Hippocampal subfields and decline in activities of daily living in Alzheimer’s disease and dementia with Lewy bodies

Background: Hippocampal atrophy is presented in Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB). Cognition, dual-tasks, muscular function, goal-related behaviors and neuropsychiatric symptoms are linked to hippocampal volumes and may lead to functional decline in activities of daily liv...

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Autores:
Borda, Miguel Germán
Jaramillo Jiménez, Alberto
Ferreira, Daniel
Garcia-Cifuentes, Elkin
Vik-Mo, Audun Osland
Aarsland, Dag
Oppedal, Ketil
Tovar Rios, Diego Alejandro
Tipo de recurso:
Article of journal
Fecha de publicación:
2020
Institución:
Universidad Autónoma de Occidente
Repositorio:
RED: Repositorio Educativo Digital UAO
Idioma:
eng
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oai:red.uao.edu.co:10614/13299
Acceso en línea:
https://hdl.handle.net/10614/13299
Palabra clave:
Demencia
Enfermedad de Alzheimer
Activities of daily living
Alzheimer’s disease
Dementia with Lewy bodies
Functional decline
Hippocampal subfields
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openAccess
License
Derechos reservados - Future Science Group, 2020
id REPOUAO2_38a7709aff98a88371de82c592676e53
oai_identifier_str oai:red.uao.edu.co:10614/13299
network_acronym_str REPOUAO2
network_name_str RED: Repositorio Educativo Digital UAO
repository_id_str
dc.title.eng.fl_str_mv Hippocampal subfields and decline in activities of daily living in Alzheimer’s disease and dementia with Lewy bodies
title Hippocampal subfields and decline in activities of daily living in Alzheimer’s disease and dementia with Lewy bodies
spellingShingle Hippocampal subfields and decline in activities of daily living in Alzheimer’s disease and dementia with Lewy bodies
Demencia
Enfermedad de Alzheimer
Activities of daily living
Alzheimer’s disease
Dementia with Lewy bodies
Functional decline
Hippocampal subfields
title_short Hippocampal subfields and decline in activities of daily living in Alzheimer’s disease and dementia with Lewy bodies
title_full Hippocampal subfields and decline in activities of daily living in Alzheimer’s disease and dementia with Lewy bodies
title_fullStr Hippocampal subfields and decline in activities of daily living in Alzheimer’s disease and dementia with Lewy bodies
title_full_unstemmed Hippocampal subfields and decline in activities of daily living in Alzheimer’s disease and dementia with Lewy bodies
title_sort Hippocampal subfields and decline in activities of daily living in Alzheimer’s disease and dementia with Lewy bodies
dc.creator.fl_str_mv Borda, Miguel Germán
Jaramillo Jiménez, Alberto
Ferreira, Daniel
Garcia-Cifuentes, Elkin
Vik-Mo, Audun Osland
Aarsland, Dag
Oppedal, Ketil
Tovar Rios, Diego Alejandro
dc.contributor.author.spa.fl_str_mv Borda, Miguel Germán
Jaramillo Jiménez, Alberto
Ferreira, Daniel
Garcia-Cifuentes, Elkin
Vik-Mo, Audun Osland
Aarsland, Dag
Oppedal, Ketil
Tovar Rios, Diego Alejandro
dc.contributor.corporatename.spa.fl_str_mv Future Medicine
dc.subject.lemb.spa.fl_str_mv Demencia
topic Demencia
Enfermedad de Alzheimer
Activities of daily living
Alzheimer’s disease
Dementia with Lewy bodies
Functional decline
Hippocampal subfields
dc.subject.armarc.spa.fl_str_mv Enfermedad de Alzheimer
dc.subject.proposal.eng.fl_str_mv Activities of daily living
Alzheimer’s disease
Dementia with Lewy bodies
Functional decline
Hippocampal subfields
