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Activities of Daily Living inActivities of Daily Living in Frontotemporal Dementiap
Eneida Mioshi
Frontotemporal dementiaFrontotemporal dementiaFTD
Behavioural variant Language variantsBehavioural variantBv-FTD
Language variants(progressive aphasia)
Semantic Progressive N Fl tSemantic
Dementia Non-Fluent Aphasia
OutlineOutline
• ObjectivesD fi iti f A ti iti f D il Li i• Definition of Activities of Daily Living (ADLs)
• Methods• Results• General Strategies
OutlineOutline
• ObjectivesD fi iti f A ti iti f D il Li i• Definition of Activities of Daily Living (ADLs)
• Methods• Results• General Strategies
ObjectivesObjectives
• Present the patterns of activity dysfunction across the three FTD variantsacross the three FTD variants
P t t t i f dd i t• Present strategies for addressing most common problems
OutlineOutline
• ObjectivesD fi iti f A ti iti f D il Li i• Definition of Activities of Daily Living (ADLs)
• Methods• Results
BADLs IADLs
ADLADLs =Activities of daily living
BADLs = IADLs = basic instrumental
Activity performance: stagesActivity performance: stages
Initiation Planning Execution
Activity performanceActivity performance
I P EI P EI P EI P E
Frontal lobes Physical
L k f ti ti
Frontal lobesLack of motivation
Planning difficulties
Difficulties in problem solving
Misjudgement
OutlineOutline
• ObjectivesD fi iti f A ti iti f D il Li i• Definition of Activities of Daily Living (ADLs)
• Methods• Results• General Strategies
MethodsMethods
• Cross sectional study: n = 59b FTD (15) SD (15) PNFA (10) AD (19)– bv-FTD (15), SD (15), PNFA (10), AD (19)
Age: 64 6; Edu: 11 6 y; duration: 4 9y• Age: 64.6; Edu: 11.6 y; duration: 4.9y– Outpatients of Cambridge Clinics
• Disability Assessment of Dementia
OutlineOutline
• ObjectivesD fi iti f A ti iti f D il Li i• Definition of Activities of Daily Living (ADLs)
• Methods• Results• General Strategies
Instrumental ADLsInstrumental ADLss
80%
100%
utio
n of
pat
ient
s
40%
60%
Dis
tribu
0%
20%
0%PNFA Semantic Dementia bv-FTD AD
Moderate to severeNo change
Severe to very severe impairmentMarginal to mild impairment
Mioshi et al, 2007
Instrumental activitiesInstrumental activities
80
100
el o
f abi
lity
40
60
el o
f abi
lity
Leve
0
20Leve
Meal prep. Teleph. Outing Fin. and corr. Medic. Leis. andHous.
FTD PNFA SD
Basic ADLsBasic ADLs
80%
100%
nts
40%
60%
butio
n of
pat
ien
0%
20%
PNFA Semantic bv-FTD AD
Dis
trib
Dementia
Moderate to severe
Severe to very severe impairment
No change
Marginal to mild impairment y pg p
Mioshi et al, 2007
Basic activitiesBasic activities
80
100
el o
f abi
lity
40
60
el o
f abi
lity
Leve
0
20
Leve
Hygiene Dressing Continence Eating
FTD PNFA SD
OutlineOutline
• ObjectivesD fi iti f A ti iti f D il Li i• Definition of Activities of Daily Living (ADLs)
• Methods• Results• General Strategies
General StrategiesGeneral Strategies
• Facilitate performance• Prevent distress• Keep patient as active as possible• Focus on abilities
Meal preparationMeal preparation
Multi tasking difficulties: breaking• Multi tasking difficulties: breaking down in single steps
Using the telephoneUsing the telephone
N t i• Not passing on messages: answering machine; turning the phone down; diverting calls; askingphone down; diverting calls; asking friends to call mobile
M ki i ll it i• Making excessive calls: monitoring outgoing calls
DrivingDriving
Lack of judgment; impulsivity:• Lack of judgment; impulsivity: have a driving assessment arranged by a third partyarranged by a third party
ShoppingShopping
• Difficulties in understanding nameDifficulties in understanding name of products: show products; vegetables
FinancesFinances
• Overspending: reduce access to t t t b hone account; contact branch
manager
• Multiple cards: keep one pin number only
CorrespondenceCorrespondence
• Intercepting mail: get a post box; have mail redirected to a family member
MedicationsMedications
•Refusal: discuss with doctor and•Refusal: discuss with doctor and pharmacist alternative formula.
HousechoresHousechores
• Planning difficulties: break down in single stepsin single steps
HygieneHygiene
Planning difficulties: break down• Planning difficulties: break down in single steps
•Lack of initiative: routine; association with an external event
DressingDressing
• Wearing same clothes: have a set sorted for him/her; hide dirty laundry in washing machine
ToiletToilet
Accidents: avoid liquids after• Accidents: avoid liquids after dinner
EatingEating
• Lack of manners: warn friends in• Lack of manners: warn friends in advance
Overeating: take dishes from the• Overeating: take dishes from the table
Take home messageTake home message• FTD patients are markedly impaired in everyday p y p y y
life
• SD and PNFA present with problems beyond language
• In bv-FTD, BADLs are more affected than in AD and language variantsand language variants
• Caregiver support is fundamentalCaregiver support is fundamental
Why?Why?
• Patient • Caregiver• Patient
A ti
• Caregiver
Sh i– Active – Sharing
– Participation – Time
– Confidence
Stress
AcknowledgementsAcknowledgements
All patients and their familiesAll patients and their families
John Hodges Kate Dawson
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