CNS Drugs

, Volume 18, Issue 13, pp 853–875 | Cite as

Activities of Daily Living in Patients with Dementia

Clinical Relevance, Methods of Assessment and Effects of Treatment
  • Abhilash K. Desai
  • George T. Grossberg
  • Dharmesh N. Sheth
Review Article


Disability, characterised by the loss of ability to perform activities of daily living (ADL), is a defining feature of dementia that results in growing caregiver burden and the eventual need for alternative care or nursing home placement. Functional decline in patients with dementia can also result from causes other than dementia, such as comorbid medical and psychiatric illnesses and sensory impairment. ADL consists of instrumental ADL (IADL) [complex higher order skills, such as managing finances] and basic ADL (BADL) [self-maintenance skills, such as bathing]. Assessment of IADL and BADL is recommended to establish a diagnosis of dementia. Functional assessment also helps the healthcare provider to offer appropriate counselling regarding safety concerns and need for custodial care. Functional capacity measures have been used increasingly in pharmacological trials of patients with Alzheimer’s disease (AD) and related dementias, although at the present time these measures are generally not primary outcome measures. Functional impairment is not a uniform construct; rather, it is multifaceted and can be measured with various clinical instruments. Many scales have been validated for use in patients with AD for characterising functional impairment and evaluating the efficacy of treatment. Research to date indicates that cholinesterase inhibitors have the potential for modest but meaningful beneficial effects on ADL in patients with mild-to-moderate AD. Memantine also has promising beneficial effects on functional abilities in persons with moderate-to-severe AD. Assessment of ADL as a primary efficacy measure using a validated scale that is non-gender biased and cross-nationally relevant is recommended in new treatment trials of patients with AD and related dementias.


Memantine Rivastigmine Tacrine Galantamine Functional Activity Questionnaire 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This paper was funded by the Division of Geriatric Psychiatry, Saint Louis University School of Medicine, Saint Louis, Missouri. Dr Desai has served on the Speakers’ Bureau and received honoraria from Eli Lilly, Pfizer, Novartis, Forrest and Janssen pharmaceutical companies. Dr Grossberg has served as a consultant for Novartis, Janssen, Eli Lilly, Abbott, Bristol-Myers Squibb and Synthelabo, and has received grant/research support from Novartis, Janssen, Eli Lilly, Forrest, Abbott, Bristol-Myers Squibb, Pfizer and GlaxoSmithKline. Dr Sheth has no conflict of interest to report.


  1. 1.
    Alzheimer’s Disease and Related Dementias Guideline Panel. Recognition and initial assessment of Alzheimer’s disease and related dementias: clinical practice guideline. Number 19. Agency for Healthcare Policy and Research (AHCPR) Publication No. 97-0702. Washington, DC: US Department of Health and Human Services, 1996 NovGoogle Scholar
  2. 2.
    Henderson AS. Epidemiology of dementia disorders. In: Wurtman RJ, Corkin S, Growdon JH, et al., editors. Advances in neurology. Vol. 51: Alzheimer’s disease. New York: Raven Press, 1990: 15–25Google Scholar
  3. 3.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994Google Scholar
  4. 4.
    McKhann G, Drachman D, Folstein M, et al. 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 1984; 34: 939–44PubMedCrossRefGoogle Scholar
  5. 5.
    Cotrell V, Schulz R. The perspective of the patient with Alzheimer’s disease: a neglected dimension of dementia research. Gerontologist 1993; 33: 205–11PubMedCrossRefGoogle Scholar
  6. 6.
    Green CR, Mohs RC, Schmeidler J, et al. Functional decline in Alzheimer’s disease: a longitudinal study. J Am Geriatr Soc 1993; 41: 654–61PubMedGoogle Scholar
  7. 7.
    Rabins PV, Mace NL, Lucas MJ. The impact of dementia on the family. JAMA 1982; 248: 333–5PubMedCrossRefGoogle Scholar
  8. 8.
    World Health Organization. The international classification of impairments, disabilities, and handicaps: a manual of classification relating to the consequences of disease. Geneva: World Health Organization, 1980Google Scholar
  9. 9.
