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This paper presents the French version of DAD-6, a validated instrument for the assessment of IADL (instrumental activities of daily living) considered as intentional and complex activities. A loss of autonomy remains a major criterion in the diagnosis of dementia. In addition, IADL assessment is recommended as a primary outcome in dementia drug trials. Since the publication in 1969 by Lawton and Brody of an IADL scale, many instruments have been developed. However, their psychometric properties remain to be improved. The need for improving the early diagnosis yielded to the design of DAD-6, an instrument allowing capturing subtle difficulties in IADL management. The DAD-6 scale emphasizes the role of the cognitive function, mainly the executive function in early IADL impairment. DAD-6 requires the participation of an informant (a patient's proxy). Relative to patients' self-reports or performance-based methods, informant-based questionnaires are the most common and practical methods used in memory clinics. In previous work, DAD-6 score gradually decreased with increasing severity of the cognitive status. The present work shows the inter-rater reliability of DAD-6. The use of the scale with the same informants by one neurologist and two neuropsychologists, separately, indicated a high agreement between raters (alpha of Krippendorff>0.80).This work also highlights the main sources of bias in the context of evaluation based on subjective judgement. The authors stress the necessity of: 1--a clarification of the relationship between cognitive function and IADL; 2--the measurement of IADL performance in a routine neuropsychological assessment by experienced professionals.

The increasing number of people suffering from Alzheimer's disease raises the question of their caring at home, especially when the disease causes disability and negative consequences in daily life such as isolation, falls, wandering, errors in drug taking. Furthermore, caregivers bear a substantial burden that can have adverse effects on their physical and mental health. New technologies of information could play an additional role as care providers without substituting family or professional caregivers help. A review of literature focused on the different technological solutions conceived for patients suffering from Alzheimer's disease and their carers shows that these appliances could help to provide reminders in daily life (drugs, tasks and appointments, meals cooking), to activate residual cognitive resources by computerized cognitive stimulation intervention, to reduce stress, anxiety and depressive symptoms in patients by visual contact with families and professionals (webconference), to contribute to patients safety by detecting falls and wandering, and to help families in the caring of patients with computerized information and counselling interventions. We also discuss the current limitations for a widespread use of these technologies and outline future research avenues. True needs of end-users are still poorly known and should be more clearly defined. Simplicity of the use of these appliances should be further improved. Demonstration of medical and social benefits for elderly people should be carried out in randomized, controlled studies. Ethical reflexion should be developed in conjunction with the use of these gerontechnologies. Finally, the economical model which would enable the providing of these appliances to the largest number of patients and caregivers should be implemented. Although these gerontechnologies are promising, research is still needed to tailor them properly to the needs of end-users, assess their benefit in ecological context of people with Alzheimer's disease in order to provide them with appropriate tools in daily life.

Caregivers of patients with Alzheimer's disease or related disorders are exposed to many stress factors which increase the risk of developing physical and psychological disturbances. To limit these negative effects, different psychosocial interventions for carers have been proposed. With progress in technologies, telephone or the internet can offer flexible and tailored means to deliver this kind of interventions. In this literature review, we listed and analysed the articles devoted to this topic. Sixteen papers concerning nine intervention programs were selected. The analysis shows that the internet, as a means to deliver an intervention programme, is more interactive, attractive and less intrusive than telephone. Efficacy of the interventions via this kind of technologies can be compared to that observed in face to face ones: despite weak methodology and inconsistent outcomes of the studies, they showed some improvement in burden, anxiety, depression and self-efficacy. Finally, before implementation of this kind of technologies, it is necessary to test learnability, adaptability and acceptability. Usability of a technology is a key factor for its adoption and efficacy.

Introduction: Over the last decades many approaches have been developed to manage cognitive and behavioral disturbances in dementia. The present work describes a global intervention program carried out with moderately to severely demented institutionalized patients. The aims of the intervention program are to stimulate and maintain the preserved abilities of demented patients in a supportive context, to decrease the behavioral disturbance and to avoid burnout of care-unit staff., Methods: This intervention combines different means: psychosocial care (validation therapy, social interaction), cognitive stimulation (memory and verbal training), and motor and sensitive stimulation. The global intervention program requires a special trained team composed of a supervisor, six aid-nurses, an occupational therapist, a speech therapist, a psychomotor therapist and a psychologist. The team cared for the patients five days per week over a three-month period. Assessments were conducted before and after the intervention program to measure the benefit., Results: Positive effects were shown for cognitive abilities, nutritional problems and staff burnout. However, due to the small sample size for this study, more research is needed to verify the effectiveness of this global intervention program, particularly the implications for nutrition., Conclusion: This global intervention combined with pharmacological treatment seems to be useful for managing psychological and behavioral disorders of institutionalized demented patients.

In this paper, a critical review of psychometric tests is proposed. The first part describes several aspects of modern, theoretical psychometry and the influence of cognitive psychology. The second part focuses on application of tests to dementia and preliminary results of a longitudinal study of cognitive evolution of patients with mild dementia. Based on this longitudinal study, the batteries of tests to be used for diagnosis, or experimental research, or clinical trials are described. The authors underline the fact that tests are not "good" or "bad" in themselves, and suggest a number of rules for selecting inclusion, evaluation and improvement criteria, related to drug treatment.