tailieunhanh - CURRENT CLINICAL NEUROLOGY - PART 6

Sa sút trí tuệ mạch máu (VAD) là liên quan đến nhận thức, thể chất, và suy yếu chức năng và là một nguồn chính của tình trạng khuyết tật ở người cao tuổi (1,2). Phần lớn các khuyết tật báo cáo ở những bệnh nhân với VAD là do sự suy giảm trong hoạt động của cuộc sống hàng ngày | 12 Functional Impairment in Vascular Dementia Patricia A. Boyle and Deborah Cahn-Weiner 1. INTRODUCTION Vascular dementia VaD is associated with cognitive physical and functional impairments and is a major source of disability among the elderly 1 2 . Much of the disability reported among patients with VaD is attributable to declines in activities of daily living ADLs . ADLs are composed of instrumental and basic self-care abilities IADLs and BADLs respectively IADLs include complex behaviors such as cooking housekeeping and medication management and BADLs include more basic tasks such as grooming and feeding 3 . ADL impairments result in a diminished quality of life for patients and their caregivers 4 and an increased use of healthcare services 5 . ADL dysfunction also often precipitates nursing home placement 5 6 . The assessment of ADLs represents an important component of the evaluation of patients with VaD and an understanding of the determinants of ADL dysfunction can facilitate improved patient care. This chapter reviews ADL assessment methods the course of ADL declines and the determinants of ADL impairment among patients with VaD. The potential use of neuropsychological tests of executive function as a marker for ADL impairment is discussed and recommendations for clinical practice and future research are provided. 2. WHY IS IT IMPORTANT TO FORMALLY ASSESS ADLs IN PATIENTS WITH VaD The assessment of ADLs constitutes an important component of the diagnosis tracking and management of patients with VaD. The Diagnostic and Statistical Manual of Mental Disorders 4th ed. text revision DSM-IV-TR 7 and National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l Enseignement en Neurosciences NINDS-AIREN 8 criteria for VaD require the presence of cognitive deficits sufficient to cause significant declines in social or occupational functioning and clarify that ADL impairments must be the result of cognitive deficits not .