description Background: Hippocampal atrophy is presented in Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB). Cognition, dual-tasks, muscular function, goal-related behaviors and neuropsychiatric symptoms are linked to hippocampal volumes and may lead to functional decline in activities of daily living. We examined the association between baseline hippocampal subfield volumes (HSv) in mild AD and DLB, and functional decline. Materials & methods: 12 HSv were computed from structural magnetic resonance images using Freesurfer 6.0 segmentation. Functional decline was assessed using the rapid disability rating scale score. Linear regressions were conducted. Results: In AD, HSv were smaller bilaterally. However, HSv were not associated with functional decline. Conclusion: Functional decline does not depend on HSv in mild AD and DLB
publishDate 2020
dc.date.issued.none.fl_str_mv 2020-09-24
dc.date.accessioned.none.fl_str_mv 2021-10-01T14:13:18Z
dc.date.available.none.fl_str_mv 2021-10-01T14:13:18Z
dc.type.spa.fl_str_mv Artículo de revista
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dc.type.content.eng.fl_str_mv Text
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dc.identifier.issn.none.fl_str_mv 17582024
dc.identifier.uri.none.fl_str_mv https://hdl.handle.net/10614/13299
identifier_str_mv 17582024
url https://hdl.handle.net/10614/13299
dc.language.iso.eng.fl_str_mv eng
language eng
dc.relation.citationedition.spa.fl_str_mv Volumen 10, número 6 (2020)
dc.relation.citationissue.spa.fl_str_mv 6
dc.relation.citationvolume.spa.fl_str_mv 10
dc.relation.cites.eng.fl_str_mv Borda, M.G., Jaramillo Jimenez, A., Tovar Rios, D. A., Ferreira, D., Garcia Cifuentes, E., Vik-Mo, A.O., Vera A., Aarsland, D., Ketil O. (2020). Hippocampal subfields and decline in activities of daily living in Alzheimer’s disease and dementia with Lewy bodies. Neurodegenerative Disease Management. (Vol. 10 (6), pp. 357-367. https://doi.org/10.2217/nmt-2020-0039
dc.relation.ispartofjournal.eng.fl_str_mv Neurodegenerative Disease Management
dc.relation.references.eng.fl_str_mv 1. Mueller SG, Schuff N, Yaffe K, Madison C, Miller B, Weiner MW. Hippocampal atrophy patterns in mild cognitive impairment and Alzheimer’s disease. Hum. Brain Mapp. 31(9), 1339–1347 (2010).
2. Mak E, Su L, Williams GB et al. Differential atrophy of hippocampal subfields: a comparative study of dementia with lewy bodies and Alzheimer disease. Am. J. Geriatr. Psychiatry 24(2), 136–143 (2016).
3. Oppedal K, Ferreira D, Cavallin L et al. A signature pattern of cortical atrophy in dementia with Lewy bodies: a study on 333 patients from the European DLB consortium. Alzheimers Dement. 15(3), 400–409 (2019). Dementia with Lewy bodies (DLB) of DemVest cohort had higher scores on all the three atrophy scales than normal controls but had less medial temporal lobe atrophy than those with Alzheimer’s disease. The most common pattern of atrophy of DLB was hippocampal-sparing.
4. Irwin DJ, Hurtig HI. The contribution of tau, amyloid-beta and alpha-synuclein pathology to dementia in Lewy body disorders. J. Alzheimer’s Dis. Parkinsonism 8(4), 444 (2018).
5. Adamowicz DH, Roy S, Salmon DP et al. Hippocampal α-synuclein in dementia with lewy bodies contributes to memory impairment and is consistent with spread of pathology. J. Neurosci. 37(7), 1675–1684 (2017).
6. Mak E, Gabel S, Su L et al. Multi-modal MRI investigation of volumetric and microstructural changes in the hippocampus and its subfields in mild cognitive impairment, Alzheimer’s disease, and dementia with Lewy bodies. Int. Psychogeriatrics 29(4), 545–555 (2017).
7. Schmidt MF, Storrs JM, Freeman KB et al. A comparison of manual tracing and FreeSurfer for estimating hippocampal volume over the adult lifespan. Hum. Brain Mapp. 39(6), 2500–2513 (2018).
8. de Schipper LJ, Hafkemeijer A, van der Grond J, Marinus J, Henselmans JML, van Hilten JJ. Regional structural hippocampal differences between dementia with lewy bodies and Parkinson’s disease. J. Parkinsons. Dis. 9(4), 775–783 (2019).
9. Yassa MA, Stark SM, Bakker A, Albert MS, Gallagher M, Stark CEL. High-resolution structural and functional MRI of hippocampal CA3 and dentate gyrus in patients with amnestic Mild Cognitive Impairment. Neuroimage 51(3), 1242–1252 (2010).
