Frailty and Cognitive Decline in Hospitalized Elderly Patients: Associations with Clinical and Laboratory Parameters

Objective To explore the associations of depressive symptoms with functional status and frailty in elderly outpatients. Methods A total of 297 geriatric outpatients(aged 65 years and over)from Zhejiang Hospital were recruited in the cross-sectional study from January 2014 to December 2015.We gathered general information, and evaluated depressive symptoms by Geriatric Depression Scale-15(GDS-15), cognitive function by mini-mental state examination(MMSE), frailty by clinical frailty scale(CFS), activities of daily living(ADL)by Barthel index, instrumental activities of daily living(IADL), balance, POMA and gait by Tinetti-performance oriented mobility assessment(Tinetti-POMA), grip strength and 4m gait speed by 4-meter walk gait speed test.According to the GDS-15 scores, 297 geriatric outpatients were divided into a depression symptom group(n=35, GDS-15≥6)and a non-depressive symptom group(n=262, GDS-15<6). The frailty and functional status were compared between two groups by SPSS 23.0. Results As compared with non-depressive symptoms, the depressive symptoms group had higher clinical frailty scale(CFS), lower body mass index(BMI), lower cognitive function and poorer grip strength and balance(all P<0.05). There were significantly negative correlations of Geriatric Depression Scale-15(GDS-15)with ADL, IADL, gait, balance, POMA and grip strength(r=-0.165、-0.154、-0.216、-0.291、-0.305、-0.314, All P<0.05), while there were significantly positive correlations with CFS score, gait speed(r=0.256、0.198, both P<0.05). The more severe the frailty was, the higher the risk of depressive symptoms was(OR=3.650, 95% CI 1.611-8.271). Conclusions The cognitive and physical functions in the elderly with depression symptoms are poorer as compared with the elderly without depression symptoms.Elderly outpatients with more severe frailty have a higher risk for depressive symptoms. Key words: Depression; Activities of daily living; Frailty; Cognitive

ObjectiveTo identify functional performance trajectories and the characteristics of people who receive inpatient geriatric rehabilitation after hospital admissions.Design, setting, participantsREStORing health of acutely unwell adulTs (RESORT) is an observational, prospective, longitudinal inception cohort study of consecutive patients admitted to geriatric rehabilitation wards at the Royal Melbourne Hospital. Recruitment commenced on 15 October 2017.Main outcome measuresFunctional performance, assessed with the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales two weeks before acute hospitalisation, on admission to and discharge from geriatric rehabilitation, and three months after discharge from geriatric rehabilitation.ResultsA total of 618 rehabilitation patients were included in our analysis. For each of the two scales, three distinct functional performance trajectories were identified by latent class growth modelling: poor at baseline and 3‐month follow‐up (remained poor: ADL, 6.6% of patients; IADL, 42%), good at baseline but poor recovery (deteriorated: ADL, 33%; IADL, 20%), and good at baseline and good recovery (recovered: ADL, 60%; IADL, 35%). Higher Clinical Frailty Scale (CFS) score (v recovered, per point: odds ratio [OR], 2.51; 95% CI, 1.64–3.84) and cognitive impairment (OR, 6.33; 95% CI, 2.09–19.1) were associated with greater likelihood of remaining poor in ADL, and also with deterioration (CFS score: OR, 1.76; 95% CI, 1.45–2.13; cognitive impairment: OR, 1.87; 95% CI, 1.24–2.82). Higher CFS score (OR, 1.64; 95% CI, 1.37–1.97) and cognitive impairment (OR, 3.60; 95% CI, 2.31–5.61) were associated with remaining poor in IADL, and higher CFS score was also associated with deterioration (OR, 1.63; 95% CI, 1.33–1.99).ConclusionsBased on ADL assessments, most people who underwent inpatient geriatric rehabilitation regained their baseline functional performance. As higher CFS score and cognitive impairment were associated with poorer functional recovery, assessing frailty and cognition at hospital admission could assist intervention and discharge planning.

