Instrumental Activities Of Daily Living In Patients Research Articles

The effect of rosemary hydroalcoholic extract on cognitive function and activities of daily living of patients with chronic obstructive pulmonary disease (COPD): A clinical trial

BackgroundIn patients living with chronic obstructive pulmonary disease (COPD), cognitive impairment and reduced activities of daily living (ADLs) are associated with poor clinical outcomes. AimThe aim of the present study was to determine the effect of rosemary hydroalcoholic extract on cognitive function and ADLs in patients with COPD. MethodsA total of 77 COPD patients aged 40–80 years were assigned to two intervention and control groups by random stratified block method in the current tripleblind clinical trial. The intervention group received 500 mg rosemary capsules and the control group received oral capsules containing corn powder twice a day, one to two hours before breakfast and dinner, for two months. The Montreal Cognitive Assessment-Basic (MoCA-B), London Chest Activity of Daily Living scale (LCADL) and Lawton Instrumental Activities of Daily Living (IADL) were used to measure cognitive function and the measure of basic and instrumental daily life activities, before and after the intervention, respectively. ResultsThe mean total score of cognitive function (P = 0.022) and the two subscales of abstraction (P = 0.003) and naming (P = 0.034) significantly increased after the intervention in the intervention group. There was no significant difference between the intervention and control groups in terms of changes in the mean scores of IADL and LCADL (P < 0.05). The final statistical model showed that the changes in the total mean score of cognitive function (P = 0.014) and IADL (P = 0.047) in intervention group patients are significantly higher than in the control group after adjusting the effect of obstructive sleep apnea (OSA). ConclusionThe rosemary hydroalcoholic extract can be effective in improving cognitive function and IADL in patients with COPD, but not LCADL. Clinical Trials Registration NumberIRCT20150919024080N16

Does the virtual shopping training improve executive function and instrumental activities of daily living of patients with mild cognitive impairment?

To date, ecological validity of virtual shopping training for patients with mild cognitive impairment (MCI) has not been confirmed yet. Main objective of this study was to investigate effects of virtual shopping training on executive function and instrumental activities of daily living (IADL) in patients with MCI. 32 patients with MCI were randomly assigned to the experimental group that received virtual shopping training or the waitlist control group for a total of 16 sessions. To examine effects of virtual shopping training on executive function and IADL, Korean version of the Executive Function Performance Test (EFPT-K) and Korean Instrumental Activities of Daily living (K-IADL) were conducted. After the 16 sessions, the experimental group showed greater improvement in the EFPT-K (p<0.001) and the K-IADL (p<0.001) compared to the control group. These results suggest that virtual shopping training might be clinically beneficial to enhance executive function and IADL in patients with MCI.

Instrumental activities of daily living and neuropsychological functioning among patients with different types of cancer.

The ability to perform instrumental activities of daily living (IADL) is important for maintaining independent living, and optimal health-related quality of life and well-being. Neuropsychological measures are predictors of IADL ratings. The aims of the present study were to measure ability to perform IADL in patients with cancer and to explore the relationship between IADL and neuropsychological functioning. We evaluated IADL in 182 patients with four different types of cancer (thyroid, colorectal, breast and prostate cancer) and examined the relationship between IADL and neuropsychological functioning 6months after chemotherapy treatment. Our results showed that patients with breast cancer had significantly greater difficulty in performing IADL compared to patients with other types of cancer. There were no differences in IADL performance among the other three study groups. In addition, we found that neuropsychological score was a predictor of IADL; the greater the patients' disability, the lower their performance on neuropsychological measures. This is in accordance with the literature that suggests neuropsychological measures to be predictors of IADL ratings. The present findings are important because, although many researchers have studied the relationship between IADL and neuropsychological functioning in cancer, few studies have investigated IADL in different types of cancer. Optimal neuropsychological functioning is connected with better ability with regard to IADL.

Relationship between executive dysfunction and neuropsychiatric symptoms and impaired instrumental activities of daily living among patients with very mild Alzheimer's disease.

