title: Natural history of functional decline in Alzheimer's disease: a systematic review.
abstract: BACKGROUND
  Knowledge of functional evolution in dementia is crucial for the patients and their families as well as the clinician.
  
  
  OBJECTIVE
  This review identifies scales and outcomes used to describe the natural history of functional decline and describes the natural history of functional decline in a representative clinical population sample of published studies of patients with Alzheimer's disease (AD).
  
  
  METHODS
  A search of three relevant databases was conducted and limited to articles published in English and French between 1998 to March 2012, using the keywords "Dementia", "Activities of Daily Living", "Instrumental Activities of Daily Living", "Functional Impairment", "Prognosis", and "Disease Progression".
  
  
  RESULTS
  The search strategy displayed 683 articles, 20 of which were found to be related to the functional evolution of AD. In these studies, different scales were used to describe the evolution of the functional decline, except for the decline of instrumental activities, for which the Lawton scale was used in all studies. Thus, it is difficult to represent the evolution of the functional decline from a clinical point of view.
  
  
  CONCLUSIONS
  Relatively little data are available to estimate the functional evolution of AD. A consensus with broadened thought is required to know if the progression of the incapacities in these scales is additive or hierarchical.
authors: Centre INSERM, ISPED, Bordeaux, France University Bordeaux Victor Segalen, Bordeaux, France CMRR d'Aquitaine, CHU de Bordeaux, Bordeaux, France.
authors: Fleur
authors: F
authors: Delva
authors: CMRR d'Aquitaine, CHU de Bordeaux, Bordeaux, France.
authors: Sophie
authors: S
authors: Auriacombe
authors: Centre INSERM, ISPED, Bordeaux, France University Bordeaux Victor Segalen, Bordeaux, France.
authors: Luc
authors: L
authors: Letenneur
authors: Centre INSERM, ISPED, Bordeaux, France University Bordeaux Victor Segalen, Bordeaux, France CMRR d'Aquitaine, CHU de Bordeaux, Bordeaux, France.
authors: Alexandra
authors: A
authors: Foubert-Samier
authors: Neurologist, Blaye, France.
authors: Alain
authors: A
authors: Bredin
authors: Hôpital Suburbain du Bouscat, Le Bouscat, France.
authors: Anne
authors: A
authors: Clementy
authors: Service de Neurologie, CHU Bordeaux, Pessac, France.
authors: Chrystelle
authors: C
authors: Latxague
authors: Service de neurologie, Clinique Saint Augustin, Bordeaux, France.
authors: Emmanuel
authors: E
authors: Puymirat
authors: Service de neurologie, CH de Bayonne, Bayonne, France.
authors: Guillaume
authors: G
authors: Ballan
authors: Neurologist, Bergerac, France.
authors: Jean-Phillipe
authors: JP
authors: Delabrousse-Mayoux
authors: Unité de Soins de Suite et Réadaptation gériatrique, CHU de Bordeaux, Bordeaux, France.
authors: Laurent
authors: L
authors: Glénisson
authors: CMP des Fontaines de Monjous, Gradignan, France.
authors: Lise
authors: L
authors: Mazat
authors: University Bordeaux Victor Segalen, Bordeaux, France Service de Neurologie, CHU Bordeaux, Pessac, France Université de Bordeaux-INSERM, Neurocentre Magendie, Bordeaux, France.
authors: Umberto
authors: U
authors: Spampinato
authors: University Bordeaux Victor Segalen, Bordeaux, France Service de Gériatrie, CHU de Bordeaux, Pessac, France.
authors: Muriel
authors: M
authors: Rainfray
authors: University Bordeaux Victor Segalen, Bordeaux, France Service de Neurologie, CHU Bordeaux, Pessac, France Université de Bordeaux, CNRS, Institut des Maladies Neurodégénératives, Bordeaux, France.
authors: François
authors: F
authors: Tison
authors: Centre INSERM, ISPED, Bordeaux, France University Bordeaux Victor Segalen, Bordeaux, France CMRR d'Aquitaine, CHU de Bordeaux, Bordeaux, France.
authors: Jean-François
authors: JF
authors: Dartigues
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000544:Alzheimer Disease / Q000150:complications* / Q000523:psychology*; D003072:Cognition Disorders / Q000209:etiology*; D016208:Databases, Factual / Q000706:statistics & numerical data; D018450:Disease Progression; D006801:Humans; D008569:Memory Disorders / Q000209:etiology*; D008609:Mental Status Schedule
keywords: Activities of daily living; Alzheimer's disease; prognosis; review