Seoul-Instrumental Activities Of Daily Living Research Articles

Effect of Dietary Habits on Alzheimer's Disease Progression.

Research on the relationship between diet and dementia among Koreans are lacking. This study investigated the association between dietary habits and dementia progression over 3 years in patients with Alzheimer's disease dementia (ADD). This study included 705 patients with mild-to-moderate ADD. Dietary habits were assessed using the Mini Dietary Assessment Index, comprising 10 questions. Outcome measures included the Clinical Dementia Rating scale-Sum of Boxes (CDR-SB), Seoul-Instrumental Activities of Daily Living, Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI), and neuropsychological test battery (NTB) z-scores, which were evaluated annually over 3 years. In Q10 (eat all food evenly without being picky), the 3-year mean differences in CDR-SB (increases in scores represent worsening) compared to the "rarely" group were -1.86 [95% confidence interval (CI)=-3.64 - -0.09, p=0.039] for the "usually" group and -2.23 (95% CI=-4.40 - -0.06, p=0.044) for the "always" group. In Q7 (add salt or soy sauce to food when eating), the 3-year mean differences in CDR-SB compared to the "always" group were -2.47 (95% CI=-4.70 - -0.24, p=0.030) for the "usually" group and -3.16 (95% CI=-5.36 - -0.96, p=0.005) for the "rarely" group. The "rarely" and "usually" groups in Q7 showed significantly less decline in NTB z-score and CGA-NPI compared to the "always" group. Eating a balanced diet and reducing salt intake were associated with a slower decline in dementia severity, cognition, and behavioral alterations in patients with ADD.

가정방문 개별 작업중심회상치료가 경증치매노인의 인지기능과 일상생활활동에 미치는 영향: 무작위 대조군 예비연구

Objective: The purpose of this study was to compare the effects of individual occupation-based reminiscence therapy (IOBRT) at home and in dementia care centers (DCC) on cognitive function (CF) and instrumental activities of daily living (IADL) among elderly people with mild dementia in the community. Methods: Ten elderly individuals with mild dementia were randomly assigned to five in either an experimental group (EG) or a control group (CG). The EG received IOBRT at home, and the CG received IOBRT at the DCC. IOBRT was provided for 60 minutes per session, once a week, for a total of 10 sessions. The Allen Cognitive Level Screen (ACLS) was used to measure changes in CF, and the Seoul-Instrumental Activities of Daily Living (S-IADL) scale was used to evaluate IADL levels. Results: After the intervention, the EG showed significant improvement in both the ACLS and S-IADL scores, but the CG showed improvement only in the S-IADL scores. There was a significant difference between the groups in the ACLS but not in the S-IADL. Conclusion: In this pilot study, IOBRT at home was confirmed to have a short-term improvement on CF and can be used as evidence for home-visit cognitive programs in Korea.

Sleep Disturbances and Depression Associated With Cognitive Function As Well As Activities of Daily Living in Older Adults With Very Mild to Mild Dementia

Objective: The present study compared cognitive function and the ability to perform daily activities in subjects with very mild to mild dementia, classified by the presence or absence of sleep disturbances and depression. Methods: A total of 1,188 psychiatric outpatients (457 males and 731 females, mean age=74.65±5.83 years) were recruited. Sleep disturbances were measured by the Korean version of the Neuropsychiatric Inventory and depression was measured by the Korean Geriatric Depression Scale. Cognitive function was assessed using the Korean version of the Mini-Mental State Examination (K-MMSE), immediate recall, delayed recall, and verbal fluency. The ability to perform daily tasks was measured by the Seoul-Instrumental Activities of Daily Living (S-IADL). Results: Participants with both sleep disturbances and depression as well as those with depression only had significantly lower K-MMSE, immediate and delayed recall, and verbal fluency scores and higher S-IADL scores than the normal group. Also, those with both sleep disturbances and depression showed the highest S-IADL scores among groups. However, there were no significant differences between subjects with sleep disturbances only and the normal group in all cognitive functional areas and S-IADL. Conclusion: The present study found the differences in cognitive function and the ability to perform daily tasks among patients with mild dementia according to their sleep disturbances and depression. Our findings suggest that depression has stronger associations with cognitive and functional decline in older adults than sleep disturbances.

