Validation of the Dementia Care Assessment Packet-Instrumental Activities of Daily Living

Objective

We aimed to evaluate the psychometric properties of the IADL measure included in the Dementia Care Assessment Packet (DCAP-IADL) in dementia patients.

Methods

The study involved 112 dementia patients and 546 controls. The DCAP-IADL was scored in two ways: observed score (OS) and predicted score (PS). The reliability of the DCAP-IADL was evaluated by testing its internal consistency, inter-rater reliability and test-retest reliability. Discriminant validity was evaluated by comparing the mean OS and PS between dementia patients and controls by ANCOVA. Pearson or Spearman correlation analysis was performed with other instruments to assess concurrent validity. Receiver operating characteristics curve analysis was performed to examine diagnostic accuracy.

Results

Chronbach''s α coefficients of the DCAP-IADL were above 0.7. The values in dementia patients were much higher (OS=0.917, PS=0.927), indicating excellent degrees of internal consistency. Inter-rater reliabilities and test-retest reliabilities were statistically significant (p<0.05). PS exhibited higher reliabilities than OS. The mean OS and PS of dementia patients were significantly higher than those of the non-demented group after controlling for age, sex and education level. The DCAP-IADL was significantly correlated with other IADL instruments and MMSE-KC (p<0.001). Areas under the curves of the DCAP-IADL were above 0.9.

Conclusion

The DCAP-IADL is a reliable and valid instrument for evaluating instrumental ability of daily living for the elderly, and may also be useful for screening dementia. Moreover, administering PS may enable the DCAP-IADL to overcome the differences in gender, culture and life style that hinders accurate evaluation of the elderly in previous IADL instruments.     

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

Objective

This 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.

Methods

This 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.

Results

The 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%).

Conclusion

The 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.     

Validation of a New Screening Tool for Dementia: The Simple Observation Checklist for Activities of Daily Living

Background and PurposeScreening tests for dementia such as the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment are widely used, but there are drawbacks to their efficient use. There remains a need for a brief and easy method of assessing the activities of daily living (ADL) that can be administered to elderly individuals by healthcare workers. We have therefore developed a new scale named the Simple Observation Checklist for Activities of Daily Living (SOC-ADL).MethodsWe developed the SOC-ADL scale as a team of experts engaged in caring for individuals with dementia. This scale comprises eight items and was designed based on the Korean instrumental activities of daily living (K-IADL) scale and the Barthel activities of daily living scale (Barthel Index). The new scale was validated by enrolling 176 patients with cognitive dysfunction across 6 centers. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were performed. We assessed its concurrent validity by performing comparisons with the Korean-MMSE, Clinical Dementia Rating, Clinical Dementia Rating-Sum of Boxes, K-IADL, and Barthel Index, and its criterion validity by performing comparisons between mild cognitive impairment (MCI) and dementia. We also used Cronbach''s alpha to assess the interitem reliability. The appropriate cutoff values were determined by analyzing receiver operating characteristic curves, including the areas underneath them.ResultsEFA extracted one factor and CFA revealed that all of the model fits exceeded the minimum acceptable criteria. The SOC-ADL scores were strongly correlated with those of the other tools for dementia and could be used to differentiate MCI from dementia. Cronbach''s alpha values indicated that the results were reliable. The optimal cutoff value of the SOC-ADL for discriminating dementia from MCI was 3 points, which provided a sensitivity and specificity of 74.5% and 75.7%, respectively.ConclusionsOur results demonstrate that the SOC-ADL is a valid and reliable tool for differentiating dementia from MCI based on an assessment of ADL. This new tool can be used for screening ADL in elderly subjects who have difficulty communicating, and to increase the efficiency of dementia screening at the population level.     

Anomaly Detection in Activities of Daily Living with Linear Drift

Cognitive Computation - Anomalyq detection in Activities of Daily Living (ADL) plays an important role in e-health applications. An abrupt change in the ADL performed by a subject might indicate...     

