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The Role of Functional Assessment as an Outcome Measure in Antidementia Treatment

Published online by Cambridge University Press:  02 December 2014

Fadi Massoud
Fadi Massoud*
Affiliation:
The Service de Gériatrie, Centre Hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, Montréal, QC, Canada
*
Centre Hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, Service de Gériatrie, 1560 Sherbrooke Est, Montréal, Quebec, H2L 4M1, Canada.
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Abstract

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Functional assessment refers to the evaluation of performance in basic activities of daily living, instrumental activities of daily living, professional duties, and hobbies. This assessment is particularly relevant in the evaluation of cognitive impairment. In fact, functional decline represents a core feature of dementia according to the DSM-IV criteria. Clinically, functional deterioration represents a diagnostic marker, can be used to chart the course of the disease, and as a prognostic marker as it contributes significantly to caregiver burden and institutionalization. For all these reasons, functional assessment has been widely used as an outcome measure in intervention trials of Alzheimer disease (AD). Appropriate function assessment scales have been developed for use in clinical trials of AD. Studies have shown that functional decline benefits from pharmacological interventions in AD and some other cognitive syndromes. This benefit translates into a stabilization ranging between 6 to 12 months compared to a gradual deterioration in the placebo group. There is rarely reversibility for IADL's lost. There are no functional scales specifically designed for assessment of subjects with non-AD cognitive impairment. Scales specifically developed for Mild Cognitive Impairment and other dementias are needed.

Résumé:

RÉSUMÉ:

L’évaluation fonctionnelle désigne l’évaluation de la performance dans les activités de base de la vie quotidienne, les activités instrumentales de la vie quotidienne (AIVQ), les activités professionnelles et les passe-temps. Cette évaluation est particulièrement pertinente dans l’évaluation de l’atteinte cognitive. En fait, le déclin fonctionnel est un élément de base de la démence selon les critères du DSM-IV. Au point de vue clinique, la détérioration fonctionnelle est un marqueur diagnostique et elle peut être utilisée pour suivre l’évolution de la maladie ainsi que comme marqueur du pronostic parce qu’elle contribue significativement au fardeau des soignants et au placement en institution. Pour toutes ces raisons, l’évaluation fonctionnelle a été largement utilisée comme critère d’évaluation dans les essais thérapeutiques sur la maladie d’Alzheimer (MA). Des échelles d’évaluation fonctionnelle appropriées ont été développées pour les essais cliniques sur la MA. Des études ont montré que des interventions pharmacologiques dans la MA et certains autres syndromes cognitifs avaient un effet favorable sur le déclin fonctionnel. Ce bénéfice se traduit par une stabilisation qui dure entre six et douze mois alors que dans le groupe témoin sous placebo on observe une détérioration graduelle. Les pertes des AIVQ sont rarement réversibles. Il n’existe pas d’échelle fonctionnelle élaborée spécifiquement pour l’évaluation de sujets dont l’atteinte cognitive n’est pas due à la MA. Il est important de développer des échelles d’évaluation spécifiques pour évaluer l’atteinte cognitive légère et les autres démences.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 34 , Issue S1 , March 2007 , pp. S47 - S51
Copyright
Copyright © The Canadian Journal of Neurological 2007

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