Disability Assessment For Dementia Scale Research Articles

Association Between Executive Dysfunction-Related Activities of Daily Living Disability and Clinical Dementia Rating Domain Patterns in Patients With Vascular Dementia and Age-Matched Patients With Alzheimer's Dementia.

Although the Clinical Dementia Rating (CDR) scale was originally developed to stage Alzheimer's dementia (AD), it is now used globally for various types of dementia. The aim of this study was to investigate the characteristic pattern of CDR domains and its association with neuropsychological findings and activities of daily living (ADL) in patients with vascular dementia (VaD) and patients with AD. We recruited very mild to mild VaD and AD patients who were age-matched among the first visitors to a dementia clinic. All subjects underwent a standardized clinical interview, physical and neurological examinations, and laboratory tests, including brain magnetic resonance imaging, according to the protocol of the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease assessment battery. A total of 105 pairs of VaD and AD patients participated in this study. Although the adjusted scores on Korean version of the Mini-Mental State Examination were similar between the two groups, the VaD patients performed better on the Boston Naming Test, Word List Memory, Word List Recall, Word List Recognition, and Constructional Recall Test. However, the scores on global CDR, CDR sum of boxes, and ADL-related CDR domains were higher in VaD patients than in AD patients (p<0.001). The VaD patients also showed poor performances on the Disability Assessment for Dementia Scale, Frontal Assessment Battery, Executive Clock Drawing Task, and Stroop tests. Despite similar general cognitive function and better memory function, patients with VaD tend to be staged as severer dementia on the CDR scale than patients with AD because of more impaired ADL associated with executive dysfunction.

The relationship between executive dysfunction‐associated activities of daily living (ADL) and the pattern of Clinical Dementia Rating (CDR) in patients with vascular dementia and age‐matched patients with Alzheimer’s disease

AbstractBackgroundClinical dementia rating (CDR) scale was originally developed to stage the severity of Alzheimer’s dementia (AD) but is now used globally regardless of types of dementia. This study aims to investigate the relationship between the characteristic pattern of CDR domains, neuropsychological findings, and activities of daily living (ADL) in patients with vascular dementia (VaD), compared with age‐matched patients with AD.MethodVery mild to mild VaD and AD patients matched for age were recruited among the first visitors to a dementia clinic. All subjects were administered a standardized clinical interview, physical and neurological examinations, and laboratory tests including the brain MRI according to the protocol of the Korean version of the CERAD assessment battery.ResultOne hundred and five pairs of VaD and AD patients participated in this study. Although the adjusted scores on MMSE were similar between two groups and the performances on Boston naming, word list memory, word list recall, word list recognition, constructional recall test were better in VaD patients, the scores on global CDR, CDR sum of box (SOB), and ADL‐related CDR domains were higher in VaD patients than in AD patients (p&lt;0.001). The poor performances on disability assessment for dementia scale, frontal assessment battery, executive clock drawing task, and Stroop tests were observed in VaD patients.ConclusionDespite similar general cognitive function and better memory function, patients with VaD tend to be staged as severer dementia on the CDR scale than patients with AD because of more impaired ADL associated with executive dysfunction.

Promoting Activity, Independence, and Stability in Early Dementia and mild cognitive impairment (PrAISED): randomised controlled trial

ObjectiveTo determine the effectiveness of an exercise and functional activity therapy intervention in adults with early dementia or mild cognitive impairment compared with usual care.DesignRandomised controlled trial.SettingParticipants’ homes and communities...

Validity and Reliability of the Persian Version of the Disability Assessment for Dementia Scale

