Activities of daily living in dementia: revalidation of the E-ADL Test and suggestions for further development

Disability-Adjusted Life Expectancy and Cognitive Function among Community-Dwelling Adults

We aimed to calculate disability-adjusted life expectancy (DALE) for Korean older adults based on their sex, educational attainment, and residential region across their cognitive status. We included 3,854 participants (aged 65-91 years) from the Korean Longitudinal Study of Aging's seventh survey data. The participant's cognitive function status (normal, moderately impaired, or severely impaired) was determined based on cognitive examination and physical function independence, which was used to calculate their DALE. Females with normal cognition had higher DALE (7.60 years, Standard Deviation (SD) = 3.88) than males (6.76, SD = 3.40); however, both sexes had comparable DALE for cognitive impairment. In contrast, the DALE values increased with higher educational achievements. Regarding residential areas, the DALE value for participants with normal cognition and moderate impairment was the highest among urban dwellers, while DALE for participants with severely impaired cognitive function was highest among rural dwellers; however, there were no statistically significant differences based on residential conditions. Our findings suggest that demographic characteristics should be considered when developing health policies and treatment strategies to meet the needs of the aging population in Korea.

Designing technology to support greater participation of people living with dementia in daily and meaningful activities

Background

People living with dementia should be at the center of decision-making regarding their plans and goals for daily living and meaningful activities that help promote health and mental well-being. The human-computer interaction community has recently begun to recognize the need to design technologies where the person living with dementia is an active rather than a passive user of technology in the management of their care.

Methods

Data collection comprised semi-structured interviews and focus groups held with dyads of people with early-stage dementia (n = 5) and their informal carers (n = 4), as well as health professionals (n = 5). This article discusses findings from the thematic analysis of this qualitative data.

Results

Analysis resulted in the construction of three main themes: (1) maintaining a sense of purpose and identity, (2) learning helplessness and (3) shared decision-making and collaboration. Within each of the three main themes, related sub-themes were also constructed.

Discussion

There is a need to design technologies for persons living with dementia/carer dyads that can support collaborative care planning and engagement in meaningful activities while also balancing persons living with dementia empowerment and active engagement in self-management with carer support.

Effects of Bowel Training and Defecation Posture on Chronic Constipation in Older Adults With Dementia: A Randomized Controlled Trial

INTRODUCTION

Chronic constipation (CC), which can cause behavioral and psychiatric symptoms of dementia and related caregiver distress, is common in older adults admitted to care facilities with dementia. This study aimed to examine the effect of defecation care on CC and related problems.

METHODS

This study compared bowel training and defecation posture intervention (intervention group) with general care (control group) as the treatment of CC among older adults with dementia in 6 long-term care facilities. The primary outcomes were the number of spontaneous bowel movements (SBMs) and complete SBMs. The secondary outcomes were Patient Assessment of Constipation Quality of Life Questionnaire, Constipation Scoring System, constipation symptoms, and Neuropsychiatric Inventory Nursing Home Version scores. The differences were analyzed using 2-way ANOVA with repeated measures.

RESULTS

The data of 30 patients (14 in the intervention group, 16 in the control group) were analyzed. Weekly mean complete SBMs increased from 0.53 times at baseline to 1.58 times at 8 weeks in the intervention group compared with a change from 0.56 to 0.43 times in the control group (interaction P < 0.001). The Patient Assessment of Constipation Quality of Life Questionnaire, Constipation Scoring System, behavioral and psychiatric symptoms of dementia, and caregiver distress scores showed significant improvement after 8 weeks of defecation care intervention.

DISCUSSION

Defecation care, including bowel training and appropriate defecation posture, is effective for CC among older adults with dementia, improving patient mental health and reducing burden on caregivers.

Social, behavioural, and functional characteristics of community-dwelling South Korean adults with moderate and severe cognitive impairment

OBJECTIVES

This study used the 2016 Korean Longitudinal Study on Aging to investigate the social, behavioural, and functional characteristics of community-dwelling South Korean adults with cognitive impairment.

METHODS

Participants were classified as normal, moderate impairment, and severe impairment according to an algorithm that combined the Korean Mini-Mental State Examination score and the number of difficulties in performing instrumental activities of daily living. Selected characteristics included grip strength, depression, participation in exercise and social activities, and living in a rural, urban, or suburban community.

