An integrated approach to the management of Alzheimer's disease: assessing cognition, function and behaviour

Alzheimer's disease is characterized by deterioration in the domains of cognition, function and behaviour. Cognitive decline is manifest as short‐term memory, language and visuospatial deficits. These, along with deficits in perception and executive function affect the patient's ability to function, as indicated by loss of ability to perform activities of daily living (ADLs). Abnormal behaviours, including depression, delusions and aggression are frequently a feature of Alzheimer's disease, occurring at different stages of the disease. Although Alzheimer's disease is primarily associated with cognitive deficits, functional decline and aberrant behaviours are its most problematic aspects for both patients and their caregivers. Loss of ability to perform ADLs imposes the need for increased levels of care. Moreover, caregiver burden is closely associated with the type and severity of behavioural disturbances. Although cognition is correlated with ability to perform ADLs, the fact that behavioural symptoms also play a role in deteriorating function means that cognitive testing alone cannot accurately predict disease progression. Hence, an integrated approach, involving measurement of cognition, function and behaviour is required for accurate diagnosis, assessment of the stage and progression of dementia, the effects of intervention, and the amount and type of assistance that the Alzheimer's disease patient requires.