1. Interreg-IPA Cross-border Cooperation Programme Romania-Serbia
10 noiembrie 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

2. 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

3. 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

4. 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

5. 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

6. 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.

7. 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

8. 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.

9. 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. 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

11. 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

12. 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

13. 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

14. 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)

15. 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)

16. 10 noiembrie 2015 - Timșoara, România
Thank you!