Detailed assessment of activities of daily living in moderate to severe Alzheimer's disease.
Patients with Alzheimer's Disease (AD) who have reached a stage of moderate to severe dementia are capable of completing a restricted range of cognitive tests and performing a limited range of activities of daily living (ADL). As part of an initiative to develop instruments to evaluate AD, we analyzed data describing the performance of a large number of ADL and scores on cognitive and global assessment measures in a cohort of patients with AD with moderate to severe cognitive impairment, defined as a Mini-Mental State Examination score ranging from 0-15 (out of 30). From the large pool of ADL, 19 met criteria of applicability, reliability, good scaling, concordant validity, and sensitivity to detect change in performance over 6-12 months. A total score derived from these 19 ADL ratings, comprising a scale termed the Alzheimer Disease Cooperative Study ADL-sev, correlated strongly with measures of cognition and of global dementia severity. Patients with moderate to severe AD showed a decline on the ADL-sev and cognitive measures over 6 and 12 months, consistent with the progression of AD. Detailed evaluation of ADL may provide a useful index to evaluate patients with moderate to severe AD and may complement cognitive assessment, especially for characterizing change in interventional or therapeutic studies.
Galasko
D
D
Department of Neurology, V127, University of California, San Diego, 3350 La Jolla Village Drive, San Diego, CA 92161, USA. dgalasko@ucsd.edu
Schmitt
F
F
Thomas
R
R
Jin
S
S
Bennett
D
D
D000203:Activities of Daily Living; D000368:Aged; D000544:Alzheimer Disease / Q000503:physiopathology / Q000523:psychology*; D003072:Cognition Disorders / Q000503:physiopathology*; D004185:Disability Evaluation; D018450:Disease Progression; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011336:Probability; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D013997:Time Factors