Hello Wayne,

There are some methods to assess physical function. As I understand the Functional Independence Measure (FIM) scale assesses physical and cognitive disability.

A colleague, Mauro Colombo, works in this particular area of research and he may be able to give you good advices on other scales and assessment tools.

 https://www.researchgate.net/profile/Mauro_Colombo/publications

In my personal experience working with individuals with dementia, I have used Timed Up and Go test and Six minute walk test. These tests are valid and are also indicated for individuals with dementia. These tests are also considered performance based tests - and are widely used to assess physical function in other chronic conditions not only dementia.

Regards,

Kamary

http://www.dementia-assessment.com.au/symptoms/fim_manual.pdf

http://ref.scielo.org/bhwqx6

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551396/

http://www.ncbi.nlm.nih.gov/pubmed/25176000

Hello again Wayne,

Just to clarify, the last article I am suggesting above,  was a study I did with older individuals. They did not have dementia (it was an exclusion criteria), but all performance-based tests that you may need to use to test function in your population with dementia were well described as part of this study. Good Luck!!

Hello,

You can find relevant methods described here:

Sobol NA, Hoffmann K, Vogel A, Lolk A, Gottrup H, Hogh P, et al. Associations between physical function, dual-task performance and cognition in patients with mild Alzheimer's disease. Aging Ment Health. 2015:1-8

Best wishes, Kasper Jørgensen

 Hi Kamary,

Thank you for your useful information. I know that FIM is quite universal in assessing both physical and cognitive functioning, but it is based on mostly the observation and judgment of health professionals during the designated tasks. Six minute walk and Timed up and go have been validated among patients with dementia, but high variability has been reported in some studies for the tests which take relatively short period of time to complete (such as timed up and go 30 second sit to stand). As you know that patients with dementia may not follow instructions properly and may have varied attention span, I wonder if there is any method to make sure that those tests are reproducible and increase their reliability. 

Wayne

http://www.ncbi.nlm.nih.gov/pubmed/19389792

Hi Jeanna,

Thanks for your answer. The assessment tool you suggested on physical activity is quite interesting. We usually use another one called Physical Activity Scale for the Elderly to assess older adults. Both of them are based on self-reported information from the caregivers. Is there any reliable tools to assess based on the physical performance of the patients with dementia?

Wayne

Since the eye is part of the brain, sending retinal photos to our center for blood flow assessment and remediation may prove to be useful objective measure of status AND the effect of interventions.

Hello Wayne,

I am not sure if there is "a method to make sure that those tests are reproducible and increase their reliability". I can tell you that to reproduce a test, you need to run the test again on the same population with similar characteristics and by doing that you can compare your results with previous results and then observe if the tests are truly reliable. I never heard of a method that makes sure functional tests are reproducible. Functional tests will show different results in different populations and this is the catch. You may expect that a test such as six minute walk test will show discrepant results, even in the same population, particularly, if there are different degrees of disability in the population being studied (dementia as your example). You know that the context or environment may influence the performance and in some cases even the population being study must be well controlled to justify that the test being used (six minute walk test or TUG) is reproduced as suggested based on its protocol, right? Having said that, you may expect that within a given group of individuals that represent a given population within a given context a test may be reproduced. Then you will be reproducing the tests and justifying its reliability and if you want validity as well. However, I do understand your point and I believe that your question is very important.

Good luck again,

Kamary

The FAST is an assessment tool used by hospices to determine both eligibility and decline.  It is subject to the clinician's assessment and should be accompanied by a detailed narrative description of cognition and functionality. It is easy to implement but without "painting the picture" leaves gaps in noting significant changes. For example "speaking 6 or less intelligible words" doesn't clarify the difference between a 6 word sentence with proper sentence structure that does relate to the question or conversation from a 6 word string of words that is clearly stated but loosely associated or repeating the same word six times. The clinician would need to document nonsensical sentences spoken and word salads from an organized statement. However, when FAST is completed successively with detail it can provide a clinical documentation of progressive clinical decline including communicability, ambulation, and degree of assistance needed to meet basic ADLs.

