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Background & study purpose

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Background & study purpose

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  1. Do Instrumental Activities of Daily Living Predict Dementia at 1- and 2- Year Follow-Up? Findings from the Development of Screening Guidelines and Diagnostic Criteria for Predementia Alzheimer’s Disease StudySietske A. M. Sikkes, PhD, Pieter JelleVisser, MD, PhD, Dirk L. Knol, PhD, et al. JAGS; December 2011, vol 59, No. 12Payal PatelMercer University, College of Pharmacy and Health SciencesRTR Medical Group1/31/2012

  2. Background & study purpose • Dementia is the most common disease in later life • Diagnosis is based on decline in scales that assess disabilities in activities of daily living (ADLs) • ADL refers to basic activity of daily living (BADL) and instrumental activities of daily living (IADL) • Complex activities are more sensitive to cognitive decline in early stages of dementia • IADL assessment can play an important role in screening/diagnosing dementia

  3. Background & study purpose • Several studies have investigated the use of IADL scales in diagnosing dementia • Previous studies showed variable results from no correlation to strong association • Difficult to compare because the selection of items and participants vary • This study investigates whether interference in IADLs can predict dementia at 1 and 2 year follow-up in a memory clinic setting

  4. Study Design and Population • Prospective cohort study • Participants selected from DESCRIPA study which was done by the European Alzheimer’s Disease Consortium • Participants recruited from 20 memory clinics across Europe between January 2003 and June 2005

  5. Study Design and Population • Inclusion Criteria: Age 55 and older with a new referral due to cognitive complaints • Exclusion Criteria: patients with cognitive impairment due to somatic, psychiatric or neurological disorder

  6. Outcome Measures • Instrumental Activities of Daily Living • Different IADL scales were used between the study centers: 16 centers used an IADL scale • 9 used Lawton IADL scale • 3 used Blessed Dementia scale and Bayer ADL scale • 1 used Alzheimer’s Disease Cooperative study ADL scale • 1 used Bristol ADL scale

  7. Primary outcome • All questionnaires completed by informant of the participant • Items related to IADLs were chosen from the questionnaires • Item content that overlapped between the different tests was selected to pool IADLs • Responses were dichotomized to ‘no problems’ or ‘slight to severe problems’

  8. Outcome Measures • Cognitive Examination • MMSE • Memory tests – • Varied between the centers • Primarily Rey Auditory Verbal Learning Test • Depression • Different scales between the centers • Scores dichotomized for clinically significant depressive symptoms in each of the scales

  9. Statistical method • Statistical analysis were performed using M-Plus version 6.1 and SPSS • Differences between participants with and without dementia were analyzed with independent t tests or chi square

  10. Statistical methods • Item response theory was used to model the dimensional structure of IADLs • The relationship between IADL and the diagnosis of dementia, depression, and memory were modeled using SEM • P<0.05 was considered statistically significant

  11. Results • sample size = 616 participants • 1st year = 531 • 2nd year = 481 • Nine items were chosen: shopping, telephone use, housekeeping, transport, finances, medication, food/drink preparation, laundry, handling money • 13 % developed dementia in 1 year with most common cause being Alzheimer’s • 20.8 % patients had developed dementia in 2 years

  12. Results • Participants with at least one IADL problem had a higher rate of having dementia after 1 year (15.9%) compared to participants without IADL problems (P = 0.04) • Participants with IADL disabilities at baseline also had a higher rate of dementia at 2 years (24.4%) compared to participants who did not have IADL problems (P = 0.04)

  13. Results • Participants who developed dementia were mostly older (p = 0.02) with lower MMSE scores ( p < 0.001) and greater memory impairments (p < = 0.001) at baseline • Depression was not found to be a risk factor for developing dementia

  14. Results

  15. Conclusion • IADL disability can be a useful tool in predicting dementia at 1 and 2 year follow-up along with other commonly used clinical measures such as MMSE and memory • IADL problems are the border between the preclinical stages of dementia and dementia • Depression is not a risk factor for developing dementia

  16. Comments • Strengths: • Sample size • Prospective design • Weaknesses: • Pooled IADL items from different questionnaires • Items might not be closely comparable • Difficult to say which IADL questionnaire should be used • Many patients did not complete the questionnaires completely • Limited use in clinical practice • Most of the scales were developed to evaluate patients over time and not for diagnostic purposes • Underestimation of the true diagnostic value of IADL problems • In some countries or regions, people may visit a memory clinic later in the disease course compared to others

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