Abstract

Comparisons of Daily Functional Performance and Relevant Factors in Patients with Alzheimer��?s Disease and Subcortical Ischemic Vascular Disease

Author(s): Min-Chien Tu, Ching-Feng Huang, Chung-Ping Lo, Ya-Kuei Yu, Wen-Hui Huang, Jie-Fu Deng, Yen-Hsuan Hsu

Abstract

Objective: To compare daily functional performance and potential predictiv e factors in pa tients withAlzheimer’s disease (AD) and subcortical ischemic vascular disease (SIVD).

Methods: Sixty-eight community patients with AD and 39 with SIVD were eva luated using t  h e informantbasedBarthel Index of Activities of Daily Living (B-ADL) and Instrumental Activities of DailyLiving (IADL). Motor function, cognition, and white matter hyperintensities (WMHs) wereassessed using the modified Rankin Scale (mRS), Cognitive Abilities Screening Instrument(CASI)/Clinical Dementia Rating (CDR), and Scheltens scale, respectively.

Results: After controlling for systemic diseases and medications, toilet use was the o  nly     B -ADL subset inwhich the patients with SIVD performed worse than those with AD in overall c omparisons andCDR0.5-1. Additionally, the SIVD group with CDR0.5-1 performed worse in bathing, mobility,and climbing stairs. Regarding IADL performance, the SIVD group had worse performancesthan the AD group in mode of transportation during CDR2. In WMHs analysis, periventricularWMHs (PWMHs) was the only factor showing significant inverse correlations with both CASI andB-ADL/IADL. Hierarchical regression of all patients suggested that the best models incl uding age,education, PWMHs, CASI, and mRS accounted for 71% and 78% of the variances in B-ADL andIADL, respectively. While mRS accounted for a significant effect in both B-ADL and IADL, CASIaccounted for a significant effect only in IADL. Subgroup analysis suggested that the effects ofCASI and PWMHs were confined within B-ADL/IADL and IADL in the AD group, respectively.

Conclusions: Motor function was the major factor in both B-ADL and IADL, and cognition ha d  a significanteffect on IADL. Although PWMH  load had inverse associations with both motor and cognitivefunctions, this radiological marker better predicted IADL in AD than in SIVD. The variationin daily functional profiles with dementia s tage and subtypes highlights the need to assessmotor function for preventive interventions.