Functional performance of Alzheimer's disease and vascular dementia in southern Taiwan

The relationship between common cognitive screening tests (Standardised Mini-Mental State Examination and Rowland Universal Dementia Assessment Scale) and the Cognitive Functional Independence Measure

OBJECTIVES

To assess whether the Cognitive Functional Independence Measure (Cog-FIM) is correlated with the Standardised Mini-Mental State Examination (SMMSE) and Rowland Universal Dementia Assessment Scale (RUDAS) and whether there is agreement between the Cog-FIM and these two tests.

METHODS

Functional Independence Measure assessments were undertaken on 98 subacute patients. Forty-eight (48) patients were administered the SMMSE, and 50 were administered the RUDAS. Agreement was examined using the Bland-Altman plot.

RESULTS

Correlation was observed between the Cog-FIM and both the SMMSE and the RUDAS. The Bland-Altman analysis demonstrated agreement between the Cog-FIM and RUDAS, but not the Cog-FIM and SMMSE. The limits of agreement between the Cog-FIM and RUDAS were -13 to 13.

CONCLUSION

The Cog-FIM is correlated with the RUDAS, but the agreement is unclear. Despite agreement of the means, the limits of agreement are large, which may suggest a clinically meaningful difference. The study should be repeated with a larger sample size.

The prevalence and course of neuropsychiatric symptoms in stroke patients impact functional recovery during in-hospital rehabilitation

Background: Neuropsychiatric symptoms are common after stroke and are distressing symptoms. They may persist after the acute event and negatively impact rehabilitation, functioning, and patients' quality of life.Objectives: To elucidate the prevalence and course of neuropsychiatric symptoms in stroke patients during rehabilitation, we prospectively investigated the trajectory change of neuropsychiatric symptoms and the association between these symptoms and functional recovery.Methods: This observational study enrolled 204 stroke patients consecutively admitted to the rehabilitation ward. We administered the Neuropsychiatric Inventory-Nursing Home Version (NPI-NH) for evaluating the neuropsychiatric symptoms (e.g., apathy and depression) and the Functional Independence Measure (FIM) and Montebello Rehabilitation Factor Score (MRFS) for functional recovery.Results: The cumulative prevalence of neuropsychiatric symptoms was 48% during hospitalization; depression, anxiety, and sleep disturbances were most frequent. Binomial logistic regression analyses revealed that the factors associated with deterioration of neuropsychiatric symptoms during hospitalization included premorbid depression (odds ratio: 18.628, P = .001), the length of stay from onset to rehabilitation ward admission (odds ratio: 1.022, P = .012), motor FIM at admission (odds ratio: 0.950, P < .001), and NPI-NH at admission (odds ratio: 0.923, P = .011). Stepwise multiple regression analyses revealed that the NPI-NH at admission was associated with the MRFS (β = -0.128, P = .037).Conclusions: Neuropsychiatric symptoms are common in stroke patients undergoing rehabilitation and have a substantially negative impact on rehabilitation outcomes. Stroke patients with prolonged acute-phase hospitalization and low functioning at admission must be monitored to detect any deterioration in the neuropsychiatric state.

Reliability and validity of the upper-body dressing scale in Japanese patients with vascular dementia with hemiparesis

The purpose of this study was to examine the reliability and validity of the Upper-body Dressing Scale (UBDS) for buttoned shirt dressing, which evaluates the learning process of new component actions of upper-body dressing in patients diagnosed with dementia and hemiparesis. This was a preliminary correlational study of concurrent validity and reliability in which 10 vascular dementia patients with hemiparesis were enrolled and assessed repeatedly by six occupational therapists by means of the UBDS and the dressing item of the Functional Independence Measure (FIM). Intraclass correlation coefficient was 0.97 for intra-rater reliability and 0.99 for inter-rater reliability. The level of correlation between UBDS score and FIM dressing item scores was -0.93. UBDS scores for paralytic hand passed into the sleeve and sleeve pulled up beyond the shoulder joint were worse than the scores for the other components of the task. The UBDS has good reliability and validity for vascular dementia patients with hemiparesis. Further research is needed to investigate the relation between UBDS score and the effect of intervention and to clarify sensitivity or responsiveness of the scale to clinical change.