The Activities of Daily Living Questionnaire: a validation study in patients with dementia

This study describes the development and validation of the Activities of Daily Living Questionnaire (ADLQ), an informant-based assessment of functional abilities, in patients with probable Alzheimer disease and other forms of dementia. The ADLQ measures functioning in six areas: self-care, household care, employment and recreation, shopping and money, travel, and communication. The ADLQ was administered to 140 caregivers followed longitudinally in the Northwestern Alzheimer's Disease Center. In a subset of 28 participants, the total ADLQ score and each of the subscales were found to be highly reproducible, with average concordance coefficients of 0.86. Concurrent validity was established by comparing the ADLQ with the Record of Independent Living, a previously validated measure of level of dependency in daily living activities. The ADLQ was also compared with other measures of dementia severity on the initial and annual follow-up visits and was found to be significantly and negatively correlated with the Mini-Mental State Examination and positively correlated with the Clinical Dementia Rating Scale. The ADLQ has high test-retest and concurrent validity and is consistent with other measures of temporal decline in patients with probable Alzheimer disease and other forms of dementia.     

针刺结合功能训练对社区脑卒中患者日常生活能力的影响

目的 探索规范针刺结合功能训练治疗对社区脑卒中患者日常生活能力的影响.方法 将长宁区三个社区176例脑卒中患者根据区域随机分成康复组和对照组,根据病程划分为软瘫期(Brunnstrom Ⅰ、Ⅱ)、痉挛期(BrunnstromⅢ、Ⅳ)、恢复期(BrunnstromⅤ、Ⅵ)和后遗症期;康复组在常规内科治疗的基础上给予规范的针刺结合功能训练治疗,对照组仅给予一般的常规内科治疗,分别在治疗后2个月末和5个月末采用改良Barthel指数评定量表进行日常生活能力的评定.结果 规范针刺结合功能训练社区康复治疗5个月后,两组患者的日常生活能力评分均提高,康复组与对照组相比具有显著性差异(P＜0.01).结论 规范针刺结合功能训练的社区康复治疗能促进脑卒中患者的日常生活能力的恢复.     

血管性痴呆患者脑脊液铝水平检测

为探讨血管性痴呆（VD）与老年性痴呆（AD）在发病机制上是否有某些共同点，对50例VD患者及25例健康对照组进行脑脊液（CSF）铝水平检测。结果表明，VD组CSF铝水平为2．48±2．42μmol／L，对照组为0．53±0．61μmol／L，VD组较对照组显著增高（P＜0．001）。推测VD发病机制可能与AD有某些共同之处。     

Neuropsychological and Neuropsychiatric Findings in Right Hemisphere Damaged Patients

Abstract: We evaluated 46 patients with right hemisphere strokes for unilateral spatial neglect (USN), anosognosia, hemiasomatognosia, extinction, constructional disturbance, motor Impersistence organic mental syndrome. High correlations were found among the incidences of USN, anosognosia, hemiasomatognosia, extinction, motor impersistence constructional disturbance.
USN, hemiasomatognosia, motor impersistence, constructional disturbance anosognosia tended to occur with large lesions. Organic personality syndrome was frequent (33%) was more often associated with USN, anosognosia, hemiasomatognosia, extinction, constructional disturbance motor impersistence than other psychiatric symptoms.     

早期康复治疗对急性脑梗死患者运动、肌痉挛及生活活动能力的影响

目的：应用Fugl-Meyer量表、改良Ashworth量表和简化巴氏指数量表（BI）分别进行评定,探讨早期康复治疗对急性脑梗死偏瘫患者运动功能、肌痉挛及日常生活活动能力（ADL）的影响。方法：选择急性脑梗死偏瘫患者90例,随机分为康复治疗组和对照组。康复治疗组在临床药物治疗的同时进行规范的康复训练,对照组给予临床药物治疗及未经指导的自我锻炼,在患者入组时和30d后分别进行有关的功能评定,评价两组的疗效。结果：治疗前两组的一般资料、运动功能、肌痉挛与ADL的评定差异无统计学意义（P〉0．05）,经30d治疗后,运动能力和BI均有一定程度的改善,改善幅度康复治疗组明显优于对照组（P〈0．05）,肌痉挛评分康复治疗组也明显优于对照组（P〈0．05）。结论：早期康复治疗有助于改善急性脑梗死偏瘫患者的运动、肌痉挛及生活活动能力。     

