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