Behavioural and psychological symptoms of dementia in patients with Alzheimer\u2019s disease and family caregiver burden: a path analysis

BackgroundStudies reported the relationship between behavioural and psychological symptoms of dementia (BPSD), cognitive function, caregiver burden, and therapeutic effects. However, the causal relationship between BPSD in community-dwelling patients with Alzheimer’s disease (AD) and caregiver burden is yet to be established. This study aimed to classify BPSD in patients with AD and identify the relationship between BPSD and the factors affecting family caregiver burden.MethodsPath analysis was conducted at a neurology outpatient clinic of a tertiary general hospital in South Korea. The medical records of 170 patients, aged ≥50 years, diagnosed with or suspected for AD were retrospectively reviewed. We investigated cognitive function (Korean version of the Mini-Mental-State Exam), dementia stages (Korean version of the Expanded Clinical Dementia Rating scale), depression (Short-form Geriatric Depression Scale-Korea), activities of daily living (ADL; Korean version of the Barthel Activities of Daily Living index), instrumental activities of daily living (IADL; Seoul-Instrumental Activities of Daily Living), and BPSD and caregiver burden (Korean Neuropsychiatric Inventory). Considering the characteristic features of BPSD with various symptoms, BPSD was classified using factor analysis. Factor extraction was performed using principal component analysis, followed by Varimax factor rotation.ResultsMean total BPSD score was 17.66 ± 20.67, and the mean score for family caregiver burden was 9.65 ± 11.12. Symptom cluster-1 (hyperactivity symptoms) included disinhibition, irritability, and agitation/aggression. Symptom cluster-2 (psychosis symptoms) included hallucinations, anxiety, elation/euphoria, delusions, and depression/dysphoria. Symptom cluster-3 (physical behaviour symptoms) included appetite and eating abnormalities, apathy/indifference, aberrant motor behaviour, sleep, and night-time behaviour disturbances. Dementia stages, ADL, and IADL had indirect effects on family caregiver burden through hyperactivity, psychosis, and physical behaviour symptoms, indicating that BPSD exerted a complete mediating effect.ConclusionsUnlike previous studies, we classified BPSD symptoms into similar symptom clusters to evaluate its effect on caregiver burden, rather than collectively investigating the 12 symptoms of BPSD. As the dementia stage worsens, symptom clusters in BPSD serve as a medium between ADL and IADL degradation and for the increase in caregivers’ burden. The development and implementation of therapeutic, nursing interventions, and policies focusing on dementia stages, ADL, and IADL, delaying and preventing BPSD can alleviate family caregivers’ burden.

Effect of Integrated Cognitive Intervention Therapy in Patients with Mild to Moderate Alzheimer's Disease.

Background and PurposeThe effect of the integrated program comprising cognitive training, art therapy, and music therapy has not been extensively studied in patients with Alzheimer's disease (AD). The present study investigated the effect of integrated cognitive intervention therapy on cognition, and activity of daily life (ADL), and mood in patients with mild to moderate AD.MethodsIn this study, the data of 59 patients who met the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer disease and Related Disorders Association (NINCDS-ADRDS) criteria of probable AD among those who registered at the Centenarian's Good Memory Program in Goyang from September 2014 to August 2019 were collected. We statistically analyzed the scores of Korean version of a Mini-Mental Status Examination (K-MMSE), Korean Dementia Screening Questionnaire-Cognition (KDSQ-C), Geriatric Depression Scale (GDS), Beck Anxiety Inventory (BAI), and Seoul-Instrumental Activities of Daily Living (S-IADL) of the same patients before and after the use of integrated cognitive intervention therapy.ResultsK-MMSE slightly increased from 18.7±4.5 to 19.7±5.0 (p<0.001) and KDSQ-C improved from 14.5±7.6 before therapy to 12.6±7.2 after therapy (p=0.001). Mean S-IADL score improved from 17.6±7.6 before therapy to 15.7±9.5 after therapy (p<0.001). Additionally, mean GDS score before the therapy was 5.6±3.5 that improved to 4.2±3.0 after the therapy (p<0.001). Mean BAI score decreased from 8.4±10.3 before therapy to 5.9±8.4 after therapy (p=0.001).ConclusionsIn conclusion, this study demonstrated the possibility that the use of an integrated cognitive therapy improved cognition, ADL, and mood (depression and anxiety) in patients with mild to moderate ADs.

