Affiliations: [a] Human Biology Integration Foundation, Deep Human Biology Learning, Eisai Co. Ltd., Tokyo, Japan
| [b] Government Relations Strategy Department, Eisai Co. Ltd., Tokyo, Japan
| [c] Human Biology Integration Foundation, Deep Human Biology Learning, Eisai Co. Ltd., Ibaraki, Japan
| [d] Microbes & Host Defense Domain, Deep Human Biology Learning, Eisai Co. Ltd., Ibaraki, Japan
| [e]
School of Integrative and Global Majors, University of Tsukuba, Ibaraki, Japan
Correspondence:
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Correspondence to: Ken Aoshima, PhD, Microbes & Host Defense Domain, Deep Human Biology Learning, Eisai Co. Ltd., 5-1-3 Tokodai, Tsukuba-shi, Ibaraki 300-2635, Japan. Tel.: +81 29 847 5900; Fax: +81 29 847 7614; E-mail: [email protected].
Abstract: Background:Preserving activities of daily living (ADL) is the key issue for Alzheimer’s disease (AD) patients and their caregivers. Objective:To clarify the ADL level of AD patients at diagnosis and the risk factors associated with decreased ADL during long-term care (≤3 years). Methods:Medical records of AD patients in a Japanese health insurance claims database were analyzed retrospectively to determine ADL using the Barthel Index (BI) and identify the risk factors associated with decreased ADL. Results:A total of 16,799 AD patients (mean age at diagnosis: 83.6 years, 61.5% female) were analyzed. Female patients were older (84.6 versus 81.9 years; p < 0.001) and had lower BI (46.8 versus 57.6; p < 0.001) and body mass index (BMI) (21.0 versus 21.7 kg/m2; p < 0.001) than male patients at diagnosis. Disability (BI≤60) increased at age≥80 years and was significantly higher in females. Complete disability was most frequent for bathing and grooming. Risk factors for decreased ADL were determined separately by sex through comparing the ADL-preserved and ADL-decreased groups using propensity score matching by age and BI and multivariable logistic regression analysis. In males, decreased ADL was significantly associated with BMI < 21.5 kg/m2, stroke, and hip fracture, and inversely associated with hyperlipidemia. In females, decreased ADL was significantly associated with BMI < 21.5 kg/m2 and vertebral and hip fractures, and inversely associated with lower back pain. Conclusion:AD patients with low BMI, stroke, and fractures had increased risks of decreased ADL; such patients should be identified early and managed appropriately, including rehabilitation to preserve ADL.
Keywords: Activities of daily living, Alzheimer’s disease, baths, body mass index, bone, fractures, stroke
