Abstract

Background: Maintenance of the remaining abilities of dementia patients is necessary to improve their quality of life and reduce the burden on caregivers.  This study aimed to identify the clinical factors that affect patients with severe dementias' remaining abilities in activities of daily living (ADL).

Methods: The participants were 93 patients with severe dementia as assessed using the Clinical Dementia Rating. The variables (ADL, cognitive function, behavioral symptoms, nutritional state, pain, comorbidities, muscle condition) were measured using the Physical Self-Maintenance Scale (PSMS), Mini-Mental State Examination (MMSE), Cognitive Test in Severe Dementia (CTSD), Neuropsychiatric Inventory Nursing Home version (NPI-NH), Cornell Scale for Depression in Dementia (CSDD), Mini-Nutritional Assessment Short Form (MNA-SF), Pain Assessment in Advanced Dementia (PAIN-AD), Charlson Comorbidity Index (CCI), Cumulative Illness Rating Scale-Geriatrics (CIRS-G), and muscle tone assessment.

Results: The logistic regression analyses identified the association between each item in PSMS as a dependent variable and the other rating as an  independent variables. Toileting correlated with CTSD, MMSE, MNA-SF, CSDD, and hypertonus of the knee. Feeding correlated with CTSD, MMSE, NPI-NH, and CSDD. Physical ambulation correlated with CTSD, MMSE, CSDD, CCI, hypertonus of the knee, and MNASF.

Conclusion: Many factors other than cognitive function affect each item of the ADL, such as agitation, comorbidities, hypertonus of the knee, and nutrition. We emphasize that intervention strategies need to be modified for the impairment of each ADL item to perform the remaining abilities for severe dementia.