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(2) 2 大仁學報第三十六期. PADLs and IADLs functional items. The PADLs and IADLs functional status scores were significantly associated with the types of dementia (P＜.05) and with the CDR of dementia patients (P＜.001). In conclusion, most dementia patients are dependent in daily activities, different types and severity of dementia lead to different disability profiles; individualized care is, therefore, most appropriate. Key words:Alzheimer’s disease, vascular dementia, Physical Activities of Daily Living, Instrumental Activities of Daily Living. *Director, Center of Health promotion St. Joseph Hospital, Kaohsiung. ** Associate Professor,Department of Psychology, Kaohsiung Medical University, Kaohsiung. *** Associate Professor,Department of Nursing, Tajen University, Pingtung. **** Associate Professor,Department of Nursing, Tajen University, Pingtung. ***** Assistant Professor,Department of Health care Management, Tajen University, Pingtung. Correspondence to：Mei Yuh Shiau, Department of Health care Management 20 Wei-hsim Rd. Yen-Pu 907 Pingtung Taiwan R.O.C Tel：08-7624002 Fax：08-7623924.
(3) Activities of Daily Living in Different Types of 3 Dementia Patients in Southern Taiwan. 南台灣社區失智症老人日常生活功 能之表現 吳小莉. 1. 余麗樺. 2. 蘇貞瑛. 3. 阮慧沁. 4. 蕭美玉. 5. 摘要 本研究之目的係以日常活動能力量表來評估不同類別失智老人在執行各項 身體性及工具性日常活動之依賴程度及應協助事項。本研究以 64 位阿茲海默氏 症、21 位血管性失智症、8 位混合型失智症及其他類型失智症，係由多段隨機 抽樣取自高高屏 3931 位 65 歲以上社區老人。診斷採 CMMSE、失智評分量表、 神經心理測驗、腦缺血失智評估、國際疾病分類、精神疾病統計資料手冊、AD 及 VaD 診斷標準等。研究結果顯示：AD 患者在 PADLs 以自行走路、盥洗為最困 難，IADLs 以準備三餐、處理金錢及家務最困難。VaD 患者以盥洗及洗澡、準備 三餐、處理家務及上街購物為最困難。研究結果也顯示 PADLs 及 IADLs 與失智 症之類別相關（P＜0.05） ，且與失智症嚴重度有明顯負相關（P＜0.001） 。多數 患者在 PADLs 及 IADLs 表現不一，應給予個別化之協助。 關鍵詞：阿茲海默氏症（AD）血管性失智症（VaD） 身體性日常活動（PADLs）工具性日常活動（IADLs）. 天主教聖功醫院健康促進中心 1 高雄醫學大學心理系 2 屏東大仁科技大學護理系 3,4 健管系 5.
(4) 4 大仁學報第三十六期. 1、Introduction Dementia is a syndrome of progressive decline the relentlessly erodes intellectual abilitites, causing congnitive and functional deterioration, which leads to impairment of social and occupational functioning (Desai, Grossberg and Sheth. 2004). The deficit is multifaceted and involves memory, judgment and abstract thought. Behavioral and pessonality changes also occur in an alert person (Burke Laramie 2000). Most peole with dementia are able to live at home in the community for a substantial part of their lives. Functional disability is a defining feature of all dementias. In dementia, functional impairment is associated with two major types of abilities：pysical activities of daily living (PADL) and instrumental activities of daily living (IADL). Functional status is measured by direct observation of the older person’s ability to complete basic self care tasks in his environment (Armer, Conn, Decker and Tripp-Raimer 2001). Lawton’s physical and instrumental activity of daily living scales (PADL and IADL) can be used to determine the level of functional status and the levels of assistance required by the demented elderly (Lawton MP. 1971). The reliability and validity of the PADL and IADL scales are considered sufficient to warrant their use in clinical assessment, program evaluation, and health planning (Katz SK. 1983), PADL could be a better predictor of dementia than cognitive impairment when diagnosing dementia. (Van Hout , Vernooij-Dassen , Hoefnagels, et al., 2002; De Lepeleire , Aertgeerts, Umbach et al., 2004 ) A population based study on functional performance of Alzheimer’s disease (AD) and vascular dementia (VaD) was investigated by the Functional Independence Measure (F1M). (Shiau, Yu, Yuan, Lu. 2006). The results showed that self-care was the most difficult subscale on the motor dimension, especially, bathing, upper and lower dressing items, and memory was the most difficult item on the cognitive dimension for the demented elerly. For the AD patients, stairs climbing, bathing and tub or shower transfer were the most difficult items on motor dimension and memory was the most difficult item on cognitive dimension. For VaD patients, upper and lower dressing, bathing and grooming were the most difficult items and problem.