    Verbrugge LM, Jette AM. The disablement process. Soc Sci Med 1994; 38: 1–14PubMedCrossRefGoogle Scholar
  10. 10.
    Barberger-Gateau P, Fabrigoule C, Amieva H, et al. The disablement process: a conceptual framework for dementia-associated disability. Dement Geriatr Cogn Disord 2002; 13(2): 60–6PubMedCrossRefGoogle Scholar
  11. 11.
    Woods B. Promoting well-being and independence for people with dementia. Int J Geriatr Psychiatry 1999; 14: 97–109PubMedCrossRefGoogle Scholar
  12. 12.
    Stuck AE, Walthert JM, Nikolaus T, et al. Risk factors for functional status decline in community-living elderly people: a systematic literature review. Soc Sci Med 1999; 48(4): 445–69PubMedCrossRefGoogle Scholar
  13. 13.
    Royall DR. Executive cognitive impairment: a novel perspective on dementia. Neuroepidemiology 2000; 19(6): 293–9PubMedCrossRefGoogle Scholar
  14. 14.
    Carswell A, Eastwood R. Activities of daily living, cognitive impairment and social function in community residents with Alzheimer disease. Can J Occup Ther 1993; 60: 130–13Google Scholar
  15. 15.
    Stern Y, Hesdorffer D, Sano M, et al. Measurement and prediction of functional capacity in Alzheimer’s disease. Neurology 1990; 40: 8–14PubMedCrossRefGoogle Scholar
  16. 16.
    Royall DR, Chiodo LK, Polk MJ. Correlates of disability among elderly retirees with ‘subclinical’ cognitive impairment. J Gerontol A Biol Sci Med Sci 2000; 55(9): M541–6PubMedCrossRefGoogle Scholar
  17. 17.
    Barberger-Gateau P, Fabrigoule C. Disability and cognitive impairment in the elderly. Disabil Rehabil 1997; 19(5): 175–93PubMedCrossRefGoogle Scholar
  18. 18.
    Reed B, Jagust WJ, Seab JP. Mental status as a predictor of daily function in progressive dementia. Gerontologist 1989; 29: 804–7PubMedCrossRefGoogle Scholar
  19. 19.
    Quesada JJ, Ferrucci L, Calvani D, et al. Formal education as an effect modifier of the relationship between Mini-Mental State Examination score and IADL disability in the older population. Aging (Milano) 1997; 9(3): 175–9Google Scholar
  20. 20.
    Stern Y, Liu X, Albert M, et al. Modeling the influence of extrapyramidal signs on the progression of Alzheimer disease. Arch Neurol 1996; 53: 1121–6PubMedCrossRefGoogle Scholar
  21. 21.
    Bassett SS, Folstein MF. Cognitive impairment and functional disability in the absence of psychiatric diagnosis. Psychol Med 1991; 21: 77–84PubMedCrossRefGoogle Scholar
  22. 22.
    Heaton RK, Pendleton MG. Use of neuropsychological tests to predict adult patients’ everyday functioning. J Consult Clin Psychol 1981; 49: 807–21PubMedCrossRefGoogle Scholar
  23. 23.
    Gurland B. Epidemiology of psychiatric disorders. In: Sadavoy J, Lazarus LW, Jarvik LF, et al., editors. Comprehensive review of geriatric psychiatry: II. Washington, DC: American Psychiatric Press Inc., 1996: 3–42Google Scholar
  24. 24.
    Tractenberg R, Weiner MF, Patterson MB, et al. Emergent psychopathology in Alzheimer’s disease patients over 12 months associated with functional, not cognitive, changes. J Geriatr Psychiatry Neurol 2002; 15: 110–7PubMedCrossRefGoogle Scholar
  25. 25.
    Warren EJ, Grek A, Conn D, et al. A correlation between cognitive performance and daily functioning in elderly people. J Geriatr Psychiatry Neurol 1989; 2: 96–100PubMedCrossRefGoogle Scholar
  26. 26.
    Gauthier S, Gelinas I, Gauthier L. Functional disability in Alzheimer’s disease. Int Psychogeriatr 1997; 9 Suppl. 1: 163–5CrossRefGoogle Scholar
  27. 27.
