Basic Activities Of Daily Living Scores Research Articles

The connection between anemia and limitations in daily activities among older males: the critical role of dynapenia

AimThe aim of the present study was to examine the relationship between anemia and basic and instrumental activities of daily living in older male patients.MethodsA total of 223 older males attending one geriatric outpatient clinic were included in this cross-sectional study. Anemia was defined as a hemoglobin level below 13 g/dL. Patients’ demographic characteristics, comorbidities, and comprehensive geriatric assessment parameters were also recorded. Handgrip strength of < 27 kg for males was accepted as dynapenia. Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) questionnaires were used to evaluate functional capacity.ResultsThe mean age (standard deviation) of the participants was 80.17 (7.69) years. The prevalence of patients with anemia was 43.9%. There was differences between anemic and non-anemic groups in terms of presence of diabetes mellitus (DM), congestive heart failure (CHF), chronic kidney disease (CKD), malnutrition, dynapenia, geriatric depression, BADL and IADL scores (all p < 0.05). In multivariate analysis, after adjusting for all confounding variables except for dynapenia, patients with anemia were associated with reduced BADL and IADL (all p < 0.05). After adjusting for all confounding variables including dynapenia, deterioration in total BADL and IADL scores did not remain significant in the anemic group compared to the non-anemic group (p > 0.05).ConclusionClose to one in two older outpatient men had anemia. Anemic men had a higher incidence of DM, CHF, CKD, malnutrition, geriatric depression and dynapenia. Anemia was associated with dependence in both BADL and IADL in older men. However, comorbidities, nutritional status, depressive mood and, specifically muscle strength, were important contributors to this association.

The impact of cardiac rehabilitation for older adults with heart failure who underwent invasive cardiac treatment eligible for long-term care needs certification: A retrospective cohort study.

This study aimed to assess the usefulness of cardiac rehabilitation (CR) for older adults with heart failure (HF) who need nursing care and investigate the effect of CR on cognitive function (CF) and basic activities of daily living (BADL). This was a retrospective cohort study. The study included older adults with HF eligible for long-term care insurance in fiscal year 2014 (FY2014) as the baseline and followed them up until March 2018. Patients were divided into two groups, CR (+) and CR (-), and the changes in their CF and BADL scores over time for 3 years were investigated. Of the 765 patients included in the study, 36.5% performed CR. BADL scores in the CR (+) and CR (-) groups (mean (SE)) were 5.81 (0.26) vs. 5.87 (0.20) in FY2014, 5.6 (0.28) vs. 5.92 (0.21) in FY2015, 5.72 (0.31) vs. 6.15 (0.22) in FY2016, and 5.64 (0.33) vs. 6.40 (0.25) in FY2017, respectively. BADL scores worsened over time in the CR (-) group but had a trend to inhibit decline in the CR (+) group, and a significant difference was observed between both groups (p = 0.04). Multivariate analysis showed a significant difference in CR as a factor suppressing ADL decline after 1 year (adjusted odds ratios: 0.54, 95% confidence intervals: 0.36-0.82; p = 0.004). However, no significant difference in the CF scores was observed. CR for older adults with HF eligible for long-term care needs certification does not affect CF and may suppress ADL decline.

Chronic kidney disease and functional impairment in a longitudinal study of older adults in China

ObjectivesTo examine the associations of chronic kidney disease (CKD) with dynamic functional impairment among older Chinese adults.DesignThis was a prospective longitudinal study.SettingData were derived from the Chinese Longitudinal Healthy Longevity...

Preventive interventions to improve older people's health outcomes: systematic review and meta-analysis.