(5) Activities of Daily Living in Different Types of 5 Dementia Patients in Southern Taiwan. solving was the most difficult item on cognitive dimension. Although the severity of dementia (CDR) was similar between two groups, VaD showed more dependent on all the F1M items. This analysis showed that the best item for distinguishing between the AD and VaD group were bed/chair transfer, upper dressing, problem solving, expression, lower dressing and bathing. In conclusion, most dementia patients are dependent in daily activities and different types and severity of dementia lead to different disability profiles; individualized care is, therefore, most appropriate. However, no population-based study has explored the differences in PADL and IADL among different types of dementia. The purpose of this study was to investigate the functional status of different types, and different degrees of severity of elderly dementia patients by assessing the PADL and IADL, and to understand the degree of dependeney and the need for assistance in performing activities of daily living.. 2、Method Subjects and design All of the subjects were collected from the two major dementia epidemiological studies in Taiwan. (Liu CK, Lin RT, Chen YF et al.,1996；Liu CK, Lai CL, Tai CT et al., 1998). A total of 3,931 examined elderly subjects, aged 65 and over, were collected by a multi-step stratified random sampling method. The ascertainment of dementia cases was done by using a two-phase study design. In the screening phase(phase 1), a culturally adapted version of the Chinese Mini Mental Status Examination (Chen YF. 1994), Blessed Dementia Rating Scale(BDRS) (Blessed, Tomlinson, Roth, 1968) and a questionnaire regarding detailed demographic data and past medical history were administered by specially trained interviewers. In phase 2, the CERAD (the Consortium to Establish a Registry of Alzhemer’s Disease) neuropsychological test battery (Morris, Heyman, Mohs, et al,1989) was performed by neuropsychologists, and comprehensive neurobehavioral examinations, including Clinical Dementia Rating Scale(CDR) (Hughes , Berg , Danziger, et al., 1982) and Hachinski Ischemia Scale, (Hachinski , Hiff , Zilhka, et al., 1975) were administered by senior neurologists. The ICD-10NA, DSM- Ⅲ -R criteria for dementia,.
(6) 6 大仁學報第三十六期. NINCDS-ADRDA guidelines for Alzheimer’s disease(AD) (McKhann , Drachman , Folstein et al., 1994) and NINDS-AIREN criteria (Roman , Tatemichi , Erkinjuntti et al., 1993) for vascular dementia(VaD) were employed to identify the subtypes of dementia.Severity of dementia was classified by the CDR, and CDR=1, 2, 3-5 represented mild, moderate,and severe, respectively. From the two studies, the total number of the demented elderly was 153. Of these 153 demented elderly, 30 died, 7 moved, and 14 could not be traced. Consequently the remaining 102 subjects were enrolled. Of these 102 demented patients, 64 (62.7%) were classified as having AD, 21 (20.6%) as having VaD, eight (7.8%) as having mixture of AD and VaD, two (2.0%) as having Parkison’s disease, and seven(6.9%) as having other disorders, including two normal-pressure hydrocephalus, three multiple causes, one traumatic, and one hypothyroidism. Functional assessment ADL scales (Fillenbaum , Delliger , Maddoxg. Pfieffe 1987；Hsiao , Chiu , Liu , 1994；Doble , Fisber , 1998) used in this study consists of 14 items covering 7 items of Instrumental Activities of Daily Living(IADL) and 7 items of Physical Activities of Daily Living(PADL). The ADL scale has adopted a 3-level scale of function, ranging from independence to complete dependence, for its measurement of each item. The higher score, the less dependence on a helper. The minimum and maximum scores of IADL and PADL that patients can obtain are 7 and 21, respectively. The reliability of IADL was 0.973 and the reliability of PADL was 0.968. Procedures The study subjects were contacted by telephone to determine their interests in participating in the study and to set up an interview. Those who had no telephones were contacted by mail. During the home visit, a specially trained researcher evaluated the patient’s performance on the PADLs and IADLs by observation and face-to face interviews with the patients and their caregivers. After assessment, health education was also conducted for caregivers to increase their knowledge about dementia, means of improving the safety of the environment, and care skills..