RESULTS

Most (72.7%) participants were classified as having normal cognition, 20.1% were classified as moderate impairment, and 7.2% were classified as severe impairment. Regardless of sex, the differences in grip strength across the cognitive status classifications were statistically significant, except for the difference between moderate and severe cognitive impairment in males (p = 0.8477). Greater number of depressive symptoms and living in rural areas were associated with significantly higher odds for severe cognitive impairment. Participants with moderate (OR = 0.51) and severe (OR = 0.33) cognitive impairment were less likely to participate in social activities than those with normal cognition.

CONCLUSIONS

The study findings revealed that social, behavioural, and functional characteristics are closely related to the cognitive status of community-dwelling adults in South Korea.

Advancing Smart Home Awareness-A Conceptual Computational Modelling Framework for the Execution of Daily Activities of People with Alzheimer's Disease

Utilizing context-aware tools in smart homes (SH) helps to incorporate higher quality interaction paradigms between the house and specific groups of users such as people with Alzheimer's disease (AD). One method of delivering these interaction paradigms acceptably and efficiently is through context processing the behavior of the residents within the SH. Predicting human behavior and uncertain events is crucial in the prevention of upcoming missteps and confusion when people with AD perform their daily activities. Modelling human behavior and mental states using cognitive architectures produces computational models capable of replicating real use case scenarios. In this way, SHs can reinforce the execution of daily activities effectively once they acquire adequate awareness about the missteps, interruptions, memory problems, and unpredictable events that can arise during the daily life of a person living with cognitive deterioration. This paper presents a conceptual computational framework for the modelling of daily living activities of people with AD and their progression through different stages of AD. Simulations and initial results demonstrate that it is feasible to effectively estimate and predict common errors and behaviors in the execution of daily activities under specific assessment tests.

Effects of a 16-week multimodal exercise program on activities of daily living in institutionalized individuals with dementia

We aimed to examine the effects of a 16-week multimodal exercise program (MEP) on activities of daily living (ADL) in individuals with dementia (IWD). Furthermore, we investigated the participants’ individual response to the MEP and whether baseline cognitive and motor performance explain ADL performance. We conducted a multicenter randomized controlled trial (RCT) involving 319 participants aged ≥ 65 years with mild to moderate dementia. ADL were assessed at baseline and after the 16-week intervention using the Barthel Index (BI), the Erlangen Test of Activities of Daily Living (E-ADL) and the 7‑item Physical Performance Test (PPT-7). We additionally assessed cognitive and motor performance using standardized and validated assessments. Intervention effects were examined through two-factor analysis of variance with repeated measurements applying a per protocol and an intention-to-treat analysis. We compared baseline cognitive and motor performance between positive-responders (positive-R), non-responders (non-R), and negative-responders (negative-R) and examined cognitive and motor performance as potential cofounders of ADL by conducting multiple regression analyses. There were no significant time×group effects on ADL. Between 20 and 32% of participants responded positively to the intervention, i.e., improved ADL performance from baseline to follow-up. Positive-R had worse baseline motor performance compared to non-R. Cognitive and motor performance explained up to 51.4% of variance in ADL. The MEP had no significant overall effect on ADL in IWD. This may be related to insufficient exercise intensity. However, our results indicate that the response to the MEP depends on individual prerequisites which should thus be considered in further research on individual exercise approaches.

A time-efficient screening tool for activities of daily living functions in Parkinson's disease dementia

INSTRUCTION

In Parkinson's disease (PD), activities of daily living (ADL) impairments are crucial for diagnosis of dementia (PDD). Performance-based tests are promising tools to discriminate between different levels of cognitive impairment in PD; however, the value of those tests for diagnosis of PDD is only sparsely investigated. Therefore, we evaluated the Erlangen Test of Activities of Daily Living (E-ADL), a time-efficient performance-based ADL test, in PD.

METHOD

In this cross-sectional study, 40 PD patients with normal cognition (PD-NC), 45 patients with mild cognitive impairment (PD-MCI) and 21 patients with PDD were assessed with a comprehensive ADL and cognitive test battery.

