Journal List > Dement Neurocogn Disord > v.12(4) > 1120810

Dement Neurocogn Disord. 2013 Dec;12(4):100-106. Korean.
Published online Dec 31, 2013.
© 2013 Korean Dementia Association
Predictive Factors for Decline in Activities of Daily Living in Alzheimer's Disease Dementia with More than 2 Follow-up
Sung-Hee Kim, M.D.,* Hyeran Yang, M.D., Ye Ji Choi, M.D.,* Hee Jin Kang, M.D.,* Kyoung-Gyu Choi, M.D.,* and Jee Hyang Jeong, M.D.*
*Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea.
Department of Neurology, Dongshin Hospital, Seoul, Korea.

Address for correspondence: Jee Hyang Jeong, M.D. Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 158-710, Korea. Tel. +82-2-2650-2776, Fax +82-2-2650-2652, Email:
Received Nov 11, 2013; Revised Dec 30, 2013; Accepted Dec 30, 2013.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



Impairment in activities of daily living (ADL) is a major problem in Alzheimer's disease (AD), and is related to increased caregiver burden.The present study evaluated whether there are any components of initial dementia evaluation that could predict ADL decline in years follow-up.


The 32 subjects underwent more than two consecutive neuropsychological evaluation and maintained anti-dementia medication from the Ewha Dementia Cohort. The first clinical, neuropsychological test results, medial temporal atrophy rating and white matter ratings were correlated with the final ADL scores. The subjects were further divided into ADL-preserved and declined groups for the comparison depending on final ADL scores.


The annual decline of the Korean Mini-mental status examination (K-MMSE) score was 1.5±1.2 and of the Seoul-instrumental ADL score was 6.1±4.6. The Factors correlated with the ADL at baseline were the clinical dementia rating, K-MMSE, memory function score and the total neuropsychological test score, left medial temporal lobe atrophy rating, and the neuropsychiatric total score. Only the neuropsychological component including total test, frontal and visuospatial function scores were statistically different between the two groups in the baseline evaluation.


The result of our preliminary study emphasize the other study results that the initial cognitive and dementia status are the strong predictive factors not only for the initial ADL dysfunction but also for the ADL decline in years followed-up dementia cohort.

Keywords: Activities of daily living; Medial temporal lobe atrophy; Alzheimer's disease dementia