10. Foo H, Mak E, Chander RJ et al. Associations of hippocampal subfields in the progression of cognitive decline related to Parkinson’s disease. NeuroImage Clin. 14, 37–42 (2016).
11. Chow N, Aarsland D, Honarpisheh H et al. Comparing hippocampal atrophy in Alzheimer’s dementia and dementia with lewy bodies. Dement. Geriatr. Cogn. Disord. 34(1), 44–50 (2012).
12. López Ruiz JR, Osuna Carrasco LP, L´opez Valenzuela CL et al. The hippocampus participates in the control of locomotion speed. Neuroscience 311(October), 207–215 (2015).
13. Hong S, Kim S, Yoo J et al. Slower gait speed predicts decline in instrumental activities of daily living in community-dwelling elderly: 3-year prospective finding from living profiles of older people survey in Korea. J. Clin. Gerontol. Geriatr. 7(4), 141–145 (2016). In a representative sample of Korean older adults, decreased gait speed has been evaluated and associated with dependency on instrumental activities of daily living (ADL).
14. Lee M-T, Jang Y, Chang W-Y. How do impairments in cognitive functions affect activities of daily living functions in older adults? PLoS ONE 14(6), e0218112 (2019).
15. Aarsland D, Rongve A, Piepenstock Nore S et al. Frequency and case identification of dementia with Lewy bodies using the revised consensus criteria. Dement. Geriatr. Cogn. Disord. 26(5), 445–452 (2008).
16. Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J. Am. Geriatr. Soc. 16(5), 622–626 (1968).
17. Folstein MF, Folstein SE, McHugh PR. ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12(3), 189–198 (1975).
18. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of alzheimer’s disease: report of the NINCDS-ADRDA work group* under the auspices of department of health and human services task force on alzheimer’s disease. Neurology 34(7), 939–944 (1984).
19. McKeith IG, Dickson DW, Lowe J et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB consortium. Neurology 65(12), 1863–1872 (2005).
20. Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br. J. Psychiatry 140(6), 566–572 (1982).
21. Skogseth R, Hortob´agyi T, Soennesyn H et al. Accuracy of clinical diagnosis of dementia with lewy bodies versus neuropathology. J. Alzheimer’s Dis. 59(4), 1139–1152 (2017).
22. Brækhus AEKBA. ‘Ferdigheter i dagliglivet - RDRS-2’. (2000). https://nhi.no/skjema-og-kalkulatorer/skjema/geriatripleie/f erdigheter-i-dagliglivet-rdrs-2/
23. Fischl B, Dale AM. Measuring the thickness of the human cerebral cortex from magnetic resonance images. Proc. Natl Acad. Sci. USA 97(20), 11050–11055 (2000).
24. Iglesias JE, Augustinack JC, Nguyen K et al. A computational atlas of the hippocampal formation using ex vivo, ultra-high resolution MRI: application to adaptive segmentation of in vivo MRI. Neuroimage 115, 117–137 (2015).
25. Saunders S, Muniz-Terrera G, Watson J et al. Participant outcomes and preferences in Alzheimer’s disease clinical trials: the electronic person-specific outcome measure (ePSOM) development program. Alzheimer’s Dement. Transl. Res. Clin. Interv. 4, 694–702 (2018).
26. Ha E, Kim K. Factors that influence activities of daily living in the elderly with probable dementia. J. Psychiatr. Ment. Health Nurs. 21(5), 447–454 (2014). A third of the ADL score was determined by stroke history, frequency of exercise, urinary and fecal incontinence, and cognitive decline. The authors highlight multidisciplinary interventions to improve ADL.
27. Giebel CM, Sutcliffe C, Stolt M et al. Deterioration of basic activities of daily living and their impact on quality of life across different cognitive stages of dementia: a European study. Int. Psychogeriatrics 26(8), 1283–1293 (2014). Impairments in each of the ADL are very variable across dementia stages. Some activities such as continence can be affected in any stage, others (i.e., bathing) in severe stages while toileting or feeding remained relatively intact.
28. Shah BM, Hajjar ER. Polypharmacy, Adverse Drug Reactions, and Geriatric Syndromes. Clin. Geriatr. Med. 28(2), 173–186 (2012).
