Activities Of Daily Living Dysfunction Research Articles

Decomposition Analysis of Depressive Symptom Differences Among Older Adults With Hypertension Between Urban and Rural Areas: Cross-Sectional Study.

Hypertension is the most prevalent chronic disease among China's older population, which comprises a growing proportion of the overall demographic. Older individuals with chronic diseases have a higher risk of developing depressive symptoms than their healthy counterparts, as evidenced in China's older population, where patients with hypertension exhibit varying rates of depression depending on residing in urban or rural areas. This study aimed to investigate factors influencing and contributing to the disparities in depressive symptoms among older urban and rural patients with hypertension in China. We used a cross-sectional study design and derived data from the 8th Chinese Longitudinal Health Longevity Survey of 2018. The Fairlie model was applied to analyze the factors contributing to disparities in depressive symptoms between urban and rural older populations with hypertension. The sample size for this study was 5210, and 12.8% (n=669) of participants exhibited depressive symptoms. The proportions of depressive symptoms in rural and urban areas were 14.1% (n=468) and 10.7% (n=201), respectively. In rural areas, years of education (1-6 years: odds ratio [OR] 0.68, 95% CI 1.10-1.21; ≥7 years: OR 0.47, 95% CI 0.24-0.94), alcohol consumption (yes: OR 0.52, 95% CI 0.29-0.93), exercise (yes: OR 0.78, 95% CI 0.56-1.08), and sleep duration (6.0-7.9 hours: OR 0.29, 95% CI 0.17-0.52; 8.0-9.9 hours: OR 0.24, 95% CI 0.13-0.43; ≥10.0 hours: OR 0.22, 95% CI 0.11-0.41) were protective factors against depressive symptoms in older adults with hypertension, while gender (female: OR 1.94, 95% CI 1.33-2.81), self-reported income status (poor: OR 3.07, 95% CI 2.16-4.37), and activities of daily living (ADL) dysfunction (mild: OR 1.69, 95% CI 1.11-2.58; severe: OR 3.03, 95% CI 1.46-6.32) were risk factors. In urban areas, age (90-99 years: OR 0.37, 95% CI 0.16-0.81; ≥100 years: OR 0.19, 95% CI 0.06-0.66), exercise (yes: OR 0.33, 95% CI 0.22-0.51), and sleep duration (6.0-7.9 hours: OR 0.27, 95% CI 0.10-0.71; 8.0-9.9 hours: OR 0.16, 95% CI 0.06-0.44; ≥10.0 hours: OR 0.18, 95% CI 0.06-0.57) were protective factors, while years of education (1-6 years: OR 1.91, 95% CI 1.05-3.49), self-reported income status (poor: OR 2.94, 95% CI 1.43-6.08), and ADL dysfunction (mild: OR 2.38, 95% CI 1.39-4.06; severe: OR 3.26, 95% CI 1.21-8.76) were risk factors. The Fairlie model revealed that 91.61% of differences in depressive symptoms could be explained by covariates, including years of education (contribution 63.1%), self-reported income status (contribution 13.2%), exercise (contribution 45.7%), sleep duration (contribution 20.8%), ADL dysfunction (contribution -9.6%), and comorbidities (contribution -22.9%). Older patients with hypertension in rural areas had more depressive symptoms than their counterparts residing in urban areas, which could be explained by years of education, self-reported income status, exercise, sleep duration, ADL dysfunction, and comorbidities. Factors influencing depressive symptoms had similarities regarding exercise, sleep duration, self-reported income status, and ADL dysfunction as well as differences regarding age, gender, years of education, and alcohol consumption.

Psychomotor processing and functional decline in Parkinson's disease predicted by the Purdue Pegboard test.