ABSTRACTBackground: Illiteracy, high cerebrovascular risk and copies of APOE-ϵ4 are risk factors for Alzheimer's disease dementia (AD). We aimed to investigate the impacts of gender, education, coronary heart disease (CHD) risk and creatinine clearance variations, body mass index (BMI) and APOE haplotypes over the rates of cognitive and functional decline of AD in one year.Methods: Consecutive outpatients with late-onset AD were assessed for gender, schooling, BMI and APOE haplotypes, variations in one year of creatinine clearance and Framingham projections of the 10-year absolute CHD risk, and prospective scores of the Mini-Mental State Examination (MMSE), the Clinical Dementia Rating Sum-of-Boxes (CDR-SOB), the Index of Independence in Activities of Daily Living (ADL) and Lawton's Scale for Instrumental Activities of Daily Living (IADL).Results: For 191 patients, mean age at AD onset was 73.26 ± 6.4 years-old, earlier for APOE-ϵ4/ϵ4 carriers (p = 0.0039). For women, higher BMI led to improvements in CDR-SOB (β = −0.091; p = 0.037) and MMSE (β = 0.126; p = 0.017) scores, while increased creatinine clearance was associated with improvements in ADL (β = 0.028; p = 0.012) and MMSE (β = 0.043; p = 0.039) scores and higher schooling led to faster worsening of IADL (β = −0.195; p = 0.022) scores. No variables impacted cognitive or functional decline for men, whereas copies of APOE-ϵ4 and the CHD risk had no significant effects whatsoever.Conclusions: Higher BMI and creatinine clearance are protective regarding cognitive and functional decline for women, whereas higher cognitive reserve may lead to faster decline in instrumental functionality. APOE haplotypes affected the age at AD onset, but not cognitive or functional decline.

Diagnosis of dementia is often difficult in subjects with low educational level. Our aim was to evaluate the role of functional performance and the possibility of preferring scores of activities of daily living (ADL) and instrumental activities of daily living (IADL) in screening elderly people for diagnosis of dementia in a rural population of Southern Italy with a very high percentage of non-educated subjects. a random sample of 300 residents, out of 1089 subjects over 60 years of age living in San Marcellino (Caserta, Campania), received door-to-door visit for information about their medical history, with clinical evaluation of general geriatric conditions, including the cumulative illness rating scale (CIRS). Dementia was diagnosed if subjects had a Clinical Dementia Rating score (CDR) > or = 1 and according to the criteria of DSMIV, but not according to scores on the Mini Mental State Examination (MMSE), ADL and IADL. Two hundred and nineteen normal subjects (NS) and 75 patients with dementia (DP) were evaluated. in NS, their mean age- and education-corrected MMSE score was 22.15 (lower than the normal cut-off value of 23.8) and 12.60 in DP (p<0.0001). In NS, the mean ADL score was higher than in DP (5.53 vs 2.64, p<0.0001); only age was correlated with ADL scores (coeff=-0.44, t=-4.557, p<0.0001). Assuming age as covariate, ADL scores highly differentiated DP from NS (F(1, 289)=26.083, p<0.0001). In both sexes, mean IADL scores were higher in NS than in DP (4.46 vs 1.80 in men, p<0.0001; 6.85 vs 2.31 in women, p<0.0001). Age and education did not influence IADL scores in men, but age greatly affected performance in women. IADL scores clearly differentiated NS from DP. In NS, a positive correlation was evident between ADL and IADL scores (r=0.234, p<0.0005), but neither scores correlated with the MMSE scores, even when correlation was performed separately for men and women. In DP, a strong correlation was observed between ADL and IADL scores (r=0.709, p<0.0001) and significant correlations were also evident between the scores of MMSE and both ADL (r=0.492,p<0.0001) and IADL (r=0.398, p<0.0004). in a rural community with a high prevalence of non-educated subjects, cognitive impairment is related to education, whereas independent functioning is limited mainly to age and not to cognition, if the latter remains (relatively) unimpaired. These results point to the importance of an "ecological" approach to the evaluation of elderly people, particularly those living in small rural communities, where education and the social environment may give rise to difficulties in diagnosis of dementia. The assessment of functional autonomy by ADL and IADL scales may be a better screening tool in diagnosing dementia than the MMSE scores.

