Tag Archives: dementia

There’s an order to things: Item response theory as a way to make sense of functional decline in dementia

Sarah McGrory is a PhD Student at the Alzheimer Scotland Dementia Research Centre at the University of Edinburgh. Reblogged from the British Geriatrics Society blog.functional decline

Are some activities harder than others for people with dementia? In our research, recently reported in Age and Ageing, we looked at how people with dementia differed in their day to day activities. 202 people with mostly mild to moderate dementia in Scotland were asked about their activities

Activities (using the telephone, shopping, food preparation, housekeeping, laundry, travelling, taking medications, handling finances) can be measured using a questionnaire called the Lawton Instrumental Activities of Daily Living (IADL) scale. Usually scores on the individual tasks are added together to give a total score ranging from 0 to 8. This number can hide a lot of information about a patient’s functional ability. It assumes every functional activity is equally difficult, which is rarely the case. For example, being able to manage your finances is likely to be harder for most people than being able to eat.

Our research used a statistical technique called item response theory (IRT) to get more information from a questionnaire about function. IRT allows the different activities to be ranked according to their difficulty. This can be especially useful for assessing progression of cognitive impairment. Knowing the expected order of decline can help to monitor progression, so any changes from the usual course, or changes in rates of decline, can be identified and studied. IRT can help to identify key tasks in a scale, and can also show in what order tasks might become more difficult as dementia progresses.  To do this, though, clinicians and researchers have to record answers to every task on a scale, not just to the total number.

We found that the tasks included in the scale could be ordered by increasing difficulty from being able to use the telephone (easiest) to the ability to shop (most difficult). This means a person may be having problems shopping independently may showing the first sign of functional difficulties related to cognitive impairment. Problems with this task should alert doctors as a possible early symptom of cognitive decline. Recognising these early stages is very important and can help people live independently for as long as possible with the help of medications, family education and counselling.  Looking at the individual tasks within a scale instead of relying on the total score can help us to understand more about dementia progression and help us to identify care requirements for patients.

Stefania’s Success Story

by Riitta Antikainen

Early in the morning in Oulu, wake-up, take a taxi to airport, a one-hour flight to Helsinki, morning flight to Milano – three hours,  train from Milano Malpensa to Milano central station, quick lunch with bread ad Coce, rushing 3-hour train trip to Venice: finally in Venice! But this was not all, there was a not-pre-planned or pre-expected 40 min ferry trip to Lido followed by short taxi trip-after having experienced all this you are there, in the Geriatric Congress Venue in Venice, Italy. Continue reading

Driving with Dementia

Professor Joseph E Ibrahim (MBBS, GradCertHE, PhD, FRACP, FAFPHM) of The Victoria and Tasmania Dementia Training Study Centre and Monash University introduces his short animation about people with dementia who want to continue to drive. (This was first blogged on the BGS Blog site).

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Assessing a patient’s fitness to continue driving a motor vehicle following a diagnosis of dementia presents an important personal, professional and community challenge. The revocation of a person’s license is a traumatic event that significantly impacts on their quality of life. This is especially so for patients who are living in regional and rural areas. This animated video addresses some of the complex issues involved in assessing whether a person with dementia is fit to drive. Continue reading

Hypertension in people with dementia – what should we do?

Tomas Welsh is a Clinical Lecturer in the Medicine of Older People at the University of Nottingham, England. (First blogged on the BGS blog)

Antihypertensive therapy is effective even in the oldest old. However, the large trials of antihypertensive medications, even in older people, frequently excluded people with dementia. This causes difficulties in applying these findings to many of our typical patient group.

People with dementia are more likely to be physically frail, are at higher risk of adverse events due to polypharmacy and are more likely to experience orthostatic hypotension than their cognitively intact peers.  There is reason to suspect, therefore, that the risk-benefit ratio of treating hypertension may be different in this group and many clinicians intuitively feel this to be the case.   Continue reading