The Purdue Pegboard test (PPT) assesses upper-extremity dexterity and motor skills. We hypothesized that PPT skill would predict functional and cognitive decline in Parkinson's disease (PD), independent of observer-rated measures of motor impairment. We utilized data from 399 PD participants enrolled in the deprenyl and tocopherol antioxidative therapy of Parkinsonism trial. Unified Parkinson Disease Rating Scale (UPDRS) metrics, neuropsychological assessments, and clinical rating scales were extracted for analysis with multivariate linear mixed-effects and generalized estimating equation regression models. In multivariate logistic regression, higher baseline and time-varying PPT scores predicted better visual processing speed and attention throughout longitudinal follow-up. No similarly strong associations were found for tests of memory, nonvisual attention, phonemic fluency, or set-shifting. Independently of observer-rated motor impairment (UPDRS part III), PPT performance was significantly associated with changes in activities of daily living (ADL) function measured with UPDRS part II. Low baseline PPT score (≤10th percentile) doubled the relative risk of later ADL dysfunction (≥90th percentile). PPT impairment selectively predicted declining psychomotor processing speed in PD. The domain-specificity of this association may reflect correlated pathophysiological changes in top-down visual and motor control pathways. PPT also predicted increasing ADL dysfunction after adjusting for objective measures of motor impairment. We suggest that PPT scores may be prognostically useful for predicting cognitive changes and ADL dysfunction, which have dramatic impacts on both patient and caregiver quality of life. Furthermore, simple task-based assessments like the PPT could be investigated for remote assessment in PD.

Attentional dysfunction and the punding spectrum in Parkinson's disease

BackgroundPunding is a complication of Parkinson's disease (PD) treatment and stimulant abuse that features excessive preoccupation with repetitive and/or aimless behaviors. We hypothesized that cognitive impairment and functional limitations influence how punding behaviors manifest in PD. MethodsWe extracted data on punding, hobbyism, and cognition from the Parkinson's Progression Marker Initiative (PPMI). Punding and hobbyism were measured with the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) scale. We determined how cognition predicted punding and hobbyism behaviors—adjusting for levodopa dose, Hoehn & Yahr stage, disease duration, and age—using generalized estimating equation (GEE) logistic regression. Activities of daily living (ADL) and motor impairment were measured with the MDS-UPDRS scale. ResultsIn GEE logistic regression models, punding was selectively associated with lower scores on the Letter Number Sequencing test (LNS), the primary attention test in PPMI (Odds ratio: 0.87 (95% CI: 0.79–0.96); p = 0.022). This was corroborated by a subscale-analysis of Montreal Cognitive Assessment (MoCA) scores, as only the attention subscale was significantly associated with punding (OR: 0.59 (0.45–0.77); p < 0.001). Baseline impairment in LNS (Hazard ratio: 2.52 (1.22–5.20); p = 0.012) and MoCA attention (HR: 2.68 (1.32–5.42); p = 0.006) predicted earlier punding in Cox regression. In turn, ADL dysfunction predicted punding (OR: 1.55 (1.20–2.00); p < 0.001), but not hobbyism. ConclusionAttentional dysfunction is a domain-specific cognitive biomarker of punding risk in PD. Further, attentional capacity and functional impairment may determine the complexity of perseverative behaviors on the continuum from rudimentary punding to semi-purposeful hobbyism.

Informant Perceptions of the Cause of Activities of Daily Living Difficulties in Parkinson’s Disease

Objective: Individuals with Parkinson’s disease (PD) can have difficulties with activities of daily living (ADL) that stem from cognitive, motor, or affective manifestations of the disease. Accurately attributing ADL difficulty specifically to cognitive decline is critical when conducting a neuropsychological evaluation of a person with PD. Informant description of ADL performance is frequently used for this purpose, but there has been little work assessing informants’ ability to attribute ADL dysfunction to a specific symptom source in PD. Method: Fifty community dwelling individuals with PD completed cognitive, motor, and affective measures. A knowledgeable informant completed an ADL scale that asked about degree and perceived source of difficulty (cognitive, motor, affective) for each task. Results: Informants indicated that motor dysfunction was the most common source of ADL difficulty, but the informants viewed difficulty with certain tasks, such as financial management, as particularly related to cognitive dysfunction. Informant reports of the source of ADL dysfunction (cognitive, motor, affective) were consistent with clinical measures of those specific dysfunctions. ADL dysfunction attributed to cognition specifically (χ2 = 9.80, p = .01) was higher in those with measurable cognitive impairment. Conclusions: Informant reports of the sources of ADL dysfunction correlate with clinical measures of these symptoms, suggesting that informants may provide useful clinical information about the cause of ADL dysfunction in persons with PD.