Recently, the Italian Ministry of Health started a national project (CRONOS project), aiming at assessing how a multi-level therapeutic approach--including 2-year free-of-charge treatment with cholinesterase inhibitors (ChE-I), pharmacologic and non-pharmacologic management of behavioral disorders, periodic multi-dimensional assessment, and informal caregivers' counseling-performs in subjects with mild-to-moderate Alzheimer's disease (AD). Five hundred and three Alzheimer Evaluation Units (AEUs) were instituted for this purpose all over Italy. In this paper we present the results of this approach in a large population of AD subjects followed for 36 weeks by 14 AEUs in Eastern Lombardy, Italy. The project lasted for two years (September 2000-September 2002). Subjects eligible for the CRONOS project had a diagnosis of probable AD, a Mini Mental State Examination (MMSE) score at baseline ranging from 10 to 26, and onset of cognitive disorders between 40 and 90 years of age. Periodic clinical and multi-dimensional assessments, including MMSE, Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) were made at 12 and 36 weeks; ChE-I doses, psychotropic and antidepressant drugs were also re-assessed at all clinical examinations. Caregivers were instructed about dementia and drug-related problems. Of the 808 subjects who completed the 36-week follow-up, 441 were naïves (i.e., never previously treated with ChE-I drugs) and 367 non-naïves. At 12 weeks, both naïves (mean variation from baseline = 0.8 points) and non-naïves (mean variation from baseline = 0.5 points) improved their MMSE scores, while at 36 weeks only naïves improved (mean variation from baseline = 0.1) and non-naïves decreased (mean variation from baseline = -1.2). The IADL and ADL scores progressively and mildly declined from baseline to the 36th week (ADL, mean variation from baseline = -0.5 for naïves, -0.3 for non-naïves; IADL = -0.7 for naïves, mean variation from baseline = -0.4). However, when the MMSE, ADL and IADL variations were controlled for age, sex and education, no significant time effect was found (MMSE, Wilks' lambda p = 0.34; ADL, Wilks' lambda p = 0.25; IADL, Wilks' lambda p = 0.3, respectively). These patterns were apparently unrelated to ChE-I doses. Neuroleptic use doubled in naïves and antidepressants increased in both groups. This multi-level therapeutic approach seems to slow down progression in cognitive and functional performance, in both naïve and non-naïve subjects. The possibility of recurrent examinations by specialized physicians, accurate, lose management of psychotropic drugs, and informal counseling to caregivers probably aid in achieving such results in a "real world" population of AD elderly subjects living at home. Future studies are needed to assess whether a multi-level therapeutic approach including higher ChE-I dose may perform better in these subjects.

The principal aim of the present study was to clarify what type of cognitive decline results in a decrease in the ability to carry out activities of daily living (ADL) in patients with Alzheimer's disease (AD). The participants comprised 1384 outpatients with mild AD. We used the Mini-Mental State Examination (MMSE) and Barthel Index (BI) as indicators of basic ADL, and the Lawton Index (LI) as an indicator of instrumental ADL (IADL). We then analyzed the relationships between MMSE and BI, as well as between MMSE and LI. We also carried out a logistic regression analysis with BI and LI subitems as dependent variables, and MMSE subitems as independent variables. For almost all BI and LI subitems, significantly high odds ratios (OR) were noted in MMSE "Copy the design shown" (e.g. dressing OR 3.66, toilet use OR 3.60 and transfers OR 2.80) and "Write a sentence" (e.g. ability to use telephone OR 5.24, laundry OR 2.60, grooming OR 2.50; P < 0.05). Visuospatial cognition had an important effect on the decrease in basic ADL and IADL. Furthermore, the subitems with minimal effect on the decrease of basic ADL and IADL differed. Therefore, it appears that specific activities have little effect on the maintenance of ADL and IADL, and that determining residual cognitive function and utilizing this as a means of compensating for decreased ADL is a useful strategy. Geriatr Gerontol Int 2018; 18: 50-56.

