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Understanding the complexities of functional ability in Alzheimer's disease: more than just basic and instrumental factors

Kristin Kahle-Wrobleski et al. Curr Alzheimer Res. 2014 May.

Abstract

Background: Dementia of the Alzheimer's type (AD) is defined by both cognitive and functional decline; new criteria allow for identification of milder, non-functionally impaired patients. Understanding loss of autonomy in AD is essential, as later stages represent a significant burden and cost to patients, their families, and society. The purpose of the present analyses was to determine the factor structure of the Alzheimer's Disease Cooperative Study-Activities of Daily Living Scale (ADCS-ADL) in a cohort of AD patients.

Methods: Baseline ADCS-ADL assessments of 734 AD patients from the PLASA study were included in an exploratory factor analysis (EFA). Because the ADCS-ADL was designed to assess change over time, change from baseline scores over 2 years were also analyzed using an EFA. Factorial solutions were evaluated based on cross-loading, non-loadings, and number of items per factor.

Results: Mean age at baseline was 79.3, mean MMSE was 19.8 and 73.3% of participants were female. Baseline data suggested a 4-factor solution that included factors for basic ADLs (BADLs), domestic/household activities, communication/engagement with the environment, and outside activities. The change scores EFA suggested a 2-factor solution of BADLs and instrumental ADLs (IADLs).

Conclusions: Distinct factors of IADLs should be considered for further validation as areas of attention to catch early functional decline.

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Figures

Fig. (1)
Fig. (1)
Flow diagram of patient participation in longitudinal study.
Fig. (2)
Fig. (2)
Baseline and 2-year scores for the 4 factors identified in the baseline analysis, according to disease severity at baseline.
See this image and copyright information in PMC

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