RESULTS

Interrater reliability (r_s =.86) indicated high consistency of the standardized E-ADL scoring system between raters. The E-ADL correlated significantly with other tests of ADL functions (p <.01), highest with an alternative performance-based ADL test (r_s = -.52), and lowest with self-ratings and a physician-rated scale. The E-ADL was also associated with cognitive impairment (p <.01), but also with motor impairment. A binary logistic regression model verified that the E-ADL (p =.04) was an independent predictor of PDD, in addition to motor impairment explaining 53.3% of variance. Receiver operating characteristic curve analysis of the E-ADL revealed an area under the curve of 0.78, a specificity of 77%, and a sensitivity of 67% for diagnosis PDD.

CONCLUSIONS

The standardized, easy, and quick to administer E-ADL showed acceptable levels of reliability, and validity in PD and measures cognitive-driven ADL functions. Therefore, it might be a suitable test to support diagnosis of PDD in the clinical daily routine.

Is Barthel Index Suitable for Assessing Activities of Daily Living in Patients With Dementia?

OBJECTIVES

To evaluate application of the Barthel Index (BI) in assessing basic activities of daily living (ADL) of patients with dementia using Rasch analysis.

DESIGN

A multi-country cross-sectional study.

SETTING AND PARTICIPANTS

Nineteen long-term care facilities located in China, Japan, South Korea, and Thailand. A total of 644 patients with dementia were included.

METHODS

Unidimensionality, global and item fit, local dependence, person-item targeting, threshold disordering, and differential item functioning (DIF) were examined. Negative correlations between scores for DIF items and Neuropsychiatric Inventory Nursing Home version (NPI-NH) were evaluated.

RESULTS

Item reliability (1.0) and person reliability (.88) were acceptable. The Rasch dimension explained 72.9% of the variance (Eigenvalue = 27), while the first contrast explained 6.6% (Eigenvalue = 2.4). The "mobility" was misfitting to the Rasch model (infit mean square = 1.86). The overall difficulty of the BI exceeded patients' ability (person location = -2.27 logits). The "stairs climbing" and "mobility" showed narrow category thresholds (< 1.4 logits). The location of "controlling bladder" and "toilet use" overlapped. Removing "stairs climbing", collapsing categories with narrow threshold widths in "mobility", and combining "controlling bowel" and "controlling bladder" into one item, improved unidimensionality, and item fit of the scale. Only three items ("grooming", "dressing", and "toilet use") were free from DIF across countries. The scores for "feeding" were negatively related to scores for "disinhibition" (r = -0.46, P < 0.01), and scores for "controlling bowel" were negatively related to scores for "disinhibition" (r = -0.44, P < 0.01), "agitation" (r = -0.32, P < 0.05), and "aggression" (r = -0.27, P < 0.01) in Japanese samples.

CONCLUSIONS AND IMPLICATIONS

The performance of the BI for assessing patients with dementia might be compromised by misfit items, person-item mistargeting, measurement gaps, redundant items, narrow threshold width, and item bias. Mobility ability might not be helpful for determining capability of basic ADL in the patients. Comparisons of BI scores between countries should be undertaken with caution due to item bias. Neuropsychiatric symptoms might interact with basic ADL abilities of the patients. We will not suggest using the instrument in patients with dementia, without future refining to improve its performance.

Recommended motor assessments based on psychometric properties in individuals with dementia: a systematic review

BACKGROUND

Motor assessments are important to determine effectiveness of physical activity in individuals with dementia (IWD). However, inappropriate and non-standardised assessments without sound psychometric properties have been used. This systematic review aims to examine psychometric properties of motor assessments in IWD combined with frequency of use and effect sizes and to provide recommendations based on observed findings.We performed a two-stage systematic literature search using Pubmed, Web of Science, Cochrane Library, ALOIS, and Scopus (inception - July/September 2018, English and German). The first search purposed to identify motor assessments used in randomised controlled trials assessing effectiveness of physical activity in IWD and to display their frequency of use and effect sizes. The second search focused on psychometric properties considering influence of severity and aetiology of dementia and cueing on test-retest reliability. Two reviewers independently extracted and analysed findings of eligible studies in a narrative synthesis.