(7) Activities of Daily Living in Different Types of 7 Dementia Patients in Southern Taiwan. The home visit was conducted for each patient, with each home visit taking one to two hours. Statistical Analyses Descriptive and univariate categorical analysis were used to explore the demographic characteristics among different types of dementia. Multivariate linear regression analysis with adjusting for confounding sex variable were used to investigate the association between the functional status of patients and the types of dementia, and between the functional status of patients and the severity of elderly dementia. All tests for inference allowed a type I error rate of 5%. The inference was examined with the SAS/STAT computing program.. 3、Results Demographic characteristics of patients with dementia are shown in Table 1. This study consisted of 64(62.7% ) AD patients, 21(20.6%) VaD patients, 8(7.8%) Mixed patients, and 9(8.9%) others. The number of female dementia patients was higher (57 patients, or 55.9%) than for male patients(45 patients, or 44.1%). It was also found that VaD patients were predominantly male(13 patients, or 61.9%). The proportion of dementia increased with age. The number of patients under 75 years old was 35(34.3%), and the number aged with 75 and over was 67(65.7%). There were significant differences in gender( (. x2 =8.97,P ＜ .05). and in age groups. x =20.72,P＜.01). The incidence of dementia was higher in the illiterate group(67 2. patients, or 65.7%) than that in literate group(35 patients, or 34.3%). Regarding the severity of dementia, 19 subjects(18.7%) were rated in CDR3 and over. However, there were no significant differences in education and severity of dementia, i.e. stage of CDR, among the four groups. Table 2 shows the degree of dependeney in different types of dementia, For the AD patients, walking and grooming were the most difficult items on PADLs, whereas preparing meals, handling money, and doing housework were the most difficult items on IADLs. For VaD patients, as grooming and bathing were the most difficult PADLs items, whereas preparing meals, doing housework and going shopping were the most difficult IADLs items. In general, for these 102 demented elderly, Four leading difficult PADL items.
(8) 8 大仁學報第三十六期. were bathing(43.6%), grooming(39.6%), walking(36.5%) and dressing(36.3%) and the two leading difficult IADL items were preparing meals(68.6%) and handling money(61.8%). The three leading easiest PADL items were toileting(60.2%), getting in and out of bed(50.0%) and walking (50.0%), the two leading easiest IADL items were taking medications(30.4%) and going shopping(28.4%). In Table 3, regarding the complete independence group(CI) of PADLs, the mildly demented patients, i.e. CDR1(63.0%~82.3%), had a higher proportion in the CI group than did the severely demented patients, i.e. CDR≧3,(0-33.3%). Similary, regarding the complete independence group(CI) of IADLs, The mildy demented patients, i.e. CDR 1 (33.8%－44.6%), had a higher proportion in the CI group than did the severely demented patients, i.e. CDR≧3,(0－5.3%). Table 4 revealed that for both PADL and IADL scales, the other types of dementia had the highest scores in both scales, i.e. less dependent. However, the Mixed type of dementia had the lowest scores in both scales, i.e. more dependent, of the four types of dementia. We also found that the more severely demented patients, i.e. patients with higher CDR were significantly associated with the poorer performance on both PADL and IADL scales.. 4、Discussion The present study uses sensitive neuropsychological and neurobehavioral evaluation resulted in improved methods of detection. Consequently, the incidence rate of dementia has apparently increased. The present study is by far the largest to date of dementia in the elderly of Taiwan. It was determined that AD and VaD were the two main causes of dementia. The most common causes of death for demented patients were infection, cardiovascular disease, stroke, and accident. All of which are related to underlying causes of the dementing diseases. Types of dementia are Alzheimer’s type accounting for 50% to 60% of cases, vascular dementia has been reported to 15% to 20%, mixed dementia(a combination of the above) 20%, and Parkinson-associated dementia 10% to 15% (Burke, Larmie, 2000). Sexual dimorphism was found to exist in patients with dementia and was adjusted in our inferences. Our study shows that females are predominant among.
