scholarly journals The Role of Functional Assessment as an Outcome Measure in Antidementia Treatment

2007 ◽  
Vol 34 (S1) ◽  
pp. S47-S51 ◽  
Author(s):  
Fadi Massoud
Keyword(s):  
Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Functional Assessment ◽  
Daily Living ◽  
Outcome Measure ◽  
Functional Decline ◽  
Evaluation Of Performance ◽  
Intervention Trials ◽  
Assessment Scales

Functional assessment refers to the evaluation of performance in basic activities of daily living, instrumental activities of daily living, professional duties, and hobbies. This assessment is particularly relevant in the evaluation of cognitive impairment. In fact, functional decline represents a core feature of dementia according to the DSM-IV criteria. Clinically, functional deterioration represents a diagnostic marker, can be used to chart the course of the disease, and as a prognostic marker as it contributes significantly to caregiver burden and institutionalization. For all these reasons, functional assessment has been widely used as an outcome measure in intervention trials of Alzheimer disease (AD). Appropriate function assessment scales have been developed for use in clinical trials of AD. Studies have shown that functional decline benefits from pharmacological interventions in AD and some other cognitive syndromes. This benefit translates into a stabilization ranging between 6 to 12 months compared to a gradual deterioration in the placebo group. There is rarely reversibility for IADL's lost. There are no functional scales specifically designed for assessment of subjects with non-AD cognitive impairment. Scales specifically developed for Mild Cognitive Impairment and other dementias are needed.

scholarly journals FUNCTIONAL ASSESSMENT OF OLDER OBESE PATIENTS CANDIDATES FOR BARIATRIC SURGERY

2014 ◽  
Vol 51 (1) ◽  
pp. 25-28 ◽  
Author(s):  
Denis PAJECKI ◽  
Marco Aurélio SANTO ◽  
Ana Lumi KANAGI ◽  
Daniel RICCIOPPO ◽  
Roberto de CLEVA ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Bariatric Surgery ◽  
Activities Of Daily Living ◽  
Functional Assessment ◽  
Daily Living ◽  
Functional Decline ◽  
The Elderly ◽  
Obese Patients ◽  
Instrumental Activities

Context Obesity in the elderly is associated with exacerbation of functional decline (dependency), that occurs with aging, because of decreased muscle mass and strength, and increased joint dysfunction. Consequently, there is progressive loss of independence, autonomy, chronic pain and impaired quality of life. The weight loss can bring benefits in all these aspects, especially when accompanied by exercises. Elderly patients with morbid obesity may be submitted to surgical treatment, taking into account that the massive weight loss, eventually caused by bariatric surgery, may exacerbate the loss of muscle mass and nutritional complications that may bring harm to the overall health and quality of life of these patients. The functional assessment of elderly patients, candidates for bariatric surgery and the extent to which surgery can bring benefits to the patients, in the field of functionality, has still to be determined. Objective To describe profile functionality in obese elderly referred to a bariatric surgery program. Methods Patients with age ≥60 and BMI ≥35 underwent comprehensive geriatric assessment that evaluates co morbidities, medication use, ability to perform basic activities of daily living and instrumental activities of daily living, and the “Timedupandgo” test to evaluate mobility, whose cut-off point was ≤10 seconds. Statistical analysis was performed in order to see if there is a positive correlation of dependency with BMI and age (over or under 65 years). Results Forty subjects have completed evaluation. The mean age was 64.1 years (60-72) and 75% were women. They had an average weight of 121.1 kg (72.7-204) and a mean BMI of 47.2 kg/m2 (35.8-68.9). 16 patients (40%) have shown dependency for activities of daily living, 19 (47,5%) for instrumental activities of daily living and 20 patients (50%) had a “Timedupandgo” test over 10 seconds. Statistical analysis (t-Student, Mann-Whitney, Binary Logistic Regression) has shown positive correlation of dependency in activities of daily living for BMI >49 kg/m2, dependency in instrumental activities of daily living for BMI >46,5 kg/m2, and “Timedupandgo” test greater than 10 seconds for BMI >51 kg/m2 (P<0,05). No dependency difference was observed for patients over or under 65 years age. Conclusions Functional decline is observed in almost half of the morbid obese patients over 60 years old. It is related to increasing BMI (BMI >46,5 kg/m2) but not related to age (60 to 65 years or over 65 years). Functional decline should be considered a co-morbidity in the elderly obese patients and should be assessed before bariatric surgery in this population.

scholarly journals Neuropsychological and Functional Impact of COVID-19 on Mild Cognitive Impairment

2020 ◽  
Vol 35 ◽  
pp. 153331752096087
Author(s):  
Kalpana P. Padala ◽  
Christopher M. Parkes ◽  
Prasad R. Padala
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Case Report ◽  
Mild Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Older Adult ◽  
Daily Living ◽  
Functional Decline ◽  
Depression And Anxiety ◽  
Physically Active