ObjectiveTo investigate whether there is a difference in balance function between older persons with and without diabetes mellitus (DM), and to identify whether mediating factors, such as diabetic complications, Instrumental Activities of Daily Living (IADL) score, Mini-Mental State Examination (MMSE) score, as well as hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), serum total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL), are associated with balance function in older persons with DM.MethodsIn this cross-sectional study, a total of 208 older persons were divided into a DM group (n=80) and a control group who did not have DM (n=128). Balance function was evaluated with the Tinetti performance-oriented mobility assessment (POMA), which includes balance and gait subscales. Activities of daily living (ADL), IADL, and the MMSE were also measured. Fall incidents in last 12 months, the use of walking aids, fear of falling, comorbidities, and polypharmacy were recorded. Diabetic complications were recorded, and HbA1c, FPG, TC, TG, and LDL were measured in the patients of the DM group.ResultsFall incidents in last 12 months were higher in the DM group than in the control group (P<0.01). POMA score as well as ADL and IADL scores were lower in the diabetic group than the control group (P<0.05). Within the diabetic group, the POMA score was positively related to the ADL score (odds ratio [OR], 11.7; 95% confidence interval [CI], 3.076–44.497; P<0.01), IADL score (OR, 16.286; 95% CI, 4.793–55.333; P<0.01), and MMSE score (OR, 10.524; 95% CI, 2.764–40.074; P<0.01), but was negatively related to age (OR, 7.707; 95% CI, 2.035–29.185; P<0.01) and diabetic complication (OR, 6.667; 95% CI, 2.279–19.504; P<0.01). Also, within the DM group, the decreased POMA score was associated with multiple diabetic complications (OR, 5.977; 95% CI, 1.378–25.926; P<0.05), decreased IADL score (OR, 10.288; 95% CI, 2.410–43.915; P<0.01), and MMSE score (OR, 13.757; 95% CI, 2.556–74.048; P<0.01).ConclusionMultiple diabetic complications, lower MMSE, ADL, and IADL scores were associated with declining balance function in the older persons with DM. These findings can alert physicians to detect and intervene earlier on declining balance in older persons with DM.

The prevalence of apathy is high after stroke, but its subsequent course remains unclear. We sought to determine the longitudinal course and predictors of apathy after stroke. Eligible patients admitted after a stroke and healthy control participants who were rated at least once on the Apathy Evaluation Scale were assessed over 5 years. Rates and levels of apathy in patients rose over 5 years. Significant risk factors for apathy were dementia, interval cerebrovascular events, poor physical functioning, and high depression scores. Apathy is common after stroke and becomes more prevalent with time, especially in those who show evidence of cognitive and functional decline.

The influence of preoperative comprehensive geriatric assessment and frailty on postoperative morbidity, mortality, delirium were examined. A total of 108 patients were evaluated. The Katz Index of Independence in Activities of Daily Living (ADL), the Lawton Brody Instrumental Activities of Daily Living Scale (IADL), the Mini-Nutrition Assessment test (MNA), the Mini-Mental State Examination (MMSE), Yesavage Geriatric Depression Scale (GDS) were performed. Fried Criteria were used to assess physical frailty. We used the Physiological and Operative Severity Scores for the Enumeration of Mortality and Morbidity score (POSSUM), the American Society of Anesthesiologists Score (ASA), and the Charlson Comorbidity Index (CCI) to determine the risk of postoperative morbidity and mortality. Assessment Test for Delirium (4AT) was applied for detection of delirium. The median age was 71years (min-max: 65-84). IADL (p = 0.032), MNA (p = 0.01), MMSE scores (p = 0.026) were found to be significantly lower in patients with morbidity. POSSUM physiology score (p = 0.005), operative score (p = 0.015) and CCI (p = 0.029) were significantly higher in the patients with morbidity. Patients developed morbidity were found to be more frail (p < 0.001). The patients with delirium were found to have lower IADL (p = 0.049) and MMSE scores (p = 0.004), higher POSSUM physiology score (p = 0.005) and all of them were frail. It was found that frailty (OR = 23.695 95% CI: 6.912-81.231 p < 0.001), POSSUM operative score (OR:1.118 95% CI: 1.021-1.224 p = 0.016) and preoperative systolic blood pressure (OR:0.937%95 CI: 0.879-0.999 p = 0.048) were independently related factors for postoperative morbidity. In our study, CGA and frailty in preoperative period were found to be indicators for postoperative morbidity and delirium.