Effect of Fall‐Related Concerns on Physical, Mental, and Social Function in Community‐Dwelling Older Adults: A Prospective Cohort Study

To determine the effect of fall-related concerns on physical, mental, and social function. Community-based prospective cohort study (secondary analysis using control group data from a randomized controlled trial). Two municipalities in the south of the Netherlands. Community-dwelling older adults (N = 260). Two groups were created using Modified Falls Efficacy Scale scores (high and low levels of fall-related concerns). Five outcome measures representing physical, mental, and social function were included: activities of daily living (ADLs), symptoms of depression, feelings of anxiety, social participation, and social support interactions. Outcomes were measured at baseline and at 2, 8, and 14 months. Data were analyzed using analysis of covariance and mixed-effect regression models for longitudinal data, adjusting for age, sex, living status (alone or with another person), educational level, cognitive status, self-perceived health, and falls history at baseline. At baseline, significantly more limitations in ADLs and social participation were found for older persons with high levels of fall-related concerns than for those with low levels of concern. These differences persisted over 14 months of follow-up and were consistent over time. No significant differences were found for symptoms of depression, feelings of anxiety, or social support interactions, except for feelings of anxiety at 14 months. Older persons with higher levels of fall-related concerns reported up to 14 months poorer ADL and social participation for up to 14 months than those with lower levels of fall-related concerns. From a clinical point of view, the clear relationship between fall-related concerns and ADL dysfunction and social participation may help to target groups who are at risk of developing adverse consequences of concerns about falls.

Prevalence of depression among memory clinic patients as measured by the Cornell Scale of Depression in Dementia

Objectives: Depression in dementia is common, but the prevalence rates differ according to the populations studied and which diagnostic tools are being used. The aim of this study is to explore the prevalence of depression among patients referred to a memory clinic or an outpatient clinic as measured by the Cornell Scale of Depression in dementia (CSDD) and to investigate which factors are associated with depression.Method: The CSDD was completed for 1470 patients on their first visit to a memory clinic or an outpatient clinic. The prevalence of depression using three different cut-off points was calculated. Logistic regression and correlation analyses were performed.Results: Half of the patients had dementia. The mean CSDD was 6.7 (SD: 5.3) for the whole group, and 50.2% had a score above 5, whereas 37.5% had depression defined as a CSDD score above 7, and 14.1% had a score above 12. The mean scores were higher among those with dementia other than Alzheimer's disease, those with previous depression, and those with greater impairment in the activities of daily living (ADL). In the logistic regression analyses, younger age, ADL dysfunction, and previous depression were significantly associated with higher CSDD scores.Conclusion: We found that depressive symptoms are common among patients referred for a dementia assessment in specialist health care. The strongest factors associated with depressive symptoms were younger age, ADL impairment, and previous depression.

Neural Correlates of Activities of Daily Living in Frontotemporal Dementia

Little research to date has investigated neural correlates of functional disability in frontotemporal dementia (FTD). Activities of daily living (ADL) were covaried against gray matter atrophy regions via Voxel-based morphometry in FTD (n = 52) and contrasted against a dementia control Alzheimer disease (AD) group (n = 20) and healthy age-matched controls (n = 18). Both patient groups had similar ADL scores. However, FTD and AD differed on the gray matter atrophy areas associated with ADL scores. The FTD showed involvement of prefrontal and thalamus regions while AD showed widespread temporal, parietal, frontal, and caudate atrophy correlating with ADL dysfunction. Importantly, only the left superior frontal gyrus was implicated in ADL dysfunction for both FTD and AD. Differences in underlying neural correlates of ADL impairment have important clinical implications as these differences should be taken into account when interventions are planned. Dementia subtypes might require specifically tailored interventions for functional disability.

Predictive Factors for Decline in Activities of Daily Living in Alzheimer's Disease Dementia with More than 2 Follow-up

Background: Impairment in activities of daily living (ADL) is a major problem in Alzheimer's disease (AD), and is related to increased caregiver burden.The present study evaluated whether there are any compo- nents of initial dementia evaluation that could predict ADL decline in years follow-up. Methods: The 32 subjects underwent more than two consecutive neuropsychological evaluation and maintained anti-de- mentia medication from the Ewha Dementia Cohort. The first clinical, neuropsychological test results, medial temporal atrophy rating and white matter ratings were correlated with the final ADL scores. The subjects were further divided into ADL-preserved and declined groups for the comparison depending on final ADL scores. Results: The annual decline of the Korean Mini-mental status examination (K-MMSE) score was 1.5 ± 1.2 and of the Seoul-instrumental ADL score was 6.1 ± 4.6. The Factors correlated with the ADL at baseline were the clinical dementia rating, K-MMSE, memory function score and the total neuropsychological test score, left medial temporal lobe atrophy rating, and the neuropsychiatric total score. Only the neuropsychological component including total test, frontal and visuospatial function scores were statistically different between the two groups in the baseline evaluation. Conclusions: The result of our preliminary study emphasize the other study results that the initial cognitive and dementia status are the strong predictive factors not only for the initial ADL dysfunction but also for the ADL decline in years followed-up dementia cohort.