Systematic reviews of preventive, non-disease-specific primary care trials for older people often report effects according to what is thought to be the intervention's active ingredient. To examine the effectiveness of preventive primary care interventions for older people and to identify common components that contribute to intervention success. A systematic review and meta-analysis of 18 randomised controlled trials (RCTs) published in 22 publications from 2009 to 2019. A search was conducted in PubMed, MEDLINE, Embase, Web of Science, CENTRAL, CINAHL, and the Cochrane Library. Inclusion criteria were: sample mainly aged ≥65 years; delivered in primary care; and non-disease-specific interventions. Exclusion criteria were: non-RCTs; primarily pharmacological or psychological interventions; and where outcomes of interest were not reported. Risk of bias was assessed using the original Cochrane tool. Outcomes examined were healthcare use including admissions to hospital and aged residential care (ARC), and patient-reported outcomes including activities of daily living (ADLs) and self-rated health (SRH). Many studies had a mix of patient-, provider-, and practice-focused intervention components (13 of 18 studies). Studies included in the review had low-to-moderate risk of bias. Interventions had no overall benefit to healthcare use (including admissions to hospital and ARC) but higher basic ADL scores were observed (standardised mean difference [SMD] 0.21, 95% confidence interval [CI] = 0.01 to 0.40) and higher odds of reporting positive SRH (odds ratio [OR] 1.17, 95% CI = 1.01 to 1.37). When intervention effects were examined by components, better patient-reported outcomes were observed in studies that changed the care setting (SMD for basic ADLs 0.21, 95% CI = 0.01 to 0.40; OR for positive SRH 1.17, 95% CI = 1.01 to 1.37), included educational components for health professionals (SMD for basic ADLs 0.21, 95% CI = 0.01 to 0.40; OR for positive SRH 1.27, 95% CI = 1.05 to 1.55), and provided patient education (SMD for basic ADLs 0.28, 95% CI = 0.09 to 0.48). Additionally, admissions to hospital in intervention participants were fewer by 23% in studies that changed the care setting (incidence rate ratio [IRR] 0.77, 95% CI = 0.63 to 0.95) and by 26% in studies that provided patient education (IRR 0.74, 95% CI = 0.56 to 0.97). Preventive primary care interventions are beneficial to older people's functional ability and SRH but not other outcomes. To improve primary care for older people, future programmes should consider delivering care in alternative settings, for example, home visits and phone contacts, and providing education to patients and health professionals as these may contribute to positive outcomes.

Peripheral Vascular Disease is Associated with Impaired Activities of Daily Living in the Elderly with Dementia: A Prospective Study.

Although distinct disorders, peripheral vascular disease (PVD) and dementia are both associated with a progressive decline in activities of daily living in elderly patients. This study aimed to compare the functional performance scores between elderly patients with and without dementia and with or without PVD. Patients with Alzheimer's disease, vascular dementia, and mixed type dementia and controls were prospectively enrolled. Functional performance scores for basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were evaluated using the Barthel scale and Lawton scale, respectively. PVD was diagnosed using the ankle brachial index (ABI). Controls without PVD were age- and sex-matched with 57 patients with both dementia and PVD and with 69 patients without dementia. The patients with PVD in both groups had lower mean BALD scores. Adjusting for age, clinical dementia rating, and depression, PVD was associated with a higher likelihood of being in the quartiles of lower BADL scores in those with dementia (p=0.020). Adjusting for age, sex, Mini-Mental State Examination (MMSE) score, depression, and comorbidity and drug counts among the patients without dementia, a significant association was observed with PVD and a higher likelihood of being in the quartiles of lower BADL scores (p=0.044). PVD was related to a higher likelihood of being in the quartiles of lower IADL scores in the non-dementia subjects (p=0.001) after adjusting for age, depression, MMSE, education, and comorbidity count. PVD presence determined the poorer status of BADL in demented individuals but not of the level of IADL. It is still unclear whether modifying PVD health risks and undergoing ABI screening may help demented people become more independent.

The Effects of Vestibular Rehabilitation on Poststroke Fatigue: A Randomized Controlled Trial Study.

