Subcortical vascular disease and functional decline: a 6-year predictor study.
OBJECTIVE
To identify predictors of activity of daily living (ADL) and instrumental activity of daily living (IADL) decline in a population with subcortical vascular dementia (SVD) and to evaluate potential mechanism of decline.


METHODS
Longitudinal.


METHODS
Hospital-based.


METHODS
Computed tomographic (CT) scanning identified 77 participants as having subcortical infarction.


METHODS
Participants were neurologically, neuropsychologically, behaviorally, and functionally assessed four times over 5.82 years. Baseline data were grouped into four modules: basic demographic and risk factor, CT scan, neurological and other clinical, and neuropsychological and behavioral. Multivariate analysis determined predictors of decline in ADLs and IADLs.


RESULTS
Predictors of ADL decline were age, alcohol consumption, coordination, snout reflex, and performance on a neuropsychological test (Block Design). Predictors of IADL decline were predominantly cognitive and included the presence of paratonia and performance on the two neuropsychological tests (attention and memory tasks).


CONCLUSIONS
These findings suggest that cognitive impairments are most likely to have an effect on IADL function, because the skills involved are complex and involve integrative activity, whereas physical and cognitive impairments combined are likely to compromise ADL function, given the more basic and physical nature of the functions involved. These findings indicate that in people with SVD, both ADL and IADL status should be monitored, because, for many, decline in function over time is likely, and thus the provision of appropriate support required.
Bennett
Hayley P
HP
Centre for Education and Research on Aging, Concord Hospital and University of Sydney, Australia. hayley.bennett@unsw.edu.au
Corbett
Alastair J
AJ
Gaden
Susan
S
Grayson
David A
DA
Kril
Jillian J
JJ
Broe
G Anthony
GA
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects; D001288:Attention; D015140:Dementia, Vascular / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008568:Memory; D008875:Middle Aged; D009483:Neuropsychological Tests; D011379:Prognosis