The impact of cognitive impairment on daily living activities,in patients with

dementia

First author: Raluca-Adela Craciun, 6th year, General Medicine, UMF Tg.Mures

Author: Adelina-Sofia Grigore, 6th year, General Medicine, UMF Tg.Mures

Adriana Andries, 6th year, General Medicine, UMF Tg.Mures

Coordinator: Gabriela Elena Buicu, MD.PhD

Background: Dementias are defined as a group of mental disorders, characterised by progressive impairment of mental functions especially memory loss, behavioral disturbances and personality changes.Dementia was estimated to affect 35.6 million people worldwide in 2010, and the prevalence of dementia will increase to 65.7 million by 2030 and by 115.4 milion by 2050.Although dementia represent an illness which is more and more frequent, as it's incidence is increasing worldwide, the therapeutic resources are still limited and have modest efficiency.

Pathological and etiological classification of dementias:

•Alzheimer’s disease (it represents 50-60% of all types of dementia and 5 % of early onset dementia)•Vascular dementia (5% of all types of dementia)•Dementia in other diseases: multiple sclerosis, Jacob-Creutzfeld disease, Hungtington disease, Parkinson’s disease, epilepsy, hypothyroidism, Wilson disease, lupus erythematosus, antifosfolipidic syndrome, temporal arteritis, sarcoidosis, Fronto-temporal dementia, toxic dementia, intracranial tumors, normotensive hidrocephalus, neurosyphilis, AIDS and others.

Signs and symptoms: Dementia syndrome is defined by: •memory loss (loss of memories from present to the past and the failure in making new acquisitions) •attention deficit •decrease of calculation abilities •slowed thinking •spatial and temporal disorientation •personality and behavioural changes such as apathy, loss of interest in activities they previously enjoyed, insensitivity to others, paranoia, delusional thinking, social withdrawal,inability to make decisions, lack of initiative, sexual disinhibition, aggressive behavior and suspiciousness

The objective of the current study:The aim of this study was to establish a correlation between the level of cognitive impairment and functional abilities on nursing home residents with dementia.

Working hypothesis: I supposed that there is a possitive correlation between the cognitive status (rated by MMSE) and functional abilities (rated by ADCS-ADL)

Material and Methods: There were 50 patients included in the study, nursing home residents with dementia from Residential Center for Elderly ”Amicus” from Campenita and Residential Center for Elderly Sarmasu. Demographics were collected from patient’s medical records and included: age, gender and dementia’s type. For the assesment of daily living activities, ADCS-ADL Scale was applied on caregivers. For the assesment of mental state, MMSE was applied on patients. Demographics and test results were analysed, precessed and plotted with GraphPad, SPSS,Windows Excel 2010. To establish correlations between monitored parameters I used Spearman’s test.

ADCS-ADL (Alzheimer’s disease Cooperative Study-Activities of Daily Livind Inventory) has 23 items which evaluates usual daily activities in the past four weeks. The answers are standardised in "independently", "with supervision“ and "with help“.

ADCS-ADL assess the eating abilities, walking, toileting, bathing, grooming, ”selecting” clothes, dressing, phone use, television, conversation, clear dishes from a table, finding personal belongings, beverage, meal or snack, dispose of garbage, travel, shopping, keeping appointments or meetings, left alone, talk about current events, reading, writing, hobby or game, household appliance.Depending on scoring, there is MINOR ADL IMPAIRMENT=71-78 points MODERATE ADL IMPAIRMENT=51-70 points SEVERE ADL IMPAIRMENT =0-50 points

MMSE (The Mini Mental State Examination) includes 30 items and analyzes functions including :

-registration, -attention and calculation,-recall, -language, -ability to follow simple commands -orientation. Depending on the obtained scores, there is :

•Mild cognitive impairment=20-26 points•Moderate dementia=11-19 points•Severe dementia =0-10 points

Study resultsDemographic data analysis:

Variable Age(years)

Sample size 50

Lowest value 65,0000

Highest value 90,0000

Arithmetic mean 79,2000

95% CI for the mean 77,4350 to 80,9650

Median 79,5000

95% CI for the median 76,6034 to 82,0000

Variance 38,5714

Standard deviation 6,2106

SPSSP<0.05 SEMNIFICATIVSummary statistics

Correlation between MMSE score and ADCS-ADL score

Rank Correlation

Variable Y MMSE Variable X Total_ADL

Total ADL

Sample size 50 Spearman's coefficient of rank correlation (rho) 0,602

Significance level P<0,0001 95% Confidence Interval for rho 0,389 to 0,754

0 10 20 30 40 50 60 70

0

5

10

15

20

25

30

Total ADL

MM

SE

Conclusions:

1. The stage of cognitive impairment has major impact on daily living activities. 2. There is a strong, positive, statistically significant correlation between MMSE (mental state) and ADCS-ADL (activities of daily living (Spearman correlation showed p<0.0001).3. Low scores on MMSE are associated with lower scores on ADL; severe cognitive impairment (severe dementia) associates severe decline on functional abilities. 4. When combined with dementia, the comorbidities have an important role also, lowering the performance of the patient.

THINGS END BUT MEMORIES LAST FOREVER (?)