Improved candidate drug mining for Alzheimer's disease

Alzheimer's disease (AD) is the main cause of dementia for older people. Although several antidementia drugs such as donepezil, rivastigmine, galantamine, and memantine have been developed, the effectiveness of AD drug therapy is still far from satisfactory. Recently, the single nucleotide polymorphisms (SNPs) have been chosen as one of the personalized medicine markers. Many pharmacogenomics databases have been developed to provide comprehensive information by associating SNPs with drug responses, disease incidence, and genes that are critical in choosing personalized therapy. However, we found that some information from different sets of pharmacogenomics databases is not sufficient and this may limit the potential functions for pharmacogenomics. To address this problem, we used approximate string matching method and data mining approach to improve the searching of pharmacogenomics database. After computation, we can successfully identify more genes linked to AD and AD-related drugs than previous online searching. These improvements may help to improve the pharmacogenomics of AD for personalized medicine.

Clinical utility of the functional independence measure for assessment of patients with Alzheimer's disease and vascular dementia

AIM

The aim of this study was to investigate the clinical utility of the Functional Independence Measure (FIM), and especially FIM-Cognition (FIM-C) scores, in patients with Alzheimer's disease (AD) and vascular dementia (VaD), and to determine the influence of behavioural and psychological symptoms of dementia (BPSD) on FIM-C scores.

METHODS

This was a cross-sectional survey of 37 AD and 40 VaD patients. Cognitive function was assessed with the Cognitive Abilities Screening Instrument. Activities of daily living were evaluated with the FIM and the Barthel Index. BPSD were assessed with the Behavioural Pathology in Alzheimer's Disease Frequency Weighted Severity Scale.

RESULTS

For both groups, Spearman's correlations were found between FIM-Motor and Barthel Index scores and between FIM-C and Mini Mental State Examination scores. Each FIM-C subscore was correlated with Cognitive Abilities Screening Instrument scores in both groups, except for the FIM-C Social interaction subscore in VaD. VaD patients showing Activity Disturbance and Aggressiveness on the Behavioural Pathology in Alzheimer's Disease Frequency Weighted Severity Scale had significantly lower FIM-C Memory and Social interaction subscores than those without BPSD.

CONCLUSION

The results suggest that the FIM-Motor and FIM-C scales are useful measures of physical and cognitive disabilities in patients with AD and VaD. The FIM-C profile of AD may reflect global cognitive function, while that of VaD may be more influenced by BPSD.

Doença de Alzheimer: declínio funcional e estágio da demência

OBJETIVOS: Verificar como o estágio da doença de Alzheimer se correlaciona com a capacidade funcional do idoso segundo a Medida de Independência Funcional. MÉTODOS: Trata-se de estudo observacional e transversal envolvendo idosos com diagnóstico de doença de Alzheimer e seus cuidadores. Para coleta de dados utilizou-se a Medida de Independência Funcional e a escala de Avaliação Clínica de Demência. RESULTADOS: A amostra foi composta por 67 idosos com média de idade de 79 anos. Demência grave foi encontrada em 46,3%, demência moderada em 22,4% e demência leve em 31,3%. As médias da Medida de Independência Funcional encontradas foram 107,9, 84,5 e 39,7 em idosos com demência leve, moderada e grave, respectivamente. Encontrou-se correlação entre o nível de independência funcional e o estágio de demência (p<0,001). CONCLUSÃO: O estágio de demência é um fator preditivo importante do comprometimento funcional de idosos com doença de Alzheimer.

Functional dependence and caregiver burden in Alzheimer's disease: a controlled trial on the benefits of motor intervention

BACKGROUND

Cognitive decline has a negative impact on functional activities in Alzheimer's disease. Investigating the effects of motor intervention with the intent to reduce the decline in functionality is an expected target for patients and caregivers. The aim of this study was to verify if a 6-month motor intervention programme promoted functionality in Alzheimer's patients and attenuated caregivers' burden.