    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 dwellers. J Am Geriatr Soc 1992; 40: 1129–34PubMedGoogle Scholar
  28. 28.
    Petersen RC, Smith GE, Waring SC, et al. Aging, memory, and mild cognitive impairment. Int Psychogeriatr 1997; 9 Suppl. 1: 65–9CrossRefGoogle Scholar
  29. 29.
    Petersen RC. Mild cognitive impairment: transition between aging and Alzheimer’s disease. Neurologia 2000; 15: 93–101PubMedGoogle Scholar
  30. 30.
    Daly E, Zaitchik D, Copeland M, et al. Predicting conversion of Alzheimer disease using standardized clinical information. Arch Neurol 2000; 57: 675–80PubMedCrossRefGoogle Scholar
  31. 31.
    Katz S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc 1983; 31(12): 121–7Google Scholar
  32. 32.
    Brodaty H, McGilchrist C, Harris L, et al. Time until institutionalization and death in patients with dementia. Arch Neurol 1993; 50: 643–50PubMedCrossRefGoogle Scholar
  33. 33.
    Riter RN, Fries BE. Predictors of the placement of cognitively impaired residents on special care units. Gerontologist 1992; 32: 184–90PubMedCrossRefGoogle Scholar
  34. 34.
    Gauthier S, Bodick N, Erzigkeit E, et al. Activities of daily living as an outcome measure in clinical trials of dementia drugs: position paper from the International Working Group on Harmonization of Dementia Drug Guidelines. Alzheimer Dis Assoc Disord 1997; 11 Suppl. 3: 6–7Google Scholar
  35. 35.
    CPMP (Working Party on Efficacy of Medicinal Products). Antidementia medicinal products. Brussels: Commission of the European Community, 1992Google Scholar
  36. 36.
    Mohr E, Feldman H, Gauthier S. Canadian guidelines for the development of antidementia therapies: a conceptual summary. Can J Neurol Sci 1995; 22: 62–71PubMedGoogle Scholar
  37. 37.
    Bavazzano A, Magnolfi SU, Calvani C, et al. Functional evaluation of Alzheimer patients during clinical trials: a review. Arch Gerontol Geriatr 1998; 26 Suppl. 1: 27–32CrossRefGoogle Scholar
  38. 38.
    Morris JC. The clinical dementia rating (CDR): current version and scoring rules. Neurology 1993; 43: 2412–4PubMedCrossRefGoogle Scholar
  39. 39.
    Gauthier S, Rockwood K, Gelinas I, et al. Outcome measures for the study of activities of daily living in vascular dementia. Alzheimer Dis Assoc Disord 1999; 13: S143–7PubMedGoogle Scholar
  40. 40.
    The Canadian Study of Health and Aging. Patterns of caring for people with dementia in Canada. Can J Aging 1994; 13: 470–87CrossRefGoogle Scholar
  41. 41.
    Schulz R, O’Brien AT, Bookwala J, et al. Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes. Gerontologist 1995; 35: 771–91PubMedCrossRefGoogle Scholar
  42. 42.
    Ballard CG, Shaw F, Lowery K, et al. The prevalence, assessment and associations of falls in dementia with Lewy bodies and Alzheimer’s disease. Dement Geriatr Cogn Disord 1999; 10: 97–103PubMedCrossRefGoogle Scholar
  43. 43.
    Bracco I, Gallato L, Grigoletto F, et al. Factors affecting course and survival in Alzheimer’s disease. Arch Neurol 1994; 51: 1214–9CrossRefGoogle Scholar
  44. 44.
    Thal LJ, Grundman M, Klauber MR. Dementia characteristics of a referral population and factors associated with progression. Neurology 1988; 38: 1083–90PubMedCrossRefGoogle Scholar
  45. 45.
    Shua-Haim JR, Burnstein L, Gross JS. C-ADAT: caregiver-Alzheimer’s disease assessment tool. Am J Alzheimer Care Rel Disord Res 1995 Jan/Feb; 10: 2–5CrossRefGoogle Scholar
  46. 46.