RESULTS

Literature searches identified 46 randomised controlled trials and 21 psychometric property studies. While insufficient information was available for validity, we observed sufficient inter-rater and relative test-retest reliability but unacceptable absolute test-retest reliability for most assessments. Combining these findings with frequency of use and effect sizes, we recommend Functional Reach Test, Groningen Meander Walking Test (time), Berg Balance Scale, Performance Oriented Mobility Assessment, Timed Up & Go Test, instrumented gait analysis (spatiotemporal parameters), Sit-to-Stand assessments (repetitions> 1), and 6-min walk test. It is important to consider that severity and aetiology of dementia and cueing influenced test-retest reliability of some assessments.

CONCLUSION

This review establishes an important foundation for future investigations. Sufficient relative reliability supports the conclusiveness of recommended assessments at group level, while unacceptable absolute reliability advices caution in assessing intra-individual changes. Moreover, influences on test-retest reliability suggest tailoring assessments and instructions to IWD and applying cueing only where it is inevitable. Considering heterogeneity of included studies and insufficient examination in various areas, these recommendations are not comprehensive. Further research, especially on validity and influences on test-retest reliability, as well as standardisation and development of tailored assessments for IWD is crucial.This systematic review was registered in PROSPERO (CRD42018105399).

Recommendations for assessing motor performance in individuals with dementia: suggestions of an expert panel - a qualitative approach

Background

Recommendations for assessing motor performance in individuals with dementia (IWD) are rare, and most existing assessment tools previously applied in IWD were initially developed for healthy older adults. However, IWD and their healthy counterparts differ in motor and cognitive capabilities, which needs to be considered when designing studies for this population. This article aims to give recommendations for motor assessments for IWD and to promote standardisation based on a structured discussion of identified assessment tools used in previous trials.

Methods

Appropriateness and standardisation of previously applied motor assessments for IWD were intensively discussed using a qualitative approach during an expert panel. Furthermore, the use of external cues and walking aids, as well as psychometric properties were considered. Starting with a comprehensive overview of current research practice, the discussion was gradually specified and resulted in the elaboration of specific recommendations.

Results

The superior discussion emphasised the need for tailoring motor assessments to specific characteristics of IWD and attaching importance to standardised assessment procedures. Specific recommendations include the use of sequential approaches, which incorporate a gradual increase of complexity from simple to more difficult tasks, a selection of motor assessments showing sufficient relative reliability and appropriateness for IWD, as well as allowing external cues and walking aids when restricted to repeated instructions and commonly used devices, respectively.

Conclusions

These are the first recommendations for assessing motor performance in IWD based on a comprehensive qualitative approach. Due to limited evidence, it was not possible to address all existing questions. It is therefore important to evaluate these recommendations in studies with IWD. Besides tailoring and evaluating available assessments, future research should focus on developing specific tools for IWD. Moreover, further progress in standardisation is necessary to enhance comparability between different trials. This article provides initial approaches for overcoming existing limitations in trials with IWD by giving recommendations and identifying future research questions, and therefore contributes to enhancing evidence regarding efficacy and effectiveness of physical activity interventions.

Factors influencing the quality of life perceptions of cognitively impaired older adults in a nursing home and their informal and professional caregivers: a mixed methods study

Background

Identifying the objective and subjective aspects of the quality of life (QoL) of institutionalized cognitively impaired older adults (CIOAs) is a challenge. However, it can reveal which aspects of their care require improvement.

Aim

The aim of this study was to identify the core aspects of the QoL of CIOAs living in a nursing home (NH) by involving informal and professional caregivers (PCs).

Methods

Our sequential, mixed methods study exploring the QoL of CIOAs was based on Lodgson et al’s (2002) quantitative quality of life–Alzheimer’s disease (QoL-AD) questionnaire. Subsequently, a qualitative phase study analyzed perceptions and impressions of QoL using interviews of CIOAs and their most significant informal caregivers (SICs) and PCs.