Background A major complication caused by stroke is poststroke fatigue (PSF), and by causing limitations in doing activities of daily living (ADL), it can lower the quality of life. Objective The present study is an attempt to examine the effects of vestibular rehabilitation on BADL (Basic Activities of Daily Living), fatigue, depression, and Lawton Instrumental Activities of Daily Living (IADL) in patients with stroke. Method Patients with a history of stroke took part voluntarily in a single-blind clinical trial. The participants were allocated to control and experimental groups randomly. The experimental group attended 24 sessions of vestibular rehabilitation protocol, while the control group received the standard rehabilitation (including three sessions per week each for around 60 min). To measure fatigue, the Fatigue Impact Scale (FIS) and the Fatigue Assessment Scale (FAS) were used. Depression, BADL, and IADL were measured using the Beck Depression Inventory-II (BDI-II), Barthel Index (BI), and Lawton Instrumental Activities of Daily Living, respectively. All changes were measured from the baseline after the intervention. Results Significant improvement was found in the experimental group compared to the control group (p < 0.05) in FIS (physical, cognition, and social subscales), FAS, BDI-II, BADL, and IADL. Moreover, the results showed small to medium and large effect sizes for the physical subscale of FIS and FAS scores based on Cohen's d, respectively; however, no significant difference was found in terms of cognition and social subscales of FIS, BDI-II, BADL, and IADL scores. Conclusion It is possible to improve fatigue, depression, and independence in BADL and IADL using vestibular rehabilitation. Thus, it is an effective intervention in case of stroke, which is also well tolerated.

Effect of Cluster Needling of Scalp Acupuncture Combined with Walking Training on Walking Ability of Stroke Patients under Different Task

<bold>Objective</bold> To observe the effect of cluster needling of scalp acupuncture combined with walking training on walking ability of stroke patients under single-task walking (STW) and dual-task walking (DTW) paradigm. <bold>Methods</bold> A total of 78 inpatients with non-acute stroke who were treated in the the Third Affiliated Hospital of Zhejiang Chinese Medicine University from September 2019 to April 2021, which were divided into the control group and the observation group according to the random number table method, with 39 cases in each group. Both groups received conventional treatment for cerebrovascular disease, the control group received walking training on the basis of conventional treatment, 40 minutes a time, once a day, five days a week, continuous treatment for four weeks, including antigravity muscle training, lower limb weight-bearing support training, lower limb step training of affect side and standing center of gravity transfer training, etc. The observation group received cluster needling of scalp acupuncture on the basis of the control group, once a day, five days a week, continuous treatment for four weeks. The parietal area, anterior parietal area and frontal area of the head were selected for cluster needling of scalp acupuncture, the needles were kept for six hours, routine walking training was performed during needle retention. Before and after treatment, the gait parameters (stride, step length, step speed, stride frequency, stride time, support time, swing time) under STW and DTW paradigms were evaluated by the gait detection evaluation and training system; activities of daily living (ADL) were used to assess patients' activities of daily living, including basic activities of daily living (BADL) and instrumental activities of daily living (IADL). <bold>Results</bold> ① Gait parameters: compared with the STW paradigm, stride, step length, stride speed, stride frequency and swing time of the stroke patients were significantly decreased under the DTW paradigm, while stride time and support time were significantly increased, the differences were statistically significant (<italic>P</italic>&lt;0.05). Under the STW and DTW paradigm, compared with before treatment, stride,step length, step speed, stride frequency and swing time of the two groups after treatment were significantly increased (<italic>P</italic>&lt;0.05), while stride time and support time were significantly decreased (<italic>P</italic>&lt;0.05). Under the STW paradigm, compared with the control group, the stride,step length, step speed, stride frequency and support time of the observation group were significantly increased (<italic>P</italic>&lt;0.05), and the stride time was significantly decreased (<italic>P</italic>&lt;0.05). Under the DTW paradigm, compared with the control group, stride,step length, step speed, stride frequency of the observation group were significantly increased, while the stride time was significantly decreased (<italic>P</italic>&lt;0.05). ② ADL scores: compared with before treatment, the ADL total score and BADL score of the two groups after treatment were significantly decreased, and the IADL score in the observation group after treatment was significantly decreased (<italic>P</italic>&lt;0.05). Compared with the control group, the ADL total score and IADL score in the observation group were significantly decreased (<italic>P</italic>&lt;0.05). <bold>Conclusion</bold> The walking ability of stroke patients with dual-task walking is lower than that of single-task walking; cluster needling of scalp acupuncture combined with walking training can effectively improve the walking ability of dual-task and activities of daily living.