    Nagi SZ. Some conceptual issues in disability and rehabilitation. In: Sussman MB, editor. Sociology and rehabilitation. Washington, DC: American Sociological Association, 1965: 100–13Google Scholar
  47. 47.
    Jonsson L, Jonsson B, Wimo A, et al. Second International Pharmacoeconomic Conference on Alzheimer Disease. Alzheimer Dis Assoc Disord 2000; 14(3): 137–40PubMedCrossRefGoogle Scholar
  48. 48.
    Pinholt EM, Kroenke K, Hanley JF, et al. Functional assessment of the elderly: a comparison study of standard instruments with clinical judgement. Arch Intern Med 1987; 147: 484–8PubMedCrossRefGoogle Scholar
  49. 49.
    Spector WD. Measuring functioning in daily activities for persons with dementia. Alzheimer Dis Assoc Disord 1997; 11 Suppl. 6: 81–90Google Scholar
  50. 50.
    Fried IP, Bandeen-Roche K, Williamson JD, et al. Functional decline in older adults: expanding methods of ascertainment. J Gerontol Med Sci 1996; 57A: M206–14CrossRefGoogle Scholar
  51. 51.
    Katz S, Downs TD, Cash HR, et al. Progress in development of the index of ADL. Gerontologist 1970; 10: 20–30PubMedCrossRefGoogle Scholar
  52. 52.
    Katz S, Ford AB, Moskowitz RW, et al. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963; 185: 914–9PubMedCrossRefGoogle Scholar
  53. 53.
    Katz S, Ford A, Moskowitz R, et al. Katz index of activities of daily living. In: Handbook of psychiatric measures. Washington, DC: American Psychiatric Association, 2000: 130–1Google Scholar
  54. 54.
    Tappen RM. Development of the Refined ADL assessment scale for patients with Alzheimer’s and related disorders. J Gerontol Nurs 1994; 20(6): 36–42PubMedGoogle Scholar
  55. 55.
    Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily. Gerontologist 1969; 9: 179–86PubMedCrossRefGoogle Scholar
  56. 56.
    Hokoishi K, Ikeda M, Maki N, et al. Interrater reliability of the physical self-maintenance scale and instrumental activities of daily living scale in a variety of health professional representatives. Aging Ment Health 2001; 5(1): 38–40PubMedCrossRefGoogle Scholar
  57. 57.
    Lawton MP, Brody EM. Lawton instrumental activities of daily living scale (Lawton IADL): handbook of psychiatric measures. Washington, DC: American Psychiatric Press, 2000: 131–3Google Scholar
  58. 58.
    Pfeffer RI, Kurosaki TT, Harrah CH, et al. Measurement of functional activities in older adults in the community. J Gerontol 1982; 37: 323–9PubMedCrossRefGoogle Scholar
  59. 59.
    Pfeffer RI. A social function measure in the staging and study of dementia. In: Bergener M, Brocklehurst JC, Finkel SI, editors. Aging, health, and healing. New York: Springer, 1995: 618Google Scholar
  60. 60.
    Karagiozis H, Gray S, Sacco J, et al. The direct assessment of functional abilities (DAFA): a comparison to an indirect measure of instrumental activities of daily living. Gerontologist 1998; 38(1): 113–21PubMedCrossRefGoogle Scholar
  61. 61.
    Spector WD, Fleishman JA. Combining activities of daily living with instrumental activities of daily living to measure functional disability. J Gerontol B Psychol Sci Soc Sci 1998 Jan; 53(1): S46–57PubMedCrossRefGoogle Scholar
  62. 62.
    Suurmeijer TP, Doeglas DM, Moum T, et al. The Groningen activity restriction scale for measuring disability: its utility in international comparisons. Am J Public Health 1994; 84: 1270–3PubMedCrossRefGoogle Scholar
  63. 63.
    Loewenstein DA, Amigo E, Duara R, et al. A new scale for the assessment of functional status in Alzheimer’s disease and related disorders. J Gerontol 1989; 44: M114–21CrossRefGoogle Scholar
  64. 64.
    Mahurin RK, DeBettignies BH, Pirozzolo FJ. Structured assessment of independent living skills: preliminary report of a performance measure of functional abilities in dementia. J Gerontol 1991; 46: P58–66PubMedCrossRefGoogle Scholar
  65. 65.
