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The Complexity of Activities of Daily Living and Their Relationship to Attention in Alzheimer Disease: A Review of ADL Classification Systems

Kaplan, Lillian R. MA, OTR; Foldi, Nancy S. PhD

doi: 10.1097/TGR.0b013e3181bdd74e

This article examines ways in which activities of daily living (ADL) are used clinically to assess persons with Alzheimer disease (AD). First, we consider 3 perspectives used to classify ADL: tasks categorized by their environment, tasks defined by performer skill, and a resource-based perspective that integrates environment and performer conditions. Second, we discuss requirements of ADL in the context of pathological and neuropsychological processes in AD. We propose that patterns of functional decline occurring early in AD are shaped by impairments of attention and that models characterizing ADL must take attentional skills into consideration.

Department of Occupational Therapy, York College, City University of New York (CUNY), Jamaica (Ms Kaplan); and Department of Psychology, Queens College and The Graduate Center, CUNY, Flushing (Ms Kaplan and Dr Foldi).

Corresponding Author: Nancy S. Foldi, PhD, Department of Psychology, 65-30 Kissena Blvd, Sci Bldg-E318, Queens College and The Graduate Center, CUNY, Flushing, NY 11367 (

This work was funded by a grant from the Professional Staff Congress, CUNY, # 69060-00-38 (Ms Kaplan), and grants from the Alzheimer Association, # IIRG-05-13534, Professional Staff Congress, CUNY # 69024-00-38 and # 68058-00-37 (Dr Foldi).

© 2009 Lippincott Williams & Wilkins, Inc.