Effect of Physical Activity on the Progression of Alzheimer's Disease: The Clinical Research Center for Dementia of South Korea Study.

There is a lack of research on the effects of physical activity (PA) on the progression of Alzheimer's disease (AD). We investigated whether PA is associated with progression of dementia and mortality in AD. In the present study, 934 patients with mild-to-moderate AD were included. PA was evaluated using a questionnaire written by the caregiver. The outcome measures were the Clinical Dementia Rating-Sum of Boxes (CDR-SB), Seoul-Instrumental Activities of Daily Living (S-IADL), Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI), a global composite score of neuropsychological subtests, and mortality. They were evaluated annually and received a maximum of three follow-up examinations. Between-group differences compared with the no PA group in the change of CDR-SB scores were -0.431 (95% CI = -0.824∼-0.039; p = 0.031) for the moderate PA group (150-750 minutes per week of moderate intensity PA), and -1.148 (-1.656∼-0.639; p < 0.001) for the high PA group (>750 minutes per week). As PA increased, there was a significant trend to slow the rate of increase in the CDR-SB, S-IADL, and CGA-NPI scores. The patients with ≥150 minutes per week for each of non-recreational and recreational PAs had a lower risk of mortality compared to those with <150 minutes per week for each of the PAs (hazard ratio 0.22, 95% CI = 0.05∼0.88; p = 0.033). More PA is associated with slower progression of dementia severity, functional decline, and abnormal behavior, and with a lower risk of mortality in AD.

한국판 노인 행동평가척도(Older Adult Behavior Checklist)의 임상적 타당도 연구

본 연구에서는 노인들의 인지, 행동, 심리적 문제와 같은 다각적인 영역을 평가하는 한국판 노인 행동평가척도(OABCL)의 임상적 타당도를 살펴보고자 하였다. 이를 위해 정신건강의학과에 내원한 60세 이상 244명의 환자 및 보호자들을 대상으로 실시한 OABCL, 한국판 간이정신상태검사(K-MMSE), 일상활동평가-복합(S-IADL), 한국판 치매임상평가척도(K-CDR), 노인 우울 척도(GDS), 신경정신행동 검사(CGA-NPI) 사이의 상관관계를 분석하였다. 또한, 치매로 진단된 59명과 우울장애로 진단된 48명을 대상으로 집단간 유의한 차가 나타난연령을 통제한 후, OABCL 결과 차이를 분석하기 위해 공분산분석을 실시하였다. 분석 결과, 연령, 교육년수를 통제한 편상관분석에서 타평가 도구들과 OABCL의 거의 모든 척도에서 유의한 상관관계를 보였고, 특히 문제행동증후군 척도의 기능적 손상, 불안/우울 척도와DSM 진단 척도의 치매문제, 우울 척도와 높은 상관을 보였다. 더불어, 치매와 우울장애 집단 사이에서 OABCL 문제증후군 척도의 걱정, 신체증상, 기능적 손상, DSM 진단 척도의 신체화 척도에서 유의한 차이를 보였다. 이를 통해 OABCL의 임상적 활용도 및 타당도를 확인할수 있었고, 이 같은 결과를 중심으로 본 연구의 의의 및 제한점에 대해 논의하였다.

Cognitive function and activities of daily living in people affected by leprosy: A cross-sectional, population-based, case-control study.

There has been controversy regarding whether or not people affected by leprosy have more cognitive dysfunction than healthy individuals. The purpose of this study was to assess cognitive functions and activities of daily living (ADL) in people affected by leprosy relative to a control population living in rural areas. We assessed cognitive functions and ADL using the Korean Mini-Mental State Examination (K-MMSE), Korean Dementia Screening Questionnaire (KDSQ), and Seoul-Instrumental ADL (S-IADL). Higher scores of K-MMSE and lower scores of both KDSQ and S-IADL are indicative of better functioning. We assessed 224 persons living in Sorokdo who were affected by leprosy and 448 age- and gender-matched control subjects living in Namwon of the Chonbuk province. After adjusting for age, gender, and educational status, the K-MMSE score was found to be significantly higher in people affected by leprosy than in control subjects (23.14 ± 4.89 vs. 22.25 ± 4.62, respectively, P = 0.022). Items related to memory in the KDSQ showed no differences between the groups, but people affected by leprosy had a better score in division for other cognitive functions than controls. On items related to ADL in the KDSQ and S-IADL, people affected by leprosy performed significantly worse compared with controls. Our results suggest that although people affected by leprosy have a lower capacity of ADL, they may have better cognitive functions than normal controls.