    Kuriansky J, Gurland B. The performance test of activities of daily living. Int J Aging Hum Dev 1976; 7: 178–81Google Scholar
  66. 66.
    Dejong R, Osterlund OW, Roy GW. Measurement of quality-of-life changes in patients with Alzheimer’s disease. Clin Ther 1989; 11: 545–54PubMedGoogle Scholar
  67. 67.
    Demers L, Oremus M, Perrault A, et al. Review of outcome measurement instruments in Alzheimer’s disease drug trials: psychometric properties of functional and quality of life scales. J Geriatr Psychiatry Neurol 2000; 13(4): 170–80PubMedCrossRefGoogle Scholar
  68. 68.
    Teunisse S, Derix MMA, van Crevel H. Assessing the severity of dementia: patient and caregiver. Arch Neurol 1991; 48: 274–7PubMedCrossRefGoogle Scholar
  69. 69.
    Gelinas I, Gauthier L, McIntyre M. Development of a functional measure for persons with Alzheimer’s disease: the disability assessment for dementia. Am J Occup Ther 1999; 53: 471–81PubMedCrossRefGoogle Scholar
  70. 70.
    Feldman H, Sauter A, Donald A, et al. The disability assessment for dementia scale: a 12-month study of functional ability in mild to moderate severity Alzheimer disease. Alzheimer Dis Assoc Disord 2001; 15: 89–95PubMedCrossRefGoogle Scholar
  71. 71.
    Erzigkeit H, Lehfeld H, Pena-Casanova J, et al. The Bayer-activities of daily living scale (B-ADL): results from a validation study in three European countries. Dement Geriatr Cogn Disord 2001; 12: 348–58PubMedCrossRefGoogle Scholar
  72. 72.
    Hindmarch I, Lehfeld H, de Jongh P, et al. The Bayer activities of daily living scale (B-ADL). Dement Geriatr Cogn Disord 1998; 9 Suppl. 2: 20–6CrossRefGoogle Scholar
  73. 73.
    Bucks RS, Ashworth DI, Wilcock GK, et al. Assessment of activities of daily living in dementia: development of the Bristol Activities of Daily Living scales. Age Ageing 1996; 25: 113–20PubMedCrossRefGoogle Scholar
  74. 74.
    Byrne LM, Wilson PM, Bucks RS, et al. The sensitivity to change over time of the Bristol activities of daily living scale in Alzheimer’s disease. Int J Geriatr Psychiatry 2000; 15(7): 656–61PubMedCrossRefGoogle Scholar
  75. 75.
    Patterson MB, Mack JL. The Cleveland scale of activities of daily living (CSADL): its reliability and validity. J Clin Geropsychol 2001; 7(1): 15–28CrossRefGoogle Scholar
  76. 76.
    Galasko D, Bennett D, Sano M, et al. An inventory to assess activities of daily living for clinical trials in Alzheimer’s disease. The Alzheimer’s Disease Co-Operative Study. Alzheimers Dis Assoc Disord 1997; 11Suppl. 2: S33–9CrossRefGoogle Scholar
  77. 77.
    Galasko DR, Schmitt FA, Jin S, et al. Detailed assessment of cognition and activities of daily living in moderate to severe Alzheimer’s disease [abstract]. Neurobiol Aging 2000; 21Suppl. 1: S168CrossRefGoogle Scholar
  78. 78.
    Stern Y, Albert SM, Sano M, et al. Assessing patient dependence in Alzheimer’s disease. J Gerontol 1994; 49: M216–22PubMedCrossRefGoogle Scholar
  79. 79.
    Brickman AM, Riba A, Bell K, et al. Longitudinal assessment of patient dependence in Alzheimer disease. Arch Neurol 2002; 59: 1304–8PubMedCrossRefGoogle Scholar
  80. 80.
    Reisberg B, Finkel S, Overall J, et al. The Alzheimer’s disease activities of daily living international scale (ADL-IS). Int Psychogeriatr 2001; 13(2): 163–81PubMedCrossRefGoogle Scholar
  81. 81.