(9) Activities of Daily Living in Different Types of 9 Dementia Patients in Southern Taiwan. AD patients, as has also been found in other studies (Morris, Scherr, Hebert, et al., 2001; Green, Cupples, Go, et al., 2002; Galasko, Salmon, Gamst, et al., 2007). Female predominance could be explained by the relatively longer life expectancy of females, and the disproportionate number of females surviving into the period of greatest risk for AD (Fratiglioni , Grut , Forsell et al., 1991；Friedland RP. 1993；Liu CK, Lai CL, Tai CT, etal, 1998).Female predominance may also be explained by environmental influences, such as a lack of social contacts, health care, and work opportunities. Alzheimer’s disease is the most common cause of dementia in old age, characterized by insidious onset and inexorable progression. It is characterized by deteriorations in cognition and ability to function, cognitive decline is manifest as short-term memory, language and visuospatial deficits. These, along with deficits in perception and executive function affect the patient’s ability to function, as indicated by loss of ability to perform activities of daily living (ADLs). Loss of function that causes patients to require increasing levels of care. This is distressing for the patient, and contributes to the burden that caregivers experience (Galasko D. 1998). The risk factors for AD were increased age, female sex, low education (iliteracy), Apolipoprotein E4 (APOE)(Liu CK, Tai CT, Lin RT et al., 2000; Galasko, Salmon, Gamst, et al., 2007) and a history of major head injury. Table 1 shows the proportionate increase of dementia with age. the proportion of AD increased with age, but, the proportion of VaD that did not increase with age was suspected to be due to the higher mortality rate of VaD. (Lin RT, Lai CL, Tai CT et al., 1998) Consequently, AD was the most commonly detected cause of dementia. However, VaD tended to affect more male than females. Man’s predominance in VaD reflects the higher incidence of stroke among men. VaD was mostly related to the nature of the stroke (Liu CK, Miller, Cummings et al., 1992；Gorelick , Chatterjee , Patel et al., 1992；Lin RT , Lai CL , Tai CT, Liu CK, Howng SL. 1998； Zhu, Fratiglion, Guo et al., 1998；Liao CC. 2006) and was also related to hypertension, cigarette smoking, diabetes mellitus, alcohol consumption, and hyperlipidemia. Stroke is a major cause of disability in the elderly and is also related to the development of dementia (Zhu, Fratiglioni, Guo et al.,1998; Liebetrau et al.,2003;.
(10) 10 大仁學報第三十六期. Roman GC, 2003).Vascular dementia, causally related to stroke, always induced physical disability such as paralysis, limb rigidity, spasticity and gait abnormality (Cummings, Benson, 1992). The prevalence of disability in bathing, dressing, toileting, transfer and continence among patients were 54.4%, 37.9%, 40.5%, 22.9%, 24.8% respectively (Zhu, Fratiglioni, Guo et al., 1998). VaD patients also had much difficulty in problem solving, which may be due to the fact that VaD patients frequently have frontal dysfunction and physical disability to conduct the task (Shiau , Yu , Yuan et al., 2006). The cost of medical support for stroke is a burden for the family and for the society as well (Liao CC. 2006). Liao (2006) reported healthy diet and regular physical activities may reduce the risk of stroke. Vascular dementia (VaD) is associated with impairments in cognitive, motor, and functional domains. VaD patients often display neurologic dysfunciton and neurobehavioral impairments influenced ADL performance and causes of impaired functioning in dementia patients were often complicated. Adequate performance of PADLs and IADLs is required for independent living, impaired PADLs and IADLs are associated with increased caregivers’ burden, higher health care expenditures, and decreased time to institutionalization among dementia patients (Boyle, Cohen, Paul et al., 2002). Mixed type of patients with dementia, combining AD and VaD, showed the worst performance in either PADL or IADL items among the four types of patients with dementia, as shown in Table 2 and Table 4. Katz reported that bathing was the most complicated task of the six daily activities(bathing, upper dressing, using the toilet, bed/chair transfer, bladder and bowel management, and eating). (Katz , Ford , Moskowitz , 1963). The present study showed that bathing, grooming and dressing were three leading most difficult ADL items, which is consistent with other studies (Wu, Hsu, Chuang .d. Chang. 1996; Guo. Yeh, Lin, et al., 1999; Rogers, Holm, Burgio et al., 2000; Cotter, E.M., Burgio, L.D., Stevens, et al., 2002; Shiau. Yu, Yuan et al., 2006). Furthermore, preparing meals, handling money and doing housework were the three leading difficult IADL items for the demented elderly (Boyle, Cohen, Paul, et al., 2002; Chen, Zhang, Huang et al., 2004; Desai, Grossberg, Sheth,2004). The present study also determined that the functional status of both ADLs and IADLs were significantly associated with the type of dementia and with the Clinical.