Patients with Alzheimer's disease (AD) experience a gradual loss in their ability to perform instrumental activities of daily living (IADLs) from the early stage. A better understanding of the possible factors associated with IADL decline is important for the development of effective rehabilitation and support programs for patients with AD. Thus, we examined the relationships between comprehensive cognitive functions and neuropsychiatric symptoms and IADLs in patients with very mild AD. In total, 230 outpatients with probable AD were recruited from the Memory Clinic at Kumamoto University Hospital between May 2007 and October 2016. All patients scored ≥21 points on the Mini-Mental State Examination at the first assessment. Relationships between the subdomains of the Lawton IADL scale and neuropsychological/neuropsychiatric tests were examined by multiple regression analysis. All analyses were performed separately in men and women. In female patients, scores on the Frontal Assessment Battery were significantly associated with telephone use ability, shopping, and ability to handle finances. Apathy scores in the Neuropsychiatric Inventory (NPI) were associated with telephone use ability, housekeeping, responsibility for own medications, and ability to handle finances. NPI agitation scores were associated with food preparation and housekeeping. Geriatric Depression Scale scores were associated with telephone use ability and ability to handle finances. In male patients, only NPI apathy scores were associated with telephone use ability. These results suggest the importance of properly assessing executive function, depression, and apathy at interventions for impaired IADLs among female patients with very mild AD.

Factors Predicting Daily and Instrumental Living Activities in Obese and Overweight Patients After Coronary Artery Bypass Graft Surgery

Aims Obese or overweight people are more likely to have complications after Coronary Artery Bypass Graft (CABG) surgery. It affects the patientschr('39') postoperative abilities to perform Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). The aim of this study was to determine the factors predicting ADLs and IADLs in overweight and obese patients after CABG. Methods &amp; Materials This analytical study with cross-sectional design was conducted over a period of 4 months on 84 patients one month after CABG, who were selected using a convenience sampling method. Data were collected using a sociodemographic form, Charlson comorbidity index, Katz Index, and Lawton IADL Scale. The collected data were analyzed in SPSS software using descriptive and inferential statistics. Findings The majority of obese and overweight patients (94%), one month after surgery, were independent of their ADLs, while most of them were in need of help in their IADLs (88.1%). Logistic regression model showed that the variables of male gender (P=0.004, OR=10.51, CI 95%=2.15-15.41) and carotid artery involvement (P=0.01, OR=0.12, CI 95%= 0.02-0.64) were the predictors of ADLs and IADLs in these patients. Conclusion Obese and overweight people have impairments in performing IADLs. It is important to pay attention to the predictors including male gender and carotid artery involvement in their return to normal life after CABG.

Investigation of factors affecting apathy in three major types of dementia

Apathy is an important factor in the clinical management of dementia, as it has been associated with poor disease outcome, reduced daily functioning and caregiver distress. Considering apathy as a problem that needs to be managed and knowing the factors affecting apathy will enable appropriate initiatives to be planned. This study was conducted to compare apathy across three types of dementia and determine the factors affecting apathy for each of the three types of dementia. The sample consisted of 46 patients with Alzheimer's disease (AD), 31 patients with frontotemporal dementia (FTD) and 29 patients with vascular dementia (VaD). Apathy was assessed using the Neuropsychiatric Inventory-apathy subscale (NPI), dementia severity was assessed using the Clinical Dementia Rating Scale (CDR), cognitive status was assessed using the Mini Mental Status Examination (MMSE) functional ability was measured with the Katz Index of Independence in Activities of Daily Living (ADL) and the Lawton-Brody Instrumental Activities of Daily Living (IADL). This is a descriptive and cross-sectional study. Significant differences were found between the apathy score of three types of dementia. Cognitive impairment correlated significantly with the apathy score in AD and VaD. Functionality scores and severity of dementia showed a significant correlation with apathy in each group. No statistically significant relationship was detected between age, gender and apathy. Multiple regression analyses show that apathy scores correlated with IADL in patients with AD. This study demonstrated that apathy is very common symptom in patients with FTD as well as patients with AD and VaD. Health professionals need to be aware of recognize apathy. Patients should be assessed for apathy regardless of dementia types, age and gender.