Predictive factors for disease progression in patients with early-onset Alzheimer's disease.

Only a few studies have investigated disease progression in patients with early-onset Alzheimer's disease (EOAD). Therefore, the aim of this study was to investigate disease progression in patients with EOAD and the influence of various factors, such as gender, education, and apolipoprotein E (APOE) genotype on disease progression. A total of 288 EOAD patients were enrolled in the study. Linear mixed models were used to investigate the rate of cognitive and functional decline in terms of age at onset, gender, education, follow-up period, and APOE genotype. EOAD patients showed an annual decline of -1.54 points/years in the Korean version mini-mental examination score, an annual increase of 3.46 points/year in the Seoul instrumental activities of daily living (SIADL) score, and an annual increase of 1.15 points/year in the clinical dementia rating scale-sum of boxes score. After stratification, higher educated patients showed faster disease progression in all three parameters, and female patients demonstrated faster disease progression as assessed by the SIADL score. Age at onset and APOE genotype had no influence on disease progression. We confirmed the rate of disease progression in Korean patients with EOAD in real-life hospital-based clinical practice. The results of this study suggest that education and female gender, not APOE genotype, may be important as independent strong predictive factors for disease progression in patients with EOAD.

일부 치매 및 치매의심환자들의 인지기능에 따른 구강보건인식 조사

Objectives: The purpose of this study is to investigate cognitive function, performance of activities of daily living, and recognition on oral health with the cognitive function testto dementia or dementia-suspected patients in the outpatients. Methods: The subjects were 94 dementia or dementia-suspected patients visiting C University hospital for the dementia test. Study instruments included Korea Mini–Mental State Examination KMMS, The Bayer-Activities of Daily Living Scale; B-ADL, Seoul-Instrumental Activities of Daily Living; S-IADL, Global Deterioration Scale; GDS, Korean Dementia Screening Questionnaire; KDSQ, and underlying diseases. Results: Dementia or dementia-suspected patients were 42 by KMMSE test, 25 patients had impaired functioning of daily living by B-ADL test, 27 patients showed the presence of depression by GDS test, and 45 patients showed impaired functioning of daily living. There was a statistically significant difference in the subjective recognition on oral health conditions. There was a statistically significant difference in the subjective recognition on oral health conditions by ADL. There was a positive correlation between the cognitive function and ADL performance. Higher cognitive function is proportional to ADL performance. Conclusions: The cognitive function was closely associated with ADL and subjective oral health conditions.

Factors associated with caregiver burden in patients with Alzheimer's disease.

ObjectiveCaregivers for patients with Alzheimer's disease (AD) suffer from psychological and financial burdens. However, the results of the relationship between burden and cognitive function, performance of activities of daily living, and depressive symptoms have remained inconsistent. Therefore, the aim of this study was to examine which factors are more significant predictors of heightened burden, cognitive impairment or functional decline, besides neuropsychiatric symptoms.MethodsA cross-sectional study was conducted in a sample comprised of 1,164 pairs of patients with AD and caregivers from the Clinical Research of Dementia of South Korea study cohorts. The cognitive function of each sub-domain, functional impairments, depressive symptoms, and caregiver burden were assessed using the dementia version of Seoul Neuropsychological Screening Battery (SNSB-D), Barthel Index for Daily Living Activities (ADL), Seoul-Instrumental Activities of Daily Living (S-IADL), the Clinical Dementia Rating Sum of Box (CDR-SB), the Global Deterioration Scale (GDS), the Korean version of the Neuropsychiatric Inventory (K-NPI), and the 15-item Geriatric Depression Scale.ResultsWe found that higher severity (higher CDR-SB and GDS scores) and more functional impairment (lower ADL and higher S-IADL scores) were significantly associated with higher caregiver burden. In addition, depressive symptoms of patients (higher Geriatric Depression Scale scores) were associated with higher caregiver burden.ConclusionTherefore, interventions to help maintain activities of daily living in patients with AD may alleviate caregiver burden and improve caregiver well-being.

