title: The advanced activities of daily living: a tool allowing the evaluation of subtle functional decline in mild cognitive impairment.
abstract: OBJECTIVE
  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 healthy persons, patients with Mild Cognitive Impairment (MCI) and patients with mild AD.
  
  
  METHODS
  Participants were on average 80 years old (SD 4.6; 66-90), 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Frailty in Ageing (FRIA) reSearch Group,Gerontology Department, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: De Vriendt
authors.forename: E
authors.initials: E
authors.lastname: Gorus
authors.forename: E
authors.initials: E
authors.lastname: Cornelis
authors.forename: I
authors.initials: I
authors.lastname: Bautmans
authors.forename: M
authors.initials: M
authors.lastname: Petrovic
authors.forename: T
authors.initials: T
authors.lastname: Mets
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000503:physiopathology; D003071:Cognition; D060825:Cognitive Dysfunction / Q000503:physiopathology / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D015577:Geriatric Assessment; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires