UPSA: avaliação do desempenho funcional nos diferentes estádios de declínio cognitivo

Abstract

Introduction: Dementia is an acquired clinical syndrome, characterized by a progressive decline of several cognitive areas. Deficits are persistent and severe enough to interfere with social relations and with the ability to perform independently the activities of daily living. Several studies showed that impairment in instrumental activities of daily living (IADL) predict significantly dementia development. In order to evaluate IADL, performance-based instruments showed to be more sensitive differentiating cognitive healthy subjects from cognitive impairment subjects. Aims: To translate and adapt the second version of UCSD-Performance-Based Skills Assessment (UPSA-2), a performance-based instrument developed for assessing IADL and to verify if exists differences in functional ability in the different stages of cognitive decline. Materials and methods: The sample was composed by 81 subjects, 34 subjects from the cognitively healthy group, 23 from the mild cognitive impairment group and 24 from the severe cognitive impairment group. The subjects were distributed between the groups according to the established inclusion criteria. Results: UPSA-2 final results were significantly lower in severe cognitive impairment subjects, more than mild cognitive impairment subjects, which in turn were lower than cognitively healthy subjects. UPSA-2 final result is strongly correlated with the Alzheimer’s Disease Cooperative Study scale, Cognitive sub-scale (ADAS-Cog) (r=-0.84/p<0.001). We also have verified that subjects without functional impairments in IADL scale, showed impairments in the UPSA-2 several domains. Conclusions: UPSA-2 is a functional assessment tool that discriminates the functional performance of cognitively healthy subjects, from the performance of mild and severe cognitive impairment subjects. This study showed that UPSA-2 has more sensibility in IADL assessment, than a self-report measure. Also, highlights the strong association between cognitive and functional performance.