Assessment and care of the community-dwelling Alzheimer's disease patient

A two-year study of 159 community dwelling Alzheimer's disease (AD) patients evaluated in a geriatric clinic is reported. Patients were not as disabled as commonly supposed, having only a moderate reduction in cognitive function (Folstein mean Mini-Mental Status [MMS], 15.3) and physical activities of daily living (PADL), mean, 3.3, but were more dependent in their instrumental activities of daily living (IADL), mean, 1.9. Associated medical problems averaged 3.4 per patient. Forty-seven percent lived alone and 39% had not been out of the home in the previous week, making isolation a major concern. During the study, 34% went into nursing homes. Initial mean MMS of these patients was 12.4 compared to 16.6 for patients who remained at home, but activities of daily living (ADL) mean scores were not significantly different. Based on this assessment, the management of AD patients, including medication use, daycare, education and support for family caregivers, and nursing home placement, is discussed.