Association Between Functional Impairment, Depression, and Extrapyramidal Signs in Neuroleptic-Free Patients With Alzheimer Disease

Extrapyramidal signs (EPSs) are commonly observed in patients with Alzheimer disease (AD). We report here the base rate of EPS in a large cohort of patients with AD who were not receiving neuroleptic drugs, and the associations of EPS with functional outcomes and depressive symptoms. In a consortium involving 56 clinics, we recruited 2614 patients with AD. We estimated basic activities of daily living (ADL) and instrumental ADL by the Barthel index and the Seoul-Instrumental Activities of Daily Living (S-IADL) scales, respectively. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). The EPS group was defined by the presence of at least 1 EPS based on a focused neurologic examination. The prevalence of EPS-positive patients was 12%. These had lower Korean version of the Mini-Mental State Examination (K-MMSE) scores than the EPS-negative cases (P < .001). After controlling for demographic, medical, radiological, genetic, and cognitive (K-MMSE) factors, the proportion of patients with impaired ADL was significantly higher in the EPS group than in the non-EPS group (P < .001, odds ratio = 1.90, 95% confidence interval, 1.45-2.48, and logistic regression). The S-IADL scores were significantly higher in the EPS group than this in the non-EPS group (P < .001, regression coefficient = 3.19, and median regression). The GDS-15 scores were higher in the EPS group (P = .04, regression coefficient = 0.89, and median regression). The presence of EPS in patients with AD who were not receiving neuroleptic drugs was associated with more impaired basic and instrumental ADL functioning and with greater depression symptoms.

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

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

Which symptoms can distinguish between subjective cognitive impairment (SCI) and mild cognitive impairment (MCI)?

The SCI, the MCI, and the Alzheimer's disease (AD) are on a spectrum of disease progression; therefore, identification of the earliest signs of cognitive deterioration is becoming a crucial issue. The goal of this study was to examine symptom characteristics and distinguish predictive symptoms in patients with MCI compared with SCI, using caregiver questionnaires. We assessed the Korean Dementia Screening Questionnaire (KDSQ) and Seoul Instrumental activities of Daily Living (S-IADL) of 344 subjects with SCI and 697 with MCI. Multivariate logistic regression analyses were conducted after adjusting for age, sex, and educational status. Common and rare symptoms were similar between the SCI and MCI groups. The most distinguishing features of KDSQ were ‘Finds it hard to go somewhere on his/her own using public transportation’ (odds ratio=OR=4.56, p<0.0001), ‘Has difficulty in operating appliances’ (OR=2.47, p=0.001), and ‘Keeps repeating the same question’ (OR=2.03, p<0.0001). In S-IADL, the most outstanding features were ‘using household appliances’ (OR=3.99, p<0.0001), ‘taking medication’ (OR=2.38, p=0.01), and ‘using public transportation’ (OR=1.94, p=0.04). The dysfunction in ‘using household appliance’ and ‘using public transportation’ reflect the possibility of MCI rather than SCI. Therefore, it is suggested that these symptoms also have a discriminative and predictive power in identifying SCI.

Impairment of Instrumental Activities of Daily Living in Patients with Mild Cognitive Impairment

ObjectiveThis study was conducted to examine the following: whether patients with mild cognitive impairment (MCI) show impairments in instrumental activities of daily living (IADL) as compared to controls; to identify the functional sub-domains of instrumental activities of daily living (IADL) that are affected in MCI and, finally, to identify the Seoul-Instrumental Activities of Daily Living (S-IADL) scale cut-off score that best differentiated between MCI and controls.MethodsThis study was carried out at the geropsychiatry clinic, university hospital. The study participants included 66 patients with MCI and 61 normal elderly. The S-IADL and Seoul-Activities of Daily Living (S-ADL) scales were administered to the main caregivers of all participants in order to assess everyday functioning.ResultsThe total S-IADL score was significantly higher in the patients with MCI [mean (SD) score=4.47 (2.06)] than in the controls [mean (SD) score=1.44 (1.65)] (p<0.001). The patients with MCI performed significantly worse on IADLs, such as the ability to use the telephone, prepare meals, take medication, manage belongings, keep appointments, talk about recent events, and perform leisure activities/hobbies (p<0.05). The S-IADL scale discriminated well between patients with MCI and controls (Area Under Curve=87%).ConclusionThe patients with MCI showed impairments in the ability to perform complex ADL in comparison to healthy controls. IADLs related to memory and frontal/executive functioning were particularly affected in MCI.