29. Borda MG, Soennesyn H, Steves CJ, Osland Vik-Mo A, Pérez-Zepeda MU, Aarsland D. Frailty in older adults with mild dementia: dementia with lewy bodies and Alzheimer’s disease. Dement. Geriatr. Cogn. Dis. Extra 9(1), 176–183 (2019). A frailty syndrome has been described in mild Alzheimer’s disease and mild DLB patients of DemVest cohort. This frailty index is a composite of comorbidities, cognitive and neuropsychiatric features. DLB patients had a higher risk of frailty.
30. Ezzati A, Katz MJ, Lipton ML, Lipton RB, Verghese J. The association of brain structure with gait velocity in older adults: a quantitative volumetric analysis of brain MRI. Neuroradiology 57(8), 851–861 (2015).
31. Knierim JJ. The hippocampus. Curr. Biol. 25(23), R1116–R1121 (2015).
32. Evans TE, Adams HHH, Licher S et al. Subregional volumes of the hippocampus in relation to cognitive function and risk of dementia. Neuroimage 178, 129–135 (2018).
33. Carmichael O, Xie J, Fletcher E, Singh B, DeCarli C. Alzheimer’s Disease Neuroimaging Initiative. Localized hippocampus measures are associated with Alzheimer pathology and cognition independent of total hippocampal volume. Neurobiol. Aging 33(6), 1124.e31–41 (2012).
34. Delli Pizzi S, Franciotti R, Bubbico G, Thomas A, Onofrj M, Bonanni L. Atrophy of hippocampal subfields and adjacent extrahippocampal structures in dementia with lewy bodies and Alzheimer’s disease. Neurobiol. Aging 40, 103–109 (2016).
35. Burton EJ, Barber R, Mukaetova-Ladinska EB et al. Medial temporal lobe atrophy on MRI differentiates Alzheimer’s disease from dementia with Lewy bodies and vascular impairment: a prospective study with pathological verification of diagnosis. Brain 132(Pt 1), 195–203 (2009).
36. Bonanni L, Perfetti B, Bifolchetti S et al. Quantitative electroencephalogram utility in predicting conversion of mild cognitive impairment to dementia with Lewy bodies. Neurobiol. Aging 36(1), 434–445 (2015).
37. Aoki Y, Kazui H, Pascal-Marqui RD et al. EEG resting-state networks in dementia with lewy bodies associated with clinical symptoms. Neuropsychobiology 77(4), 206–218 (2019).
38. Elahi FM, Miller BL. A clinicopathological approach to the diagnosis of dementia. Nat Rev Neurol. 13(8), 457–476 (2017).
39. Whelan CD, Hibar DP, Van Velzen LS et al. Heritability and reliability of automatically segmented human hippocampal formation subregions. Neuroimage 128, 125–137 (2016).
40. Wolf D, Fischer FU, de Flores R, Ch´etelat G, Fellgiebel A. Differential associations of age with volume and microstructure of hippocampal subfields in healthy older adults. Hum. Brain Mapp. 36(10), 3819–3831 (2015).
41. Brown EM, Pierce ME, Clark DC et al. Test-retest reliability of FreeSurfer automated hippocampal subfield segmentation within and across scanners. Neuroimage 210, 116563 (2020).