METHODS

The sample comprised 32 community patients with Alzheimer's disease and their 32 respective caregivers. Patients were divided into two groups: 16 participated in the motor intervention programme and 16 controls. Subjects performed 60 minutes of exercises, three times per week during the 6-month period, to improve flexibility, strength, agility and balance. Caregivers followed the procedures with their patients during this period. Functionality was evaluated by the Berg Functional Balance Scale and the Functional Independence Measure. Caregivers completed the Neuropsychiatric Inventory Caregiver Distress Scale and the Zarit Carer Burden Scale. Two-way ANOVA was used to verify the interaction between time (pre- and post-intervention) and the motor intervention program.

RESULTS

While patients in the motor programme preserved their functionality, as assessed by the Functional Independence Measure, the controls suffered a relative decline (motor intervention group: from 109.6 to 108.4 vs controls: from 99.5 to 71.6; P= 0.01). Patients from motor intervention also had better scores than the controls on functional balance assessed by Berg scale (F: 22.2; P= 0.001). As assessed by the Neuropsychiatric Inventory and Zarit scale, burden was reduced among caregivers whose patients participated in the motor intervention programme compared with caregivers whose patients did not participate in this programme (Neuropsychiatric Inventory, caregiver's part: F: 9.37; P= 0.01; Zarit: F: 11.28; P= 0.01).

CONCLUSION

Patients from the motor intervention group showed reduced functional decline compared to the controls, and there was an associated decrease in caregivers' burden.

Poorer clock draw test scores are associated with greater functional impairment in peripheral artery disease: the Walking and Leg Circulation Study II

We hypothesized that, in the absence of clinically recognized dementia, cognitive dysfunction measured by the clock draw test (CDT) is associated with greater functional impairment in men and women with peripheral artery disease (PAD). Participants were men and women aged 60 years and older with Mini-Mental Status Examination scores ≥ 24 with PAD (n = 335) and without PAD (n = 234). We evaluated the 6-minute walk test, 4-meter walking velocity at usual and fastest pace, the Short Physical Performance Battery (SPPB), and accelerometer-measured physical activity. CDTs were scored using the Shulman system as follows: Category 1 (worst): CDT score 0-2; Category 2: CDT score 3; Category 3 (best): CDT score 4-5. Results were adjusted for age, sex, race, education, ankle-brachial index (ABI), and comorbidities. In individuals with PAD, lower CDT scores were associated with slower 4-meter usual-paced walking velocity (Category 1: 0.78 meters/second; Category 2: 0.83 meters/second; Category 3: 0.86 meters/second; p-trend = 0.025) and lower physical activity (Category 1: 420 activity units; Category 2: 677 activity units; Category 3: 701 activity units; p-trend = 0.045). Poorer CDT scores were also associated with worse functional performance in individuals without PAD (usual and fast-paced walking velocity and SPPB, p-trend = 0.022, 0.043, and 0.031, respectively). In conclusion, cognitive impairment identified with CDT is independently associated with greater functional impairment in older, dementia-free individuals with and without PAD. Longitudinal studies are necessary to explore whether baseline CDT scores and changes in CDT scores over time can predict long-term decline in functional performance in individuals with and without PAD.

[Functional independence level and cognitive deficit in elderly individuals with Alzheimer's disease]

This study investigated the influence of the functional independence level of elderly individuals with Alzheimer's disease, according to cognitive assessment scores. Participants were 67 elderly individuals who received care in the Behavioral Neurology Outpatient Clinic of Hospital das Clinicas in Ribeirão Preto. Participants were evaluated in 2008 through a questionnaire for sociodemographic data, Functional Independence Measure (FIM) and the mini-mental state examination (MMSE). The cognitive deficit influenced the performance in carrying out activities of daily living. The average FIM for elderly people without cognitive deficit was 107.7 and for individuals with deficit, 63.2 (p < 0.001). Average FIM motor scores were 81.7 and 49.4 (p < 0.001), and FIM cognitive scores were 25.7 and 13.8 (p < 0.001), respectively. Knowing the reduction of independence and cognitive capacity is essential to maintain the provision of the basic needs of daily life. The study can support nurses' practice, improving elderly individuals and their families' living conditions.