Assessing and predicting functional impairment in Alzheimer’s disease: The emerging role of frontal system dysfunction

Abstract

Alzheimer's disease (AD) is associated with neuropsychologic and neuropsychiatric dysfunction and is a leading cause of disability among the elderly. Impairments in activities of daily living (ADL) contribute significantly to the disability reported among patients with AD and diminish quality of life for patients and their families. ADL assessment represents an important component of the diagnosis, tracking, and management of AD. Further, an understanding of the determinants of ADL dysfunction is critical for the early identification of individuals at risk for functional disability and for improved patient care. This manuscript reviews methods for assessing ADL in patients with AD and summarizes the available literature on the neuropsychologic and neuropsychiatric correlates of functional impairment in AD. The emerging role of frontal system dysfunction as an important determinant of ADL impairment is discussed, and recommendations for clinical practice and future research are provided.

Apathy and depression in Alzheimer's disease are associated with functional deficit and psychotropic prescription

“…This was also confirmed by histopathological post-mortem examinations (Marshall et al, 2006). This is in line with the fact that prefrontal clinical and neuropathological features are recognized as poor-prognosis predictors in AD (Boyle, 2004).…”

Zarit Burden Inventory and Activities of Daily Living in the Behavioral Variant of Frontotemporal Dementia

“…The DAD items 'initiation', 'planning' and 'effective performance' were altered to a similar extent in both groups. Numerous studies have assessed ADL in AD [26][27][28] and found them to be correlated with visuospatial disturbances and apathy [9,10,29] . Such studies in FTD are, however, few and far between and concern only small numbers of cases.…”

Efficacy of rivastigmine transdermal patch on activities of daily living: item responder analyses

“…Frontal system dysfunction is emerging as an important contributing factor to impairments in ADL among patients with AD (Boyle, 2004). Frontal system pathology results in executive dysfunction, a common feature of AD, which manifests as an inability to coordinate and perform everyday functions and processes (Swanberg et al, 2004;Bullock and Lane, 2007).…”

“…Frontal system pathology results in executive dysfunction, a common feature of AD, which manifests as an inability to coordinate and perform everyday functions and processes (Swanberg et al, 2004;Bullock and Lane, 2007). Numerous studies have suggested a close correlation between executive function and attention (functions controlled by frontal lobe circuits) and ADL (Boyle et al, 2003;Boyle, 2004). Consistent with these findings, significant associations were noted between total ADCS-ADL scores and measures of executive function and attention (Ten Point Clock-Drawing Test and Trail-Making Test Part A, respectively) in this trial, at baseline and at Week 24.…”

“…Studies that underpin the relationship between cognitive impairment and ADL have tended to focus on global cognitive or neuropsychiatric dysfunction. More recently, researchers have begun investigating specific elements of cognitive impairment responsible for diminished ADL, to better understand the symptoms associated with functional impairments in AD, e.g., Boyle et al (2003;Boyle, 2004).…”