Background: As dementia progresses in the course of life, one's functions may be reduced regarding to fulfill the activities of daily living. One of the most important factor to diagnose and determine the severity of dementia is to assess activities of daily living. Objectives: one the most important factor in determining the severity of dementia in the area of activities of daily living is disability assessment for dementia (DAD) scale, which is not available in Persian and there is no validity and reliability report for it in Iranian community. Therefore, the aim of this study was to provide a Persian version of the valid and reliable DAD scale to assess functional disability in patients with dementia of Alzheimer type within the scope of everyday living activities. Patients and Methods: After the permission from the developer of the original scale, we translated the English version to Persian according to the international quality of life assessment (IQOLA) approach. To review the clarity and the necessity of the items translated, content validity index (CVI) and content validity ratio (CVR) methods were applied. Also, to assess the reliability of the scale, test-retest and inter-rater reliability techniques were used. The internal consistency of the items was also measured using the Cronbach’s alpha coefficient. Results: Cronbach’s alpha coefficient was very good for the scale (Cronbach’s α = 0.78) and the inter-rater reliability and test-retest reliability were excellent (intraclass correlation/ICC = 0.99, ICC = 0.99). The clarity and necessity of the translated items based on the scores of CVI and CVR were also acceptable. Conclusions: The Persian version of DAD, during the study, had a very good validity and reliability and can serve as a useful scale in clinical assessment of functional disability in patients with Alzheimer’s in the area of activities of daily living.

Test Your Memory is sensitive to cognitive change but lacks prospective validity

ObjectiveTo determine the prospective validity of Test Your Memory (TYM) and its sensitivity to change in cognitive state. Type of studyLongitudinal prospective. MethodsThis longitudinal prospective study followed 71 patients with subjective cognitive symptoms and 48 with mild cognitive impairment for a mean time period of 35.2±15 months. Subjects did not have dementia or depression at the beginning of follow-up and each participant was given the TYM at least two times. A psychometric threshold was established to determine presence of a cognitive deficit (z-score≤1.5 on at least one cognitive domain) and the Disability Assessment for Dementia scale was used to ensure full functional ability. The criterion for deterioration was a change in the stage on the Global Deterioration Scale. ResultsSixty-one patients remained cognitively stable and 58 worsened. There were no differences between them with respect to sex, educational attainment, the initial stage on the GDS, or the score on the first TYM. Subjects who worsened were older than those who did not. The TYM increased an average of 0.04 points per month in patients who remained stable or improved (95% CI, −0.01 to 0.08) and decreased an average of 0.14 points per month in those whose condition worsened (95% CI, −0.19 to −0.09). Subjects with mild cognitive impairment who worsened displayed a sharper loss of TYM points than did subjects with subjective cognitive symptoms. ConclusionsWhile the TYM lacks prospective validity, it is sensitive to changes in cognitive state.

Validation Study of the Spanish Version of the Disability Assessment for Dementia Scale.

The aim of this study was to determine reliability and validity of the Spanish version of the Disability Assessment for Dementia Scale (DAD-E) in the following areas: content, response process, internal structure, and relation to other constructs.We designed a cross-sectional observational study. The DAD-E was administered to 132 participants diagnosed with mild cognitive decline, prodromal Alzheimer disease, Alzheimer disease, or no cognitive decline. For the reliability study, we performed analyses of internal consistency, test–retest, and equivalent measures. To study validity, we performed item analysis, principal components analysis, and correlations with other measures.The sample was composed of 37 healthy participants (28%) and 95 patients (72%). In the total scale, Cronbach alpha was 0.963, intraclass correlation coefficient in the test–retest analysis was 0.983 (95% CI [95% confidence interval] = 0.969–0.991), and the analysis for equivalent measures was 0.949 (95% CI = 0.897–0.975). Out of the 40 items, we found that 37 presented a correlation index with the total score above 0.40. The principal components analysis suggests that 61.7% of the variance is explained by a single component that groups all scores on Activities of Daily Living. The DAD total score presents correlations with Barthel's Index of 0.882 (P = 0.000) and with Lawton and Brodie's Index of 0.877 (P = 0.000) and with the Mini Mental State Examination of 0.679 (P = 0.000).The DAD-E is a reliable and valid instrument to assess functional disability in people with cognitive decline in Spanish population.

CAN WE PREDICT THE RESPONSE TO GALANTAMINE IN ALZHEIMER`S DISEASE PATIENTS?