Introduction: Skin lesions observed concomitantly with increasing functional dependency and/or cognitive impairment can lead to significant additional challenges. In this study, we aimed to assess the relationship between functional dependency, cognitive status, and skin lesions in elderly individuals Methods: Individuals presenting to the geriatric outpatient clinic of a tertiary reference center were included in a cross-sectional study. The level of dependency was determined using the Katz Index of Independence in Activities of Daily Living (ADL) and the Lawton-Brody Instrumental Activities of Daily Living (IADL) scale, classifying individuals as "totally dependent," "partially dependent," or "independent." Cognitive status was assessed using the Standardized Mini-Mental State Examination (MMSE), with scores of 24 and above considered "normal." Results: Of the 228 individuals included in the study, 63.60% were male, with a mean age of 76.20 (±7.10) years. The three most commonly observed skin findings in the study group were scar (43.90%), xerosis (40.40%), and dermatophytosis (36.40%). It was revealed that the occurrence of xerosis, infection-related lesions, eczema, diabetic foot ulcers, decubitus ulcers, and pruritus was statistically significantly lower in individuals with "totally independent" ADL, "totally independent" IADL, and/or "normal" cognitive function assessed by MMSE. Conclusion: There is a significant relationship between functional and cognitive status and the occurrence of skin lesions in elderly individuals. Certain skin lesions such as xerosis, infection-related lesions, eczema, diabetic foot ulcers, decubitus ulcers, and pruritus may be particularly common in elderly individuals who are functionally dependent and/or have impaired cognitive functions and should be taken into consideration in clinical practice.

Background Aging is a multifactorial irreversible process associated with decline in muscle mass, physical fitness and neuromuscular functions. One of the most efficient methods to counteract age- related changes in muscle mass and function is physical exercise. Functional disability in the elderly is defined as an acquired difficulty in performing basic everyday tasks or more complex tasks needed for independent living. Physical Activity (PA) can attenuate the physiological declines associated with aging and muscular disuse, prevent the onset of chronic diseases, prevent functional limitations, and improve cognitive functioning and mental health. There are many risk factors for functional disability among elderly like age, chronic diseases, cognitive impairment, and depression Objective to detect risk factors of functional disability among Egyptian community elderly males and its relation to physical performance. Methods it is Cross Sectional Cohort Study included 102 Egyptian elderly males (60 years and older); participants were recruited from Ain Shams University Hospitals out-patient clinics. Assessment of physical performance was done using Katz index of activities of daily living (ADL), instrumental activities of daily living (IADL) and Short Physical Performance Battery test (SPPB). Results Mean ADL score was 5.66 (±0.8), with 9 (8.8%) patients were dependent, and 93 (91.2%) patients were independent, IADL mean score was 6.79 (±1.75) with 38 (37.3%) patients were dependent and 64 (62.7%) patients were independent. In comparing both ADL, IADL dependent and independent group as regard risk factor of dependency and comorbidities we found that they were older, and Hypertension (HTN) prevalence, cerebrovascular stroke (CVS) prevalence, BPH prevalence and Charlson comorbidity index score, geriatric depression scale score (GDS-15) was significantly higher in ADL, IADL dependent group than in ADL, IADL independent group. (P value &amp;lt;0.05), Mini mental state examination (MMSE) score was lower in ADL, IADL dependent group than the independent group. predictors of physical dependency using SPPB, total balance score can significantly predict ADL dependency at cut-off ≤2. Repeated chair stand score can significantly predict ADL dependency at cut-off ≤2. Gait speed score can significantly predict ADL dependency at cut-off ≤2. Total SPPB score can significantly predict ADL dependency at cut off ≤7. Conclusion Risk factors of functional dependency were age, had one or more of these comorbidities: Hypertension (HTN), cerebrovascular stroke (CVS), Benign prostatic Hyperplasia (BPH), chronic kidney disease (CKD), chronic liver disease (CLD), osteoarthritis, previous falls, higher Charlson comorbidity index score, higher geriatric depression scale score (GDS-15), lower Mini mental state examination (MMSE) score. Functional disability associated with lower scores of SPPB test. Independent predictors of ADL dependency were SPPB gait score ≤2 followed by Charlson score &amp;gt; 2 followed by cerebrovascular stroke prevalence.