Results

Fifteen CIOAs, 12 SICs, and 2 PCs were recruited. Two-thirds of the older adults were females, overall average age was 86 years (SD=6.1), and all had a severe clinical dementia rating (CDR=3). A high level of comorbidity (measured using the Cumulative Illness Rating Scale for Geriatrics) was significantly associated with a lower QoL-AD score (P=0.046). Higher numbers of visits by SICs or family members had a positive effect on QoL-AD scores (P=0.036). No significant differences were found in overall QoL-AD scores as rated by CIOAs, SICs, and PCs (P=0.080). Combining quantitative and qualitative data analyses revealed four significant themes influencing the QoL of CIOAs: 1) human dignity and acceptance; 2) development and existence; 3) functionality and health; and 4) recognizability and safety.

Conclusion

Sequentially using mixed methods proved an appropriate way to examine the QoL of severe CIOAs living in an NH, and these results were compared with the perceptions of informal and PCs. The factors optimizing overall health were visits by SICs and family members, and the major aspect that increases the QoL was freedom of movement inside and outside the NH.

The Erlangen test of activities of daily living in persons with mild dementia or mild cognitive impairment (ETAM) - an extended validation

BACKGROUND

The ability to perform activities of daily living (ADLs) is a central marker in the diagnosis and progression of the dementia syndrome. ADLs can be identified as basic ADLs (BADLs), which are fairly easy to perform, or instrumental ADLs (IADLs), which involve more complex activities. Presently, the only performance-based assessment of IADL capabilities in persons with cognitive impairment is the Erlangen Test of Activities of Daily Living in Persons with Mild Dementia or Mild Cognitive Impairment (ETAM). The aim of the present study was to revalidate the ETAM in persons with mild cognitive impairment (MCI) or mild dementia and to analyze its application to persons with moderate dementia.

METHODS

We used baseline data from a cluster randomized controlled trial involving a sample of 443 users of 34 day-care centers in Germany. We analyzed groups of persons with MCI, mild dementia, and moderate dementia, categorized on the basis of the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). An item analysis was performed, and new discriminant validities were calculated. We computed a confirmatory factor analysis (CFA) to examine the postulated theoretical model of the ETAM with all six items loading on a single IADL factor. This was the first time that the ETAM's sensitivity to change was analyzed after a time period of 6 months.

RESULTS

The overall sample scored on average 17.3 points (SD = 7.2) on the ETAM (range: 0-30 points). Persons with MCI scored on average 23.2 points, persons with mild dementia scored 18.4 points, and persons with moderate dementia scored 12.9 points, p < .001 (ANOVA). The item analysis yielded good difficulty indices and discrimination powers. The CFA indicated a good fit between the model and the observed data. After 6 months, both the ETAM score at baseline and the change in MMSE score (t0-t1) were significant predictors of the ETAM score at t1.

CONCLUSIONS

The ETAM is a valid and reliable instrument for assessing IADL capabilities in persons with MCI or mild dementia. It is sensitive to changes in cognitive abilities. The test parameters confirm its application to persons with moderate dementia.

TRIAL REGISTRATION

Identifier: ISRCTN16412551 (Registration date: 30 July 2014, registered retrospectively).

Validation of a core patient-reported-outcome measure set for operationalizing success in multimodal pain therapy: useful for depicting long-term success?

Background

The study aims to validate a previously developed and published combined success criterion for patients after multimodal pain therapy (Donath et al., BMC Health Serv Res 15:272, 2015). The criterion classifies treated patients as successful in the long term on the basis of pain severity, disability through pain, depressiveness, and health-related quality of life.

Methods

Routine longitudinal data of 135 pain patients treated with multimodal pain therapy in 2014–2015 at the Interdisciplinary Pain Center of the University Clinic Erlangen were available at baseline, therapy start, therapy end, and 12 months after treatment. Patients were, on average, 51.0 (SD 11.1) years old and to 63.7% female, two thirds were employed (66.7%). We conducted an analysis of concurrent validity (with: pain severity, disability through pain, depressiveness, mental and physical quality of life), criterion validity (with disability days, self-rated success), convergent validity (with stress, anxiety, well-being), and discriminant validity (with chronicity of pain, comorbidity), objectivity, and reliability. Statistically, descriptive and inference statistics, graphical methods and MANOVAs were used.

