The Usefulness of Evaluating Performance of Activities in Daily Living in the Diagnosis of Mild Cognitive Disorders.

Patricia De Vriendt,Wilfried Cools,Ellen Gorus,Elise Cornelis

doi:10.3390/ijerph182111623

Abstract

The Assessment of Activities of Daily Living (ADL) is paramount to ensure the accurate early diagnosis of neurocognitive disorders. Unfortunately, the most common ADL tools are limited in their use in a diagnostic process. Hence, we set out to validate a tool to evaluate basic (b-), instrumental (i-), and advanced (a-) ADL called the Brussels Integrated Activities of Daily Living Inventory (BIA). At the geriatric day hospital of the University Hospital Brussels (Belgium) older persons (65+) labelled as Cognitively Healthy Persons (CHP) (n = 47), having a Mild Cognitive Impairment (MCI) (n = 39), and having Alzheimer’s disease (AD) (n = 44) underwent a diagnostic procedure for neurocognitive disorders. Additionally, the BIA was carried out. An exploration using both (cumulative) logistic regressions and conditional inference trees aimed to select the most informative scales to discriminate between the HCP, persons with MCI and AD. The distinction between CHP and MCI and between MCI and AD was moderately successful with the i-ADLs, in addition to age. Therefore, it is advisable to conduct a multidomain assessment in which the i-ADL could serve as non-invasive and non-time-consuming screening, while the BIA might be useful for diagnostics and disease management.

Highlights

Dementia is a progressive clinical syndrome that affects cognitive abilities and behavior, significantly interfering with older persons’ autonomy and ability in everyday functioning [1,2,3,4]
The objective of this study was to demonstrate the functional decline on the three levels of Activities of Daily Living (ADL), to test the hypothesis that this functional decline in ADLs can discriminate between cognitively healthy persons and persons with Mild Cognitive Impairment (MCI) and dementia, and, to evaluate how the BIA, as a comprehensive tool encompassing the three levels of ADL, can efficiently be used to discriminate between patients with different levels of cognitive impairment in the same clinical sample
The demographics for the different groups, Cognitively Healthy Persons (CHP), MCI, and Alzheimer’s disease (AD), were largely overlapping, significant differences were noted for the age and educational level of the participants (Table 1)

Summary

Introduction

Dementia is a progressive clinical syndrome that affects cognitive abilities and behavior, significantly interfering with older persons’ autonomy and ability in everyday functioning [1,2,3,4]. A diagnosis of dementia offers opportunities for psychosocial interventions, which focus on improving and optimizing functioning and quality of life, preferably already at an early stage [6]. The concept of Mild Cognitive Impairment (MCI) has been developed to capture the early phase of cognitive deterioration and is considered as the transitional stage between normal cognitive functioning and early dementia [7]. The distinction between MCI and dementia can be made based on the extent to which cognitive decline interferes with everyday functioning in activities of daily living (ADLs). Cognitive impairment decreases independence in everyday functioning, while in MCI, individuals remain autonomous; subtle problems may already occur in complex

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