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Keywords:

  • activities of daily living;
  • observation-based ADLs;
  • informant-based ADLs;
  • functional assessment;
  • caregiver burden;
  • caregiver psychological distress;
  • functional ability;
  • dementia;
  • cognitive impairment

OBJECTIVES: To assess the relationship between performance- and informant-based measures of activities of daily living (ADLs) in patients with early dementia and burden or psychological distress experienced by the patients' caregivers.

DESIGN: Descriptive study.

SETTING: Ambulatory center.

PARTICIPANTS: Thirty-four patient-caregiver dyads in which the patient had mild dementia (Mini-Mental State Examination score >17).

MEASUREMENTS: A performance-based ADL measure (the Direct Assessment of Functional Status (DAFS)) was administered to patients with mild dementia. Caregivers completed an informant-based measure of patient functional status (instrumental activities of daily living). Caregivers also completed the Caregiver Burden Inventory (CBI) and the Brief Symptom Inventory (BSI).

RESULTS: Significant correlations were found between the informant-based ADL measure and caregiver burden (CBI) and psychological distress (BSI) (correlation coefficient (r)=−0.34 to −0.71, all P<.05). Alternatively, fewer and weaker relationships were observed between the DAFS (performance-based) ADL measure and caregiver burden or distress ratings (r=−0.32 to −0.43, all P<.05). Of the seven tasks assessed using the DAFS, impairments in orientation, communication, financial, and transportation skills in patients were associated with greater time and developmental burden and greater hostility in caregivers. Impairment in financial skills in patients was the strongest predictor of time-dependence burden and hostility in caregivers, whereas impairment in patient transportation skills was the best predictor of developmental burden.

CONCLUSIONS: The ADL abilities of cognitively impaired patients can predict caregiver burden and psychological distress, with informant-based measures having the greatest association with patient impairment.