Functional decline in Alzheimer's disease: a longitudinal study.
OBJECTIVE
To assess the reliability of activities of daily living (ADL) measures and determine the rate and pattern of longitudinal ADL change in patients with Alzheimer's disease (AD).


METHODS
Longitudinal study with evaluations every 6 months.


METHODS
Alzheimer's Disease Research Center Clinics at Mount Sinai Medical Center, New York, and the Veterans Affairs Medical Center, Bronx, New York.


METHODS
104 patients meeting NINCDS-ADRDA criteria for probable AD were followed an average of 31 months.


METHODS
Physical Self-Maintenance Scale (PSMS) and Instrumental Activities of Daily Living Scale (IADLS) of Lawton and Brody and the Blessed Test of Information, Memory, and Concentration.


RESULTS
For men there was inconsistency over time in the decision about whether or not some IADLS items such as "Laundry" were appropriate for a given patient. Test-retest and inter-rater reliabilities were high for all PSMS items and for IADLS items that were judged to be appropriate. IADLS scores changed an average of 2.06 (+/- 3.27) points annually, and change scores were smaller for patients with severe dementia. PSMS scores changed an average of 2.44 (+/- 3.87) points annually with virtually all change occurring in severely demented patients. There was a marked ceiling effect for the IADLS and a curvilinear relationship of PSMS annual change with PSMS baseline.


CONCLUSIONS
Both PSMS and IADLS measures can be reliable in AD patients, but better IADLS items for males need to be developed. IADLS scores are sensitive to change in mild and moderately demented AD patients, while PSMS scores are sensitive to change in more severely demented patients.
Department of Psychiatry, Mount Sinai School of Medicine, New York, New York.
C R
CR
Green
R C
RC
Mohs
J
J
Schmeidler
M
M
Aryan
K L
KL
Davis
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000503:physiopathology*; D005069:Evaluation Studies as Topic; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012648:Self Care; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012737:Sex Factors