Executive Function and Personality Predict Instrumental Activities of Daily Living in Alzheimer Disease

Previous research shows that executive function (EF) and personality independently predict functional decline. Our objective was to determine whether personality traits predict independence with instrumental activities of daily living (IADLs), after accounting for executive dysfunction, in a mixed sample of patients with amnestic mild cognitive impairment (MCI) and Alzheimer disease (AD). In a cross-sectional analysis at a university medical center, 63 healthy older adults (median age: 67.6 years; 71% women) and 119 patients (median age: 75.0 years; 58% women) with varying degrees of AD (probable AD: 85; possible AD: 3; amnestic MCI: 31) were studied. Standardized neuropsychological measures, NEO Five-Factor Inventory (NEO-FFI), and informant-report Lawton and Brody IADL scales were used. All participants underwent neuropsychological evaluation, including administration of self- and informant-report NEO-FFI. Patients additionally underwent neurologic examination, and their informants completed the Lawton and Brody IADL scale. When testing the association between EF and personality on IADLs in the patient sample, conceptual card sorting, informant-report Openness, and informant-report Conscientiousness all significantly predicted IADLs, after accounting for age, education, and depression. In addition, a significant interaction showed that low Conscientiousness and executive dysfunction, in combination, can predict impairment of IADLs. Personality has a unique association with IADLs in patients with AD pathology that is not explained by EF. The findings confirm prior speculation that personality, in addition to cognitive dysfunction, is a risk factor for functional decline. Early identification of vulnerable individuals may allow for intervention to prolong functional independence.

Virtual reality and neuropsychological assessment: The reliability of a virtual kitchen to assess daily-life activities in victims of traumatic brain injury

ABSTRACTTraumatic brain injury (TBI) causes impairments affecting instrumental activities of daily living (IADL). However, few studies have considered virtual reality as an ecologically valid tool for the assessment of IADL in patients who have sustained a TBI. The main objective of the present study was to examine the use of the Nonimmersive Virtual Coffee Task (NI-VCT) for IADL assessment in patients with TBI. We analyzed the performance of 19 adults suffering from TBI and 19 healthy controls (HCs) in the real and virtual tasks of making coffee with a coffee machine, as well as in global IQ and executive functions. Patients performed worse than HCs on both real and virtual tasks and on all tests of executive functions. Correlation analyses revealed that NI-VCT scores were related to scores on the real task. Moreover, regression analyses demonstrated that performance on NI-VCT matched real-task performance. Our results support the idea that the virtual kitchen is a valid tool for IADL assessment in patients who have sustained a TBI.

P15.04 * DEVELOPMENT OF A NEW QUESTIONNAIRE TO MEASURE INSTRUMENTAL ACTIVITIES OF DAILY LIVING (I-ADL) IN PATIENTS WITH PRIMARY BRAIN TUMOURS: RESULTS OF PHASE 1

BACKGROUND: Next to health-related quality of life, information on daily life functioning in brain tumour patients is essential. Instrumental Activities of Daily Living (I-ADL) are complex daily activities, such as food preparation and shopping. I-ADL may be negatively influenced by a cognitive decline, characteristic of brain tumor patients. OBJECTIVE: In the first phase of this project, we generated a provisional list of items measuring I-ADL that are relevant for primary brain tumour patients. METHODS: Questions from the Amsterdam IADL Questionnaire®, a 70-item questionnaire developed and validated to measure I-ADL in patients with dementia, were evaluated for relevance to brain tumour patients. In addition, new activities were generated. In the first step, 6 professional experts in neuro-oncology and 10 primary brain tumour patient-proxy dyads were asked to evaluate items in the Amsterdam IADL Questionnaire®. Experts had to indicate if these activities (1) could be considered as I-ADL, (2) were affected in brain tumour patients and (3) were clearly formulated. Patients and their proxies only needed to answer the latter two questions. In the second step, the same 6 experts, and in addition 6 other patient-proxy dyads were asked to generate new activities. To do so, in-depth interviews were conducted. Decision rules were determined to aid in deciding which items to retain (step 1) or to add (step 2). Activities that were indicated as IADL, affected and clearly formulated were retained. Activities that were considered as IADL and affected, but not clearly formulated, were rephrased. New activities that were frequently generated were added to the existing list of items. RESULTS: In step 1, experts indicated that 37% of the activities described in the Amsterdam IADL questionnaire® fulfilled all three criteria: conform the definition of IADL, clearly formulated and affected in brain tumour patients. Twenty-three per cent of the activities were affected and conform the provided definition, but not clearly formulated. According to patients and their proxies, 19% and 17% of the activities were clearly formulated and affected in brain tumour patients, respectively. Moreover, 1-3% of the activities were indicated to be affected, but not clearly formulated. Several new activities (concerning social interaction and work) were generated in step 2. With the decision rules as guide, it was decided in consensus that a total of 30 questions of the Amsterdam IADL questionnaire® could also be used to measure I-ADL in primary brain tumour patients. In addition, 16 new questions covering other relevant activities for brain tumour patients were added. CONCLUSION: This first phase resulted in a provisional questionnaire of 46 items intending to measure I-ADL in primary brain tumour patients. The next step is to validate this provisional questionnaire in a larger sample of patients.