Frailty is associated with poor sleep quality in the oldest old

Background/aimSleep disorders and frailty increase with advancing age, along with physical disabilities, cognitive dysfunction, mood disorders, and social vulnerability. Thus, the study objective was to evaluate the relationship between frailty and sleep quality in the oldest old patients.Materials and methods In this study, 100 patients aged ≥80 years were assessed using comprehensive geriatric assessment (CGA) including basic activities of daily living (ADL), instrumental ADL, handgrip strength, the Geriatric Depression Scale-15, the Mini-Mental State Examination, and the Mini-Nutritional Assessment-Short Form. The sleep quality and frailty status of the patients were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Fried Frailty Index, respectively.ResultsThe median age of the participants was 84 years (80–92), 55% of them were women, and 41% of them were frail. There was no statistically significant difference between the frail and nonfrail groups in terms of age, sex, and comorbidities (P > 0.050). The frail patients scored poorly according to the CGA tests when compared to the nonfrail ones (P < 0.050). The median score for the PSQI was significantly higher in the frail group, 12 points (3–19) versus 6 points (1–19) in the nonfrail patients (P < 0.001). The PSQI score (odds ratio [OR] of 1.308, 95% confidence interval [CI]: 1.092–1.566, P = 0.004), female sex (OR of 5.489, 95% CI: 1.063–28.337; P = 0.042), and the basic ADL score (OR of 0.383; 95% CI: 0.207–0.706; P = 0.002) were found to be independently associated with frailty using multivariate analysis.ConclusionSleep quality was significantly decreased in the oldest old frail patients compared to the nonfrail ones, and poor sleep quality was independently associated with frailty. Evaluating the sleep patterns of the oldest old patients with CGA in daily geriatric practice might help to improve the quality of life of frail patients.

Dietary Habits, Anthropometric Features and Daily Performance in Two Independent Long-Lived Populations from Nicoya peninsula (Costa Rica) and Ogliastra (Sardinia).

(1) Background: Longevity Blue Zones (LBZs) are populations characterized by exceptional longevity. The purpose of this cross-sectional study was to compare the food habits of two representative samples of the oldest old subjects from the population residing in the LBZs of Nicoya peninsula (Costa Rica) and in the mountainous part of Ogliastra (Sardinia, Italy). (2) Methods: Data were collected using validated tools, including a food frequency questionnaire, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) scales for functional autonomy, body mass index, and waist and limbs circumferences. (3) Results: A total of 210 subjects, 60 (31 male) from Nicoya (age range 80–109 years), and 150 (61 male) from Ogliastra (age 90–101 years) were included in the study. In both populations, the highest frequencies of consumption were recorded for plant-derived foods (cereals 60–80% daily, legumes ≥ 80% daily in Nicoya, ≥ 60% 2–5 servings/week in Ogliastra), followed by those of animal origin (dairy products, meat) ≥60% and 80% daily, in Nicoya and Ogliastra, respectively. The frequency of milk consumption showed a positive correlation with BADL (ρ = 0.268 for Nicoya and ρ = 0.214 for Ogliastra) and IADL scores (ρ = 0.466 for Nicoya and ρ = 0.471 for Ogliastra), whereas legumes consumption correlated negatively with self-rated health (ρ = −0.264) and IADL (ρ = −0.332). (4) Conclusions: Our results indicate that the dominant dietary model among the elderly of Nicoya and Ogliastra is a plant-based diet complemented by a non-negligible consumption of animal products, mostly dairy products. Further prospective studies are needed to ascertain a possible cause–effect relationship between food habits and increased likelihood of reaching advanced age.

Prognostic regression models of life expectancy after diagnosis of Alzheimer’s disease – a 20-year follow-up

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.

Feasibility of Continuous Geriatric Assessments as a Prognostic Indicator in Elderly People with Gastrointestinal Cancer.

