The association between white matter changes and activities of daily living (ADL) in a large, well-defined cohort of patients with mild-to-moderate dementia (either Alzheimer’s disease or subcortical vascular dementia) were investigated. A total of 289 patients were divided into three groups (140 mild, 99 moderate, and 50 severe) depending on the degree of white matter changes as indicated on brain magnetic resonance image scans. Further, we analyzed the three groups’ performances on basic and instrumental ADL. The degree of white matter changes was associated with greater age, hypertension, previous history of stroke, higher Hachinski Ischemic Score, worse global cognitive and functional status, and an increased impairment of basic ADL and instrumental ADL. The increased impairment with regard to the severe group’s performance on both the basic and instrumental ADL remained significant after adjustment for age and hypertension. Tasks involving physical activities were most significant. This was the first study investigating the association between white matter changes and ADL in a large, well-defined dementia cohort. The present study suggests that severe white matter changes may be associated with higher impairment on both basic and instrumental ADL.

Keywords:
Dementia, White matter changes, Ischemia, Alzheimerߣs disease, Vascular dementia, Barthel Index, Instrumental activities of daily living
1.
Lawton MP, Brody EM: Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179–186.
2.
Mahoney FI, Barthel DW: Functional evaluation: The Barthel Index. Md State Med J 1965;14:61–65.
3.
Shah A, Hoxey K, Mayadunne V: Some predictors of mortality in acutely medically ill elderly inpatients. Int J Geriatr Psychiatry 2000;15:493–499.
4.
Galasko D, Bennett D, Sano M, Ernesto C, Thomas R, Grundman M, Ferris S: An inventory to assess activities of daily living for clinical trials in Alzheimer’s disease. The Alzheimer’s Disease Cooperative Study. Alzheimer Dis Assoc Disord 1997;11(suppl 2):S33–S39.
5.
Hindmarch I, Lehfeld H, de Jongh P, Erzigkeit H: The Bayer Activities of Daily Living Scale (B-ADL). Dement Geriatr Cogn Disord 1998;9(suppl 2):20–26.
6.
Gelinas I, Gauthier L, McIntyre M, Gauthier S: Development of a functional measure for persons with Alzheimer’s disease: the disability assessment for dementia. Am J Occup Ther 1999;53:471–481.
7.
Ku H, Kim J, Kwon E, Kim S, Lee H, Ko H, Jo S, Kim D: A study on the reliability and validity of Seoul-Instrumental Activities of Daily Living (S-IADL). J Korean Neuropsychiatr Assoc 2004;43:189–199.
8.
Pohjasvaara TI, Jokinen H, Ylikoski R, Kalska H, Mantyla R, Kaste M, Erkinjuntti T: White matter lesions are related to impaired instrumental activities of daily living poststroke. J Stroke Cerebrovasc Dis 2007;16:251–258.
9.
Samuelsson M, Soderfeldt B, Olsson GB: Functional outcome in patients with lacunar infarction. Stroke 1996;27:842–846.
10.
Gouw AA, Van der Flier WM, van Straaten EC, Barkhof F, Ferro JM, Baezner H, Pantoni L, Inzitari D, Erkinjuntti T, Wahlund LO, Waldemar G, Schmidt R, Fazekas F, Scheltens P: Simple versus complex assessment of white matter hyperintensities in relation to physical performance and cognition: the LADIS study. J Neurol 2006;253:1189–1196.
11.
Pantoni L, Poggesi A, Basile AM, Pracucci G, Barkhof F, Chabriat H, Erkinjuntti T, Ferro JM, Hennerici M, O’Brien J, Schmidt R, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitari D: Leukoaraiosis predicts hidden global functioning impairment in nondisabled older people: the LADIS (Leukoaraiosis and Disability in the Elderly) study. J Am Geriatr Soc 2006;54:1095–1101.
12.
Inzitari D, Simoni M, Pracucci G, Poggesi A, Basile AM, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Hennerici M, Langhorne P, O’Brien J, Barkhof F, Visser MC, Wahlund LO, Waldemar G, Wallin A, Pantoni L: Risk of rapid global functional decline in elderly patients with severe cerebral age-related white matter changes: the LADIS study. Arch Intern Med 2007;167:81–88.
13.
Steffens DC, Bosworth HB, Provenzale JM, MacFall JR: Subcortical white matter lesions and functional impairment in geriatric depression. Depress Anxiety 2002;15:23–28.
14.
Ylikoski R, Ylikoski A, Erkinjuntti T, Sulkava R, Raininko R, Tilvis R: White matter changes in healthy elderly persons correlate with attention and speed of mental processing. Arch Neurol 1993;50:818–824.
15.
Morris JC: The clinical dementia rating: current version and scoring rules. Neurology 1993;43:2412–2414.
16.
Blacker D, Albert MS, Bassett SS, Go RC, Harrell LE, Folstein MF: Reliability and validity of NINCDS-ADRDA criteria for Alzheimer’s disease. The National Institute of Mental Health Genetics Initiative. Arch Neurol 1994;51:1198–1204.
17.
Kang Y, Na D: Seoul Neuropsychological Screening Battery. Incheon, Human Brain Research and Consulting, 2003.
18.
Kim H, Na D: Normative data on the Korean version of the Boston Naming Test. J Clin Exp Neuropsychol 1999;21:127–133.
19.
Pantoni L, Basile AM, Pracucci G, Asplund K, Bogousslavsky J, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Hennerici M, O’Brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitari D: Impact of age-related cerebral white matter changes on the transition to disability – the LADIS study: rationale, design and methodology. Neuroepidemiology 2005;24:51–62.
20.
Scheltens P, Barkhof F, Leys D, Pruvo JP, Nauta JJ, Vermersch P, Steinling M, Valk J: A semiquantative rating scale for the assessment of signal hyperintensities on magnetic resonance imaging. J Neurol Sci 1993;114:7–12.
21.
Wade DT, Collin C: The Barthel ADL Index: a standard measure of physical disability? Int Disabil Stud 1988;10:64–67.
22.
Gresham GE, Phillips TF, Labi ML: ADL status in stroke: relative merits of three standard indexes. Arch Phys Med Rehabil 1980;61:355–358.
23.
Baezner H, Blahak C, Poggesi A, Pantoni L, Inzitari D, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Langhorne P, O’Brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Hennerici MG: Association of gait and balance disorders with age-related white matter changes: the LADIS study. Neurology 2008;70:935–942.
24.
Poggesi A, Pracucci G, Chabriat H, Erkinjuntti T, Fazekas F, Verdelho A, Hennerici M, Langhorne P, O’Brien J, Scheltens P, Visser MC, Crisby M, Waldemar G, Wallin A, Inzitari D, Pantoni L: Urinary complaints in nondisabled elderly people with age-related white matter changes: the Leukoaraiosis and Disability (LADIS) study. J Am Geriatr Soc 2008;56:1638–1643.
© 2010 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.