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Background and Objectives: Dementia with Lewy Bodies (DLB) is a heterogeneous disease, with variable signs and symptoms across multiple domains. We aimed to identify associations with rate of change in cognition, everyday functioning (IADL) and quality of life (QoL).Methods: We included 121 DLB patients (69 ± 6 yrs, 14%F, MMSE: 25 ± 3) in our prospective cohort (follow-up 2 ± 1 yrs). We described progression of symptoms and cognitive decline over time. Mixed models were used to investigate whether changes in symptoms were associated to changes in IADL (FAQ), QoL (QoL-AD) and caregiver burden (ZBI). Last, we investigated whether baseline symptoms and biomarkers predicted decline in cognition (MMSE), IADL (FAQ) and QoL (QoL-AD).Results: Parkinsonism and RBD were most frequently present early in the disease course, while hallucinations were more likely to develop in a later stage. MMSE (annual change β ± SE = -2.06 ± 0.23), QoL-AD (-1.03 ± 0.20), and FAQ (3.04 ± 0.30) declined over time. Increasing severity of clinical symptoms was associated to increases in FAQ, QoL-AD and caregiver burden. Baseline clinical symptoms were not predictive for decline in these outcomes. By contrast, AD co-pathology (CSF pTau/Aβ42 ratio) was associated to steeper decline in MMSE (-1.23 ± 0.54). Medial temporal atrophy (-0.81 ± 0.26) and global cortical atrophy (-0.73 ± 0.36) predisposed for decline in QoL-AD.Conclusions: Our findings imply that underlying disease processes, rather than clinical symptomatology aid in predicting decline. These findings are relevant for treatment strategies and the development of DLB specific outcome measures. [ABSTRACT FROM AUTHOR]

Background: To date, only a few studies have investigated the association between personality and functional impairment. Therefore, our purpose was to add to this knowledge. Methods: Data from wave 7 of the Survey of Health, Ageing and Retirement in Europe (SHARE) were used (70 028 individuals in the analytical sample). Personality was measured using the 10‐item Big Five Inventory (BFI‐10). Functional impairment was quantified using activities of daily living (ADL) and instrumental activities of daily living (IADL) indices. Multiple linear regressions were conducted. Results: Regressions showed that an increased likelihood of limitations in ADL was associated with higher extraversion, higher agreeableness, lower conscientiousness, higher neuroticism, and higher openness to experience. Similarly, an increased likelihood of limitations in IADL was associated with higher agreeableness, lower conscientiousness, higher neuroticism, and higher openness to experience (only with one IADL index). Conclusions: This knowledge of associations between personality and functional limitations may help in determining individuals at risk for increased functional impairment (e.g., individuals with low conscientiousness or high neuroticism). Future research is needed to clarify the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Objective: We aimed to assess the effect of socioeconomic status and physical activity on cognitive function using a large population-based survey data in China.Methods: We took advantage of the Chinese Longitudinal Healthy Longevity Survey conducted in 2014 to examine the relationship between sociodemographic, physical activity, and cognitive function in older adults (OAs) for persons aged above 65 (N = 2848). Socioeconomic status was assessed by sex, age, co-residence situation, category of residence, years of schooling, and marital status. Multiple linear regression for predictors was utilized. Physical activity was assessed using activities of daily living (ADL) and instrumental activities of daily living (IADL) measures. Cognitive function was assessed by the Modified Mini-Mental State Examination.Results: The mean age of the OAs was 80.65 years (SD = 8.55). Their mean Mini-Mental State Examination score was 21.55 (SD = 2.38), mean ADL Total score was 6.24 (SD = 0.95), and mean IADL Total score was 10.21 (SD = 3.84). OAs' age at testing, co-residence and category of residence significantly predicted both ADL Total score and IADL Total score (P < 0.05), sex significantly predicted IADL Total score (R2  = 0.02, β = 0.13, P = 0.000) but not ADL Total score (R2  = 0.00, β = 0.02, P = 0.211). OAs' sex, age, co-residence, and years of schooling significantly predicted cognitive function (P < 0.05), IADL total score significantly predicted cognitive function (P < 0.01), while the relationship between ADL total score and cognitive function was not significant (P = 0.94).Conclusion: OAs' sex, age, co-residence, years of schooling, and IADL were significantly associated with cognitive function. Improving OAs' IADL, especially in lower social classes, may help to improve the overall cognitive function of the OAs. [ABSTRACT FROM AUTHOR]

