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| |  Daily-Living Assessment Predicts Risk of Nursing-Home Placement for Alzheimer's Patients: Presented at ANA By Jacquelyn Beals WASHINGTON, DC -- October 17, 2007 -- Scores on the Activities of Daily Living (ADL) scale of the Alzheimer's Disease Cooperative study (ADCS) provide an important tool for predicting when patients will require nursing-home care, it was noted here at the Annual Meeting of the American Neurological Association (ANA). Hind T. Hatoum, PhD, Center for Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, Illinois, United States and colleagues noted "increased concern among health-care authorities that the cognitive deterioration of patients with AD, as measured by established tools,... [is] not always sufficient to reflect AD progression, leading to an increased risk of nursing-home placement." The currently established tool for such prediction is the Mini-Mental-State-Examination (MMSE), which measures cognitive functioning. Since nursing-home placement is the greatest cost of care in late stages of AD, a better predictor of the need for nursing-home placement could reduce personal, social, and financial costs and guide the development of cost-effective treatments. Scores on the Activities of Daily Living (ADL) scale of the Alzheimer's Disease Cooperative study (ADCS) reflect patients' performance in 23 activities, assessed by a caregiver, with higher scores indicating better functioning and longer time until nursing-home placement. Data were derived from a 24-month, prospective, randomised, parallel-group drug trial that compared the effects of rivastigmine and donepezil in 994 AD patients. The present study analysed data from 800 of these patients for whom information on living status was available. Data contributing to the predictive model were: age, gender, initial total ADL (TADL) score, and TADL 24 months later. The mean initial age of participants was 75.4 years; 69.7% were women. The TADL score comprises Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) scores. These assess abilities ranging from skills needed for personal care and communication, to hobbies and interests, to decision-making. The total score ranges from 0 to 78. Regression analysis showed that the hazard ratio of nursing-home placement increased with: · Greater age -- hazard ratio increased 3.7% per year of age Higher initial TADL score decreased the hazard ratio of nursing-home placement by 1.9% for each TADL point. By comparison, MMSE change from baseline was not a significant predictor in the ADL models, the authors noted. For the test population (n = 800), the mean initial BADL score was 18.6 +- 4.1; mean initial TADL score was 29.9 +- 13.4; mean initial TADL score was 48.4 +- 16.6. After 24 months, the mean TADL score changed by -15.1 +- 16.9. This study was supported by Novartis Pharmaceuticals. Dr. Hatoum is a consultant for Novartis; other authors include Novartis consultants or clinical investigators, have received speaker honoraria, or are Novartis employees.
[Presentation title: Predicting Time to Nursing Home Placement Based on Activities of Daily Living Scores. Abstract T-16]
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