    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: 797–811PubMedCrossRefGoogle Scholar
  82. 82.
    Knopman DS, Knapp MJ, Gracon SI, et al. The clinician interview based impression (CIBI): a clinician’s global change rating scale in Alzheimer’s disease. Neurology 1994; 44: 2315–21PubMedCrossRefGoogle Scholar
  83. 83.
    Schneider LS, Olin JT. Clinical global impressions in Alzheimer’s clinical trials. Int Psychogeriatr 1996; 8: 277–90PubMedCrossRefGoogle Scholar
  84. 84.
    Schwartz GE. Development and validation of the geriatric evaluation by relative’s rating instrument (GERRI). Psychol Rep 1983; 53: 479–88PubMedCrossRefGoogle Scholar
  85. 85.
    Brane G, Gottfries CG, Winblad B. The Gottfries-Brane-Steen scale: validity, reliability and application in anti-dementia drug trials. Dement Geriatr Cogn Disord 2001; 12(1): 1–14PubMedCrossRefGoogle Scholar
  86. 86.
    Hughes CP, Berg L, Danziger WL, et al. A new clinical scale for the staging of dementia. Br J Psychiatry 1982; 140: 566–72PubMedCrossRefGoogle Scholar
  87. 87.
    Reisberg B, Ferris SH, de Leon MJ, et al. The global deterioration scale for assessment of primary degenerative dementia. Am J Psychiatry 1982; 139: 1136–9PubMedGoogle Scholar
  88. 88.
    Reisberg B. Functional assessment staging in Alzheimer’s disease: reliability, validity, and ordinality. Int Psychogeriatr 1992; 4 Suppl. 1: 55–9Google Scholar
  89. 89.
    Hamilton AW, Limacre JM, Wright BD, et al. Relationship between impairment and physical disability as measured by the functional independence measure. Arch Phys Med Rehabil 1993; 74: 566–73PubMedCrossRefGoogle Scholar
  90. 90.
    Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Md State Med J 1965; 14: 61–5PubMedGoogle Scholar
  91. 91.
    Swash M, Brooks DN, Day NE, et al. Clinical trials in Alzheimer’s disease. J Neurol Neurosurg Psychiatry 1991; 54: 178–81PubMedCrossRefGoogle Scholar
  92. 92.
    Poon LW. On the paradox of improving sensitivity of ADL scales for the detection of behavioral changes in early dementia. Int Psychogeriatr 1994; 6: 171–7PubMedCrossRefGoogle Scholar
  93. 93.
    Rubenstein LZ, Schairer C, Wieland GD, et al. Systematic biases in functional status assessment of elderly adults: effects of different data sources. J Gerontol 1984; 39(6): 686–91PubMedCrossRefGoogle Scholar
  94. 94.
    Zimmerman SI, Magaziner J. Methodological issues in measuring the functional status of cognitively impaired nursing home residents: the use of proxies and performance based measures. Alzheimer Dis Assoc Disord 1994; 8Suppl. 1: S281–90PubMedGoogle Scholar
  95. 95.
    Beck CK, Frank LB. Assessing functioning and self-care abilities in Alzheimer disease research. Alzheimer Dis Assoc Disord 1997; 11 Suppl. 6: 73–80Google Scholar
  96. 96.
    Rozzini R, Frisoni GB, Bianchetti A, et al. Physical performance test and activities of daily living scales in the assessment of health status in elderly people. J Am Geriatr Soc 1993; 41: 1109–13PubMedGoogle Scholar
  97. 97.
    Nygard L, Bernspang B, Fisher AG, et al. Comparing motor and process ability of persons with suspected dementia in home and clinic settings. Am J Occup Ther 1994; 48: 689–96PubMedCrossRefGoogle Scholar
  98. 98.
    Cotter EM, Burgio LD, Stevens AB, et al. Correspondence of the functional independence measure (FIM) self-care subscale with real-time observations of dementia patients’ ADL performance in the home. Clin Rehabil 2002; 16: 36–45PubMedCrossRefGoogle Scholar
  99. 99.