dc.rights.eng.fl_str_mv Derechos reservados - Future Science Group, 2020
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spelling Borda, Miguel Germán14a783d386e18bc2ad422ed2be6960d8Jaramillo Jiménez, Alberto34fd642eb22d8cac308a2bb4b116e1f6Ferreira, Danielba65b09e9ed535c154c1eb8087dc0475Garcia-Cifuentes, Elkin6d60e942769c01a36bfb30e6457e89adVik-Mo, Audun Osland04f87172f1233d4dbf62b7ea29b1b95eAarsland, Dag1a74bad426808a6748d681f33fae72c8Oppedal, Ketil01047d4f2bccae67c3e2c8e18c2b0683Tovar Rios, Diego Alejandrod4393ded46de2274d5db0566239086a5Future Medicine2021-10-01T14:13:18Z2021-10-01T14:13:18Z2020-09-2417582024https://hdl.handle.net/10614/13299Background: Hippocampal atrophy is presented in Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB). Cognition, dual-tasks, muscular function, goal-related behaviors and neuropsychiatric symptoms are linked to hippocampal volumes and may lead to functional decline in activities of daily living. We examined the association between baseline hippocampal subfield volumes (HSv) in mild AD and DLB, and functional decline. Materials & methods: 12 HSv were computed from structural magnetic resonance images using Freesurfer 6.0 segmentation. Functional decline was assessed using the rapid disability rating scale score. Linear regressions were conducted. Results: In AD, HSv were smaller bilaterally. However, HSv were not associated with functional decline. Conclusion: Functional decline does not depend on HSv in mild AD and DLB11 páginasapplication/pdfengFuture Science Group - FSGPlace, London, N3 1QB, UKDerechos reservados - Future Science Group, 2020https://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessAtribución-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0)http://purl.org/coar/access_right/c_abf2Hippocampal subfields and decline in activities of daily living in Alzheimer’s disease and dementia with Lewy bodiesArtículo de revistahttp://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_2df8fbb1Textinfo:eu-repo/semantics/articlehttp://purl.org/redcol/resource_type/ARTinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/version/c_970fb48d4fbd8a85DemenciaEnfermedad de AlzheimerActivities of daily livingAlzheimer’s diseaseDementia with Lewy bodiesFunctional declineHippocampal subfieldsVolumen 10, número 6 (2020)610Borda, M.G., Jaramillo Jimenez, A., Tovar Rios, D. A., Ferreira, D., Garcia Cifuentes, E., Vik-Mo, A.O., Vera A., Aarsland, D., Ketil O. (2020). Hippocampal subfields and decline in activities of daily living in Alzheimer’s disease and dementia with Lewy bodies. Neurodegenerative Disease Management. (Vol. 10 (6), pp. 357-367. https://doi.org/10.2217/nmt-2020-0039Neurodegenerative Disease Management1. Mueller SG, Schuff N, Yaffe K, Madison C, Miller B, Weiner MW. Hippocampal atrophy patterns in mild cognitive impairment and Alzheimer’s disease. Hum. Brain Mapp. 31(9), 1339–1347 (2010).2. Mak E, Su L, Williams GB et al. Differential atrophy of hippocampal subfields: a comparative study of dementia with lewy bodies and Alzheimer disease. Am. J. Geriatr. Psychiatry 24(2), 136–143 (2016).3. Oppedal K, Ferreira D, Cavallin L et al. A signature pattern of cortical atrophy in dementia with Lewy bodies: a study on 333 patients from the European DLB consortium. Alzheimers Dement. 15(3), 400–409 (2019). Dementia with Lewy bodies (DLB) of DemVest cohort had higher scores on all the three atrophy scales than normal controls but had less medial temporal lobe atrophy than those with Alzheimer’s disease. The most common pattern of atrophy of DLB was hippocampal-sparing.4. Irwin DJ, Hurtig HI. The contribution of tau, amyloid-beta and alpha-synuclein pathology to dementia in Lewy body disorders. J. Alzheimer’s Dis. Parkinsonism 8(4), 444 (2018).5. Adamowicz DH, Roy S, Salmon DP et al. Hippocampal α-synuclein in dementia with lewy bodies contributes to memory impairment and is consistent with spread of pathology. J. Neurosci. 