Executive Function and Activities of Daily Living in Alzheimer’s Disease: A Correlational Meta-Analysis

Background: The assessment of executive function (EF) and activities of daily living (ADL) are important elements in the diagnosis of Alzheimer’s disease. Methods: Following a comprehensive search in three databases, a random-effects meta-analysis was used to investigate the association between ADL ability and seventeen tests of EF, three tests of attention and working memory and the Mini-Mental State Examination. The association between EF and ADL ability was further investigated in relation to four different methods of assessing ADL, and one specific ADL, driving. Results: Forty-nine studies met the inclusion criteria, and a total of 3,663 participants were included, the majority of whom were diagnosed with Alzheimer’s disease. Most of the individual tests, including commonly used tests of EF such as the Clock Drawing Test, Letter Fluency and the Trail Making Test Part B, showed a significant moderate association with ADL. Associations between EF and ADL ability were similar for all four methods of assessing ADL ability. Driving ability was also moderately associated with EF. Conclusion: The meta-analysis suggests a consistent moderate association between ADL and EF, supporting the growing evidence for a link between ADL and executive dysfunction in early dementia.

Prevention of disability by exercise among the elderly: A population-based, randomized, controlled trial

Objective. To assess the effectiveness of an intervention planned and implemented by regional geriatric care teams in order to prevent disability in an elderly population. Design. Randomized, controlled trial with intention-to-treat and subgroup analyses. Subjects and setting. All home-dwelling persons aged 85 years or older in the City of Oulu (n = 555, 67%), including 486 persons with a history of recurrent falls or at least one risk factor for disability in the activities of daily living (ADL) or mobility. Interventions. Programme consisting of home exercise, walking exercise, group exercise, and self-care exercise. Main outcome measures. Change in ADL and mobility during the intervention. Results. Change in ADL performance did not differ (p = 0.462) but a positive change was found in mobility performance (p = 0.013) in the intervention subjects (n = 243) compared with the controls (n = 243). At the end of the intervention period, severe mobility restrictions existed similarly in intervention and control subjects: 48 (34%) and 46 (31%) (p = 0.650) respectively. Frequency of admissions into long-term institutional care were similar in intervention and control groups: 15 (7%) and 13 (6%) (p = 0.669). Impaired balance existed in fewer intervention subjects (64, 45%) than controls (89, 59%) (p = 0.015). Frequency and times of home exercise activity reduced in control subjects (p < 0.001) but did not change in subjects assigned to home exercise intervention (p > 0.05). Conclusion. A pragmatic intervention slowed down the reduction of movement performance but positive effects could not be found in subjects with severe movement and any ADL dysfunction. Positive effects were also found in balance performance.

Assessing and predicting functional impairment in Alzheimer's disease: the emerging role of frontal system dysfunction.

Alzheimer's disease (AD) is associated with neuropsychologic and neuropsychiatric dysfunction and is a leading cause of disability among the elderly. Impairments in activities of daily living (ADL) contribute significantly to the disability reported among patients with AD and diminish quality of life for patients and their families. ADL assessment represents an important component of the diagnosis, tracking, and management of AD. Further, an understanding of the determinants of ADL dysfunction is critical for the early identification of individuals at risk for functional disability and for improved patient care. This manuscript reviews methods for assessing ADL in patients with AD and summarizes the available literature on the neuropsychologic and neuropsychiatric correlates of functional impairment in AD. The emerging role of frontal system dysfunction as an important determinant of ADL impairment is discussed, and recommendations for clinical practice and future research are provided.

Factors affecting the quality of life in patients with epilepsy in Seoul, South Korea.