    Spector WD. Measuring functional and self-care abilities [abstract]. Conference on Defining and Measuring Outomes in Alzheimer’s Research; 1996 Sep 11–12; Washington, DCGoogle Scholar
  100. 100.
    Magaziner J. The use of proxy respondents in health surveys of the aged. In: Wallace RB, Wodson RF, editors. The epidemiologic study of the elderly. New York: Oxford University Press, 1991: 120–8Google Scholar
  101. 101.
    Feinstein A, Josephy BR, Wells CK. Scientific and clinical problems in indexes of functional disability. Ann Intern Med 1986; 105: 413–20PubMedGoogle Scholar
  102. 102.
    Qizilbash N, Whitehead A, Higgins J, et al. Cholinesterase inhibition for Alzheimer disease: a meta-analysis of the tacrine trials. Dementia Trialists’ Collaboration. JAMA 1998; 280(20): 1777–82Google Scholar
  103. 103.
    Tariot PN, Cummings JL, Katz IR, et al. A randomized, double-blind, placebo-controlled study of the efficacy and safety of donepezil in patients with Alzheimer’s disease in the nursing home setting. J Am Geriatr Soc 2001; 49(12): 1590–9PubMedCrossRefGoogle Scholar
  104. 104.
    Burns A, Rossor M, Hecker J, et al. The effects of donepezil in Alzheimer’s disease: results from a multinational trial. Dementia Geriatr Cogn Disord 1999; 10: 237–44CrossRefGoogle Scholar
  105. 105.
    Rogers SL, Friedhoff LT. The efficacy and safety of donepezil in patients with Alzheimer’s disease: results of a US multicenter, randomized, double-blind, placebo-controlled trial. The Donepezil Study Group. Dementia 1996; 7: 293–303Google Scholar
  106. 106.
    Winblad B, Engedal K, Soininen H, et al. A 1-year, randomized, placebo-controlled study of donepezil in patients with mild to moderate AD. Neurology 2001; 57: 489–95PubMedCrossRefGoogle Scholar
  107. 107.
    AD2000 Collaborative Group. Long-term donepezil treatment in 565 patients with Alzheimer’s disease (AD2000): randomized double-blind trial. Lancet 2004; 363: 2105–15CrossRefGoogle Scholar
  108. 108.
    Schneider LS, Anand R, Farlow MR. Systematic review of the efficacy of rivastigmine for patients with Alzheimer’s disease. Int J Geriatr Psychopharmacol 1998; 1Suppl. 1: S26–34Google Scholar
  109. 109.
    Wilcock GA, Lilienfeld S, Gaeus E. Efficacy and safety of galantamine in patients with mild to moderate Alzheimer’s disease: multicentre randomized controlled trial. Galantamine International-1 Study Group. BMJ 2000; 321: 1–7Google Scholar
  110. 110.
    Tariot PN, Solomon PR, Morris JC, et al. A 5-month, randomized, placebo-controlled trial of galantamine in AD. Galantamine USA-10 Study Group. Neurology 2000; 54: 2268–76Google Scholar
  111. 111.
    Raskind MA, Peskind ER, Wessel T, et al. Galantamine in AD: a 6-month randomized, placebo-controlled trial with a 6-month extension. Galantamine USA-1 Study Group. Neurology 2000; 54: 2261–8Google Scholar
  112. 112.
    Wilkinson D, Murray JR. Galantamine: a randomized, double-blind, dose-finding trial in patients with Alzheimer’s disease. Int J Geriatr Psychiatry 2001; 16(9): 852–7PubMedCrossRefGoogle Scholar
  113. 113.
    Farlow MR, Cyrus PA. Metrifonate therapy in Alzheimer’s disease: a pooled analysis of four randomized, double-blind, placebo-controlled trials. Dement Geriatr Cogn Disord 2000; 11(4): 202–11PubMedCrossRefGoogle Scholar
  114. 114.
    Feldman H, Gauthier S, Hecker J, et al. 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: 737–44PubMedCrossRefGoogle Scholar
  115. 115.
    Feldman H, Gauthier S, Hecker J, et al. A 24-week, randomized, double-blind study of donepezil in moderate to severe Alzheimer’s disease. Neurology 2001; 57: 613–20PubMedCrossRefGoogle Scholar
  116. 116.
