Identifying factors of activities of daily living important for cost and caregiver outcomes in Alzheimer's disease

2015 ◽  
Vol 28 (2) ◽  
pp. 247-259 ◽  
Author(s):  
Catherine Reed ◽  
Mark Belger ◽  
Bruno Vellas ◽  
Jeffrey Scott Andrews ◽  
Josep M. Argimon ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Activities Of Daily Living ◽  
Caregiver Burden ◽  
Daily Living ◽  
Linear Models ◽  
Functional Impairments ◽  
Societal Costs ◽  
Patient Functioning ◽  
The Relationship

ABSTRACTBackground:We aimed to obtain a better understanding of how different aspects of patient functioning affect key cost and caregiver outcomes in Alzheimer's disease (AD).Methods:Baseline data from a prospective observational study of community-living AD patients (GERAS) were used. Functioning was assessed using the Alzheimer's Disease Cooperative Study – Activities of Daily Living Scale. Generalized linear models were conducted to analyze the relationship between scores for total activities of daily living (ADL), basic ADL (BADL), instrumental ADL (IADL), ADL subdomains (confirmed through factor analysis) and individual ADL questions, and total societal costs, patient healthcare and social care costs, total and supervision caregiver time, and caregiver burden.Results:Four distinct ADL subdomains were confirmed: basic activities, domestic/household activities, communication, and outside activities. Higher total societal costs were associated with impairments in all aspects of ADL, including all subdomains; patient costs were associated with total ADL and BADL, and basic activities subdomain scores. Both total and supervision caregiver hours were associated with total ADL and IADL scores, and domestic/household and outside activities subdomain scores (greater hours associated with greater functional impairments). There was no association between caregiver burden and BADL or basic activities subdomain scores. The relationship between total ADL, IADL, and the outside activities subdomain and outcomes differed between patients with mild and moderate-to-severe AD.Conclusions:Identification of ADL subdomains may lead to a better understanding of the association between patient function and costs and caregiver outcomes at different stages of AD, in particular the outside activities subdomain within mild AD.

Variables Associated with High Caregiver Stress in Patients with Mild Cognitive Impairment or Alzheimer's Disease: Implications for Providers in a Co-Located Memory Assessment Clinic

2014 ◽  
Vol 36 (2) ◽  
pp. 145-159 ◽  
Author(s):  
Daniel Hall ◽  
Joseph Wilkerson ◽  
James Lovato ◽  
Kaycee Sink ◽  
Dana Chamberlain ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Caregiver Burden ◽  
Daily Living ◽  
Functional Independence ◽  
Assessment Clinic ◽  
Behavioral Disturbances ◽  
Memory Assessment

Caregiver burden—the stress associated with caring for a loved one with chronic illness—is rated as high or very high by about two-thirds of Alzheimer's caregivers. At Wake Forest School of Medicine, both patients with memory loss or cognitive impairment and caregivers are evaluated at a geriatrician-led co-located Memory Assessment Clinic (MAC). In a sample of 100 MAC-evaluated patient-caregiver dyads this study assessed both patient severity of Alzheimer's disease or other dementia, self-reported behavioral disturbances, degree of functional independence in general activities of daily living and instrumental activities of daily living (IADLs), and caregiver stress as measured by the Caregiver Burden Scale (CBS). Several patient factors were found to be related to high caregiver stress (CBS score > 25), in particular moderate-severe dementia; inability to perform most IADLs, especially managing medications; and most behavioral disturbances, especially agitation/aggression and appetite/eating problems. The article also suggests ways medical and mental health providers and researchers can help reduce caregiver stress.

scholarly journals Relationship between Performance on the Mini-Mental State Examination Sub-Items and Activities of Daily Living in Patients with Alzheimer’s Disease

2020 ◽  
Vol 9 (5) ◽  
pp. 1537
Author(s):  
Gwanghee Han ◽  
Michio Maruta ◽  
Yuriko Ikeda ◽  
Tomohisa Ishikawa ◽  
Hibiki Tanaka ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Activities Of Daily Living ◽  
Mental State ◽  
Odds Ratio ◽  
Daily Living ◽  
Mini Mental State Examination ◽  
Cognitive Status ◽  
The Relationship ◽  
State Examination

Mini-mental state examination (MMSE) subitems provide useful information about the cognitive status of patients with Alzheimer’s disease (AD). If the relationship between MMSE subitems and activities of daily living (ADL) can be shown, the performance of sub-items can predict ADL status and may provide useful information for early ADL intervention. Therefore, the purpose of this study was to investigate the relationship between MMSE subitem scores and ADL. The study sample consisted of 718 patients with AD. Logistic regression analysis using the Physical Self-maintenance Scale (PSMS) and Lawton’s Instrumental ADL (L-IADL) was performed with each of the subitems as the dependent variables and the MMSE subitem as the independent variable. As a result, the subitems of MMSE, which are strongly related to each item in PSMS differed (e.g., toilet: registration odds ratio 3.00, grooming: naming 3.66). In the case of L-IADL, most items were strongly associated with “writing” (e.g., shopping: odds ratio 4.29, laundry 3.83). In clinical practice, we often focus only on the total MMSE score in patients with AD. However, the relationship between each MMSE subitem and ADL suggested in this study may be useful information that can be linked to ADL care from the performance of the MMSE subitem.