The assessment of daily living activities could provide information about daily functions and participation restrictions to develop intervention strategies. The purposes of this study were to assess the scores of the Barthel Index (BI) and Lawton Instrumental Activities of Daily Living (IADL) scale in older adults with cognitive impairment and to explore the different effects that levels of cognitive functions have on changes in IADL functions. We recruited 31 participants with dementia, 36 with mild cognitive impairment (MCI), and 35 normal controls (NCs) from the neurology outpatient department of a regional hospital. The results of the demographic and clinical characteristics through the Lawton IADL scale, BI, Quick Mild Cognitive Impairment (Qmci) screen, Montreal Cognitive Assessment (MoCA), and Mini-Mental State Examination (MMSE), were collected on the same day and compared with the Kruskal–Wallis test, Wilcoxon rank-sum test, Fisher’s exact test, and a multiple linear regression analysis, as appropriate. In the BI, bathing was the most discriminating activity to differentiate patients with MCI and dementia; in the Lawton IADL scale, medication responsibility and shopping were the most discriminating activities to differentiate NCs and patients with MCI, and patients with MCI and dementia, respectively. In addition, the predictors of changes in Lawton IADL scale scores were the problem-solving score of the Clinical Dementia Rating scale, a Qmci score of > 20.4 and an age of ≤ 81.2 years, a MoCA score of < 9.4 and an age of > 81.2 years, and the MMSE score and an age of > 81.2 years. This study adds to the evidence that the description of basic and instrumental daily activities is integrated in older adults with cognitive impairment. Notably, the Qmci is the most significant predictor of changes in IADL function for “young” older adults, as are the MoCA and MMSE for “old” older adults.

To determine characteristics that might affect survival times in Alzheimer's disease (AD) patients treated with cholinesterase inhibitors (ChEI) in clinical practice, and create statistical models of estimated life-span after AD diagnosis. The Swedish Alzheimer Treatment Study (SATS) is a prospective, observational, multicenter study to evaluate the use of long-term ChEI therapy. The SATS enrolled 1,021 participants with a clinical diagnosis of mild-to-moderate AD (Mini-Mental State Examination (MMSE) score, 10–26) at the start of ChEI treatment (shortly after AD diagnosis). Cognitive ability, instrumental and basic activities of daily living (ADL) were evaluated at baseline and semiannually over 3 years, and the date of death was recorded. After up to 20 years of follow-up, 966 patients (95%) were deceased. Two types of multivariate linear regression models were created, one using only sociodemographic and clinical characteristics at baseline, and another model including baseline and longitudinal measures. Both main models included cognitive ability, and the extended models also included ADL capacities, as well as aspects of ChEI therapy in the longitudinal model. Significant independent predictors of longer life expectancy in all models were female sex, younger age, no use of antihypertensive/cardiac therapy or antidiabetics, (but not the specific apolipoprotein E genotype or solitary living), indicating the stability and validity of our regression models. A higher education level predicted shorter survival time in both baseline models (with and without ADL) and in the longitudinal model including cognition only. In the baseline model including ADL capacities, instrumental ADL (IADL) and basic ADL scores were stronger predictors of mortality than cognition. In the longitudinal model including ADL capacities, IADL and basic ADL scores (but not MMSE score) at baseline, progression rates in cognition and basic ADL predicted survival independently. A longer period of ChEI treatment in the study was also a strong predictor of longer life-span of up to ∼2 years. The survival time after a diagnosis of AD could be predicted with a high degree of explanation using multivariate regression models including sociodemographic and clinical factors. These clinically relevant prognostic models can be used to estimate life expectancy for AD patients.