    Reisberg B, Doody R, Stoffler A, et al. Memantine in moderate-to-severe Alzheimer’s disease. N Engl J Med 2003; 348: 1333–41PubMedCrossRefGoogle Scholar
  117. 117.
    Tariot PN, Farlow MR, Grossberg GT, et al. Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial. JAMA 2004; 291: 317–24PubMedCrossRefGoogle Scholar
  118. 118.
    Erkinjuntti T, Kurz A, Gauthier S, et al. Efficacy of galantamine in probable vascular dementia and Alzheimer’s disease combined with cerebrovascular disease: a randomized trial. Lancet 2002; 359: 1283–90PubMedCrossRefGoogle Scholar
  119. 119.
    Kumar V, Anand R, Messina J, et al. An efficacy and safety analysis of Exelon in Alzheimer’s disease patients with concurrent vascular risk factors. Eur J Neurol 2000; 7: 159–69PubMedCrossRefGoogle Scholar
  120. 120.
    Doody RS, Stevens JC, Beck C, et al. Practice parameter: management of dementia (an evidence-based review). Neurology 2001; 56: 1154–66PubMedCrossRefGoogle Scholar
  121. 121.
    Farlow M, Gracon SI, Hershey LA, et al. A 12-week, double-blind, placebo-controlled, parallel-group study of tacrine in patients with probable Alzheimer’s disease. JAMA 1992; 268: 2523–9PubMedCrossRefGoogle Scholar
  122. 122.
    Knapp MJ, Knopman DS, Solomon PR, et al. Controlled trials of high-dose tacrine in patients with Alzheimer’s disease. JAMA 1994; 271: 985–91PubMedCrossRefGoogle Scholar
  123. 123.
    Rosler M, Anand R, Cicin-Sain A, et al. Efficacy and safety of rivastigmine in patients with Alzheimer’s disease: international randomised controlled trial. BMJ 1999; 318: 633–9PubMedCrossRefGoogle Scholar
  124. 124.
    Corey-Bloom J, Anand R, Veach J, et al. A randomized trial evaluating the efficacy and safety of ENA 713 (rivastigmine tartrate), a new acetylcholinesterase inhibitor, in patients with mild to moderately severe Alzheimer’s disease. Int J Geriatr Psychopharmacol 1998; 1: 55–65Google Scholar
  125. 125.
    Schneider LS. AD2000: donepezil in Alzheimer’s disease [comment]. Lancet. 2004; 363: 2100–1PubMedCrossRefGoogle Scholar
  126. 126.
    Trinh N, Hoblyn J, Mohanty S, et al. Efficacy of cholinesterase inhibitors in the treatment of neurospychiatric symptoms and functional impairment in Alzheimer disease. JAMA 2003; 289: 210–6PubMedCrossRefGoogle Scholar
  127. 127.
    Callahan CM, Hendrie HC, Tierney WM. Documentation and evaluation of cognitive impairment in elderly primary care patients. Ann Intern Med 1995; 122: 422–9PubMedGoogle Scholar
  128. 128.
    Sternberg SA, Wolfson C, Baumgarten M. Undetected dementia in community-dwelling older people: the Canadian Study of Health and Aging. J Am Geriatr Soc 2000; 48(11): 1430–4PubMedGoogle Scholar
  129. 129.
    Boise L, Camicoli R, Morgan DL, et al. Diagnosing dementia: perspectives of primary care physicians. Gerontologist 1999; 39: 457–64PubMedCrossRefGoogle Scholar
  130. 130.
    Cummings JL. Use of cholinesterase inhibitors in clinical practice: evidence-based recommendations. Am J Geriatr Psychiatry 2003; 11: 131–45PubMedGoogle Scholar

Copyright information

© Adis Data Informotion BV 2004

Authors and Affiliations

  • Abhilash K. Desai
    • 1
  • George T. Grossberg
    • 1
  • Dharmesh N. Sheth
    • 1
  1. 1.Division of Geriatric PsychiatrySaint Louis University School of MedicineSaint LouisUSA

Personalised recommendations