Cornelis Elise, Gorus Ellen, Beyer Ingo, Bautmans Ivan, De Vriendt Patricia
Department of Geriatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium.
Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium.
PLoS Med. 2017 Mar 14;14(3):e1002250. doi: 10.1371/journal.pmed.1002250. eCollection 2017 Mar.
Assessment of activities of daily living (ADL) is paramount to determine impairment in everyday functioning and to ensure accurate early diagnosis of neurocognitive disorders. Unfortunately, most common ADL tools are limited in their use in a diagnostic process. This study developed a new evaluation by adopting the items of the Katz Index (basic [b-] ADL) and Lawton Scale (instrumental [i-] ADL), defining them with the terminology of the International Classification of Human Functioning, Disability and Health (ICF), adding the scoring system of the ICF, and adding the possibility to identify underlying causes of limitations in ADL.
The construct validity, interrater reliability, and discriminative validity of this new evaluation were determined. From 2015 until 2016, older persons (65-93 y) with normal cognitive ageing (healthy comparison [HC]) (n = 79), mild cognitive impairment (MCI) (n = 73), and Alzheimer disease (AD) (n = 71) underwent a diagnostic procedure for neurocognitive disorders at the geriatric day hospital of the Universitair Ziekenhuis Brussel (Brussels, Belgium). Additionally, the ICF-based evaluation for b- and i-ADL was carried out. A global disability index (DI), a cognitive DI (CDI), and a physical DI (PDI) were calculated. The i-ADL-CDI showed high accuracy and higher discriminative power than the Lawton Scale in differentiating HC and MCI (area under the curve [AUC] = 0.895, 95% CI .840-.950, p = .002), MCI and AD (AUC = 0.805, 95% CI .805-.734, p = .010), and HC and AD (AUC = 0.990, 95% CI .978-1.000, p < .001). The b-ADL-DI showed significantly better discriminative accuracy than the Katz Index in differentiating HC and AD (AUC = 0.828, 95% CI .759-.897, p = .039). This study was conducted in a clinically relevant sample. However, heterogeneity between HC, MCI, and AD and the use of different methods of reporting ADL might limit this study.
This evaluation of b- and i-ADL can contribute to the diagnostic differentiation between cognitively healthy ageing and neurocognitive disorders in older age. This evaluation provides more clarity and nuance in assessing everyday functioning by using an ICF-based terminology and scoring system. Also, the possibility to take underlying causes of limitations into account seems to be valuable since it is crucial to determine the extent to which cognitive decline is responsible for functional impairment in diagnosing neurocognitive disorders. Though further prospective validation is still required, the i-ADL-CDI might be useful in clinical practice since it identifies impairment in i-ADL exclusively because of cognitive limitations.
日常生活活动（ADL）评估对于确定日常功能障碍以及确保神经认知障碍的准确早期诊断至关重要。不幸的是，大多数常见的ADL工具在诊断过程中的应用有限。本研究通过采用Katz指数（基本[b-]ADL）和Lawton量表（工具性[i-]ADL）的项目，用《国际功能、残疾和健康分类》（ICF）的术语对其进行定义，添加ICF评分系统，并增加识别ADL受限潜在原因的可能性，开发了一种新的评估方法。
确定了这种新评估方法的结构效度、评分者间信度和区分效度。2015年至2016年期间，认知老化正常（健康对照[HC]）（n = 79）、轻度认知障碍（MCI）（n = 73）和阿尔茨海默病（AD）（n = 71）的老年人（65 - 93岁）在比利时布鲁塞尔大学医院老年日间医院接受了神经认知障碍诊断程序。此外，还进行了基于ICF的b-ADL和i-ADL评估。计算了总体残疾指数（DI）、认知残疾指数（CDI）和身体残疾指数（PDI）。在区分HC和MCI（曲线下面积[AUC] = 0.895，95%CI 0.840 - 0.950，p = 0.002）、MCI和AD（AUC = 0.805，95%CI 0.805 - 0.734，p = 0.010）以及HC和AD（AUC = 0.990，95%CI 0.978 - 1.000，p < 0.001）方面，i-ADL - CDI显示出高准确性且比Lawton量表具有更高的区分能力。在区分HC和AD方面，b-ADL - DI显示出比Katz指数显著更好的区分准确性（AUC = 0.828，95%CI 0.759 - 0.897，p = 0.039）。本研究是在一个临床相关样本中进行的。然而，HC、MCI和AD之间的异质性以及ADL报告方法的不同可能会限制本研究。
这种b-ADL和i-ADL评估有助于区分老年人认知健康老化与神经认知障碍。该评估通过使用基于ICF的术语和评分系统，在评估日常功能方面提供了更多清晰度和细微差别。此外，考虑受限潜在原因的可能性似乎很有价值，因为在诊断神经认知障碍时确定认知衰退对功能损害的影响程度至关重要。尽管仍需要进一步的前瞻性验证，但i-ADL - CDI可能在临床实践中有用，因为它专门识别由于认知限制导致的i-ADL损害。
