Dependence as a unifying construct in defining Alzheimer's disease severity.
This article reviews measures of Alzheimer's disease (AD) progression in relation to patient dependence and offers a unifying conceptual framework for dependence in AD. Clinicians typically characterize AD by symptomatic impairments in three domains: cognition, function, and behavior. From a patient's perspective, changes in these domains, individually and in concert, ultimately lead to increased dependence and loss of autonomy. Examples of dependence in AD range from a need for reminders (early AD) to requiring safety supervision and assistance with basic functions (late AD). Published literature has focused on the clinical domains as somewhat separate constructs and has given limited attention to the concept of patient dependence as a descriptor of AD progression. This article presents the concept of dependence on others for care needs as a potential method for translating the effect of changes in cognition, function, and behavior into a more holistic, transparent description of AD progression.
Janssen Alzheimer Immunotherapy Research & Development, South San Francisco, CA, USA.
Trent
T
McLaughlin
Howard
H
Feldman
Howard
H
Fillit
Mary
M
Sano
Frederick
F
Schmitt
Paul
P
Aisen
Christopher
C
Leibman
Lisa
L
Mucha
J Michael
JM
Ryan
Sean D
SD
Sullivan
D Eldon
DE
Spackman
Peter J
PJ
Neumann
Joshua
J
Cohen
Yaakov
Y
Stern
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000191:economics / Q000523:psychology* / Q000628:therapy; D003858:Dependency, Psychological; D004185:Disability Evaluation; D018450:Disease Progression; D006801:Humans; D057187:Independent Living / Q000523:psychology; D008875:Middle Aged; D012720:Severity of Illness Index