Measurement and prediction of functional capacity in Alzheimer's disease
Abstract
Functional loss in Alzheimer's disease is difficult to measure or predict. The Blessed Dementia Rating Scale (Part 1) correlates well with postmortem changes but is not an effective antemortem index of functional change since disparate behavioral domains are assessed. We performed a factor analysis of the Blessed items in 187 patients with clinically diagnosed Alzheimer's disease and identified 4 independent factors: (I) cognitive, (II) personality, (III) apathy, and (IV) basic self-care. An endpoint, consisting of a score indicative of moderate disability, was determined for each factor. We then used life table analyses to compare the probability of reaching these endpoints over time in longitudinally followed patients. Patients with extrapyramidal signs at their initial visit reached the factor IV endpoint sooner, and those with psychosis or no family history of dementia also reached the factor I endpoint faster. These data illustrate the utility of a multifactorial approach to the assessment of functional capacity in Alzheimer's disease, and also indicate that extrapyramidal symptoms and psychosis are powerful predictors of the rate of decline in basic self-care activities and cognition.
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We can be confident that bias was not introduced by factors such as different environmental or socioeconomic conditions experienced by successive age groups.
“Therefore, we can be confident that bias was not introduced by such factors as different environmental or socioeconomic conditions experienced by successive age groups [2].”
From Rate of medial temporal lobe atrophy in typical aging and Alzheimer's disease (1998) · cites this paper as [2]
Cerebral atrophy is a well accepted biological concomitant of Alzheimer's disease.
“A well accepted biological concomitant of AD is cerebral atrophy([4](#R4)).”
From Medial temporal atrophy on MRI in normal aging and very mild Alzheimer's disease (1997) · cites this paper as [4]
The analysis of the association between MTL volume and age is based on a cross-sectional sample, and secular effects of different environmental or socioeconomic conditions experienced by successive age groups may be unrecognized.
“In analyzing the association between MTL volume and age we recognize that this is a cross-sectional sample and that secular effects of different environmental or socioeconomic conditions experienced by successive age groups may be unrecognized ([4](#R4)).”
From Medial temporal atrophy on MRI in normal aging and very mild Alzheimer's disease (1997) · cites this paper as [4]
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“This is in line with older findings that show that declines in IADL are influenced by cognitive functioning, and are affected relatively early in the course of dementia (Stern et al., 1990) and, in particular, the executive component in IADL tasks that requires higher frontal lobe activation (Baddeley et al.”
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Matsuda, O., & Saito, M. (2005) · International Psychogeriatrics · doi:10.1017/s1041610205001304 · Cited by 29 · see citing works
“However, the majority of the studies (Breen et al., 1984; Teri et al., 1989; Mahurin et al., 1991; Spinnler and Della Sala, 1988; Stern et al., 1990; Teri et al., 1989; Teri et al., 1988) did not examine the relationships between different cognitive domains and functional impairment.”
BackgroundResponse programming in dementia of the Alzheimer type: A kinematic analysis
Bellgrove, M. A., Phillips, J. G., Bradshaw, J. L., et al. (1997) · Neuropsychologia · doi:10.1016/s0028-3932(96)00081-4 · Cited by 30 · see citing works
Utility of the drs for predicting problems in day-to-day functioning
Fields, J. A., Machulda, M. M., Aakre, J. A., Ivnik, R. J., Boeve, B. F., Knopman, D. S., Petersen, R. C., & Smith, G. E. (2010) · The Clinical Neuropsychologist · doi:10.1080/13854046.2010.514865 · Cited by 29 · see citing works
Perilli, V., Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Cassano, G., Cordiano, N., Pinto, K., Minervini, M. G., & Oliva, D. (2012) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2012.01.007 · Cited by 26 · see citing works
Is Functional Decline Necessary for a Diagnosis of Alzheimer’s Disease?
Park, K. W., Pavlik, V., Rountree, S. D., Darby, E. J., & Doody, R. S. (2007) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000109268 · Cited by 25 · see citing works
Hamilton, J. M., Salmon, D. P., Raman, R., et al. (2013) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2013.04.003 · Cited by 24 · see citing works
“Psychosis in patients with AD is associated with a rapid decline in behaviors requiring higher order functional skills [5,24,45] independent of cognitive decline [9,10] and depression [9].”
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Stallard, E., Kinosian, B. P., & Stern, Y. (2017) · Alzheimer s Research & Therapy · doi:10.1186/s13195-017-0302-6 · Cited by 22 · see citing works
“They were ranked as follows (based on p values) (Additional file 1: Table A.2): dependence scale score [40], BDRS score [38, 39], CDR rating [25], MMSE score [27], psychiatric symptoms [41, 42], and total weekly alcohol consumption [45]; the top five were included in Table 2.”
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Natural history of Alzheimer's disease: prognostic value of plateaux
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“Alzheimer’s disease is associated with significant neuropsychologic and neuropsychiatric dysfunction [10,11], and numerous studies have demonstrated that dementia severity [5,19,20] and neuropsychiatric symptoms [21,22] contribute to the disability associated with AD.”
BackgroundDeterioration of Functional Capacities in Alzheimer’s Disease After a 1-Year Period
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Cognitive profile of Alzheimer patients with extrapyramidal signs: A longitudinal study
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Development of a Scale to Predict Decline in Patients with Mild Alzheimer's Disease
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LAM, L. C. W., Chiu, H. F. K., Chan, C. K. Y., Ng, K. O., Li, S. W., Chan, W. F., & Wong, M. A. (1997) · International Psychogeriatrics · doi:10.1017/s1041610297004183 · Cited by 16 · see citing works
- Authors
- Stern, Y., Hesdorffer, D., Sano, M., & Mayeux, R.
- Affiliations
- Columbia University Irving Medical Center (US)
- Venue
- Neurology
- Published
- 1990-01
- Volume
- 40
- Issue
- 1
- Pages
- 8-8
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- OpenAlex
- W2120924264
- Cited by
- 147
- References
- 0
- Citations by year
- 2024: 1 · 2021: 1 · 2020: 2 · 2019: 1 · 2018: 4 · 2017: 1 · 2016: 2 · 2015: 3 · 2014: 2 · 2013: 6 · 2012: 4
- FWCI
- 6.09
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (AG08702, AG 07370, P01AG007232, AG 07232, P50AG008702)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- Alzheimer's disease, functional capacity, factor analysis, cognitive decline, personality, apathy, extrapyramidal signs, psychosis, family history of dementia, functional decline prediction, life table analysis
- MeSH terms
- Aged, Aged, 80 and over, Alzheimer Disease, Cognition Disorders, Female, Humans, Male, Middle Aged, Neuropsychological Tests, Personality Disorders, Predictive Value of Tests, Self Care, Social Isolation, Life Tables
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