Results

Patients classified as successful had significantly better values on the 5 variables demonstrating concurrent validity (all p < .001), significantly fewer Disability days (M = 15.31 (SD = 23.15) vs. M = 26.75 (SD = 29.15)); t (133) = 2.308; p = .024, less Anxiety (Pillai-Spur: F (3, 131) = 2.972, p = .034), less Stress (Pillai-Spur: F (3, 131) = 9.907, p < .001), and better Well-being (Pillai-Spur: F (3, 131) = 9.594, p < .001) 12 months after treatment than patients classified as not successful. The Spearman correlation between success classification and Chronicity stage was .094 (p = .280).

Conclusion

We demonstrated the validity of the combined success criterion with long-term data in addition to confirming the reliability and objectivity of the criterion. Future research might consider identifying predictors of success in multi-modal pain therapy.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-2911-6) contains supplementary material, which is available to authorized users.

The association between cognitive fluctuations and activities of daily living and quality of life among institutionalized patients with dementia

OBJECTIVE

Cognitive fluctuations (CFs) occur commonly in dementia of all types. While it is generally accepted that CFs can affect the clinical rating of dementia severity and neuropsychological performance, little is known about their impact on patients' activities of daily living (ADLs) and quality of life (QOL). Our study aims to explore the impact of CFs on ADLs and QOL among institutionalized patients with dementia.

METHODS

The present study examined the nature and frequency of CFs in 55 institutionalized dementia patients. We used the Dementia Cognitive Fluctuation Scale (DCFS) to assess the presence and severity of CFs. The Alzheimer's Disease Functional Assessment of Change Scale (ADFACS) was used to assess patients' ADLs, and the Quality of Life in Late Stage Dementia scale (QUALID) was used to assess QOL. Linear regression models were used to assess the relationships between CFs, ADLs, and QOL.

RESULTS

The mean age of the patients was 90.41 years (SD = 2.84). Their mean Aggressive Behavior Scale score was 1.13 (SD = 1.59), mean Severe Impairment Battery total score was 86.65 (SD = 13.77), and mean DCFS score was 10.07 (SD = 3.04). The mean ADFACS-ADL score was 10.88 (SD = 6.37), mean ADFACS-IADL score was 16.61 (SD = 9.54), and mean QUALID total score was 18.25 (SD = 5.70). DCFS significantly predicted ADFACS-ADL score (R²  = 0.39, β = 0.30, P = .011) although the relationship between ADFACS-IADL score and DCFS score was not significant (R²  = 0.16, P = .111). DCFS significantly predicted QUALID score (R²  = 0.08, β = 0.29, P = .033).

CONCLUSION

More severe CFs in patients with dementia were significantly associated with impaired ability to engage in ADLs and poorer QOL.

Comparison of Effect of Two Exercise Programs on Activities of Daily Living in Individuals with Dementia: A 9-Week Randomized, Controlled Trial

OBJECTIVES

To compare the effects of two exercise programs on proxy- and performance-based measures of activities of daily living (ADLs) and to explore potential motor and cognitive mediators underlying ADL improvements in individuals with dementia.

DESIGN

A parallel, three-group, single-blind, randomized, controlled trial.

SETTING

Psychogeriatric wards.

PARTICIPANTS

Individuals with dementia (mean age 85.6 ± 5.1).

INTERVENTIONS

Each 9-week intervention consisted of thirty-six 30-minute sessions. A combined group (n = 35) participated in two strength and two walking sessions, an aerobic group (n = 35) participated in four walking sessions, and a social control group (n = 35) participated in four nonexercise social visits per week. The social group was used as a reference for the mediation analysis, which was performed in the combined and aerobic groups.

MEASUREMENTS

ADLs were assessed using the Katz index (proxy-reported ADL performance), Erlangen-ADL test (E-ADL) (instrumental ADL performance), and 7-item Physical Performance Test (PPT-7) (physical ADL performance).

RESULTS

There was a group effect for Katz index (P = .02), E-ADL (P < .001), and PPT-7 (P = .003). Differences from baseline to after the intervention were similar in the combined and aerobic groups. Exercise-induced changes in global cognition mediated changes in Katz index (95% confidence interval (CI) = 0.05-0.41), leg muscle strength mediated changes in E-ADL (95% CI = 0.03-0.43), and leg muscle strength (95% CI = 0.01-0.36) and walking endurance (95% CI = 0.01-0.43) mediated changes in PPT-7 only in the combined group.