Detecting Everyday Action Deficits in Alzheimer’s Disease Using a Nonimmersive Virtual Reality Kitchen

Alzheimer's disease (AD) causes impairments affecting instrumental activities of daily living (IADL). Transdisciplinary research in neuropsychology and virtual reality has fostered the development of ecologically valid virtual tools for the assessment of IADL, using simulations of real life activities. Few studies have examined the benefits of this approach in AD patients. Our aim was to examine the utility of a non-immersive virtual coffee task (NI-VCT) for assessment of IADL in these patients. We focus on the assessment results obtained from a group of 24 AD patients on a task designed to assess their ability to prepare a virtual cup of coffee, using a virtual coffee machine. We compared performance on the virtual task to an identical daily living task involving the actual preparation of a cup of coffee, as well as to global cognitive, executive, and caregiver-reported IADL functioning. Relative to 32 comparable, healthy elderly (HE) controls, AD patients performed worse than HE controls on all tasks. Correlation analyses revealed that NI-VCT measures were related to all other neuropsychological measures. Moreover, regression analyses demonstrated that performance on the NI-VCT predicted actual task performance and caregiver-reported IADL functioning. Our results provide initial support for the utility of our virtual kitchen for assessment of IADL in AD patients.

Validation of a Chinese Version of the Frenchay Activities Index in Patients with Traumatic Limb Injury

The Frenchay Activities Index (FAI) is a frequently used measure that assesses instrumental activities of daily living (IADL). However, the measurement properties of the FAI are largely unknown for patients with traumatic limb injuries. The purpose of this study was to examine the measurement properties of a Chinese version of the FAI, including score distribution, internal consistency, construct validity, predictive validity, and responsiveness in patients with traumatic limb injuries. We performed a secondary data analysis, primarily using non-parametric item response theory, on a data set. The FAI and the World Health Organization Quality of Life Assessment (WHOQOL-BREF) were administered via telephone interview to a cohort of patients at 3, 6, and 12 months after injury. Totals of 342 patients' data (at 3 months after injury), 1,010 patients' data (6 months), and 987 patients' data (12 months) were available for analysis. After the deletion of 5 items (i.e., travel outings, gardening, household/car maintenance, reading books, and gainful work), the 10-item revised FAI (R-FAI) formed a unidimensional construct. The R-FAI exhibited a unidimensional construct at each of the 3 time points. The R-FAI had sufficient score distribution, internal consistency, predictive validity, and responsiveness in patients with limb injuries. Our results support the conclusion that the R-FAI has satisfactory measurement properties. The R-FAI is useful for assessing IADL in patients with limb injuries.

Disability in Instrumental Activities of Daily Living in Elderly Patients with Mild Cognitive Impairment and Alzheimer‘s Disease

Background/Aims: The aim is to examine disability in instrumental activities of daily living (IADL) in elderly persons with mild cognitive impairment (MCI) and Alzheimer‘s disease (AD), further to identify items of IADL which separate the two conditions and to explore potential gender differences. Methods: A cross-sectional study of 729 patients aged ≥65 years recruited from outpatient memory clinics. Multiple logistic regression analysis was used in the main analysis to explore the association between IADL and diagnosis. Results and Conclusions: We found an association between IADL and diagnosis, and a difference in the proportion of disability in IADL in patients with MCI and AD, i.e. 66 and 88%, respectively. Six of the 8 items revealed differences in the proportions of patients with IADL disability among MCI and AD. No substantial gender differences were found, except for laundry.

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.