Table 1
The comparison between baseline and follow-up evaluation
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Table 2
Correlation coefficients between baseline evaluationfactors andS-IADL atbaseline and follow-up
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Table 3
Correlation coefficients between baseline evaluation factors and medial temporal lobe atrophyat baseline imaging
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Table 4
The comparison between ADL-preserved groupandADL-aggravated group
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1. Mendez MF, Cummings JL. In: Dementia: a clinical approach. 3rd ed. Philadelphia, Penn: Butterworth-Heinemann; 2003.
2. Querfurth HW, LaFerla FM. Alzheimer's disease. N Engl J Med 2010;362:329–344.
3. Van Hoesen GW, Hyman BT. Hippocampal formation: anatomy and the patterns of pathology in Alzheimer's disease. Prog Brain Res 1990;83:445–457.
4. Lee YW, Cho IS, Kim HS. Comparison in care burden, fatigue, and life contentment of caregivers by gender relationship with demented elders. Korean J Women Health Nurs 2009;15:196–204.
5. Park KW, Kim SY, Kim EG, Kim JW, Kim TY, Sung SM, et al. Factors affecting depression and life satisfaction in family caregivers of patients with dementia. J Korean Neurol Assoc 2005;23:776–783.
6. Kim TY, Kim SY, Kim JW, Kim EG, Park KW, Sung SM, et al. The difference of caregiver burden in patients with Alzheimer's disease and vascular dementia. J Korean Neurol Assoc 2005;23:463–470.
7. Hirano A, Suzuki Y, Kuzuya M, Onishi J, Hasegawa J, Ban N, Umegaki H. Association between the caregiver's burden and physical activity in community-dwelling caregivers of dementia patients. Arch Gerontol Geriatr 2011;52:295–298.
8. Atchison TB, Massman PJ, Doody RS. Baseline cognitive function predicts rate of decline in basic-care abilities of individuals with dementia of the Alzheimer's type. Arch Clin Neuropsychol 2007;22:99–107.
9. Wang PN, Liu HC, Lirng JF, Lin KN, Wu ZA. Accelerated hippocampal atrophy rates in stable and progressive amnestic mild cognitive impairment. Psychiatry Res 2009;171:221–231.
10. Rusinek H, Endo Y, De Santi S, Frid D, Tsui WH, Segal S, et al. Atrophy rate in medial temporal lobe during progression of Alzheimer disease. Neurology 2004;63:2354–2359.
11. Visser PJ, Verhey FR, Hofman PA, Scheltens P, Jolles J. Medial temporal lobe atrophy predicts Alzheimer's disease in patients with minor cognitive impairment. J Neurol Neurosurg Psychiatry 2002;72:491–497.
12. Dickerson BC, Salat DH, Bates JF, Atiya M, Killiany RJ, Greve DN, et al. Medial temporal lobe function and structure in mild cognitive impairment. Ann Neurol 2004;56:27–35.
13. Jack CR Jr, Petersen RC, Xu Y, O'Brien PC, Smith GE, Ivnik RJ, et al. Rates of hippocampal atrophy correlate with change in clinical status in aging and AD. Neurology 2000;55:484–489.
14. Wang PN, Lirng JF, Lin KN, Chang FC, Liu HC. Prediction of Alzheimer's disease in mild cognitive impairment: a prospective study in Taiwan. Neurobiol Aging 2006;27:1797–1806.
15. Suh GH, Ju YS, Yeon BK, Shah A. A longitudinal study of Alzheimer's disease: rates of cognitive and functional decline. Int J Geriatr Psychiatry 2004;19:817–824.
16. Risacher SL, Saykin AJ, West JD, Shen L, Firpi HA, McDonald BC. Baseline MRI predictors of conversion from MCI to probable AD in the ADNI cohort. Curr Alzheimer Res 2009;6:347–361.
17. Marcos A, Gil P, Barabash A, Rodriquez R, Encinas M, Fernandez C, et al. Neuropsychological markers of progression from mild cognitive impairment to Alzheimer's disease. Am J Alzheimers Dis Other Demen 2006;21:189–196.
18. Jack CR Jr, Petersen RC, Xu YC, O'Brien PC, Smith GE, Ivnik RJ, et al. Prediction of AD with MRI-based hippocampal volume in mild cognitive impairment. Neurology 1999;52:1397–1403.
19. Choi SH, Na DL, Kwon HM, Yoon SJ, Jeong JH, Ha CK. The Korean version of the neuropsychiatric inventory: a scoring tool for neuropsychiatric disturbance in dementia patients. J Korean Med Sci 2000;15:609–615.
20. Ku HM, Kim JH, Kwon EJ, Kim SH, Lee HS, Ko HJ, et al. A study on the reliability and validity of Seoul-instrumental activities of daily living (S-IADL). J Korean Neuropsychiatr Assoc 2004;43:189–199.
21. Ahn HJ, Chin J, Park A, Lee BH, Suh MK, Seo SW, et al. Seoul Neuropsychological Screening Battery-dementia version (SNSB-D): a useful tool for assessing and monitoring cognitive impairments in dementia patients. J Korean Med Sci 2010;25:1071–1076.
22. Jack CR Jr, Shiung MM, Gunter JL, O'Brien PC, Weigand SD, Knopman DS, et al. Comparison of different MRI brain atrophy rate measures with clinical disease progression in AD. Neurology 2004;62:591–600.
23. Kim GH, Kwon HJ, Go SA, Kim JE, Park KD, Choi KG, et al. T1-Axial medial temporal atrophy visual rating: a comparable study with Schelten's T1-coronal visual rating. Dement Neurocogn Disord 2009;8:37–44.
24. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. AJR Am J Roentgenol 1987;149:351–356.
25. Gillette-Guyonnet S, Andrieu S, Nourhashemi F, Gardette V, Coley N, Cantet C, et al. Long-term progression of Alzheimer's disease in patients under antidementia drugs. Alzheimers Dement 2011;7:579–592.
26. Feldman H, Gauthier S, Hecker J, Vellas B, Emir B, Mastey V, et al. Donepezil MSAD Study Investigators Group. Efficacy of donepezil on maintenance of activities of daily living in patients with moderate to severe Alzheimer's disease and the effect on caregiver burden. J Am Geriatr Soc 2003;51:737–744.
27. Park HK, Na DL, Han SH, Kim JY, Cheong HK, Kim SY, et al. Clinical characteristics of a nationwide hospital-based registry of mild-to-moderate Alzheimer's disease patients in Korea: a CREDOS (Clinical Research Center for Dementia of South Korea) study. J Korean Med Sci 2011;26:1219–1226.
28. Stern Y, Gurland B, Tatemichi TK, Tang MX, Wilder D, Mayeux R. Influence of education and occupation on the incidence of Alzheimer's disease. JAMA 1994;271:1004–1010.
29. Monaci L, Morris RG. Neuropsychological screening performance and the association with activities of daily living and instrumental activities of daily living in dementia: baseline and 18- to 24-month follow-up. Int J Geriatr Psychiatry 2012;27:197–204.
30. Razani J, Casas R, Wong JT, Lu P, Alessi C, Josephson K. Relationship between executive functioning and activities of daily living in patients with relatively mild dementia. Appl Neuropsychol 2007;14:208–214.
31. Yang Y, Yang HD, Hong YJ, Kim JE, Park MH, Na HR, et al. Activities of daily living and dementia. Dement Neurocogn Disord 2012;11:29–37.
32. Devanand DP, Liu X, Tabert MH, Pradhaban G, Cuasay K, Bell K, et al. Combining early markers strongly predicts conversion from mild cognitive impairment to Alzheimer's disease. Biol Psychiatry 2008;64:871–879.