Juliann Pancari, RNBC, BSN, M.Ed, CCS, CHPCA

(Certified Hospice and Palliative Care Administrator)

 Hi Kamary,

Thanks again for your comments. I understand that how reliability and validity of an assessment tool can be developed (I'm conducting a study to validate a clinical assessment for people with dementia), and I know that all parameters such as the environment and other contexts must be well-controlled, so that the assessment really measure the performance of individuals. But since the performance varies depending on, not just the physical capability, but also the cognitive status (e.g. ability to comprehend instructions, attention span, executive function etc.), I wonder if there is method, either statistically or technically (how to conduct those physical function assessments), to incorporate the cognitive status which may truly reflect the physical capability of people with dementia. For example, the level of assistance offered by the assessor such as verbal or physical prompt may affect the performance of individuals. 

It's my random thought when I was planning my study. Hope you understand my point :)

Wayne

Yes Wayne,

I believe your idea is genuine. I truly hope some of the other suggesting above will help you with your research.

All the best,

Kamary

If you are searching for an easy tool to measure fine motor skills you may contact me. In our validation study (in German, alas) we found that it worked also among many demented patients.

I have been interested in this subject for many years and I always said it would make a great PhD for someone. Currently in Ireland and the UK the older persons "dependency" score is rated in residential care and the tools being used by the majority are the "Barthel" index which was actually designed for stroke patients and the MMSE which as academics we know is very unsuitable on the basis that there is no knowledge about what the residents MMSE was ever before the cognitive impairment developed. Some residents with Dementia can still perform many "functional" or "physical" tasks but are still very dependent in relation to supervision and safety so they end up getting a low dependency score due to their physical abilities and this does not tell the full story. This makes staffing allocation very difficult. Please keep me informend of your developments. 

Have you considered the FAST scale?  JG

No I hadn't known about it - have just taken a look - looks good. 

kind Wayne Chan

I've been directed into the discussion you ignited by Kamary Coriolano

here follow a review that you could look at, and the DAFS assessment tool

may I suggest DAD (Disability Assessment of Dementia) and also BANSS (Bedford Alzheimer Nursinf Severity Scale) for more advanced cases

best regards, Mauro

Thank you

Thank you very much Mauro.

dear Kamary, you're welcome, Mauro

This is a very interesting discussion.  The real issue is what you want from the scale.  If you are looking for some sense of capacity, then the suggestion of the DAD is spot-on. It captures initiation and planning. If you ware looking for a measure to track long-term decline in function, then the DAD also works.  But, I don't really find any work that tracks capacity or planning alone from the DAD, only work with the global scale score.  

The BANS-S is, as indicated, probably more helpful with more impaired persons.

But, if you want to understand more clearly the care needs of a person, then I don't really think the DAD or Bans-S are terribly helpful.  It is unclear what a DAD score of 62 vs 52 really means in terms of care needs?  52 is worse, but the scale score gives you little help in understanding how much help a person needs with ADLs or IADLs.

If what you are interested in is care needs and resources use you might be better served with information found in http://www.ncbi.nlm.nih.gov/pubmed/10619316. Morris' work gives one a clear intuitive sense of where a person is, in terms of their impairment and care needs, and it correlates well with the care time time required for a person. Note, though that these analyses focus on nursing home residents. 

Found the original paper in my personal library !

thanks for the hint, Mauro Colombo

The Neuro Psychiatric Inventory (NPI) may address some of the functionality questions raised above.  I've used the NPI-NH in my passive sleep sensor assessment in people with dementia. 

See Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44: 2308-2314.

I have discovered a method of analysis of retinal photographs that correlates with blood flow in the retina, which is essentially part of the brain. I have interventions that improve blood flow in the retina (brain?).

Dear Mauro,

Thanks for your information. The assessment tools you suggested are very useful not just on my research but also on my daily clinical practice. I will apply it when I need to assess the ADL functions of my clients with dementia.

I'm currently conducting a research on the assessment tools for the physical performance of people with dementia, specifically on functional mobility and exercise tolerance. It would be interesting to see the results.

Many thanks,

Wayne 

i do agree with Phillips's hint: MDS has world wide well acknowledged value, and the paper proposed is a milestone

waiting for your results, Mauro

I use the Rikli & Jonesw senior Fitness test to have an comparison what the possibilities are of people of the same age and wath people with demnetia are capable to. Than tehre are people how has an great difference with people with the same age and often has lie that in endurance and balance , but there are alos people with dementia that are capable to hold the level of there age. But overall all people with dementia can move lesser than she should accoring the age .

Succes 

jan van de Rakt