The level of, and factors affecting the quality of life (QOL) in patients with epilepsy may be different in Korea where social prejudice toward them is still pronounced. However, these issues have not yet been addressed properly. We consecutively identified 154 epilepsy patients who visited the outpatient clinic at the Seoul National University Hospital. An interview was performed by two research nurses with the use of a standardized questionnaire, which included data pertaining to seizure characteristics, symptoms of depression/anxiety, social support, family life/social life satisfaction, and the activities of daily living (ADLs). The QOL was assessed with the use of QOL in Epilepsy Inventory (QOLIE-31). Factors affecting the QOL were: age (P<0.01), education in years (P<0.01), employment status (P<0.05), employment type (P<0.05), current economic status (P<0.05), seizure frequency (P<0.01), the number of antiepileptic drugs (P<0.01), family life/social life dissatisfaction (P<0.01, respectively), social support (P<0.01), the symptoms of anxiety and depression (P<0.01, respectively) and ADL dysfunction (P<0.01). In multiple regression analysis, the symptom of anxiety was the most important factor in explaining lower QOL in patients with epilepsy, while depression (P<0.01), social life dissatisfaction (P<0.01), ADL dysfunction (P<0.05) and seizure frequency (P<0.05) were also significant factors. Psycho-social factors outweighed the physical factors in determining QOL in Korean epilepsy patients. Recognition of these factors will lead health professionals to develop different strategies to improve the QOL of these patients.

Differential Contributions of Cognitive and Motor Component Processes to Physical and Instrumental Activities of Daily Living in Parkinson’s Disease

Patients with Parkinson’s disease (PD) become dependent upon caregivers because motor and cognitive disabilities interfere with their ability to carry out activities of daily living (ADLs). However, PD patients display diverse motor and cognitive symptoms, and it is not yet known which are most responsible for ADL dysfunction. The purpose of this study was to identify the contributions that specific cognitive and motor functions make to ADLs. Executive functioning, in particular sequencing, was a significant independent predictor of instrumental ADLs whereas simple motor functioning was not. By contrast, simple motor functioning, but not executive functioning, was a significant independent predictor of physical ADLs. Dementia severity, as measured by the Dementia Rating Scale, was significantly correlated with instrumental but not physical ADLs. The identification of selective relationships between motor and cognitive functioning and ADLs may ultimately provide a model for evaluating the benefits and limitations of different treatments for PD.

Differential Contributions of Cognitive and Motor Component Processes to Physical and Instrumental Activities of Daily Living in Parkinson's Disease

Patients with Parkinson’s disease (PD) become dependent upon caregivers because motor and cognitive disabilities interfere with their ability to carry out activities of daily living (ADLs). However, PD patients display diverse motor and cognitive symptoms, and it is not yet known which are most responsible for ADL dysfunction. The purpose of this study was to identify the contributions that specific cognitive and motor functions make to ADLs. Executive functioning, in particular sequencing, was a significant independent predictor of instrumental ADLs whereas simple motor functioning was not. By contrast, simple motor functioning, but not executive functioning, was a significant independent predictor of physical ADLs. Dementia severity, as measured by the Dementia Rating Scale, was significantly correlated with instrumental but not physical ADLs. The identification of selective relationships between motor and cognitive functioning and ADLs may ultimately provide a model for evaluating the benefits and limitations of different treatments for PD.

Prevalence of Low Plasma IGF‐I in Poliomyelitis Survivors

To compare plasma levels of insulin-like growth factor-I (IGF-I, also termed somatomedin C) in polio survivors and healthy control subjects and to determine their relation to selected clinical characteristics. Cross sectional study. Polio survivors living in the community recruited from the Wisconsin Polio Support Group. A total of 124 polio survivors (49 males and 75 females), ages 35 to 77 years, and 261 healthy control subjects (139 males and 122 females) of similar age. Plasma IGF-I levels were compared in polio survivors and age-matched control subjects. In the polio survivor group, the relation of IGF-I to selected clinical characteristics was examined before and after adjusting for covariates. Statistical analyses showed that the IGF-I concentrations were significantly lower in the polio survivors than in the controls. This difference was reflected in the means and standard errors of the two groups (0.45 +/- 0.02 vs 0.60 +/- 0.02 units/mL, P < 0.01). Plasma IGF-I below 0.35 units/mL in adults indicates little or no growth hormone secretion. In polio survivors, 38% of the plasma IGF-I values were < 0.35 units/mL compared with 19% in the healthy group. Univariate analysis showed that IGF-I in the polio survivors was significantly correlated with age, gender, and body mass index, and with dependency, pain, and difficulty in the activities of daily living (ADLs). The correlations with ADL dysfunction were independent of the correlations with age, gender, and body mass index. IGF-I level did not correlate with the subjective report of recent decline in functional status. Lower levels of IGF-I are seen in polio survivors, and this finding correlates with ADL dysfunction. The hyposomatomedinemic tendency of polio survivors may have an adverse effect on their neuromuscular function and quality of life.