(11) Activities of Daily Living in Different Types of 11 Dementia Patients in Southern Taiwan. Dementia Rating (CDR) of patients with dementia. Regarding either PADL or IADL scales, the mixed type of dementia had the lowest scores in either ADL scale, i.e. less independent, of the four types of dementia. Table 4 shows PADL scores were higher than IADL, because functional loss starting with high level and transportation and progressing to losses in PADL (Gerdner and Hall 2001). In past studies, the mixed type of dementia was often misclassified as VaD, that is, VaD was overestimated and the mixed type was underestimated (Yoshitake. Kiyohara Kato, et al., 1995). Taking this into account, the present study avoided this mistake and found that the incidence rate of the mixed type of dementia was consistent with earlier studies (White, Petrovitch, Ross, et al. 1996). We also found that the more severely demented patients, i.e. patients with higher CDR, were significantly associated with poorer performance on both PADL and IADL scales. The higher CDR stage obstained the poor functional performace in both PADL and IADL (Table4),need more assistance. Furthermore, the mixed type of dementia patients were found to have a higher mortality rate that could be related to the severity of underlying disease, and may explain the lower incidence rate than either AD or VaD. In dementia, functional impairment is associated with two major types of abilities; Physical activities of daily liveng (PADL) and Instrumental activities of daily living (IADL).PADL refers to basic activities necessary for one’s routine comfort and well-being, and IADLs are more complex activities needed to carry out self-care activities. IADLs is a combination of physical and cognitive abilities reflecting performance of more complex activities. The completion of IADLs involves sequencing, judging, and organizational ability, all of which entail executive control. Bell-McGinty et al. suggested that, with a decrease in executive control, a breakdown in performing complex behavioral procedures, such as handling finances and managing medications, is likely (Bell-McGinty, Podell, Franzen. 2002). The present study reveals that handling money is one of the leading difficult IADL items. Information on PADLs, may increase the specificity and sensitivity of the diagnosis of dementia (Warren, Grek, Conn et al., 1989). The assessment of IADLs could provide crucial guidance in the clinical diagnosis of early stage AD (Gauthier Gelinas, Gauthier. 1997). Performance on specific IADL items (such as telephones.
(12) 12 大仁學報第三十六期. use, use of means of transportation, responsibility for medication intake, handling finances) can also be used to screen for very early dementia (Barberger-Gateau, Commenges. Gagnon et al., 1992). Therefore, the ability to perform PADL and IADL are critical indicators of an individual’s ability to live independently (Katz SK. 1983; Bolye, Chen, Paul et al., 2002; Desai , Grossberg and Sheth., 2004). To assist patients in accomplishing bathing, grooming, and dressing tasks, general principles (i.e., promote as much function and independence as the patient and situation allow, or “help-but-do-not-do” as long as possible) should be mentioned first, and then the following information and intervention should be informed to the caregivers. Firstly, bathing must be performed in a wet and slippery environment, which poses safety concerns, bathing chairs can be used when getting in and out of the bathtub. Extended-handle brushes for bathing should be also available. Use of a hand-held shower device may be helpful for showering. Secondly, grooming can enhance self-esteem and improve hygiene. We suggest the patient maintain an easy to care for hairstyle. Some suggestions for caregivers should be mentioned: electric razors are easier for shaving, allowing the patient to shave himself as long as possible, make-up will enhance the patient’s self-image, the patients should brush their own teeth as long as possible, and the deodorant should be used if necessary. Lastly, dressing is a complex activity that involves sequencing and perception as well as the physical act of donning and doffing clothing. When assisting with dressing, offer one item of clothing at a time. Soft, comfortable, clean-durable, adhesive strip and length fitable clothing should be considered. Simplify clothing can be made easier to handle by adding self-care devices to the pull so that a weak or uncoordinated hand can pull it up and down. A patient with hemiplegia is taught to dress by placing clothing on the affected arm or leg first. When undressing, the hemiplegia is instructed to undress the unaffected arm or leg first. This study showed toileting and walking were the easiest PADL items, it includes bladder management and bowel management. Bladder management was more difficult than bowel management. Urge incontinence in AD may relate to dysfunction of sphincter control and forgetfulness from central degenerations. However, stroke can cause bladder dysfunction, resulting in neurogenic bladder and.
