title: Understanding the complexities of functional ability in Alzheimer's disease: more than just basic and instrumental factors.
abstract: BACKGROUND
  Dementia of the Alzheimer's type (AD) is defined by both cognitive and functional decline; new criteria allow for identification of milder, non-functionally impaired patients. Understanding loss of autonomy in AD is essential, as later stages represent a significant burden and cost to patients, their families, and society. The purpose of the present analyses was to determine the factor structure of the Alzheimer's Disease Cooperative Study-Activities of Daily Living Scale (ADCS-ADL) in a cohort of AD patients.
  
  
  METHODS
  Baseline ADCS-ADL assessments of 734 AD patients from the PLASA study were included in an exploratory factor analysis (EFA). Because the ADCS-ADL was designed to assess change over time, change from baseline scores over 2 years were also analyzed using an EFA. Factorial solutions were evaluated based on cross-loading, non-loadings, and number of items per factor.
  
  
  RESULTS
  Mean age at baseline was 79.3, mean MMSE was 19.8 and 73.3% of participants were female. Baseline data suggested a 4-factor solution that included factors for basic ADLs (BADLs), domestic/household activities, communication/engagement with the environment, and outside activities. The change scores EFA suggested a 2-factor solution of BADLs and instrumental ADLs (IADLs).
  
  
  CONCLUSIONS
  Distinct factors of IADLs should be considered for further validation as areas of attention to catch early functional decline.
authors.forename: Kristin
authors.initials: K
authors.lastname: Kahle-Wrobleski
authors.forename: Nicola
authors.initials: N
authors.lastname: Coley
authors.forename: Benoit
authors.initials: B
authors.lastname: Lepage
authors.forename: Christelle
authors.initials: C
authors.lastname: Cantet
authors.forename: Bruno
authors.initials: B
authors.lastname: Vellas
authors.forename: Sandrine
authors.initials: S
authors.lastname: Andrieu
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000544:Alzheimer Disease / Q000503:physiopathology*; D018450:Disease Progression; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D011446:Prospective Studies; D012720:Severity of Illness Index