Objectives: To examine the evolution of instrumental activity of daily living (IADL) performance according to the presence of brain amyloid deposition. Design: Longitudinal analysis of a randomized controlled trial. Setting: Neuroimaging ancillary study from the Multidomain Alzheimer Prevention Trial (MAPT). Participants: Community‐dwelling individuals aged 70 and older without dementia (N = 269; 60% female, mean age 75±4). Measurements: Linear mixed models were used to assess the 36‐month evolution of the performance of an IADL questionnaire for primary prevention studies in dementia, the Activity of Daily Living Prevention Instrument (ADL‐PI), according to the presence of amyloid deposition using florbetapir positron emission tomography (PET) (standardized uptake value≥1.17). Additional analyses were also conducted to examine the changes in specific domains of daily functioning with and without adjustment for age, sex, apolipoprotein E, randomization group, and time between baseline and PET examination. Results: One hundred two (37.9%) participants were amyloid positive. Amyloid‐negative participants had statistically significant improvement in ADL‐PI total score between baseline and 36 months (p=.04). The difference after 3 years between amyloid‐positive and ‐negative participants was not significant (β=–0.95±0.53 at 36 months, p=.08; adjusted models: β=–1.07±0.56, p=.06). Amyloid‐negative participants also improved in memory‐related IADLs (p<.001) throughout the study, unlike amyloid‐positive participants. Conclusion: Amyloid‐positive and ‐negative older adults are likely to have different trajectories in IADL performance. Future research is needed to better understand the relationship between amyloid plaques and functional limitations. [ABSTRACT FROM AUTHOR]

Abstract: A 66‐year‐old man was admitted with visual impairment, functional disability, and worsening glycemic control. On admission, he had optic atrophy without diabetic retinopathy in both eyes, sensory impairment of the lower extremities, ataxia, and cognitive impairment. As both serum and cerebrospinal fluid tested positive for syphilis, he was diagnosed with neurosyphilis and treated with antibiotics. Functional ability and cognitive function improved after conducting syphilis treatment; we consequently started him on an insulin self‐administration program. Two years later, his glycemic control has normalized. Dementia caused by neurosyphilis is one of the most important differential diagnoses of treatable dementia; hence, early diagnosis and early treatment are important. [ABSTRACT FROM AUTHOR]

Abstract: Background: Interference in everyday functioning is part of the diagnostic criteria for dementia. Questionnaires measuring “instrumental activities of daily living” (IADL) are used to measure this interference, but the psychometric quality of these questionnaires is often questioned. In addition, these questionnaires are less suited for early-onset patients. This is problematic, given the high frequency of relatively young patients in memory clinics. In this article, we describe the development and psychometric properties of a new informant-based IADL questionnaire aimed at detecting incipient dementia and appropriate for a broad age range. Methods: We defined IADL in consensus with experts and constructed items based on existing items and suggestions from experts and informants. Informants of subjects (n = 206) who visited the Alzheimer Center of the VU University Medical Center completed the questionnaire. Factor structure was investigated using classical exploratory factor analysis and item response theory. We assessed test–retest reliability in 73 informants using weighted κ values. Results: The questionnaire consisted of 75 items and was computerized to enhance ease of administration. Exploratory factor analysis supported a single-factor model, with 48.3% of the variance being explained by the first factor. We removed five items, as they did not fit the model. High internal consistency was demonstrated. Test–retest reliability showed that the majority of items (87.9%) had substantial-to-almost perfect κ values. Conclusion: The Amsterdam IADL Questionnaire (Amsterdam IADL questionnaire is a registered trademark of Alzheimer Center VU University Medical Center, Amsterdam, The Netherlands) is a 70-item informant-based computerized questionnaire aimed at detecting early dementia and early-onset dementia. Initial results show that this questionnaire is a promising new tool. [Copyright &y& Elsevier]