(13) Activities of Daily Living in Different Types of 13 Dementia Patients in Southern Taiwan. uninhibited bladder, causing incontinence, which may be aggravated by memory lapses, inattention, emotional factors, inability to communicate, and impaired physical mobility (Black, Hawks, Keene, 2001; Shiau, YU, Yuan, et al., 2006).In our study, toileting and walking were the easiest in PADLs. Bladder and bowel management was the most tough task for the dementia patients. Some suggestions should be used for the caregivers: schedule toileting times for urge or functional incontinence to habit training, provider good skin care to perianal area,visual aids such as big-lettered signs or a picture of the toilet, fluorescent marker and well lighted and provide unconditional positive regard for the performance. Protective, absorbency pad will be needed for the bedridden dementia elderly. Although walking was easy PADL item, we should provide unobstractive way for walking and pacing to prevent for falling. A regular walk through the neighborhood or time is helpful both physically and mentally. In assisting patients to prepare meals, handle money and do house work, the use of simple meal plans, simple cooking device, reliable family or friends helping handle money tasks, and introducing adaptive devices to do house work, the caregivers can teach the patient and family about related adaptive equipments and techniques. Furthermore, the assistance should be individualized according to the need of each demented patient. Household chores that aren’t too complex for the person’s memory can promote a sense of purpose and a feeling of helpfulness (Scherder, Dekker, Eqqermont,2008). The present study provides more precise diagnoses and findings. Recently there has been an increased understanding of dementing illnesses, in general and of Alzheimer’s disease, and contemporary studies have applied more sensitive assessment methods (KoKmen, Beard, O’Brien, et al., 1993). Additionally, the criteria for the diagnosis of dementia and its subtypes, i.e., AD and VaD, have been better established. (American Psychiatric Association 1987; WHO. 1991; Roman, Tatemichi, Erkinjuntti, et al.,1993; McKhann, Drach-man, Folstein, et al., 1994). Healthcare provides should aware that ADLs (PADLs and IADLs) are good predictors in diagnosing dementia, and are associated with different types of dementia, different severity of dementia (CDR) and different degree of dependency. These suggestions and findings could be of practical value in diagnosing, staging,.
(14) 14 大仁學報第三十六期. managing and following up on demented patients and could prove a valuable reference for dementia policy and decision making.. 5、Acknowledgments This study was supported by a reserch grant from the National Science Council of Taiwan (NSC 85-2413-H-037001). We also greatly appreciate Tung Kay YI’s assistance in typing this manuscript.. 6、References (1)American Psychiatric Association. Diagnostic and Statistical Manual of Mental disorders. 3rd ed., revised. Washington, DC: American Psychiatric Press. 1987;103-7. (2)Armer JM, Conn VS, Decker SA; and Tripp-Reimer T. Self care In. Mass ML, Buckwalter KC, Hardy MD, et al (eds). Nursing Care of older Adults : Diagnoses, Outcomes and Interventions, 2nd edition, St Louis: Mosby, 2001; 361-382 (3)Barberger-Gateau P, Commenges D, Gagnon M et al. Instrumental activities of daily living as a screening tool for cognitive impairment and dementia in elderly community dewellers. JAMA Geriatr Soc 1992; 40:1129-34. (4)Bell-McGinty S., Podell K., Franzen M., Baird A.D., & Williams M.J. Standard measures of executive function in predicting instrumental activities of daily living in older adults. International Journal of Geriatric Psychiatry 2002; 17:828-34. (5)Black JM, Hawks JH, Keene AM:Management of client with degenerative neurologic disorders In: Medieal Surgieal Nureing 6th edition. New York; WB Saunders, 2001: 1953-81,2002-13. (6)Blessed G, Tomlinson BE, Roth M. The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry 1968; 114:797-811. (7)Boyle P.A., Cohen R.A., Paul R., Moser 0D and Gordon N. cognitive and motor impairments predict functional declines in patients with vascular dementia. Int. J Geriatr Psychiatry 2002; 17:164-69. (8)Burke MM, Laramie JA. Primary Care of the Older Adult. 1st edition, St. Louis, Mosby, Inc. 2000：411-25.
(15) Activities of Daily Living in Different Types of 15 Dementia Patients in Southern Taiwan. (9)Chen X., Zhang Z.X., Huang J.B., Wen H.B., Comparative study on the clinical features of Alzheimer’s disease and vascular dementia. Chung-Kuo i Hsueh Ko Hsueh Yuan Hsueh Pao Acta Academic Medicine Sinicae 2004; 26(2):122-27. [in Chinese] (10)Chen YF. Validation of Chinese version of Mini-Mental Status Examination in the field study. Kaohsiung, Taiwan: Kaohsiung Medical College 1994. Master Thesis. [in Chiness] (11)Cotter, EM, Burgio, LD, Stevens, AB, Roth, DL,& Gitlin, LN, Correspondence of the Functional Independence Measure (FIM) Self-care subscale with real-time observation of dementia patient’s ADL performance in the home. Clinical Rehabilitation 2002; 16:36-45. (12)Cummings JL, Benson DF. Dementia : a clinical approach. Butterworth-Heinemann. Boston, U.S.A. 2nd ed., 1992; 1-8:152-153. (13)De Lepeleire, J., Aertgeerts, B., Umbach, I., Pattyn, P., Temsin, F., Nestor, L., et al. The diagnostic value of IADL evaluation in the detection of dementia in general Practice. Aging & Mental Health, 2004, 8,52-57. (14)Desai AK, Grossberg GT, and Sheth DN Activities of Daily Living in patients with Dementia. CNS Drugs. 2004; 18(13):853-875 (15)Fillenbaum GG., Dellinger D, Maddox G, Pfieffer E. Assessment of individual functional status-in a program evaluation and resource allocation model in multidimensional functional assessment：the OARS methodology. (2nd ed.). Duke University Center for the Study of Aging and Human Development, Durham, NC 1987. (16)Fratiglioni, L., Grut, M., Forsell, Y., Viitanen, M., Grafstrom, M., Holmen, K., et al. Prevalence of Alzheimer’s disease and other dementia in an elderly urban population: relationship with age, sex, and education. Neurology 1991; 41:1886-92. (17)Friedland RP. Epidemiology, education, and the ecology of Alzheimer’s disease Neurology 1993; 43:246-9. (18)Galasko D.: An integrated approach to the management of Alzheimer’s disease : assessing cognition and behaviour. European Journal of Neurology 1998, 5(Suppl 4), S9-S17.
