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I nterreg- IPA Cross-border Cooperation Programme Romania-Serbia

This article explores the importance of functional assessment in dementia care, highlighting the impact of functional disability on patients, families, and society. It discusses various assessment tools and scales, such as ADCS-ADL and CIBIS/CIBIC-Plus, that can be used to evaluate patients' daily functioning. The article emphasizes the need for a team-based approach and coordination with community-based services to enhance the quality of care for individuals with dementia.

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I nterreg- IPA Cross-border Cooperation Programme Romania-Serbia

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  1. 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 ahigh burden for patients, families, and society • Over the typical disease course of 5 to 10 years, thecondition results in progressive functional disability,frequent transitions in care, and excess health carecosts • In the context of thedisease, functional decline is believed to be the resultof progressive deficits in cognitive, emotional, andphysical function

  4. New models of dementia care focus on ateam-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 thepatient'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 orinability to perform an activity in the manner, or withinthe 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 withvarious 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. 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

  11. ADCS-ADL • Caregiver / informant-based scale assessing instrumental and basicADLs • 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 asubject’s actual performance of specific actions and behaviors asobserved by the caregiver over the past 4 weeks • Scores range from 0-78 with lower scores indicating greaterimpairment • 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 offunctioning in areas of Cognition, Behavior and Daily Functioning • Both caregiver and subject are interviewed

  14. 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. Thank you!

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