Accuracy of Functional Performance in Healthy Elderly Subjects, with Mild Cognitive Impairment and Alzheimer’s Disease (original) (raw)
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Alzheimer Disease & Associated Disorders, 2010
Current criteria for mild cognitive impairment (MCI) require "essentially intact" performance of activities of daily living (ADLs), which has proven difficult to operationalize. We sought to determine how well the Functional Activities Questionnaire (FAQ), a standardized assessment of instrumental ADLs, delineates the clinical distinction between MCI and very mild Alzheimer's disease (AD). We identified 1801 subjects in the National Alzheimer's Coordinating Center Uniform Data Set with MCI (n=1108) or very mild AD (n=693) assessed with the FAQ and randomized them to the development or test sets. Receiver-operator curve (ROC) analysis of the development set identified optimal cut-points that maximized the sensitivity and specificity of FAQ measures for differentiating AD from MCI and were validated with the test set. ROC analysis of total FAQ scores in the development set produced an area under the curve of 0.903 and an optimal cut-point of 5/6, which yielded 80.3% sensitivity, 87.0% specificity, and 84.7% classification accuracy in the test set. Bill paying, tracking current events, and transportation (p's<0.005) were the FAQ items of greatest diagnostic utility. These data suggest that the FAQ exhibits adequate sensitivity and specificity when used as a standardized assessment of instrumental ADLs in the diagnosis of AD versus MCI.
Age and Ageing, 1998
Objectives to assess the validity of the Direct Assessment of Functional Status (DAFS) performance-based functional scale for the staging of dementia severity by comparing it with established clinical, functional and cognitive scales. Patients and methods: 93 consecutive Alzheimer's disease patients underwent DAFS. Socio-demographic variables, cognitive status (Mini-Mental State Examination; MMSE), global disease severity (Clinical Dementia Rating; CDR), disease duration, physical performance (Physical Performance Test, PPT) and functional status (as reported by the primary caregiver) were also recorded and basic (B) and instrumental (I) activities of daily living (ADL) assessed. Results: a significant correlation was found between DAFS and MMSE (Pearson's r = 0.60; P < 0.01), PPT (r = 0.54; P < 0.01) and CDR (Spearman correlation coefficient: -0.48; P < 0.01). A mild, significant correlation was found between DAFS score and daily function as reported by the primary caregiver (r= -0.30 for BADL and r--0.27 for IADL). On multiple regression analysis, only MMSE and PPT were independently associated with the DAFS score, explaining 56% of DAFS total variance. ADL scales did not independently contribute to DAFS variance. A multivariate regression model of the association of DAFS with CDR showed that the association was significant even after adjustment for MMSE and PPT, suggesting that DAFS scores provide additional information on dementia severity. Conclusion: DAFS is a valid tool for the assessment of dementia severity, capturing cognitive and physical aspects of disability.
Journal of the International Neuropsychological Society, 2010
The magnitude of functional impairment that may indicate the threshold between MCI and incipient Alzheimer's disease (AD) has not been clearly defi ned. The objective was to examine the pattern of functional impairment in the continuum MCI-AD. Eighty-nine older adults (32 cognitively unimpaired, 31 MCI, and 26 AD patients) were examined with the Brazilian version of the Direct Assessment of Functional Status (DAFS-BR) at a university-based memory clinic. MCI patients were sub-divided according to the progression to AD upon follow-up, and had baseline cognitive, functional and biological variables analyzed. MCI patients displayed mild defi cits in functional abilities, with intermediate scores as compared to controls and AD. The DAFS-BR items that differentiated MCI from controls involved the ability to deal with fi nances and shopping skills. At baseline, scores obtained by MCI patients who converted to AD were not signifi cantly different from scores of nonconverters. The magnitude of functional defi cits was associated with AD-like pathological fi ndings in the CSF. In conclusion, MCI patients present with early functional changes in complex, instrumental abilities that require the integrity of memory and executive functions. The objective measurement of the functional state may help identify older adults with increased risk of developing dementia in the MCI-AD continuum. ( JINS , 2010, 16 , 297-305.)