Although considerate progress was obtained by adding imagistic and laboratory test, clinical examination remains the core of the diagnosis for Alzheimer`s disease. After 20 years of experience with anticholinergic drugs we know that only one third of the patients respond to the treatment; the treatment is more efficient in the initial stages of the neurocognitive decline. It is important to evaluate the efficacy of drugs as soon as possible. We examined patients with mild and moderate Alzheimer`s disease referred through our outpatient clinic. They fulfilled the NINCDS-ADRDA criteria for Alzheimer`s disease and they scored at baseline 21 to 26 points on MMSE. The patients were treated with Galantamine, 8 mg/day for the first month and then 16 mg/day. We evaluated the patients after 2 and 6 months of treatment; we performed MMSE and ADAS-Cog in order to see if a more complex evaluation would be helpful. We considered that the treatment was efficient if MMSE score did not decrease after 6 months of treatment. We also evaluated clinical disability using DAD (Disability Assessment for Dementia Scale) and the difficulty of living with a patient with dementia using CBS (Caregiver Burden Scale). The examination using MMSE and ADAS-Cog after two months of treatment does not have a predictable value. ADAS-Cog examination can be useful for patients that have a stable MMSE score after six months of treatment. Although the evolution of ADAS-Cog and MMSE scores were significantly positive, clinical disability of the patients progressed, rising concerns for their caregivers.

El Test Your Memory es sensible al cambio cognitivo pero carece de validez prospectiva

ObjectiveTo determine the prospective validity of Test Your Memory (TYM) and its sensitivity to change in cognitive state. MethodsThis longitudinal prospective study followed 71 patients with subjective cognitive symptoms and 48 with mild cognitive impairment for a mean time period of 35.2±15 months. Subjects did not have dementia or depression at the beginning of follow-up and each participant was given the TYM at least two times. A psychometric threshold was established to determine presence of a cognitive deficit (z-score≤1.5 on at least one cognitive domain) and the Disability Assessment for Dementia scale was used to ensure full functional ability. The criterion for deterioration was a change in the stage on the Global Deterioration Scale. ResultsSixty-one patients remained cognitively stable and 58 worsened. There were no differences between them with respect to sex, educational attainment, the initial stage on the GDS, or the score on the first TYM. Subjects who worsened were older than those who did not. The TYM increased an average of 0.04 points per month in patients who remained stable or improved (95% CI, -0.01 to 0.08) and decreased an average of 0.14 points per month in those whose condition worsened (95% CI, -0.19 to -0.09). Subjects with mild cognitive impairment who worsened displayed a sharper loss of TYM points than did subjects with subjective cognitive symptoms. ConclusionsWhile the TYM lacks prospective validity, it is sensitive to changes in cognitive state.

Functional disability in dementia: A validation study of the Thai version of Disability Assessment for Dementia scale

PurposeThis study aimed to determine the validity and reliability of the Thai version of Disability Assessment for Dementia scale (DAD-T). MethodsThe DAD-T was administered to Thai caregivers, including 40 people with dementia [mean age 74.9 years, standard deviation (SD) 7.2 years] and 20 normal controls (mean age 69.6 years, SD 7.4 years). To study the convergent and divergent validity, the DAD-T was administered concurrently with the Thai version of Barthel Index of Activities of Daily Living (BI) and the Thai version of Mini Mental State Examination (TMSE). ResultsThe mean (SD) scores on the DAD-T were 95.2 (6.0) for normal controls, 59.9 (15.6) for mild dementia, and 20.6 (17.1) for moderate to severe dementia. The DAD-T had a high correlation with both the BI (r = 0.82, p < 0.001) and the TMSE (r = 0.91, p < 0.001). The DAD-T demonstrated excellent internal, consistent reliability (Cronbach's alpha 0.98) and test–retest reliability (r = 0.98, p < 0.001). Analysis of its relationship with sociodemographic factors showed that the DAD-T score was not significantly associated with gender, age, and education. ConclusionThe DAD-T was found to be a valid and reliable measure to assess functional disability in Thai people with dementia.

Validity and reliability of inertial measurement units when measuring lumbar range of motion, movement control, repetetive movement and reposition error