We present a case report to showcase that behavioral, cognitive, and functional decline may be associated with COVID-19 stay-home guidance among older adults with pre-existent cognitive impairment. In a functionally independent and physically active older adult with Mild Cognitive Impairment, there was worsening in depression and anxiety symptoms associated with the restrictions of COVID-19. Functional decline was also noted as assessed by Instrumental Activities of Daily Living. We discuss solutions to mitigate the effects of COVID-19 restrictions in this vulnerable population.

scholarly journals The process of decline in advanced activities of daily living: a qualitative explorative study in mild cognitive impairment

2012 ◽  
Vol 24 (6) ◽  
pp. 974-986 ◽  
Author(s):  
Patricia De Vriendt ◽  
Ellen Gorus ◽  
Elise Cornelis ◽  
Anja Velghe ◽  
Mirko Petrovic ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Functional Decline ◽  
International Classification Of Functioning ◽  
Cognitive Changes ◽  
Wide Range ◽  
Day Hospitals ◽  
Constant Comparative Analysis

ABSTRACTBackground: The notion of “minimal impairment in instrumental activities of daily living (i-ADL)” is important in the diagnosis of mild cognitive impairment (MCI), but is presently not adequately operationalized. ADL is stratified according to difficulty, complexity, and also to vulnerability to early cognitive changes in a threefold hierarchy: basic activities of daily living (b-ADL), i-ADL, and advanced activities of daily living (a-ADL). This study aims to gain a deeper understanding of the functional decline in the process of MCI.Methods: In a qualitative design, 37 consecutive patients diagnosed with amnestic (a)-MCI and their proxies were interviewed at two geriatric day hospitals. Constant comparative analysis was used for the analysis.Results: The a-ADL-concept emerged as important in the diagnosis of MCI. All participants were engaged in a wide range of activities, which could be clustered according to the International Classification of Functioning, Disability and Health (ICF). Participants reported subtle difficulties in performance. A process of functional decline was identified in which adaptation and coping mechanisms interacted with the process of reduced skills, leading to an activity disruption and an insufficiency in functioning.Conclusion: This study asserts the inclusion of an evaluation of a-ADL in the assessment of older persons. When evaluating ADL at three levels (b-ADL, i-ADL, and a-ADL), all the activities one can perform in daily living are covered.

Discriminative power of the advanced activities of daily living (a-ADL) tool in the diagnosis of mild cognitive impairment in an older population

2015 ◽  
Vol 27 (9) ◽  
pp. 1419-1427 ◽  
Author(s):  
P. De Vriendt ◽  
T. Mets ◽  
M. Petrovic ◽  
E. Gorus
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Clinical Evaluation ◽  
Predictive Value ◽  
Cognitive Aging ◽  
Daily Living ◽  
Functional Decline ◽  
Community Dwelling ◽  
Discriminative Power

ABSTRACTBackground:Mild cognitive impairment (MCI) is characterized by subjective and objective memory impairments in the absence of manifest functional decline. Mild changes in activities of daily living (ADL) can be present and probably predict conversion to dementia. A new advanced (a)-ADL tool was developed, evaluating high-level activities and, taking each participant as their own reference, distinguishing a global Disability Index (a-ADL-DI), a Cognitive Disability Index (a-ADL-CDI), and a Physical Disability Index (a-ADL-PDI), based on the number of activities performed and the severity and causes of the functional problem. This study evaluates the discriminative validity of the a-ADL in MCI.Method:Based upon clinical evaluation and a set of global, cognitive, mood, and functional assessments, 150 community-dwelling participants (average age 80.3 years (SD 5; 66–91)) were included and diagnosed as (1) cognitively healthy participants (n = 50); (2) patients with a-MCI (n = 48), or (3) mild to moderate AD (n = 52). The a-ADL tool was not a part of the clinical evaluation.Results:The a-ADL-DI and the a-ADL-CDI showed a sensitivity and specificity ranging from 70% to 94.2%, Positive Predictive Value ranging from 70% till 93.8%, and Negative Predictive Value from 64.4% and 93.8%, an area under the curve (AUC) ranging from 0.791 to 0.960. Functional decline related to physical deficits, as assessed by the a-ADL-PDI, did not discriminate between the different groups.Conclusion:The a-ADL tool has a good ability to distinguish normal and pathological cognitive aging. Its discriminative power for underlying causes of limitations may be an advantage.

scholarly journals Complex activities of daily living vary by mild cognitive impairment subtype

2010 ◽  
Vol 16 (4) ◽  
pp. 630-639 ◽  
Author(s):  
KATHERINE J. BANGEN ◽  
AMY J. JAK ◽  
DAWN M. SCHIEHSER ◽  
LISA DELANO-WOOD ◽  
ELIZABETH TUMINELLO ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Financial Management ◽  
Daily Living ◽  
Functional Decline ◽  
Health And Safety ◽  
Functional Abilities ◽  
Cognitively Normal ◽  
Amnestic Mci