CONCLUSION

Physical exercise can improve ADL levels in individuals with dementia, but improvements are small and seem independent of exercise type. Additional analyses suggest that combined aerobic and strength exercise may be more effective than aerobic-only exercise to effectively target ADL dysfunction in individuals with dementia. Future research is warranted to justify these exercise-specific findings.

Effectiveness of a 16-Week Multimodal Exercise Program on Individuals With Dementia: Study Protocol for a Multicenter Randomized Controlled Trial

BACKGROUND

The increasing prevalence of dementia in the next decades is accompanied by various societal and economic problems. Previous studies have suggested that physical activity positively affects motor and cognitive skills in individuals with dementia (IWD). However, there is insufficient evidence probably related to several methodological limitations. Moreover, to date adequate physical activity interventions specifically developed for IWD are lacking.

OBJECTIVE

This study aims to investigate the effectiveness of a multimodal exercise program (MEP) on motor and cognitive skills in IWD in a high-quality multicenter trial.

METHODS

A multicenter randomized controlled trial with baseline and postassessments will be performed. It is planned to enroll 405 participants with dementia of mild to moderate stage, aged 65 years and older. The intervention group will participate in a 16-week ritualized MEP especially developed for IWD. The effectiveness of the MEP on the primary outcomes balance, mobility, and gait will be examined using a comprehensive test battery. Secondary outcomes are strength and function of lower limbs, activities of daily living, and cognition (overall cognition, language, processing speed, learning and memory, and visual spatial cognition).

RESULTS

Enrollment for the study started in May 2015. It is planned to complete postassessments by the beginning of 2017. Results are expected to be available in the first half of 2017.

CONCLUSIONS

This study will contribute to enhancing evidence for the effects of physical activity on motor and cognitive skills in IWD. Compared to previous studies, this study is characterized by a dementia-specific intervention based on scientific knowledge, a combination of motor and cognitive tasks in the intervention, and high standards regarding methodology. Findings are highly relevant to influence the multiple motor and cognitive impairments of IWD who are often participating in limited physical activity.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00010538; https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00010538 (Archived by WebCite at http://www.webcitation.org/6oVGMbbMD).

Association between comorbid conditions and BADL/IADL disability in hypertension patients over age 45: Based on the China health and retirement longitudinal study (CHARLS)

Hypertension usually coexists with other chronic conditions and can cause disability in relation to activities of daily living. We examined the association between the number and categories of comorbid conditions and disability affecting activities of daily living in hypertension patients.The data were collected from the 2013 follow-up survey of the China Health and Retirement Longitudinal Study (CHARLS), which contains information about chronic conditions and disability. Additionally, socio-demographic characteristics of 3754 hypertension patients aged 45 and older were included in this study. Comorbid conditions included dyslipidemia, stroke, and 12 other chronic conditions. Disability in relation to activities of daily living was assessed using the basic activities of daily living (BADL) and the instrumental activities of daily living (IADL) instruments. Differences in BADL/IADL disability among patients with different comorbid conditions were compared using the chi-square test, and the influence of chronic conditions and socio-demographic characteristics on BADL/IADL disability was analyzed using logistic models.Without considering the influence of specific chronic conditions on BADL/IADL, hypertension patients with additional comorbid conditions were more likely to suffer from BADL/IADL disability. When considering the effect of specific chronic conditions, the number of comorbid conditions did not significantly influence BADL/IADL disability. Dyslipidemia, chronic lung disease, stroke, memory-related diseases, and arthritis/rheumatism were associated with BADL disability. Chronic lung diseases, heart diseases, stroke, stomach/digestive system diseases, emotional/nervous/psychiatric problems, memory-related diseases, arthritis/rheumatism, and asthma were associated with IADL disability. Additionally, female, people with lower education level, people living in village, and people living in middle and western China were more likely suffer from BADL/IADL disability.Comorbid conditions were associated with disability in activities of daily living in hypertension patients aged 45 and older. The specific comorbid conditions had a stronger effect on disability in activities of daily living than the number of comorbid conditions. In addition, we should pay attention to socioeconomic factors related to disability.