Results: Of 12 eligible persons with mild to moderate dementia screened, 8 of them participated in this pilot while 4 declined due to geographic reasons or no caregivers for accompanying. The overall attendance (100%) and retention (75%) rates were satisfactory. Two participants withdrew due to uncontrolled psychotic symptoms. No adverse event was observed. In general, participants and caregivers were positive towards the intervention and compile to the training protocol. On completion of intervention, the handgrip strength improved from 15.3± 3.1 kgf to 18.5± 3.6 kgf (p= 0.005), the 6-minute walk test improved from 177.4± 60.3 m to 210.0± 61.1 m (p= 0.003), and the Berg Balance Scale score improved from 35.4± 8.1 to 40.3± 7.0 (p= 0.013). Mini-mental State Examination score remained similar before (18.5± 2.1) and after (19.3± 1.3) the intervention (p= 0.432). The Disability Assessment for Dementia scale improved from 56.7± 13.3% to 65.0± 14.9% (p= 0.039). No significant difference was observed in Geriatric Depression Scale ShortForm (3.0± 3.1 to 1.3± 1.1; p= 0.128) and Zarit Burden Index score (36.0± 8.6 to 28.0± 12.9; p= 0.106). Conclusion(s): Our pilot demonstrated the feasibility of conducting a multimodal physical exercise training program to people with mild to moderate dementia. It appears to improve the physical parameters, maintain the cognitive functions, and improve global function and activities of daily living. The program is well accepted by participants and caregivers. Implications: Physical training may improve motor performances and potentially delay the decline in cognitive functions in people with dementia. This intervention should be tested out in a randomized controlled trial with a larger sample size and long-term follow-up. Moreover, educational class on disease management, strategies to delay symptoms of dementia, fall prevention and caring skills should be incorporated into the intervention for further reducing the burden of caregivers.

Cholinesterase inhibitors for rarer dementias associated with neurological conditions

Cholinesterase inhibitors for rarer dementias associated with neurological conditions

Functional Disability in Alzheimer Disease

This study aimed to determine the reliability and validity of the Turkish version of Disability Assessment for Dementia (DAD) scale in the Turkish elderly population with Alzheimer disease (AD). The DAD scale was administered to the primary caregivers of 157 patients (age 77.7 ± 6.8 years) with AD. The Turkish version of the DAD scale showed high internal consistency (Cronbach α = .942), excellent test-retest, and interrater reliability (intraclass correlation coefficient [ICC] = 0.996 and ICC = 0.994, respectively). The DAD scale was significantly correlated with activities of daily living (ADL; Modified Older Americans Research Survey ADL) and instrumental activities of daily living (IADL; Lawton and Brody IADL) scales (r = .89, P < .001 and r = .90, P < .001). Disability Assessment for Dementia had a high negative correlation with the Global Deterioration Scale (GDS; r = -.880, P < .001). Post hoc comparisons with Tukey test showed significant differences in the mean DAD scores in different GDS stages. Construct validity was estimated using total score correlation analyses between the standardized Mini-Mental State Examination (MMSE) and the DAD scale. Results revealed high and significant correlation between MMSE score and DAD scale (r = .812, P < .001). The results of multivariate analysis showed that DAD score was not correlated with gender, education, and age. The DAD total score was affected mostly by GDS, MMSE, and duration of the disease. Turkish version of the DAD scale was found to be a reliable and valid instrument to assess functional disability in Turkish elderly patients with AD. This scale assists caregivers and physicians to decide for proper interventions.

Understanding the relative importance of preserving functional abilities in Alzheimer’s disease in the United States and Germany

To estimate the relative importance that Alzheimer's disease (AD) caregivers in the United States and Germany place on preserving patients' ability to perform activities of daily living. US and German residents providing care for a person with AD completed an online preference survey. Each respondent completed five best-worst scaling questions. Each question related to five of 10 activities from the Disability Assessment for Dementia scale. Preference weights, indicating the relative importance of preserving the ability to perform these 10 activities for 36 months, were estimated using maximum-difference scaling. A separate model was estimated for each country. Four hundred and three US and 400 German caregivers completed the survey. In both countries, preserving a patients' ability to use the toilet without accidents was the most important activity and handling money was the least important activity. There were few differences between US and German caregivers in the relative importance across activities. Caregivers generally placed greater importance on preserving basic activities of daily living than on preserving instrumental activities of daily living. Understanding differences in the relative importance of functional items in the DAD may contribute to a better understanding of the benefits of different AD treatment and support measures.

