Évaluation gérontologique de l’autonomie: méthodes — applications à la prise en charge diagnostique et thérapeutique de la maladie d’Alzheimer

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Résumé

La maladie d’Alzheimer (MA) a une forte prévalence chez les sujets âgés avec un chiffre de l’ordre de 20 % parmi les sujets de 75 ans ou plus en France. Les troubles cognitifs sont souvent mis en avant parmi les symptômes décrits par les patients souffrant d’une MA. Pourtant, la perte d’autonomie secondaire à la MA est systématique et représente un poids important en termes de retentissement sur la vie quotidienne des patients et de leur entourage, et bien entendu aussi financier. La perte d’autonomie pour les activités de la vie quotidienne dépend essentiellement des troubles cognitifs et de l’âge, bien que les troubles du comportement puissent aussi jouer un rôle non négligeable. Certains patients, aux troubles cognitifs plus importants, ont un risque de déclin fonctionnel rapide. Cette perte d’autonomie semble avoir un profil unique pour la majorité des patients. La HAS a publié en 2008 des recommandations dans la prise en charge des patients, parmi lesquelles l’évaluation des sujets par l’échelle IADL de Lawton est essentielle. Il s’agit d’une échelle qui étudie l’autonomie du patient pour 14 activités, évaluée avec l’aide de l’interrogatoire de l’entourage. Cette échelle permet une évaluation des activités réellement effectuées dans la vie quotidienne, et la mise en place des aides nécessaires pour pallier la perte d’autonomie. Cette échelle est facile à utiliser et son usage pour le suivi des patients essentiel.

Mots clés

Maladie d’Alzheimer Perte d’autonomie Évaluation 

Assessment of functional decline in gerontology: methods — applications to diagnosis and treatment procedure of patients with Alzheimer’s disease

Abstract

Prevalence rate of Alzheimer’s disease (AD) is about 20% in elderly subjects above 75 years in France. Cognitive decline is a core feature for AD patients and their caregiver. Nevertheless, functional decline occurring in AD is systematic and represent a major consequence for patients and caregivers in the daily living. Financial burden is also very high. Main risk factors of the loss of autonomy for activities of the daily living are age and cognitive disturbances, but behavioural disturbances could have great effects on functional decline. Some patients, with heavy cognitive disturbance, have a risk for a rapid functional decline. This functional decline appears to follow a unique pattern of losses of autonomy in activities of the daily living. The High Authority of Health (HAS in France) published in 2008 new guidelines in diagnosis and follow-up of AD patients. These guidelines underlined the use of the IADL scale (Lawton scale) to assess functional decline. This scale permit to assess 14 activities of the daily living, completed while an interview with the caregiver. This scale is useful to assess activities usually performed by patients, when real abilities performed by patients are not assessed with the scale. Besides, the use of Lawton scale permit careers and physicians to planify and to set assistance for the patient and caregiver. In spite of some limits, Lawton scale is very useful in care of AD patients, and its use is yet recommanded by HAS.

Keywords

Alzheimer’s disease Functional decline Assessment 
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Copyright information

© Springer 2009

Authors and Affiliations

  1. 1.Service de médecine gériatriquehôpital Sainte-PérineParis cedex 16France

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