February 2001
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23 Reads
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6 Citations
Archives of gerontology and geriatrics. Supplement
Functional decline is a core feature of dementia, but its relationship with cognitive impairment is not always predictable. In the present study, we looked for the cognitive and non-cognitive determinants of the functional status in subjects with Alzheimer's disease (AD) and vascular dementia (VD). We studied 85 patients referred to our outpatient clinic: 44 affected by AD and 41 by VD (NINCDS-ADRDA, and NINDS-AIREN criteria, respectively). Cognitive impairment was measured with mini mental state examination (MMSE) and with an extended neuropsychological battery; functional impairment with Barthel index (BI), basic activities of daily living (BADL) and instrumental activities of daily living (IADL); comorbidity with index of disease severity (IDS). Depressive symptoms were evaluated by the geriatric depression scale (GDS), behavioral disorders by the UCLA neuropsychiatric inventory (NPI). The two groups were matched for gender, age, educational level, MMSE, GDS and NPI. VD patients compared to AD showed a lower BI, a greater comorbidity, a more frequent presence of neurological gait disorders at the physical examination and a lower score at the tasks assessing selective attention and verbal fluency. In the multivariate analysis, measures of selective attention and of picture naming, together with the presence of neurological gait disorders, were independently related to BI. In our case-mix, VD patients were more disabled than those with AD, in spite of the same MMSE score, and showed more severe attentional defects.