scholarly journals 200 - Neuropsychiatric symptoms influence performance of activities of daily living in symptomatic Alzheimer’s Disease

2021 ◽  
Vol 33 (S1) ◽  
pp. 5-6
Author(s):  
Nikos Giannakis ◽  
Maria Skondra ◽  
Suzanna Aligianni ◽  
Eliza Georgiou ◽  
Savvina Prapiadou ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Activities Of Daily Living ◽  
Cognitive Deficits ◽  
Daily Living ◽  
Neuropsychiatric Symptoms ◽  
Gradient Boosting ◽  
Neurocognitive Disorder ◽  
Older Individuals ◽  
Functional Impairments

Background:The triad of symptom groups of Alzheimer’s disease (AD) encompasses cognitive impairment (e.g. impaired memory or orientation), neuropsychiatric symptoms like apathy, depressive mood, delusions, hallucinations or anxiety, and functional impairment exclusively in complex activities of daily living (cADL, e.g. preparing meals, managing finances) in minor neurocognitive disorder due to AD and both in complex and basic ADL (bADL, e.g. dressing, toileting) in major neurocognitive disorder due to AD. These functional impairments are widely thought to be exclusively attributable to the cognitive deficits of the disease. Of note, mounting evidence indicates that neuropsychiatric symptoms are very common in AD and pose a heavy burden to both patients and their caregivers.Research objective:To unravel potential associations between neuropsychiatric symptoms and cADL and bADL in individuals with neurocognitive disorder due to AD by means of machine learning (ML).Methods:The study included 189 cognitively intact older individuals (CI) and 130 with either minor or major neurocognitive disorder due to AD. Neuropsychiatric symptoms were captured with the Neuropsychiatric Inventory (NPI), covering delusions, hallucinations, aggression, depression, anxiety, apathy, elation, disinhibition, irritability, motor disturbance, nighttime behavioural disturbances and appetite disturbances; cognitive function was assessed with the Cognitive Telephone Screening Instrument (COGTEL); The Bristol ADL scale, an informant-rated measure, was employed for tapping performance of ADL. A variety of ML-models was constructed and trained/tested using a 5-fold cross validation, with SMOTE employed as a remedy for class imbalances. In all cases the features had been selected beforehand based on LASSO technique. The dependent variable was either cADL or bADL (after their discretization based on kMeans quantization). Additionally, the modelling of the diagnosis was also attempted within our ML framework.Results:Gradient Boosting models performed superiorly. cADL and bADL levels are predicted based on both deficits in cognitive domains and NPI variables with an accuracy of 82.3% and 84.8% respectively.In addition, diagnosis can be predicted, with an accuracy of 83.5%, based on a model in which NPI and Bristol ADL variables were significant predictors.Conclusions:cADL- and bADL performance in patients with AD is influenced by both cognitive deficits and neuropsychiatric symptoms.

scholarly journals A-05 Dyadic Influence on Levels of Depression in Individuals with Alzheimer’s Disease

2020 ◽  
Vol 35 (6) ◽  
pp. 795-795
Author(s):  
Conniff K ◽  
Gomez R
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Activities Of Daily Living ◽  
Caregiver Burden ◽  
Daily Living ◽  
Disease Process ◽  
The United States ◽  
Community Dwelling ◽  
Care Recipient ◽  
Positive Aspects Of Caregiving

Abstract Objective Two people who are significantly linked, such as in a husband and wife relationship, are known as a dyad. Dyadic units are helpful to look at as members influence the function of one another. This study looks at families where one member is the caregiver and the other has Alzheimer’s disease and receives care (labeled here as Alzheimer’s disease care recipient or CR). Symptoms of Alzheimer’s include cognitive and functional impairment, social withdrawal, impaired judgment, and mood changes. Notably, there is little research examining how Alzheimer’s dyads influence one another’s level of depression. This study examines how the influence of cognitive and psychosocial variables from the dyad impact depression severity in CRs. Method Archival data of 670 Alzheimer’s disease community-dwelling care recipients from several major cities throughout the United States from the Resources for Enhancing Alzheimer’s Caregivers Health II (REACH II) study was analyzed. The measures included: Mini Mental State Examination (MMSE), Revised Memory and Behavior Problems Checklist (RMBPL), Activities of Daily Living/Instrumental Activities of Daily Living (IADL), Caregiver Burden, Social Support, and Positive Aspects of Caregiving. Results A multiple regression found that caregiver burden (β = 0.34, p < .001), IADL (β = 0.14, p < .001), and positive aspects of caregiving (β = 0.10, p = .02) significantly predicted CR depression ratings. Conclusion Increased positive aspects of caregiving, caregiver burden, and higher levels of CR functional decline were associated with significantly increased levels of depression in CRs. Increased CR depression could correspond with higher levels of awareness during earlier stages of the disease process regarding their impairment and impact on their caregiver.

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