People with dementia in nursing home research: a methodological review of the definition and identification of the study population

Background

There are various definitions and diagnostic criteria for dementia, leading to discrepancies in case ascertainment in both clinical practice and research. We reviewed the different definitions, approaches and measurements used to operationalize dementia in health care studies in German nursing homes with the aim of discussing the implications of different approaches.

Methods

We conducted a systematic search of the MEDLINE and CINAHL databases to identify pre-2016 studies conducted in German nursing homes that focused on residents with dementia or cognitive impairment. In- or exclusion of studies were consented by all authors; data extraction was independently carried out by 2 authors (RP, SJ). The studies’ sampling methods were compared with respect to their inclusion criteria, assessment tools and methods used to identify the study population.

Results

We summarized case ascertainment methods from 64 studies. Study participants were identified based on a diagnosis that was evaluated during the study, or a recorded medical dementia diagnosis, or a recorded medical diagnosis either with additional cognitive screenings or using screening tests exclusively. The descriptions of the diagnostics that were applied to assess a diagnosis of dementia were not fully transparent in most of the studies with respect to either a clear reference definition of dementia or applied diagnostic criteria. If reported, various neuropsychological tests were used, mostly without a clear rationale for their selection.

Conclusion

Pragmatic considerations often determine the sampling strategy; they also may explain the variances we detected in the different studies. Variations in sampling methods impede the comparability of study results. There is a need to consent case ascertainment strategies in dementia studies in health service research in nursing homes. These strategies should consider resource constraints and ethical issues that are related to the vulnerable population of nursing home residents. Additionally, reporting about dementia studies in nursing homes need to be improved. If a diagnosis cannot be evaluated based on either ICD or DSM criteria, the study population may not be reported as having dementia. If a diagnosis is evaluated based on ICD or DSM criteria within the study, there is a need for more transparency of the diagnostic process.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-016-0249-7) contains supplementary material, which is available to authorized users.

Increased serum levels of interleukin-18, -23 and -17 in Chinese patients with Alzheimer's disease

AIMS

To evaluate the serum levels of interleukin (IL)-18, IL-23 and IL-17 in Chinese patients with Alzheimer's disease (AD), and explore correlations between the three cytokines and relevant parameters.

METHODS

Serum concentrations of IL-18, IL-23 and IL-17 were measured by ELISA for 53 AD patients and 53 sex- and age-matched healthy controls in a community of elderly individuals in a Shanghai suburb.

RESULTS

Serum concentrations of IL-18, IL-23 and IL-17 were significantly higher in AD patients than controls. The serum level of IL-23 was observed to be significantly higher (p = 0.049) in female AD patients than male AD patients. In addition, a significantly inverse correlation was found between IL-18 and MMSE score (rs = -0.356, p = 0.011) for all AD patients.

CONCLUSION

Elevated IL-18, IL-23 and IL-17 levels are observed in AD patients and differences may exist between males and females. Besides, IL-18 may correlate with the severity of AD.

A Direct Performance Test for Assessing Activities of Daily Living in Patients with Mild Degenerative Dementia: The Development of the ETAM and Preliminary Results

BACKGROUND

There are currently only a few performance tests that assess the capacity to perform activities of daily living. These measures frequently require a long time to administer, are strongly cognition oriented, or have not been adequately validated.

METHODS

The Erlangen Test of Activities of Daily Living in Mild Dementia (ETAM) was developed in a 4-phase process that was based on the International Classification of Functioning, Disability, and Health (ICF). A pilot study was conducted on 30 subjects with mild dementia with a mean age of 80 years. The subjects' mean score on the MMSE was 21.5. Twenty-one of the 30 subjects were women.

RESULTS

Ten items were developed and tested in the pilot study. The mean time required to complete the test was 26 min. The item analysis showed difficulties that ranged primarily from r = 0.28 to r = 0.79. The ETAM had a moderate correlation with the MMSE (rMMSE = 0.310) and a low correlation with the Geriatric Depression Scale-15 (GDS-15; rGDS-15 = 0.149).

CONCLUSION

The preliminary version of the ETAM is quick and easy to use and has predominantly satisfactory item characteristics. There still is the need to revise the items 'giving directions' and 'making tea' with regard to standardisation.