AbstractThere is increasing consensus regarding the importance of operationally defining and measuring functional decline in mild cognitive impairment (MCI). However, few studies have directly examined functional abilities in MCI or its presumed subtypes and, to date, reported findings have been discrepant. Nondemented older adults (n = 120) were administered a comprehensive cognitive battery measuring multiple domains as well as a performance-based functional ability measure. Participants were characterized as either cognitively normal, amnestic MCI, or non-amnestic MCI. MCI individuals demonstrated decrements in instrumental activities of daily living (IADL) relative to their cognitively normal counterparts. Specifically, participants with amnestic MCI demonstrated significant decrements in financial management, whereas those with non-amnestic MCI showed poorer performance in abilities related to health and safety. Moreover, decreased functional abilities were associated with decrements in global cognitive functioning but not memory or executive functions in the MCI participants. Finally, logistic regression demonstrated that functional abilities accurately predicted MCI subtype. Results support the need for better delineation of functional decline in MCI. Given the implications of functional status for MCI diagnosis and treatment, the direct assessment of functional abilities is recommended. Results further suggest performance-based IADL assessment may have utility in distinguishing MCI subtypes. (JINS, 2010, 16, 630–639.)

Analysis of Functional and Cognitive Impairment in Institutionalized Individuals with Movement Disorders

2019 ◽  
Vol 19 (7) ◽  
pp. 1022-1031 ◽  
Author(s):  
Paula D. Cebrián ◽  
Omar Cauli
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Cognitive Performance ◽  
Functional Impairment ◽  
Movement Disorders ◽  
Neurological Disorders ◽  
Daily Living ◽  
Severe Cognitive Impairment

Background: Many neurological disorders lead to institutionalization and can be accompanied in their advanced stages by functional impairment, and progressive loss of mobility, and cognitive alterations. Objective: We analyzed the relationship between functional impairment and cognitive performance and its related subdomains in individuals with Parkinson’s disease, Alzheimer’s disease accompanied by motor dysfunction, and with other neurological disorders characterized by both motor and cognitive problems. Methods: All participants lived in nursing homes (Valencia, Spain) and underwent cognitive evaluation with the Mini-Mental State Examination; functional assessment of independence in activities of daily living using the Barthel score and Katz index; and assessment of mobility with the elderly mobility scale. Results: The mean age of the subjects was 82.8 ± 0.6 years, 47% of the sample included individuals with Parkinson’s disease, and 48 % of the sample presented severe cognitive impairment. Direct significant relationships were found between the level of cognitive impairment and functional capacity (p < 0.01) and mobility (p < 0.05). Among the different domains, memory impairment was not associated with altered activities of daily living or mobility. The functional impairment and the risk of severe cognitive impairment were significantly (p<0.05) higher in female compared to male patients. Among comorbidities, overweight/obesity and diabetes were significantly (p < 0.05) associated with poor cognitive performance in those individuals with mild/moderate cognitive impairment. Conclusion: In institutionalized individuals with movement disorders there is an association between functional and cognitive impairment. Reduction of over-weight and proper control of diabetes may represent novel targets for improving cognitive function at such early stages.

scholarly journals Impacts of stroke and cognitive impairment on activities of daily living in the Taiwan longitudinal study on aging

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pi-Hsia Lee ◽  
Ting-Ting Yeh ◽  
Hsin-Yen Yen ◽  
Wan-Ling Hsu ◽  
Valeria Jia-Yi Chiu ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Longitudinal Study ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Skill Training ◽  
Community Dwelling ◽  
Combined Effects ◽  
Stroke Group ◽  
The Individual ◽  
Community Dwelling Older Adults

AbstractStroke and cognitive impairment are common in older population. They often occur together and their combined effects significantly increase disability in both basic (BADLs) and instrumental (IADLs) activities of daily living. We investigated the individual and combined impacts of stroke and cognitive impairment on BADLs and IADLs. A total of 3331 community-dwelling older adults were enrolled from the Taiwan longitudinal study on aging in 2011. Both BADLs and IADLs were analyzed. Combination of stroke and cognitive impairment increased severity of ADL disabilities, but similar prevalence, similar numbers of summed BADL and IADL tasks with disability, and similar levels of difficulty for each BADL and IADL task were found between the stroke group and cognitive impairment group. The former had more difficult in dressing while the latter had more difficult in using the telephone, transport, and managing finances. A hierarchy of ADLs was also observed in all groups. ADL skill training supplemented with cognitive and physical interventions should focus on secondary prevention of dementia and improve motor functional capacity to reduce loss of ADLs.

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