Interreg-IPA Cross-border Cooperation Programme Romania-Serbia 10 noiembrie 2015 - Timșoara, România Interreg-IPA Cross-border Cooperation Programme Romania-Serbia General functionality assessment in dementia = Vuk Vuković, MD = May 2017 Employment promotion and basic services strengthening for an inclusive growth
Dementias are a worldwide burden to public health systems. Given the demographic changes with a global aging trend, faster in developing countries, estimates on the rising prevalence of these disorders are discouraging, considering associated cost in primary, secondary and tertiary care
Dementias lead to a high burden for patients, families, and society Over the typical disease course of 5 to 10 years, the condition results in progressive functional disability, frequent transitions in care, and excess health care costs In the context of the disease, functional decline is believed to be the result of progressive deficits in cognitive, emotional, and physical function
New models of dementia care focus on a team-based approach in support of the family caregiver and seek to improve patients' quality of life These new care models emphasize coordinationwith community-based services, modifications to the patient's home, and movement toward dementia-prepared communities
World Health Organization classification of Impairment, Disability, and Handicap The negative counterpart of functional ability, that is, functional disability, is defined as any restriction or inability to perform an activity in the manner, or within the range, considered normal for a human being at different stages of his or her development
However, functional impairment is not a uniform construct Multifaceted and can be measured with various clinical instruments. Traditional scales have focused on self-care needs and instrumental activities of daily living Others consider patient disability and caregiver burden.
Functional assessment of patients with dementia in terms of performance of activities of daily living (ADL), is a critical element in patient care. For investigational drug studies, changes in ADL performance can be used as a secondary outcome measure to document that cognitive or other effects of an anti-AD
Along with the forthcoming neurological damage, basic activities and social interaction also become compromised The nature of the relationship between real-life Activities of Daily Living (ADL) and neuropsychological performance has yet to be fully delineated. Further, this relationship may vary across different geriatric populations.
Dependence Functional deficits do not fully describe patients’ dependence on other individuals Significant decline in dependency is not completely accounted for by a decline in global cognition Patient dependency is a relevant functional domain that should be considered in behavioralstudies of AD and new treatment trials
10 noiembrie 2015 - Timșoara, România Scales Rating scales essential tools for AD diagnosis, staging, assessment and careful monitoring of AD symptoms as well as for evaluation of treatment effects Most assessments focused on cognition, which is the lead symptom in AD Symptoms more relevant to a patient's quality of life, caregiver burden and institutionalization are functional and behavioral symptoms Rating scales are essential tools for AD diagnosis, staging, assessment and careful monitoring of AD symptoms as well as for evaluation of treatment effects. For decades most AD assessments were predominantly focused on cognition, which is the lead symptom in AD. Nevertheless, it has been realized that the symptoms more relevant to a patient's quality of life, caregiver burden and institutionalization are functional and behavioral symptoms
ADCS-ADL Caregiver / informant-based scale assessing instrumental and basic ADLs 19-item version (ADCS-ADL19), covering mainly basic ADL - assessment of patients with more severe AD while the 23-item version (ADCS-ADL23) - more complex ADL for the assessment of mild to moderate AD
ADCS-ADL A 23-item, standardized clinician administered inventory assessing a subject’s actual performance of specific actions and behaviors as observed by the caregiver over the past 4 weeks Scores range from 0-78 with lower scores indicating greater impairment The ADL also assesses the amount of intervention (supervision) needed to enable the subject to perform each activity Relatively straightforward administration Takes about 20 minutes
CIBIS/CIBIC-Plus Semi-structured, but informal interviews, with probes to assess level of functioning in areas of Cognition, Behavior and Daily Functioning Both caregiver and subject are interviewed
Assesses four major categories (each are subdivided into Domains): CIBIS/CIBIC-Plus Assesses four major categories (each are subdivided into Domains): – General – Cognitive Function – Behavior – Activities of Daily Living (Social Functions, Basic and Complex Functional Ability)
Dependence Scale Measures the amount of assistance needed by Alzheimer’s disease patients 13-item questionnaire completed by an AD patient’s primary caregiver (yes/no)
10 noiembrie 2015 - Timșoara, România Thank you!