínio cognitivo em idosos: Estudo SABE

“…There was a 22% absolute difference in the adjusted probability of decline between elderly that did not perform AADL and those that performed 12 activities (data not shown). The findings thus provide evidence that these activities can be used as an ancillary instrument in the assessment of cognitive function in the elderly 13 . There is evidence that patients with mild cognitive decline display lower scores on the MMES and on performance of complex activities, especially tasks that involve memory or complex reasoning 14 .…”

“…Cognitive decline is associated with a specific pattern of functional losses, beginning with impaired performance of AADL, followed by losses in instrumental activities of daily living (IADL) and progressing to basic activities of daily living (BADL) 12,13 . Thus, some studies suggest that minor alterations in the performance of AADL are the first signs of mild cognitive impairments 12,13,14 .…”

“…Thus, some studies suggest that minor alterations in the performance of AADL are the first signs of mild cognitive impairments 12,13,14 . AADL, also known as complex activities of daily living, require multiple intact physical, psychological, social, and cognitive functions for their performance and involve activities within dimensions of participation in social, productive, and leisure-time activities, such as: skills to maintain working and planning trips, participation in community groups or movements, driving, planning events, or playing games 10,11,12,13 .…”

“…Other studies 12,13 have shown an association between cognitive decline and performance of AADL, but most of the evidence comes from cross-sectional studies, and there are few studies on this subject, thus hindering the establishment of causal relations between these factors. The current study thus aimed to investigate the impact of performance of AADL on the incidence of cognitive decline in a representative sample of communityliving elderly in the city of São Paulo, Brazil.…”

Associação entre o desempenho de Atividades Avançadas de Vida Diária e a incidência de declínio cognitivo: Estudo SABE

“…(D'orsi et al, 2011;Fonseca, 2006; 11,12,13 As AAVD, também chamadas de atividades complexas de vida diária, exigem a integridade de múltiplas funções físicas, psicológicas, sociais e cognitivas para sua realização e envolvem a realização de atividades dentro dimensões de participação em atividades sociais, produtivas e de lazer, tais como: habilidades para manter o trabalho, viajar e planejar viagens, participação em grupos ou movimentos comunitários, dirigir, planejar eventos ou jogar. 9,10,11,12 Apesar dos resultados de alguns estudos 11,12 20,21,22,23 A literatura científica sugere que os padrões de atividade e redes neurais relacionadas que são estabelecidos no início da vida possam ser mais importantes para manter a saúde cognitiva na velhice, no sentido de minimizar os efeitos da diminuição da velocidade de processamento cognitivo no envelhecimento. 20,24 A exposição a ambientes complexos com experiências cerebrais estimulantes ao longo da vida, relacionadas a variáveis sociodemográficas e de funcionalidade, tais como alta escolaridade, atividades laborais mais complexas e atividades de lazer promoveriam crescimento neuronal e favoreceriam a neuroplasticidade.…”