Objective The feasibility of continuous geriatric assessments (GAs) has not been evaluated fully in elderly patients with cancer. We prospectively investigated this issue by administering a recommended-GA set (r-GA) repeatedly to patients undergoing chemotherapy for gastrointestinal cancer on an outpatient basis. Methods We administered the r-GA before chemotherapy and every two months thereafter. Continuous GAs was defined as the completion of at least two assessments, including the pre-treatment evaluation. The r-GA included the Barthel Index [Basic Activities of Daily Living (BADL)], Mini-Mental State Examination-Japanese (MMSE-J), Instrumental Activities of Daily Living (IADL) scale, Vitality Index (VI), and Geriatric Depression Scale-15. We also used the Vulnerable Elders Survey (VES)-13 to screen overall vulnerability. We analyzed the correlations between each baseline GA score and the overall survival (OS) and the association between the OS and changes in each patient's GA scores over time. Patients Patients ≥65 years of age who presented to our department for initial consultation were enrolled and followed between December 2012 and January 2017. Results Twenty-one elderly patients (median age, 76 years old) were enrolled. GAs were completed within 20 minutes. In an age- and performance status (PS)-adjusted Cox proportional hazards analysis, the baseline BADL, MMSE-J, and VI scores correlated significantly with the OS (p=0.012, p=0.032, and p=0.012, respectively). During the clinical course, decreases in the MMSE-J and VES-13 scores were correlated with the OS (p=0.022 and p=0.019, respectively). Conclusion Outpatient GA administration is feasible. Low baseline BADL, MMSE-J, and VI scores and decreased MMSE-J and VES-13 scores over time may prognosticate the OS.

P2‐282: PROGNOSTIC REGRESSION MODELS OF LIFE EXPECTANCY AFTER DIAGNOSIS OF ALZHEIMER'S DISEASE: A 20‐YEAR FOLLOW‐UP

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.

Depressive symptoms and functional decline following coronary interventions in older patients with coronary artery disease: a prospective cohort study.

BackgroundDepressive symptoms are prevalent in patients with coronary artery disease (CAD). It is unclear, however, how depressive symptoms change over time and the impact of these changes on long-term functional outcomes. We examined the association between different trajectories of depressive symptoms over 1 year and change in functional status over 30 months among patients undergoing coronary angiography.MethodsThis was a prospective cohort study of 350 patients aged 60 and older undergoing non-emergent cardiac catheterization (October 2003–February 2007). A dynamic measure of significant depressive symptoms (i.e., Geriatric Depression Scale score 5+) capturing change over 12 months was derived that categorized patients into the following groups: (i) no clinically important depressive symptoms (at baseline, 6 and 12 months); (ii) baseline-only symptoms (at baseline but not at 6 and 12 months); (iii) new onset symptoms (not at baseline but present at either 6 or 12 months); and, (iv) persistent symptoms (at baseline and at either 6 or 12 month assessment). Primary outcomes were mean change in Older Americans Resources and Services (OARS) instrumental (IADL) and basic activities of daily living (BADL) scores (range 0–14 for each) across baseline (pre-procedure) and 6, 12, and 30 months post-procedure visits.ResultsEstimates for the symptom categories were 71 % (none), 9 % (baseline only), 8 % (new onset) and 12 % (persistent). In adjusted models, patients with persistent symptoms showed a significant decrease in mean IADL and BADL scores from baseline to 6 months (−1.32 [95 % CI −1.78 to −0.86] and −0.63 [−0.97 to −0.30], respectively) and from 12 to 30 months (−0.79 [−1.27 to −0.31] and −1.00 [−1.35 to −0.65], respectively). New onset symptoms were associated with a significant decrease in mean IADL scores at 6 months and from 6 to 12 months. Patients with no depressive symptoms showed little change in scores whereas those with baseline only symptoms showed significant improvement in mean IADL at 6 months.ConclusionsPatients with persistent depressive symptoms were at greatest risk for worse functional status 30 months following coronary interventions. Proactive screening and follow-up for depression in this population offers prognostic value and may facilitate the implementation of targeted interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0986-3) contains supplementary material, which is available to authorized users.