(16) 16 大仁學報第三十六期. (19)Galasko D., Salmon D., Gamst A., Olichney J., Thal L.J., et al. Prevalence of dementia in Chamorros on Guam: Relationship to age, gender, education, and APOE. Neurology 2007; 68:1772-81. (20)Gauthier S, Gelinas I, Gauthier L, Functional disability in Alzheimer’s disease, Int Psychogeriatr 1997; 9 suppl:163-5. (21)Gerdner LA, Hall GR. Chronic confusion. In: Maas ML, Buckwalter KC, Hardy MD, et al. Nursing Care of Older Adults: Diagnoses, Outcomes and Interventions,2nd edition. St Louis: Mosby 2001:421-41. (22)Gorelick P.B., Chatterjee A., Patel D., Flowerdew G., Dollear W., Taber J. et al. Cranial computed tomographic observations in multi-infarct dementia: A controlled study. Stroke 1992; 23:804-11. (23)Green RC, Cupples LA, Go R, Benke KS, Edeki T, Griffith PA, William SM, Hipps Y, Graff-Radford N, Bachman D, Farrer LA, MIRAGE Study Group. Risk of dementia among white and African relatives of patients with Alzheimer disease. JAMA 2002;287:329-36. (24)Guo NW, Yeh SH, Lin JH, Chen HY, Liu CK, Yuan HS, Yu LF Chen HT. A study on structural analysis of functional independence measure in Taiwan. J of Rehab of Rep of China 1999, 27: 217-26 [in Chinese] (25)Hachinski VC, Hiff LD, Zilhka E, Du Boulay GH, McAllister VL, Marshall J, Russell RW, Symon L. Cerebral blood flow in dementia. Arch Neurol 1975; 32:632-7. (26)Hsiao SH, Chiu HC, Liu HW. A replication of multidimensionality of activities of daily living (ADL) on the elderly in southern Taiwan. Kaohsiung J Med Sci 1994; 10:449-57. [in Chinese] (27)Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiat 1982; 140:566-72. (28)Katz SK. Assessing self-maintenance activities of daily living: mobility and instrumental activities of daily living. J Am Geriatr Soc 1983; 31-721-7. (29)Katz, S., Ford, A.B., Moskowitz, R.W., Jackson, B.A., % Jaffee, M.W. Studies of illness in the aged: the index of ADLs. JAMA 1963; 185-914-9. (30)KoKmen E, Beard CM, O’Brien PC, Offord KP, Kurland LT, Is the incidence of dementing illness Changing ? A. 25-year timed trend study in Rochester,.
