Characteristic Profiles of Activities of Daily Living and Relationship with Cognitive Performance in Thai Elderly with Different Stages from Normal Cognitive Function,Mild Cognitive Impairment to Dementia

ABSTRACT

Objective: The objectives were twofold—first, to evaluate the functional difference among normal cognitive elderly, mild cognitive impairment (MCI), and people with dementia; and second, to investigate the relationship between cognitive performance and functional abilities. Method: The Disability Assessment for Dementia (DAD) was administered to 90 participants: 20 normal controls (NC), 20 with MCI, 25 with mild dementia, 15 with moderate dementia and 10 with severe dementia patients. Results: The mean (SD) scores on instrumental activities of daily living (IADL) were 94.8 (6.4) for NC, 89.1 (9.9) for MCI, 33.6 (21.7) for mild dementia, 13 (12.2) for moderate dementia and 1.7 (4.2) for severe dementia. MCI participants presented slightly noticeable deficit in one IADL domain: ‘finance and correspondence’, whereas mild dementia presented deficit in all six IADL domains. Scores of basic activities of daily living (BADL) of the NC and MCI groups were equal at a perfect 100. The scores were slightly reduced in mild dementia patients (92.7 [12.3]) and were decreased in moderate (68.6 [26.4]) and severe dementia participants (10 [14.4]). Conclusions: Our studies demonstrated that IADL can be subtly impaired in people with MCI, but markedly impaired in those with mild dementia. BADL begin to decline in moderate dementia and then reach a level of severe impairment in severe dementia.     

Clinical predictive score for detecting nonalcoholic fatty liver disease with significant fibrosis in patients with metabolic syndrome

Patients with metabolic syndrome are at a higher risk of nonalcoholic fatty liver disease (NAFLD) and liver fibrosis than the general population. Still, accessibility of screening method for NAFLD with significant fibrosis, such as transient elastography (FibroScan) are limited in some settings. This study aimed to develop a simple clinical predictive score for detecting NAFLD with significant fibrosis in patients with metabolic syndrome.A cross-sectional study was designed to obtain the data from medical records of all relevant patients who underwent transient elastography between January 2011 and December 2020 at Siriraj Hospital, Thailand. A liver stiffness cutoff value of 7.0 kilopascal was used to define the presence of significant liver fibrosis. To examine potential predictors, medical history and clinical data commonly assessed in routine practice were selected by following expert opinions and univariable statistical analysis. Backward and forward stepwise logistic regression was performed to acquire a final prediction model. To simplify the model, a weighted score was assigned for each categorized predictor. In addition, eligible cutoff values of the score and their predictive performances were determined.A total of 745 medical records were reviewed. The prevalence of NAFLD with significant fibrosis in patients with metabolic syndrome was 12.6%. Most clinical characteristics of patients with NAFLD with significant fibrosis and those non-NAFLD and NAFLD with no/mild fibrosis were quite disparate. The most practical model comprised globulin, aspartate transaminase, platelet count, and type 2 diabetes. It provided a good predictive performance with an area under the receiver operating characteristic curve of 0.828 (95% confidence interval [CI]: 0.782, 0.874). At the proper cutoff value, sensitivity and specificity were 76.6% (95% CI: 66.7%, 84.7%) and 72.4% (95% CI: 68.7%, 75.8%), respectively. The likelihood ratio of testing positive for NAFLD with significant fibrosis was 2.8 (95% CI: 2.34, 3.27) among patients with scores above the cutoff value.The first score for detecting of NAFLD with significant fibrosis in patients with metabolic syndrome was developed. This practical score, providing a good predictive performance, should be useful to help clinicians prioritize needs for further investigations among high-risk patients, especially in resource-limited settings.