The ASCOMALVA trial: Association between the cholinesterase inhibitor donepezil and the cholinergic precursor choline alphoscerate in Alzheimer's disease with cerebrovascular injury: Interim results

BackgroundCholinesterase inhibitors (ChE-Is) are among the drugs more largely used for the treatment of mild-to-moderate symptoms of Alzheimer's disease (AD), but beneficial long-term effects of these compounds on the cognitive, functional, and behavioural symptoms of the disease are small and not always apparent in practice. Preclinical investigations have suggested that association between ChE-Is and the cholinergic precursor choline alphoscerate enhances cholinergic neurotransmission more effectively than single compounds alone. The ongoing clinical trial on the “Effect of association between a ChE-I and choline alphoscerate on cognitive deficits in Alzheimer's disease associated with cerebrovascular injury” (ASCOMALVA) was designed to assess if association of the ChE-I donepezil with choline alphoscerate has a more favourable clinical profile than monotherapy with donepezil alone. MethodsASCOMALVA is a double-blind multicentre trial that has completed the first 12months of observation of 91 patients of the 210 planned. Patients were aged between 56 and 91years (mean 75±10years) and were included in the protocol with a MMSE score between 15 and 24. Patients with AD diagnosed according to the DSM IV criteria suffer from ischemic brain damage documented by neuroimaging (MRI and CT scan), with a score≥2 in at least one subfield of the New Rating Scale for Age-Related White Matter Changes (ARWMC). Patients were randomly allotted to an active treatment group (donepezil+choline alphoscerate) or to a reference treatment group (donepezil+placebo) and were examined after 3, 6, 9 and 12months of treatment. ResultsCognitive functions, patient's daily activities and behavioural symptoms were assessed by the Mini‐Mental State Evaluation (MMSE), Alzheimer's Disease Assessment Scale Cognitive subscale (ADAS-cog), Basic Activities of Daily Living (BADL), Instrumental Activities of Daily Living (IADL) and Neuropsychiatric Inventory (NPI), of severity and of caregiver distress measures (NPI-F and NPI-D). Patients of the reference group (donepezil+placebo) showed along the course of the 12months of observation, a slight time-dependent worsening of MMSE, ADAS-cog, IADL and NPI-D scores and no changes in the BADL and NPI-F scores. Donepezil plus choline alphoscerate improved compared to donepezil alone the different items analysed except the BADL. ConclusionsThe first results of the ASCOMALVA trial suggest that association of choline alphoscerate to the standard treatment with a ChE-I may represent an option to prolong beneficial effects of cholinergic therapies in AD with concomitant ischemic cerebrovascular injury.

Interactions of household composition and required care level with functional and cognitive status among disabled Japanese elderly living in a suburban apartment complex

In the forthcoming super-aging society, the appropriate assessment of functional and cognitive conditions of disabled elderly people will become increasingly significant in providing care services. Care level and household composition would be key factors to assess function. There might also be an interaction between the two factors with the function. The present study examined the associations of household composition and care level with functional and cognitive status among the disabled elderly living in a suburban apartment complex with a high rate of aged residents (39% in 2009). Participants were 190 disabled elderly persons aged 65 years and over who lived in the apartment complex. Cross-sectional data were collected between May 2009 and August 2010, including care level, household composition, basic activities of daily living (BADL), instrumental activities of daily living (IADL) and the independence level in relation to cognitive status. Lower scores meant less independence in BADL and IADL, and as determined by the cognitive/independence scale. Approximately half of the participants lived alone. Generalized linear model procedure showed significant interactions with the BADL score and cognitive/independence scale between household composition and care level. Scores for BADL and the cognitive/independence scale in groups receiving a higher care level were lower; however, the slope of the trend for the elderly living alone was more gradual than for the elderly living with others. It is important for health-care providers to assess in detail the status of the disabled elderly considering both their household composition and care level in planning and providing assistance for them.

Memantine benefits functional abilities in moderate to severe Alzheimer's disease.

