Association between Cognition, Physical Function, Behavioral Problem and Activities of Daily Living in People with Dementia

• Main Authors: Hung-Chia Huang, 黃竑嘉
• Other Authors: Hui-Mei Chen
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/dveg4a

碩士 === 高雄醫學大學 === 職能治療學系碩士班 === 106 === Specific dementia may lead to different clinical features (cognition, physical decline, and behavioral disturbance). Both self-report and performance-based measures are often used in assessment pattern of everyday functioning for patients with dementia, few comparative studies by using two pattern measures in specific dementia were determined potential differences and its relative importance of factors. The purpose of this study was: (1) to investigate the differences of activities of daily living (ADL), cognition, physical function and behavioral problem (2) to determine the relationships of performance-based or informant-based ADL assessment and cognition, physical function or behavioral measurement. (3) to identify the predictors of performance-based and informant-based ADL assessments across three dementia types. Participants were 30 healthy elders, 49 outpatients with Alzheimer’s disease (AD), 17 outpatients with vascular dementia (VaD), and 14 outpatients with Lewy body dementia (DLB). Taiwan Performance-based Instrumental Activities of Daily Living (TPIADL), Disability Assessment for Dementia (DAD), Montreal Cognitive Assessment (MoCA), Physical Performance Test (PPT), and Neuropsychiatric Inventory (NPI) were administered. Correlation analyses were conducted to examine the relationships among the ADL measures and other clinical tests. Linear regression analyses further examined the amount of variability predicted in performance-based and informant rating ADL. The results indicated that: (1) As expected, patients with three dementia types had worse MoCA, PPT, NPI, TPIADL, DAD and its subscale of instrumental activities of daily living (DAD-IADL) and basic activities of daily living (DAD-BADL) than healthy control group. However, no significant differences in TPIADL, DAD, MoCA, PPT and NPI among three types of dementia groups. (2) The moderate and significant correlations (r= -.653, -.675, -.550, .330; p< .001) between TPIADL and DAD, MoCA, PPT or NPI scores in whole dementia samples. (3) For AD group, our regression analyses explained 48.2-62.3% of the variances in the TPIADL, DAD, DAD-IADL or DAD-BADL. In the TPIADL score, MoCA (β= -.615, p< .001) and PPT (β= -.238, p= .046) were significant predictors; In DAD-IADL score, MoCA (β= .563, p< .001) and NPI (β= -.252, p= .033) were significant predictors; In DAD-BADL score, MoCA (β= .473, p= .001) and PPT (β= .299, p= .024) were significant predictors. For VaD group, only MoCA (β= -.622, p= .008) predicted TPIADL score. For DLB group, there was no significant predictor for two pattern assessment. Our results suggest that performance-based and informant-rating assessments of IADL/BADL function are influenced by different clinical characteristics of patients with AD. Performance-based and informant rating IADL/BADL measures are consistently influenced by the AD patient’s cognitive deficit. In particular, informant-rating IADL appears to be more influenced by the patient’s behavioral status than performance-based ADL measure. This has important implications for IADL measure selection. Performance-based measure may be more sensitive to IADL functional change subsequent to treatments targeting cognition than informant-rating measure. However, fixed observation can''t be asserted due to caveat of small sample size in patients with VaD or DLB. These results may guild clinical professionals to select appropriate ADL assessments and can be useful to healthcare providers in treatment planning for patients with dementia.