Predicting functional ability in mild cognitive impairment with the Dementia Rating Scale-2
International Psychogeriatrics, 2012
ABSTRACTBackground: We examined the utility of cognitive evaluation to predict instrumental activities of daily living (IADLs) and decisional ability in Mild Cognitive Impairment (MCI).Methods: Sixty-seven individuals with single-domain amnestic MCI were administered the Dementia Rating Scale-2 (DRS-2) as well as the Everyday Cognition assessment form to assess functional ability.Results: The DRS-2 Total Scores and Initiation/Perseveration and Memory subscales were found to be predictive of IADLs, with Total Scores accounting for 19% of the variance in IADL performance on average. In addition, the DRS-2 Initiation/Perseveration and Total Scores were predictive of ability to understand information, and the DRS-2 Conceptualization helped predict ability to communicate with others, both key variables in decision-making ability.Conclusions: These findings suggest that performance on the DRS-2, and specific subscales related to executive function and memory, is significantly related to I...
International Journal of Environmental Research and Public Health, 2021
The Assessment of Activities of Daily Living (ADL) is paramount to ensure the accurate early diagnosis of neurocognitive disorders. Unfortunately, the most common ADL tools are limited in their use in a diagnostic process. Hence, we set out to validate a tool to evaluate basic (b-), instrumental (i-), and advanced (a-) ADL called the Brussels Integrated Activities of Daily Living Inventory (BIA). At the geriatric day hospital of the University Hospital Brussels (Belgium) older persons (65+) labelled as Cognitively Healthy Persons (CHP) (n = 47), having a Mild Cognitive Impairment (MCI) (n = 39), and having Alzheimer’s disease (AD) (n = 44) underwent a diagnostic procedure for neurocognitive disorders. Additionally, the BIA was carried out. An exploration using both (cumulative) logistic regressions and conditional inference trees aimed to select the most informative scales to discriminate between the HCP, persons with MCI and AD. The distinction between CHP and MCI and between MCI a...
Dementia and Geriatric Cognitive Disorders Extra, 2019
Aim: The aim of this study was to determine Activities of Daily Living/Instrumental Activities of Daily Living (ADL/IADL) evaluations that will enable better understanding of the severity of Alzheimer’s disease (AD). Methods: AD patients were evaluated by Functional Independence Measure (FIM), Hyogo Activities of Daily Living Scale (HADLS), and Assessment of Motor and Process Skills (AMPS) to identify the assessments that will enable highly precise discrimination of AD Clinical Dementia Rating (CDR) 2 (moderate) and CDR3 (severe) using receiver operating characteristic (ROC) curve and discriminant analyses. Results: The participants were 75 AD patients (CDR2 = 50, mean age = 80.3 ± 5.9 years; CDR3 = 25, mean age = 78.3 ± 9.0 years). The evaluation methods consisted of FIM, HADLS, and AMPS. The results were divided into FIM-M, FIM-C, HADLS-ADL, HADLS-IADL, AMPS-motor skills, and AMPS-process skills. The values for the area under the curve (AUC) were compared by ROC curve and discrimi...
Dementia and Geriatric Cognitive Disorders Extra, 2014
Objective: Considering the lack of studies on measures that increase the diagnostic distinction between Alzheimer's disease (AD) and mild cognitive impairment (MCI) and on the role of the Cambridge Cognitive Examination (CAMCOG) in this, our study aims to compare the utility of the CAMCOG, Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in helping to differentiate AD from MCI in elderly people with >4 years of schooling. Method: A total of 136 elderly subjects - 39 normal controls as well as 52 AD patients and 45 MCI patients treated at the Institute of Geriatrics and Gerontology, Porto Alegre, Brazil - were assessed using the MMSE, CAMCOG, clock drawing test (CDT), verbal fluency test (VF), Geriatric Depression Scale and Pfeffer Functional Activities Questionnaire. Results: The results obtained by means of a receiver operating characteristic curve showed that the MoCA is a better screening test for differentiating elderly subjects with AD from t...
The journal of nutrition, health & aging, 2013
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. Participants were on average 80 years old (SD 4.6; 66-90), were community dwelling, and were diagnosed as (1) c...