Functional Disability in Alzheimer Disease

Abstract

The assessment of activities of daily living (ADL) is important both for the diagnosis and staging of dementia. The objective of this study was to verify the applicability and validity of the Brazilian version of the Disability Assessment for Dementia (DAD-Br). The DAD was applied to caregivers of 89 patients with probable Alzheimer disease (AD) and to 40 elderly individuals without cognitive impairment (controls). We assessed the construct validity of the scale and its diagnostic accuracy (sensitivity, specificity, and predictive value). In addition, intergroup and intragroup analyses were conducted to characterize patient performance on basic and instrumental ADL and to determine underlying deficits (initiation, planning, or effective execution). AD patients and controls had mean ages of 76.4+/-6.9 years and 74.5+/-7.3 years (P=0.08), respectively. Mean Mini-Mental State Examination scores were 17.4+/-5.0 and 26.1+/-5.1 (P<0.001) and scores on the DAD were 68.4+/-19.0 and 99.8+/-0.9 (P<0.001), for patients and controls, respectively. The DAD scale showed good internal consistency (Cronbach alpha=0.77) and correlation with the Mini-Mental State Examination (r=0.44; P<0.001). The AD group did better on basic ADL than on instrumental ADL (P<0.001). As expected, controls did not exhibit significant deficits on the items evaluated. The Brazilian version of the DAD is an adequate and reliable tool for assessing functional ability in AD patients.