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Longitudinal changes in functional disability in Alzheimer's disease patients

Published online by Cambridge University Press:  13 February 2013

H. Michael Arrighi ,
Isabelle Gélinas ,
Trent P. McLaughlin ,
Jacqui Buchanan  and
Serge Gauthier
H. Michael Arrighi*
Affiliation:
Janssen Alzheimer Immunotherapy Research & Development, LLC, South San Francisco, California, USA
Isabelle Gélinas
Affiliation:
School of Occupational and Physical Therapy, McGill University, Montreal, Quebec, Canada
Trent P. McLaughlin
Affiliation:
Janssen Alzheimer Immunotherapy Research & Development, LLC, South San Francisco, California, USA
Jacqui Buchanan
Affiliation:
Janssen Alzheimer Immunotherapy Research & Development, LLC, South San Francisco, California, USA
Serge Gauthier
Affiliation:
McGill Centre for Studies in Aging, McGill University, Montreal, Quebec, Canada
*
Correspondence should be addressed to: H. Michael Arrighi, PhD, Janssen Alzheimer Immunotherapy Research & Development, LLC, 700 Gateway Blvd., South San Francisco, CA 94080, USA. Phone: +650-794-2568; Fax: +650-794-2504. Email: marrighi@janimm.com.
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Abstract

Background: Functional impairment is a core symptom of Alzheimer's disease (AD) often measured by loss of ability to perform activities of daily living (ADL). The objective is to describe the progressive loss of specific ADL functional capabilities expressed by AD patients’ cognitive ability.

Methods: Data are from ELN-AIP-901, an observational study of cognitive progression in participants aged 50–85 with AD (n = 196), mild cognitive impairment (n = 70), or cognitively normal (n = 75). Participants were evaluated using the Mini-Mental Status Exam (MMSE) and the Disability Assessment for Dementia (DAD) every six months for ≤2 years. Hierarchical regression was used to estimate annual change in DAD and MMSE; first, by individuals’ rate of change using linear regression, then controlling for baseline diagnosis.

Results: Over a two-year period, in AD participants, a 1-point change in MMSE was associated with a 3-point change in DAD (2.79, 95% CI: 1.97–3.63); DAD items within the finance, medication, and outings subdomains were impacted earlier than other subdomains; a hierarchy of functional impairment was observed, with instrumental ADL generally impaired prior to basic ADL.

Conclusions: ADL are impacted in a progressive and hierarchical manner associated with cognitive decline, but substantial variability remains among individuals, as well as in the relative order of items affected.

Keywords

Alzheimer's disease (AD)activities of daily living (ADL)carecognitive disorderdementiadisability
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 6 , June 2013 , pp. 929 - 937
Copyright
Copyright © International Psychogeriatric Association 2013

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