Cognitive rehabilitation in patients with dementia of the Alzheimer type and its impact on activities of daily living

Martina Tomagová, Ivana Bóriková, Michaela Miertová
Institute of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic

Korespondenční autor: Martina Tomagová (tomagova@jfmed.uniba.sk)

ISSN 1804-7181 (On-line)

Full verze:

Submitted:8. 10. 2012
Accepted: 13. 5. 2013
Published online: 28. 6. 2013

Summary

Aim: The aim of this pilot study is to demonstrate the possibility of using the resulting score of selected measurement tools to assess the impact of cognitive rehabilitation on carrying out ADL (activities of daily living) in patients with dementia of Alzheimer type. Methods: We used qualitative methods – a case study. Empirical data on two female patients were obtained by the following methods: interview with the patients and their relatives, observation of the patient, analysis of medical records, selected measurement tools to assess ADL and IADL (instrumental activities of daily living). Results: We presented two selected patients with mild stage of dementia of Alzheimer type and detected changes on the level of the ADL in patients during cognitive rehabilitation. For assessment of ADL we used the following tools: The Barthel Index of Activities of Daily Living (Barthel ADL) and The Lawton Instrumental Activities of Daily Living Scale (Lawton-Brody IADL). With repeated assessment of cognitive functions and the level of ADL performance (in patients before and after cognitive rehabilitation) by measurement tools, we did not determine changes in the comparison of input data. Discussion: Subjective ADL assessment of patients also provides important information for the evaluator, even though for self-assessed instruments there may be a discrepancy between subjective and objective statements and clinical findings. Complete self-sufficiency in ADL was maintained as well as the same level of the dependence in IADL. Decrease of the cognitive abilities in patient with dementia of Alzheimer type has resulted in an increase of the dependence on the implementation of an instrumental ADL. Lawton-Brody IADL identified an increasing reliance on instrumental ADL in patients. It is not realistic to expect an improvement in cognitive functions in dementia of Alzheimer type and the ADL level considering the course and the prognosis of the disease. Success can be understood as maintaining at least the existing level of functions. Conclusion: Stabilization of the ADL level in patients with dementia is an effect of complex therapy, not only of cognitive rehabilitation. The instruments used in case studies have limitations and they are appropriate screening tools in the assessment of ADL level.

Keywords: dementia; cognitive rehabilitation; activities of daily living; Barthel ADL; Lawton-Brody IADL

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