37(7), 1675–1684 (2017).6. Mak E, Gabel S, Su L et al. Multi-modal MRI investigation of volumetric and microstructural changes in the hippocampus and its subfields in mild cognitive impairment, Alzheimer’s disease, and dementia with Lewy bodies. Int. Psychogeriatrics 29(4), 545–555 (2017).7. Schmidt MF, Storrs JM, Freeman KB et al. A comparison of manual tracing and FreeSurfer for estimating hippocampal volume over the adult lifespan. Hum. Brain Mapp. 39(6), 2500–2513 (2018).8. de Schipper LJ, Hafkemeijer A, van der Grond J, Marinus J, Henselmans JML, van Hilten JJ. Regional structural hippocampal differences between dementia with lewy bodies and Parkinson’s disease. J. Parkinsons. Dis. 9(4), 775–783 (2019).9. Yassa MA, Stark SM, Bakker A, Albert MS, Gallagher M, Stark CEL. High-resolution structural and functional MRI of hippocampal CA3 and dentate gyrus in patients with amnestic Mild Cognitive Impairment. Neuroimage 51(3), 1242–1252 (2010).10. Foo H, Mak E, Chander RJ et al. Associations of hippocampal subfields in the progression of cognitive decline related to Parkinson’s disease. NeuroImage Clin. 14, 37–42 (2016).11. Chow N, Aarsland D, Honarpisheh H et al. Comparing hippocampal atrophy in Alzheimer’s dementia and dementia with lewy bodies. Dement. Geriatr. Cogn. Disord. 34(1), 44–50 (2012).12. López Ruiz JR, Osuna Carrasco LP, L´opez Valenzuela CL et al. The hippocampus participates in the control of locomotion speed. Neuroscience 311(October), 207–215 (2015).13. Hong S, Kim S, Yoo J et al. Slower gait speed predicts decline in instrumental activities of daily living in community-dwelling elderly: 3-year prospective finding from living profiles of older people survey in Korea. J. Clin. Gerontol. Geriatr. 7(4), 141–145 (2016). In a representative sample of Korean older adults, decreased gait speed has been evaluated and associated with dependency on instrumental activities of daily living (ADL).14. Lee M-T, Jang Y, Chang W-Y. How do impairments in cognitive functions affect activities of daily living functions in older adults? PLoS ONE 14(6), e0218112 (2019).15. Aarsland D, Rongve A, Piepenstock Nore S et al. Frequency and case identification of dementia with Lewy bodies using the revised consensus criteria. Dement. Geriatr. Cogn. Disord. 26(5), 445–452 (2008).16. Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J. Am. Geriatr. Soc. 16(5), 622–626 (1968).17. Folstein MF, Folstein SE, McHugh PR. ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12(3), 189–198 (1975).18. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of alzheimer’s disease: report of the NINCDS-ADRDA work group* under the auspices of department of health and human services task force on alzheimer’s disease. Neurology 34(7), 939–944 (1984).19. McKeith IG, Dickson DW, Lowe J et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB consortium. Neurology 65(12), 1863–1872 (2005).20. Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br. J. Psychiatry 140(6), 566–572 (1982).21. Skogseth R, Hortob´agyi T, Soennesyn H et al. Accuracy of clinical diagnosis of dementia with lewy bodies versus neuropathology. J. Alzheimer’s Dis. 59(4), 1139–1152 (2017).22. Brækhus AEKBA. ‘Ferdigheter i dagliglivet - RDRS-2’. (2000). https://nhi.no/skjema-og-kalkulatorer/skjema/geriatripleie/f erdigheter-i-dagliglivet-rdrs-2/23. Fischl B, Dale AM. Measuring the thickness of the human cerebral cortex from magnetic resonance images. Proc. Natl Acad. Sci. USA 97(20), 11050–11055 (2000).24. Iglesias JE, Augustinack JC, Nguyen K et al. A computational atlas of the hippocampal formation using ex vivo, ultra-high resolution MRI: application to adaptive segmentation of in vivo MRI. Neuroimage 115, 117–137 (2015).25. Saunders S, Muniz-Terrera G, Watson J et al. Participant outcomes and preferences in Alzheimer’s disease clinical trials: the electronic person-specific outcome measure (ePSOM) development program. Alzheimer’s Dement. Transl. Res. Clin. Interv. 4, 694–702 (2018).26. Ha E, Kim K. Factors that influence activities of daily living in the elderly with probable dementia. J. Psychiatr. Ment. Health Nurs. 21(5), 447–454 (2014). A third of the ADL score was determined by stroke history, frequency of exercise, urinary and fecal incontinence, and cognitive decline. The authors highlight multidisciplinary interventions to improve ADL.27. Giebel CM, Sutcliffe C, Stolt M et al. Deterioration of basic activities of daily living and their impact on quality of life across different cognitive stages of dementia: a European study. Int. Psychogeriatrics 26(8), 1283–1293 (2014). Impairments in each of the ADL are very variable across dementia stages. Some activities such as continence can be affected in any stage, others (i.e., bathing) in severe stages while toileting or feeding remained relatively intact.28. Shah BM, Hajjar ER. Polypharmacy, Adverse Drug Reactions, and Geriatric Syndromes. Clin. Geriatr. Med. 28(2), 173–186 (2012).29. 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