(17) Activities of Daily Living in Different Types of 17 Dementia Patients in Southern Taiwan. Minnesota. Neurology 1993;43: 1887-92 (31)Lawton MP. The functional assessment of elderly peoples. J. Am Geriatr Soc 1971; 19:465-80. (32)Liao Chien Chang, Life and the Risk of stroke Taiwan J. Fam Med 2006; 16: 143-54. (33)Liebetrau M, Steen B, Skoog I: Stroke in 85-Year-olds: Prevalence, incidence, risk factors, and relation to mortarlity and dementia. Stroke 2003;34:2617-22 (34)Lin RT, Lai CL, Tai CT, Liu CK, & Howng SL. Cranial computed tomography in stroke patients with and without dementia. Kaohsiung Journal of Medical Science 1998; 14:204-12. (35)Lin RT, Lai, CL, Tai, CT, Liu CK, Yen, YY, & Howng, SL. Prevalence and subtypes of dementia in southern Taiwan: impact of sex, education, and urbanization. Journal of Neurological Sciences 1998; 160:67-75. (36)Liu CK, Tai CT, Lin RT, Lai CL. Epidemiology of dementia in Taiwan. Research in Applied Psychology, NO.7 Fall 2000,157-169 (37)Liu CK, Lai CL, Tai CT, Lin RT, Yen YY, Howng SL. Incidence and subtypes of dementia in southern Taiwan: impact of socio-demographic factors. Neurology 1998; 50:1572-9. (38)Liu CK, Lin RT, Chen YF, Tai CT, Yen YY, Howng SL. Prevalence of Dementia in an urban area in Taiwan. J Formos Med Assoc 1996; 95:762-8. (39)Liu CK, Miller BL, Cummings JL, Goldberg MA, Howng SL, Benson DF.A Quantitative MRI study of vascular dementia. Neurology 1992; 42:138-43. (40)McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1994; 34:939-44. (41)Morris JC, Heyman A, Mohs RC, Hughes JP, van Belle G, Fillenbaum G, Mellits ED, Clark C. The Consortium to Establish a Registry for Alzheimer’s Disease(CERAD) Part I Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology 1989; 39:1159-65. (42)Morris MC, Scherr PA, Hebert LE, Glynn RJ, Bennet DA, Evans DA. Association of incident Alzheimer disease and blood pressure measured from 13.
(18) 18 大仁學報第三十六期. years before to 2 years after diagnosis in a large community study. Arch Neurol 2001; 58:1640-6. (43)Rogers JC, Holm MB,Burgio LD, et al, Excess disability during morning care in nursing home residents with dementia. Int Psychogeriatr.2000;12:267-82. (44)Roman GC : Stroke, cognitive decline and vascular dementia: the silent epidemic of the 21st centry, Neuroepidemiology, 2003; 22:161-164. (45)Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, Amaducci L, Orgogozo JM, Brun A, Hofman A, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN international Workshop. Neurology 1993; 43:250-60. (46)Scherder E, Dekker W, Eqqermont L. Higher –level hand function in aging and (preclinical) dementia: its relationship with (instrumental) activities of daily life-a mini-review Gerontology.2008;54(6):333-41.Epub 2008 Nov 11. (47)Shiau MY, Yu lifa, Yuan Hui Shin, Lin Jan-Hong, Liu Chin Kuan, Functional Performance of Alzheimer’s Disease and Vascular Dementia in Southern Taiwan. Kaohsiung J Med Sci 2006;22:437-46 (48)Van Hout HPJ, Vernooij-Dassen MJFJ, Hoefnagels WHL, Kuin Y, Stalman WAB, Moons, KGM, Grol RPTM. Dementia:predictors of diagnostic accuracy and the contribution of diagnostic recommendations. J Fam Pract 2002;51:693-9. (49)Warren EJ, Grek A, Conndetal A correlation, between cognitive performance and daily functioning in elderly people. J. Geriotr psychiarty Neurol 1989; 2:96-100. (50)White L., Petrovitch H., Ross W., Masaki K.H., Abbott R.D., Teng E.L., et al. Prevalence of dementia in older Japanese-American men in Hawaii: The Honolulu-Asia Aging Study. JAMA 1996;276:955-60. (51)World Health Organization (WHO). The neurological adaptation of the international Classification of Disease (ICD-10NA). Draft. Geneva: World Health Organization, 1991. (52)Wu SC, Hsu HC, Chuang YC, Chang MC. Application of functional assessment in estimating long term care need among. Non-institutionalized elderly adults. In Taiwan J of Health med of the Rep of China 1996; vol15, No.6,533-545[in Chinese].
(19) Activities of Daily Living in Different Types of 19 Dementia Patients in Southern Taiwan. (53)Yoshitake T. Kiyohara Y, Kato I, Ohmura T, Iwamoto H, Nakayama K, Ohmori S, Nomiyama K, Kawano H, Ueda K, et al. Incidence and risk factors of vascular dementia and Alzheimer’s disease in a defined elderly Japanese population: the Hisayama Study. Neurology 1995;45:1161-8. (54)Zhu L, Fratiglioni L, Guo Z, Aguero-Torres H, Winblad B Vitanen M. Association of stroke with dementia, cognitive impairment, and functional disability in the very old a population-based study Stroke 1998;29:2094-99..
(20) 20 大仁學報第三十六期.
(21) Activities of Daily Living in Different Types of 21 Dementia Patients in Southern Taiwan.
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(23) Activities of Daily Living in Different Types of 23 Dementia Patients in Southern Taiwan.
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Wayne Chang National Changhua University of Education- Master of Math Michael Wen National Kaohsiung Normal University - Bachelor of Math Peter Sun National Kaohsiung
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