Functional abilities are severely impacted in Alzheimer's disease (AD). Loss of the ability to perform complex (instrumental) and basic activities of daily living (ADL), leads to decreased independence and increased caregiver burden. This post-hoc analysis investigated the effect of memantine (20 mg/day) on ADLs, as measured by Alzheimer's Disease Cooperative Study-Activities of Daily Living 19-item (ADCS-ADL19) and 23-item (ADCS-ADL23) scales, in patients with moderate-to-severe AD. Data were pooled from six multicenter, randomized, placebo-controlled, double-blind, 6-month studies of memantine 20 mg/day. Male and female patients aged ≥ 50 years at baseline with a Mini Mental State Examination (MMSE) score < 20. ADCS-ADL19 and ADCS-ADL23 scales were pooled, and 14 shared items, with a score range of 0-45, were identified and included in the analysis (ADL14). Basic ADLs (BADLs) were defined as: eating, walking, toileting, bathing, and grooming. Instrumental ADLs (IADLs) were defined as: using a telephone, watching television, conversing, clearing a table, finding belongings, obtaining a beverage, disposing of household rubbish, travelling outside the house, and being left alone. Changes from baseline on single-item, BADL (range: 0-15), IADL (range: 0-30), and total ADL14 scores were analysed for observed cases using ANCOVA, with study, center and treatment as categorical explanatory variables and score at baseline as a covariate. 959 patients were treated with memantine and 867 patients received placebo. Memantine-treated patients had less decline from baseline on the ADL14 total score, compared with placebo (p < 0.001) at study end. Memantine also showed lower reductions in BADLs (p < 0.05) and IADLs (p < 0.001), for observed cases, compared with placebo. Memantine-treated patients showed less worsening than placebo recipients for the ADL items: toileting (p < 0.01), grooming (p < 0.01), finding belongings (p < 0.01), and travelling outside the house (p < 0.05). Compared with placebo, memantine shows benefits for both basic and instrumental ADLs in patients with moderate-to-severe AD, suggesting that memantine treatment may lead to a more interactive and dignified life for patients with moderate-to-severe AD.

Effects of dehydroepiandrosterone supplementation on cognitive function and activities of daily living in older women with mild to moderate cognitive impairment

There is little evidence that dehydroepiandrosterone (DHEA) has beneficial effects on physical and psychological functions in older women. We investigated the effect of DHEA supplementation on cognitive function and ADL in older women with cognitive impairment. A total of 27 women aged 65-90 years (mean ± standard deviation, 83 ± 6) with mild to moderate cognitive impairment (Mini-Mental State Examination, MMSE; 10-28/30 points), receiving long-term care at a facility in Japan were enrolled. Twelve women were assigned to receive DHEA 25 mg/day p.o. for 6 months. The control group (n = 15) matched for age and cognitive function was followed without hormone replacement. Cognitive function was assessed by MMSE and Hasegawa Dementia Scale-Revised (HDS-R), and basic activities of daily living (ADL) by Barthel Index at baseline, 3 and 6 months. Plasma hormone levels including testosterone, DHEA, DHEA-sulfate and estradiol were also followed up. After 6 months, DHEA treatment significantly increased plasma testosterone, DHEA and DHEA-sulfate levels by 2-3-fold but not estradiol level compared to baseline. DHEA administration increased cognitive scores and maintained basic ADL score, while cognition and basic ADL deteriorated in the control group (6-month change in DHEA group vs control group; MMSE, +0.6 ± 3.2 vs -2.1 ± 2.2, P < 0.05; HDS-R, +2.8 ± 2.8 vs -0.3 ± 4.1, P < 0.05; Barthel Index, +3.7 ± 7.1 vs -2.7 ± 4.6, P = 0.05). Among the cognitive domains, DHEA treatment improved verbal fluency (P < 0.05). DHEA supplementation in older women with cognitive impairment may have beneficial effects on cognitive function and ADL.

