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Do functional disability is a good predictor index for Alzheimer's disease?
Annals of General Psychiatryvolume 5, Article number: S294 (2006)
Functional disabilities in the activities of everyday living (ADLs) are an important determinant of Dementia of Alzheimer's type. The aim of the present study was to investigate which ADLs deteriorate first in mild DAT and if this can help the clinician to diagnose the probable DAT.
Materials and methods
29 mild DAT patients were included in this study. The mean of age and educational level was 73.2 and 9.4 years respectively, though the mean of mental state as measured by MMSE was 23.7/30. All the patients had an established diagnosis of DAT according to the criteria of the DSM-IV and the NINCDS-ADRDA, as well as based on neurological, neuropsychological and neuroimaging data. We administered the Disability Assessment for Dementia Scale (DAD) (Gauthier and Gilinas, 1999) which is a caregiver- based interview comprised of a 40-item questionnaire to evaluate basic and instrumental ADLs in dementia.
The regression analysis showed that deterioration in the following ADLs could predict the early stages of the disease: the ability to carry out everyday needs out of the house, to adequately handle money and to organize free time and household chores. In particular, we found out that a patient in the early stages of DAT faces difficulties in using the public means of transportation, organizing to go out (walk, shop, visit) at an appropriate time, estimating the distances and the money he/she needs or making a shopping list. Concerning the ability to handle their finance, they have difficulties in handling the bills, checking the change, organizing the monthly expenses. They also don't do well in organizing and completing household chores that they used to perform in the past and they have accidents at home.
These functional abilities are tightly related with the higher cognitive abilities that deteriorate first in DAT (planning and organization, solving problems, using strategies, hierarchy of tasks). The knowledge of the functional disabilities that a DAT patient faces in the early stages of the disease can be very useful, not only for the diagnosis to be made, but also for the appropriate rehabilitation plan to be designed according to the patient's special needs.