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Understanding dementia’s impact on Activities of Daily Living (ADLs) is critical for informing providers, caregivers, and families on how to best care for and support dementia patients.
Impairments in Activities of Daily Living, including the ability to complete basic ADLs such as eating, bathing, and dressing, accompany the cognitive, functional, and behavioral changes in dementia patients.
Below we detail several aspects of dementia’s impact on neurocognitive function, traditional methods for assessing dementia’s impact on Activities of Daily Living, their limitations, and how to bridge the gap to better patient care and support.
There are several cognitive and functional aspects of brain function that can hinder a patient’s ability to perform Activities of Daily Living, including executive functioning, memory, judgment, attention, and spatial memory.
Executive functioning refers to the high-level cognitive abilities required to control and coordinate other cognitive abilities and behaviors. The executive functioning of dementia patients can be affected in a number of ways, including in the ability to pay attention, organize and prioritize, focus on tasks, and self-monitor. Dementia patients often struggle with sequencing, planning, and organizing a set of tasks. For example, this may become apparent when performing multi-step activities such as washing their hair or getting dressed.
Many dementia patients, particularly in the later stages, experience memory loss. Symptoms of memory loss may include forgetting recently learned information, repeating the same question, and forgetting birthdays or other important dates and events and being unable to remember them later. Patients with memory loss may also struggle with remembering to change into clean clothes in the morning or brush their teeth and hair.
Judgment and decision-making skills are often impacted in dementia patients, as the parts of the brain involved in remembering, understanding, and processing information may be affected. Dementia patients may make inappropriate decisions such as wearing shorts and a t-shirt when it’s snowing outside, giving away money, or deciding that bathing is unnecessary.
Dementia patients may become easily distracted, struggle with concentrating, or have a short attention span, potentially impacting their ability to complete normal tasks. This may make starting and completing tasks like dressing, bathing, or eating more difficult.
Spatial memory is the ability to recall the locations of objects, places, or events. A patient in the early stages of dementia may forget where they placed objects in their environment and may even place objects in abnormal locations. When looking for misplaced objects, patients may have difficulty retracing their steps.
To assess a dementia patient’s ability to perform Activities of Daily Living, the Alzheimer’s Association recommends the use of the Katz ADL and Lawton-Brody Instrumental ADL (IADL). Both assessments aim to assess a patient’s ability to perform Activities of Daily Living or tasks necessary to live independently in a community.
The Katz ADL is typically administered by a caregiver and assesses the following activities:
The Lawton-Brody IADL is similar but is considered to assess Activities of Daily Living of higher complexity by evaluating the following activities:
While both assessments can provide a decent understanding of a patient’s function, they may not be sensitive to small, incremental, intra-individual change—in other words, they don’t sufficiently capture enough detail to ensure the patient is receiving proper care and support for their current neurocognitive functioning abilities.
Additionally, assessing a patient's ability to complete the six to eight types of activities through a demonstration of each task is very time-consuming and can often lead to self-reporting or surrogate reporting methods, resulting in significant inaccuracies such as the overestimation or underestimation of functional abilities. Due to the administrative needs of these assessments, it becomes difficult to assess the abilities of patients regularly, which is necessary to effectively update care plans and evaluate the changing needs of patients.
Assessing the changes in a patient's ability to complete ADLs longitudinally at a granular level is arguably the best measure of how a dementia patient’s brain and abilities are changing over time; however, this is often not feasible through traditional assessments.
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