title: Modeling Alzheimer Disease Through Functional Independence and Participation.
abstract: BACKGROUND
  The relationship between cognitive and functional impairment in Alzheimer Disease (AD) at the earliest stages of the disease is not well characterized. This study aimed at investigating such relationships along AD evolution by means of the Disability Assessment for Dementia (DAD).
  
  
  METHODS
  Consecutive pairs of AD outpatients and their primary informal caregivers were enrolled. Patients were evaluated by means of the Mini Mental State Examination and neuropsychological tests. A clinician completed the Clinical Dementia Rating Scale to stage dementia severity and interviewed the caregivers to complete the Neuropsychiatric Inventory to assess behavioral disturbances and the DAD to evaluate patients' functional competence.
  
  
  RESULTS
  A total of 158 dyads were enrolled; the Mini Mental State Examination score was used to stratify patients into 4 groups (>24; 20 to 23.9; 10 to 19.9; <10) that were compared. The statistical analysis revealed that all the cognitive domains were positively related to functional independence, but only logical and executive functions seemed to predict autonomy. An intergroup comparison did not show significant differences in the DAD subscales measuring initiation, planning and organization, and performance. The role of education emerged, confirming the relevance of cognitive reserve.
  
  
  CONCLUSIONS
  As the field moves toward earlier intervention in preclinical AD, the detection of early functional changes may drive the definition of trials on prevention or intervention for dementia.
authors.affiliation: *Neuro-Oncology Unit, IRCCS Regina Elena Cancer Institute, Rome †Department of Rehabilitation, Neurorehabilitation Unit, HABILITA Care & Research Rehabilitation Hospitals, Zingonia di Ciserano, Bergamo ‡Alzheimer Assessment Unit/Laboratory of Neuropsychology, IRCCS Neurological National Institute C. Mondino Foundation, Pavia, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Zucchella
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Bartolo
authors.forename: Sara
authors.initials: S
authors.lastname: Bernini
authors.forename: Marta
authors.initials: M
authors.lastname: Picascia
authors.forename: Paola
authors.initials: P
authors.lastname: Malinverni
authors.forename: Elena
authors.initials: E
authors.lastname: Sinforiani
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000523:psychology*; D010054:Brief Psychiatric Rating Scale; D017028:Caregivers / Q000523:psychology; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D057187:Independent Living; D008137:Longitudinal Studies; D008297:Male; D058992:Social Participation / Q000523:psychology*