doi: 10.1111/j.1741-2358.2010.00427.x Associations of instrumental activities of daily living and handgrip strength with oral self-care among home-dwelling elderly 75+ Objective: To study the associations of instrumental activities of daily living (IADL) and the handgrip strength with oral self-care among dentate home-dwelling elderly people in Finland. Materials and methods: The study analysed data for 168 dentate participants (mean age 80.6 years) in the population-based Geriatric Multidisciplinary Strategy for Good Care of the Elderly (GeMS) study. Each participant received a clinical oral examination and structured interview in 2004-2005. Functional status was assessed using the IADL scale and handgrip strength was measured using handheld dynamometry. Results: Study participants with high IADL (scores 7-8) had odds ratios (ORs) for brushing their teeth at least twice a day of 2.7 [95% confidence intervals (CI) 1.1-6.8], for using toothpaste at least twice a day of 2.0 (CI 0.8-5.2) and for having good oral hygiene of 2.8 (CI 1.0-8.3) when compared with participants with low IADL (scores ≤6). Participants in the upper tertiles of the handgrip strength had ORs for brushing the teeth at least twice a day of 0.9 (CI 0.4-1.9), for using the toothpaste at least twice a day of 0.9 (CI 0.4-1.8) and for good oral hygiene of 1.1 (CI 0.5-2.4) in comparison with the study subjects in the lowest tertile of handgrip strength. Conclusion: The results of this study suggest that the functional status, measured by means of the IADL scale, but not handgrip strength, is an important determinant of oral self-care among the home-dwelling elderly. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine trajectories of change in everyday function for individuals with cognitive deficits suggestive of mild cognitive impairment (MCI). DESIGN: Using data from the longitudinal, multisite Advanced Cognitive Training for Independent and Vital Elderly Study allowed for post hoc classification of MCI status at baseline using psychometric definitions for amnestic MCI, nonamnestic MCI, multidomain MCI, and no MCI. SETTING: Six U.S. cities. PARTICIPANTS: Two thousand eight hundred thirty-two volunteers (mean age 74; 26% African American) living independently, recruited from senior housing, community centers, hospitals, and clinics. MEASUREMENTS: Mixed-effect models examined changes in self-reported activities of daily living and instrumental activities of daily living (IADLs) from the Minimum Data Set Home Care Interview in 2,358 participants over a 3-year period. RESULTS: In models for IADL performance, IADL difficulty, and a daily functioning composite, there was a significant time by MCI classification interaction for each MCI subtype, indicating that all MCI groups showed faster rates of decline in everyday function than cognitively normal participants with no MCI. CONCLUSION: Results demonstrate the importance of MCI as a clinical entity that not only predicts progression to dementia, but also predicts functional declines in activities that are key to autonomy and quality of life. MCI classification guidelines should allow for functional changes in MCI, and clinicians should monitor for such changes. Preservation of function may serve as a meaningful outcome for intervention efforts. [ABSTRACT FROM AUTHOR]