Delusions Increase Functional Impairment in Alzheimer’s Disease

Background/Aims: Delusions in Alzheimer’s disease (AD) may be associated with functional impairment. No studies to date have used functional instruments sensitive to changes in frontal executive function, possibly underestimating the impact. Methods: Patients with AD with and without delusions were administered cognitive tests and questionnaires to assess depression and quality of life. Caregivers were administered questionnaires to assess functional impairment, caregiver burden and behavioural symptoms. Results: AD patients with delusions (n = 19) when compared to AD patients without delusions (n = 19) matched for age, education and global cognitive function were significantly more functionally impaired based on performance on the Disability Assessment for Dementia Scale (p < 0.005). Conclusion: AD patients with delusions have significantly worse functional performance.

The effects of dependence and function on costs of care for Alzheimer's disease and mild cognitive impairment in Ireland

To explore the incremental effects of patient dependence and function on costs of care for patients with Alzheimer's disease (AD) and amnestic mild cognitive impairment (MCI) in Ireland. Cost analysis based on reported resource use for a cross-section of 100 community-based people with AD and MCI. Formal care included general practice visits, hospitalizations, outpatient clinic consultations, accident and emergency visits, respite care, meals on wheels services and other health and social care professional consultations. Informal care included time input provided by caregivers. Resource unit costs were applied to value formal care and the opportunity cost method was used to value informal care. Patient dependence on others was measured using the Dependence Scale and patient functional capacity using the Disability Assessment for Dementia scale. Multivariate regression analysis was used to model the cost of care. Both dependence and function were independently and significantly associated with total formal and informal care cost: a one point increase in dependence was associated with a €796 increase in total cost and a one point improvement in function with a €417 reduction in total cost over 6 months. Patient function was significantly associated with formal care costs, whereas patient function and dependence were both significantly associated with informal care costs. The costs of care for patients with AD and MCI in Ireland are substantial. Interventions that reduce patient dependence on others and functional decline may be associated with important economic benefits.

DAD-6: A 6-ltem Version of the Disability Assessment for Dementia Scale Which May Differentiate Alzheimer’s Disease and Mild Cognitive Impairment from Controls

Background: The need to detect early changes in instrumental activities of daily life led us to modify the Disability Assessment for Dementia Scale (DAD) by focusing on executive components of 6 instrumental items (DAD-6). Aim: To evaluate the relevance of the DAD-6 for detecting early impairment in a nondemented population. Methods: The DAD-6 was administered to informants of 84 patients: 31 with mild dementia (MD), 53 with mild cognitive impairment (MCI) and 55 healthy controls. Results: DAD-6 scores gradually decreased with increasing severity of the cognitive status [18 in healthy controls vs. 15.1 ± 3.2 in MCI versus 9.6 ± 3.5 in MD, p < 0.0001). Receiver-operating characteristic curve analyses yielded an optimal cut score of 14 to distinguish MCI from MD with a sensitivity of 0.83 (95% confidence interval 0.74–0.92) and a specificity of 0.84 (0.71–0.94), and a cut score of 15 to distinguish single-domain MCI from multi-domain MCI with a sensitivity of 0.96 (0.90–0.99) and a specificity of 0.54 (0.33–0.75). Conclusion: The DAD-6 reliably detects early loss of autonomy due to cognitive impairment.

Relative importance of patient disease indicators on informal care and caregiver burden in Alzheimer's disease

Cognition, abilities in activities of daily living (ADL), and behavioral disturbances in patients with Alzheimer's disease (AD) all influence the number of hours informal caregivers spend caring for their patients, and the burden caregivers experience. However, the direct effect and relative importance of each disease severity measure remains unclear. Cross-sectional interviews were conducted with 1,222 AD patients and primary caregivers in Spain, Sweden, the U.K. and the U.S.A. Assessments included informal care hours, caregiver burden (Zarit Burden Inventory; ZBI), cognition (Mini-mental State Examination; MMSE), ADL-abilities (Disability Assessment for Dementia scale; DAD), and behavioral symptoms (Neuropsychiatric Inventory Questionnaire; NPI-severity). Multivariate analyses of 866 community-dwelling patients revealed that ADL-ability was the strongest predictor of informal care hours (36% decrease in informal care hours per standard deviation (SD) increase in DAD scores). Severity of behavioral disturbances was the strongest predictor of caregiver burden (0.35 SD increase in ZBI score per SD increase in NPI-Q severity score). In addition, the effect of ADL-abilities was, although attenuated, not negligible (0.28 SD increase in ZBI score per SD increase in DAD score). Decreasing cognition (MMSE) was associated with more informal care hours and increased caregiver burden in univariate, but not in adjusted analyses. For patients residing in community dwellings, the direct influence of patients' cognition on caregiver burden is limited and rather mediated by other disease indicators. Instead, the patients' ADL-abilities are the main predictor of informal care hours, and both ADL-abilities and behavioral disturbances are important predictors of perceived caregiver burden, where the latter has the strongest effect. These results were consistent across Sweden, U.K. and the U.S.A.

