title: Hierarchical structure of the activities of daily living scale in dementia.
abstract: OBJECTIVE
  To describe the sequence of basic activities of daily living (ADL) loss to determine whether there is a hierarchical structure of ADL in dementia in two epidemiological prospective studies: the Paquid study and the Three City Study (3C).
  
  
  METHODS
  Two prospective population-based cohort studies: Paquid (over 22 years of follow-up) and 3C (over 10 years of follow-up).
  
  
  METHODS
  Paquid Study, Gironde, Dordogne, France; The Three Cities Study, Bordeaux, Montpellier, Dijon, France.
  
  
  METHODS
  We analyzed four ADL of the Katz scale: bathing, dressing, transferring and feeding. The a priori hierarchical relationship of the 4 activities tested was 1) no ADL-disability at all four activities; 2) moderate ADL-disability, or disability at bathing and/or dressing (and no disability in transferring nor feeding); and 3) severe ADL-disability, or disability in bathing and/or dressing and transferring and/or feeding. We performed a Guttman scale analysis to establish the hierarchical properties scale.
  
  
  RESULTS
  In total, 845 incident cases of dementia were included, among which 838 cases (99.2%) were without any missing data for ADL. Upon diagnosis of dementia, 564 subjects (67.3%) had no ADL-disability, 236 (26.2%) had moderate ADL-disability, and 38 subjects (4.5%) had severe disability. The a priori hierarchy was respected with non-discordance.
  
  
  CONCLUSIONS
  We defined 3 simple relevant stages of ADL functional decline in dementia that would be easy to collect in clinical practice: stage 1, subjects with no major ADL disabilities; stage 2, subjects with complete disability in bathing and/or dressing; and stage 3, subjects with complete disability in all 4 tasks.
authors.affiliation: F. Delva, ISPED, case 11, University Bordeaux Segalen, 146 rue Léo Saignat, 33076 Bordeaux Cedex, Tel: 33557574538, Fax: 33557571486, E-mail: fleur.delva@isped.u-bordeaux2.fr.
authors.forename: F
authors.initials: F
authors.lastname: Delva
authors.forename: A
authors.initials: A
authors.lastname: Edjolo
authors.forename: K
authors.initials: K
authors.lastname: Pérès
authors.forename: C
authors.initials: C
authors.lastname: Berr
authors.forename: P
authors.initials: P
authors.lastname: Barberger-Gateau
authors.forename: J F
authors.initials: JF
authors.lastname: Dartigues
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003704:Dementia / Q000503:physiopathology*; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012648:Self Care / Q000706:statistics & numerical data