Journal of Neurology

, Volume 266, Issue 6, pp 1310–1322 | Cite as

Mapping the neuroanatomy of functional decline in Alzheimer’s disease from basic to advanced activities of daily living

  • Andrea SlachevskyEmail author
  • Gonzalo Forno
  • Paulo Barraza
  • Eneida Mioshi
  • Carolina Delgado
  • Patricia Lillo
  • Fernando Henriquez
  • Eduardo Bravo
  • Mauricio Farias
  • Carlos Muñoz-Neira
  • Agustin Ibañez
  • Mario A. Parra
  • Michael Hornberger
Original Communication



Impairments in activities of daily living (ADL) are a criterion for Alzheimer’s disease (AD) dementia. However, ADL gradually decline in AD, impacting on advanced (a-ADL, complex interpersonal or social functioning), instrumental (IADL, maintaining life in community), and finally basic functions (BADL, activities related to physiological and self-maintenance needs). Information and communication technologies (ICT) have become an increasingly important aspect of daily functioning. Yet, the links of ADL, ICT, and neuropathology of AD dementia are poorly understood. Such knowledge is critical as it can provide biomarker evidence of functional decline in AD.


ADL were evaluated with the Technology–Activities of Daily Living Questionnaire (T-ADLQ) in 33 patients with AD and 30 controls. ADL were divided in BADL, IADL, and a-ADL. The three domain subscores were covaried against gray matter atrophy via voxel-based morphometry.


Our results showed that three domain subscores of ADL correlate with several brain structures, with a varying degree of overlap between them. BADL score correlated mostly with frontal atrophy, IADL with more widespread frontal, temporal and occipital atrophy and a-ADL with occipital and temporal atrophy. Finally, ICT subscale was associated with atrophy in the precuneus.


The association between ADL domains and neurodegeneration in AD follows a traceable neuropathological pathway which involves different neural networks. This the first evidence of ADL phenotypes in AD characterised by specific patterns of functional decline and well-defined neuropathological changes. The identification of such phenotypes can yield functional biomarkers for dementias such as AD.


Alzheimer’s disease Functional impairment Activities of daily living Technology–activities of daily living questionnaire 



Funding from CONICYT/FONDECYT/11404223 (to A.S, C.D, E.B, F.H, C.M., and P.B); FONDAP Program Grant 15150012 (to AS, PL, GF and AI); CONICYT/FONDECYT (Regular 1170010), CONICYT/FONDECYT regular 1160940 (to AS and PL), the INECO Foundation (to AI), the Global Brain Health Institute (GBHI-UCSF) (to AI),  the Inter-American Development Bank (IADB) (to AI and AS), PIA-CONICYT Basal Funds for Centers of Excellence Project FB0003 (to A.S; PB and FH) and the Alzheimer’s Society (Grant AS-SF-14-008) (to MAP).

Compliance with ethical standards

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All the procedures conducted with the participants of this study were carried out according to the Declaration of Helsinki. Ethical approvals were provided by the Ethical and Scientific Committees of the East Metropolitan Health Service and Hospital Clínico Universidad de Chile from Santiago, Chile.

Supplementary material

415_2019_9260_MOESM1_ESM.docx (172 kb)
Supplementary material 1 (DOCX 172 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Andrea Slachevsky
    • 1
    • 2
    • 3
    • 5
    • 17
    Email author
  • Gonzalo Forno
    • 1
    • 2
    • 3
  • Paulo Barraza
    • 4
  • Eneida Mioshi
    • 6
  • Carolina Delgado
    • 7
    • 17
  • Patricia Lillo
    • 1
    • 16
    • 17
  • Fernando Henriquez
    • 1
    • 2
    • 3
    • 4
  • Eduardo Bravo
    • 8
  • Mauricio Farias
    • 8
  • Carlos Muñoz-Neira
    • 3
  • Agustin Ibañez
    • 10
    • 11
    • 12
    • 13
    • 14
  • Mario A. Parra
    • 9
    • 10
  • Michael Hornberger
    • 6
    • 15
  1. 1.Geroscience Center for Brain Health and Metabolism (GERO), Faculty of MedicineUniversity of ChileSantiagoChile
  2. 2.Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department - ICBM, Neurocience and East Neuroscience Departments, Faculty of MedicineUniversity of ChileSantiagoChile
  3. 3.Memory and Neuropsychiatric Clinic (CMYN) Neurology DepartmentHospital del Salvador and Faculty of Medicine, University of ChileSantiagoChile
  4. 4.Center for Advanced Research in Education (CIAE)University of ChileSantiagoChile
  5. 5.Servicio de Neurología, Departamento de MedicinaClínica Alemana-Universidad del DesarrolloSantiagoChile
  6. 6.School of Health SciencesUniversity of East AngliaNorwichUK
  7. 7.Neurology and Neurosurgery Department, Clinical HospitalUniversity of ChileSantiagoChile
  8. 8.Neuroradiologic DepartmentInstitute of Neurosurgery AsenjoSantiagoChile
  9. 9.Psychology Department, School of Psychological Sciences & HealthUniversity of StrathclydeGlasgowUK
  10. 10.Universidad Autonoma del CaribeBarranquillaColombia
  11. 11.Institute of Cognitive and Translational Neuroscience (INCYT), INECO FoundationFavaloro UniversityBuenos AiresArgentina
  12. 12.National Scientific and Technical Research Council (CONICET)Buenos AiresArgentina
  13. 13.Center for Social and Cognitive Neuroscience (CSCN), School of PsychologyUniversidad Adolfo IbañezSantiagoChile
  14. 14.Centre of Excellence in Cognition and its DisordersAustralian Research Council (ACR)SydneyAustralia
  15. 15.Norfolk and Suffolk Foundation TrustNorwichUK
  16. 16.Departamento de Neurociencia y Neurología Sur, Facultad de MedicinaUniversidad de ChileSantiagoChile
  17. 17.Departamento de Neurociencia, Facultad de MedicinaUniversidad de ChileSantiagoChile

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