Background: To determine characteristics that might affect survival times in Alzheimer’s disease (AD) patients treated with cholinesterase inhibitors (ChEI) in clinical practice, and create statistical models of estimated life-span after AD diagnosis. Method: The Swedish Alzheimer Treatment Study (SATS) is a prospective, observational, multicenter study to evaluate the use of long-term ChEI therapy. The SATS enrolled 1,021 participants with a clinical diagnosis of mild-to-moderate AD (Mini-Mental State Examination (MMSE) score, 10–26) at the start of ChEI treatment (shortly after AD diagnosis). Cognitive ability, instrumental and basic activities of daily living (ADL) were evaluated at baseline and semiannually over 3 years, and the date of death was recorded. Result: After up to 20 years of follow-up, 966 patients (95%) were deceased. Two types of multivariate linear regression models were created, one using only sociodemographic and clinical characteristics at baseline, and another model including baseline and longitudinal measures. Both main models included cognitive ability, and the extended models also included ADL capacities, as well as aspects of ChEI therapy in the longitudinal model. Significant independent predictors of longer life expectancy in all models were female sex, younger age, no use of antihypertensive/cardiac therapy or antidiabetics, (but not the specific apolipoprotein E genotype or solitary living), indicating the stability and validity of our regression models. A higher education level predicted shorter survival time in both baseline models (with and without ADL) and in the longitudinal model including cognition only. In the baseline model including ADL capacities, instrumental ADL (IADL) and basic ADL scores were stronger predictors of mortality than cognition. In the longitudinal model including ADL capacities, IADL and basic ADL scores (but not MMSE score) at baseline, progression rates in cognition and basic ADL predicted survival independently. A longer period of ChEI treatment in the study was also a strong predictor of longer life-span of up to ~2 years. Conclusion: The survival time after a diagnosis of AD could be predicted with a high degree of explanation using multivariate regression models including sociodemographic and clinical factors. These clinically relevant prognostic models can be used to estimate life expectancy for AD patients.

Purpose To determine the level of limitations in activities of daily living (ADL) and instrumental ADL, and identify related factors to instrumental ADL among elderly persons with severe aortic stenosis (AS). Materials and methods We prospectively enrolled 112 consecutive elderly persons (mean age, 84.6 ± 4.4 y) with severe AS. We assessed ADL and instrumental ADL using the Barthel index (BI) and the Frenchay activities index (FAI), respectively. Cardiac, physical, cognitive and kidney functions, nutritional status, medical histories, and comorbidities were assessed. A multiple logistic analysis was developed to explore related factors to the FAI. Results The medians (ranges) of BI and FAI were 100 (15–100) and 21 (0–38), respectively. The multiple logistic analysis revealed that a history of heart failure (sβ = −0.189), a history of cerebrovascular disease (sβ = −0.233), the short physical performance battery score ≤ 8 (sβ = −0.272), the mini-mental state examination score ≤ 23 (sβ = -0.168) were significantly related to the FAI (p < 0.05). Conclusions Physical frailty, a history of heart failure, cerebrovascular disease, and cognitive decline were independently related to declined instrumental ADL. IMPLICATIONS FOR REHABILIATION Activities of daily living was well-preserved among elderly persons with severe aortic stenosis. Instrumental activities of daily living varied among patients with aortic stenosis and was sometimes impaired. Physical frailty, a history of heart failure, and a history of cerebrovascular disease were independently associated with instrumental activities of daily living in elderly persons with severe aortic stenosis.