Objectives: To apply diagnostic criteria for mild cognitive impairment (MCI) to a geographically representative sample, to estimate the prevalence of MCI, and to estimate 10-year trajectories of incident disability for cognitively intact participants and subgroups with MCI. Design: Prospective cohort; 10 years of follow-up. Setting: Community-based survey of noninstitutionalized population aged 65 and or older in two rural Iowa counties (Washington and Iowa). Participants: Iowa Established Populations for Epidemiologic Studies of the Elderly (aged ≥65; N=3,673; 61.3% female; 99.9% white). Measurements: Age, sex, education, Short Portable Mental Status Questionnaire (SPMSQ), 20-item word recall, activities of daily living (ADLs), instrumental activities of daily living (IADLs), chronic medical conditions. Results: MCI was prevalent in 24.7% of participants at baseline. Most participants in the overall cohort remained stable or changed slowly (≤1 new limitations) over 10 years (63.1% for SPMSQ, 89.3% for word recall, and 61.7% for ADL disability). For MCI/no prevalent IADL disability (Stage 1 MCI), disability progression was similar to that in the cognitively intact subgroup (median=0.08 vs 0.05 disabilities per year). For MCI plus prevalent IADL disability (Stage 2 MCI), the median rate of change was equivalent to that of the severely impaired (0.23 disabilities per year; interquartile range=0.12–0.36). Conclusion: Unlike participants with MCI who reported no IADL limitations, those with such limitations were more likely to develop ADL disability—a prerequisite for a diagnosis of dementia. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2004; 18; 387–395Determinants and characteristics of help provision for elderly people living at home and in relation to quality of lifeThe aim of this study was to investigate determinants of help from informal or formal caregivers or a combination of both among people aged 75 or more and living at home, and the characteristics of the recipients, the help they received and their quality of life (QoL). The sample for this study was 448 elderly people, 75–99 years of age, living at home and receiving help with activities for daily living, instrumental or both instrumental and personal. Regression analysis showed high QoL not to be significantly related to who was providing the help, whilst it was related to higher age, living with someone, lower number of complaints and managing to be alone at home. Multinomial regression analysis showed age, number of children, number of complaints, the ability to stay alone at home and living alone to predict receiving help from different kinds of caregivers. Recipients receiving help from informal caregivers were younger, more often married and living together with someone, whilst those receiving help from both informal and formal caregivers had more help with instrumental and personal activities for daily living and were not able to stay alone at home as much as those receiving help from other kinds of caregivers. Those receiving help from formal caregivers had fewer children, were single and were living alone more often than the other recipients. Thus the responsibility for help for elderly people rests heavily on informal caregivers, whom it seems essential to support. As public service at home is preferably given to those living alone or able to stay alone at home, those without relatives may not be able to remain at home when their need of help increases. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine the prevalence of independence and ease of performance in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) at ages 70 and 77 in a well-characterized cohort and to measure the effect of regular exercise at age 70 on independence and ease of performance 7 years later. DESIGN: Two stages of a longitudinal study of an age-homogeneous cohort employing extensive interview data, physical examination, and clinical laboratory investigation. SETTING: Home-based interviews and examinations in Jerusalem. PARTICIPANTS: Two hundred eighty-seven west Jerusalem residents, born between June 1920 and May 1921, who participated fully in two phases of an ongoing longitudinal cohort study. Subjects were culled from a larger study population of 605 in the first phase and 1,021 in the second phase. MEASUREMENTS: Two-stage comprehensive demographic, social, and economic profile; medical history and examination; cognitive and affective assessment; and clinical laboratory studies performed in 1990–91 and 1997–98. The investigation questionnaire included details of ADL and IADLs and voluntary exercise. RESULTS: Most aspects of personal and social life did not change from age 70 to 77. Independence in ADLs remained high, as did self-reliance in IADLs for women. A more-sensitive marker of diminished function was reported ease in performance, which declined for use of the toilet, dressing, and all spheres of IADLs. For nearly every task, subjects who reported exercising 4 days a week at age 70 were more likely to report ease in performance at age 77. In a logistic regression accounting for the presence of diabetes mellitus, hypertension, obesity, chronic back pain, loneliness, and performance with ease at age 70 and deterioration in self-assessed health from age 70 to 77, ease of performance in at least three of four ADL tasks was independently related to exercise at age 70 for women (odds ratio (OR) = 8.5, 95%... [ABSTRACT FROM AUTHOR]

OBJECTIVES: To identify predictors of activity of daily living (ADL) and instrumental activity of daily living (IADL) decline in a population with subcortical vascular dementia (SVD) and to evaluate potential mechanism of decline. DESIGN: Longitudinal. SETTING: Hospital-based. PARTICIPANTS: Computed tomographic (CT) scanning identified 77 participants as having subcortical infarction. MEASUREMENTS: Participants were neurologically, neuropsychologically, behaviorally, and functionally assessed four times over 5.82 years. Baseline data were grouped into four modules: basic demographic and risk factor, CT scan, neurological and other clinical, and neuropsychological and behavioral. Multivariate analysis determined predictors of decline in ADLs and IADLs. RESULTS: Predictors of ADL decline were age, alcohol consumption, coordination, snout reflex, and performance on a neuropsychological test (Block Design). Predictors of IADL decline were predominantly cognitive and included the presence of paratonia and performance on the two neuropsychological tests (attention and memory tasks). CONCLUSION: These findings suggest that cognitive impairments are most likely to have an effect on IADL function, because the skills involved are complex and involve integrative activity, whereas physical and cognitive impairments combined are likely to compromise ADL function, given the more basic and physical nature of the functions involved. These findings indicate that in people with SVD, both ADL and IADL status should be monitored, because, for many, decline in function over time is likely, and thus the provision of appropriate support required. [ABSTRACT FROM AUTHOR]