The effect of cholinesterase inhibitors on decline in multiple functional domains in Alzheimer's disease: a two-year observational study in the Sunnybrook dementia cohort

Despite widespread use of second-generation cholinesterase inhibitors (CHEIs) for the symptomatic treatment of Alzheimer's disease (AD), little is known about possible long-term effects in different functional domains. This study seeks to assess change in activities of daily living (ADLs) over two years in AD patients treated with CHEIs matched to untreated patients in the same longitudinal cohort study. This study is based on the two-year prospective cohort study at the Memory Clinic in Sunnybrook Health Sciences Centre, University of Toronto. Probable AD patients (N = 130: untreated = 65, treated = 65) underwent standardized neuropsychological assessments including the Disability Assessment for Dementia Scale (DAD), at baseline, one-year and two-year follow-up. Groups received a careful evaluation of comorbid illnesses, concomitant medication use, and vascular risk factors. At baseline, there were no significant differences in demographics and characteristics. Treated patients showed less decline in overall function and in instrumental and basic ADLs. Furthermore, less decline was seen in the overall scores for initiation and planning over two years with moderate to large effect sizes. These findings have clinical relevance since functional ability has been increasingly recognized as a key outcome variable in AD treatment. It is also of note that the subscores reflecting executive functioning appear to drive these beneficial differences.

Apathy in Dementia: Relations with Depression, Functional Competence, and Quality of Life

This study set out to clarify the association of apathy and depression in dementia as well as apathy's association with basic (ADLs) and instrumental (IADLs) activities of daily living and quality of life. 68 outpatients with mild dementia were assessed on apathy, depression, global cognition, traditional ADLs/IADLs, complex daily living activities requiring intact executive functioning (DAD: Disability Assessment for Dementia Scale), and quality of life. The sample was stratified into high and low global cognition groups and compared. While no relationship was found between scores on apathy and depression in the high cognition group, there was a significant relationship between apathy and depression in the low cognition group. Further, high and low cognition groups differed in the relationship between apathy and ability to perform basic and complex activities of daily living. Specifically, in the high cognition group, increased apathy was correlated with diminished ability to perform traditional IADLs as well as those activities requiring intact executive functioning (i.e., DAD). In the low cognition group, increased apathy was associated with poor performance on traditional ADLs and IADLs, but was not related to performance on independent daily activities demanding good executive functioning. Finally, increased apathy was significantly associated with worse quality of life, but this held for the high cognition group only, suggesting that dementia patients with better cognition have insight into their deficits and, perhaps, experience poor quality of life as a result.

Functional Disability in Early Alzheimer’s Disease – A Validation Study of the Italian Version of the Disability Assessment for Dementia Scale

Aim: To determine the applicability and psychometric properties of the Italian version of the Disability Assessment of Dementia scale (DAD-I) in a community-residing population with early-stage Alzheimer’s disease (AD). Methods: The DAD-I was administered to the primary caregivers of 159 patients (mean age ± SD 77.1 ± 5.2) with mild AD (mean Mini Mental State Examination, MMSE, ± SD 23.1 ± 2.2). Results: The DAD-I showed excellent internal consistency reliability (Cronbach’s α = 0.92) and good construct validity. The DAD-I score was not significantly associated with gender, education and presumed duration of the illness, and had a low negative correlation with age. The DAD-I score correlated moderately with the traditional Instrumental Activities of Daily Living and Activities of Daily Living scales, respectively, with r = 0.53 and r = 0.54 (p < 0.0001). Relatively low, but statistically significant correlations (r ranging between 0.21 and 0.31) with the MMSE were also found. Conclusion: The DAD-I was found to be a reliable and valid instrument to assess functional disability in community-dwelling Italian subjects with early-stage AD.