Patterns of Loss of Basic Activities of Daily Living in Alzheimer Patients: A Cross-Sectional Study of the French REAL Cohort

Background/Aims: To characterize loss of basic activities of daily living (BADL) in 687 Alzheimer’s disease (AD) community-dwelling patients included in the French REAL cohort. Methods: Patients had mild to moderately severe AD, and the mean age was 77.8 years. Patterns of loss of the 6 BADL were described at inclusion using the Lawton scale. Results: With 6 binary BADL scores, each patient presented at inclusion a set of losses. For 53% of women, the sets of losses were included within each other or were identical, adding losses in physical ambulation, grooming, bathing, dressing, toilet and feeding, respectively. For 47% of men, a similar sequence was identified, with loss of dressing occurring secondly. A global cohesion of sets of losses was found for 87% of women and 86% of men. The Lawton scale is very useful for the assessment of AD patients.

FOOD DIVERSITY IS CLOSELY ASSOCIATED WITH ACTIVITIES OF DAILY LIVING, DEPRESSION, AND QUALITY OF LIFE IN COMMUNITY‐DWELLING ELDERLY PEOPLE

FOOD DIVERSITY IS CLOSELY ASSOCIATED WITH ACTIVITIES OF DAILY LIVING, DEPRESSION, AND QUALITY OF LIFE IN COMMUNITY‐DWELLING ELDERLY PEOPLE

Community‐dwelling elderly with chewing difficulties are more disabled, depressed and have lower quality of life scores

Since 2006, the Japanese Ministry of Health, Welfare and Labor has recommended to screen swallowing and chewing abilities with the community-based comprehensive health-check examination to prevent disability of the elderly population. However, nationwide data of the actual condition of chewing disability in the community-dwelling elderly in Japan remains to be collected and be put in order. To address this important issue in a cross-sectional study in a community in Japan, we analyzed prevalence of elderly subjects with chewing difficulty associated with comprehensive geriatric assessment. The study population consisted of 877 people aged 65 years and older (309 men, 568 women; mean age, 75.6 years; standard deviation, 6.7) living in Tosa, Kochi Prefecture, Japan (the response rate of questionnaire was 59.3% and the complete answering rate was 50.0% of the eligible population in the town). Using self-reported questionnaires, chewing difficulty was screened along with additional assessment of activities of daily living (ADL), depression and subjective quality of life (QOL) in community-dwelling elderly subjects in 2007. Each elderly subject was asked, “In the past 6 months, do you feel chewing difficulty when you eat hard foods?” to identify the deterioration in chewing ability on a yes/no basis. For the assessment of basic ADL, the scores for seven items (walking, ascending and descending stairs, feeding, dressing, using the toilet, bathing, and grooming) were summed using a rating scale from 3 to 0 (3, completely independent; 2, need some help; 1, need help much; 0, completely dependent) into a basic ADL score (0–21). For assessing higherlevel ADL, each subject rated his/her independence in the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC). This assessment consists of a 13-item index including three sublevels of competence: instrumental self-maintenance (0–5), intellectual activity (0–4) and social role (0–4). We screened for depressive symptoms using the Japanese version of the 15-item Geriatric Depression Scale (GDS-15). Quantitative QOL were assessed using a 100 mm visual analog scale (worst QOL on the left end of the scale, best on the right) in the following five items: subjective sense of health, relationship with family, relationship with friends, financial satisfaction and subjective happiness. SPSS statistical software package ver. 16.0 (SPSS, Chicago, IL, USA) was used for statistical analysis with a significance of P < 005. Table 1 shows the comparison of scores in ADL, GDS-15 and subjective QOL between elderly subjects with and without chewing difficulty. The proportion of elderly who had chewing difficulty was 35.2% in this population. The elderly subjects with chewing difficulty were significantly older than those without chewing difficulty (77.5 vs 75.5 years). Mean scores in each ADL were significantly lower in the elderly with chewing difficulty than those without chewing difficulty after the adjustment for the effect of age. Mean score in GDS15 was significantly higher and subjective QOL were lower in the elderly with chewing difficulty than those without. A significantly close association between Correspondence: ••. Email: •• 1