不同侧别脑损伤患者失算症的特点分析

目的 比较脑损伤组与对照组的数字加工和计算测验（Number Processing and Calculation,NPC）成绩, 探讨不同侧别脑损伤患者失算症的特点。 方法 对40例脑损伤患者（左脑20例,右脑9例,双侧11例）和48例正常对照者进行NPC测验,对所 得数据进行统计分析。 结果 脑损伤组NPC测验的数字序列、数字理解、数字编码转换、计算成绩和总分均明显低于对照组 （P <0.01）。左脑损伤组的数字编码转换、计算成绩和总分低于右脑损伤组（P <0.05）。双侧脑损伤组 分别与左脑损伤组、右脑损伤组的成绩间差异无统计学意义（P >0.05） 结论 脑损伤患者的数字加工和计算能力较正常人下降。左脑损伤患者的受损表现与言语能力密切 相关。右脑损伤患者的受损表现与视空间等非言语认知能力有联系。     

血管性痴呆的事件相关电位P300研究

目的探讨血管性痴呆(Vascular dementia,VD)的事件相关电位(Event-related potentials,ERP)P300的变化特点.方法应用Nicolet Bravo脑诱发电位仪对18例VD患者和20例正常老年人进行P300检测.结果与正常老年组相比,VD组的P300表现为靶N2、P3潜伏期延长,靶P3、非靶P2波幅下降,有显著性差异(P＜0.05-0.01).结论P300可反映VD认知功能的变化,尤其是靶P3的潜伏期和波幅,有助于评估VD的认知功能状态.     

腔隙性脑梗死合并智能障碍的危险因素分析

目的了解导致腔隙性脑梗死患者并发血管性痴呆的可能危险因素.方法对68名住院的腔隙性脑梗死患者按合并血管性痴呆与否分组研究,了解高血压、糖尿病及寇心病等病史,检测外周血中总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、载脂蛋白(A)、载脂蛋白(B)、脂蛋白(a)、血粘度、空腹血糖、糖耐量试验及24小时动态血压监测.结果两组患者有高血压、糖尿病及寇心病病史的比例无显著差异(P>0.05),而较之无智能障碍组,伴发血管性痴呆组患者血脂蛋白(a)含量更高(P<0.01)、糖耐量异常的比例更高(P<0.05)、更多的患者收缩压和舒张压昼夜节律消失(均P<0.01).结论脂蛋白(a)水平的升高、糖耐量的异常及夜间高血压可能是导致腔隙性脑梗死患者发生血管性痴呆的危险因素.     

Relationship between the Head Deviation Angle and Hemineglect in Patients with Right Hemisphere Stroke

Background: Patients with hemineglect have been reported to have abnormal head posture. We attempted to determine the extent to which the angles are correlated with the severity of hemineglect. Methods: In a prospective, single-center, cross-sectional study on 40 patients with single right hemisphere stroke, we evaluated left hemineglect severity using the line bisection and line cancellation tests. Head deviation angles were measured at admission and discharge using a head device containing 3 graduated discs that determined the angles of head deviation in the sagittal, coronal and transverse planes. Results: Head angles in the transverse and coronal planes differed significantly between the left hemineglect and non-hemineglect groups. Scores obtained from the line bisection and line cancellation tests correlated with these angles. Furthermore, improvement in left hemineglect after rehabilitation training corresponded to a reduction in the angles. Conclusion: Stroke patients with hemineglect exhibited significant head deviations in the transverse and coronal planes. Deviation angles correlated with hemineglect test scores.