INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Int J Geriatr Psychiatry 2003; 18: 977–982. Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/gps.999 Role of behavioural disturbance in the loss of autonomy for activities of daily living in Alzheimer patients L. Lechowski 1 *, B. Dieudonne ´ 2 , D. Tortrat 2 , L. Teillet 1 , P. H. Robert 3 , M. Benoit 3 , B. Forette 1,2 , B. Vellas 4 and PHRC-REAL. FR (Re ´seau sur la maladie d’Alzheimer franc ¸ais) 1 Service de Ge ´rontologie II, Assistance Publique—Ho ˆpitaux de Paris, Ho ˆpital Sainte-Pe ´rine, Paris, France 2 Centre Claude Bernard de Ge ´rontologie, Assistance Publique—Ho ˆpitaux de Paris, Ho ˆpital Sainte-Pe ´rine, Paris, France 3 Centre me ´moire de Ressource et de Recherche—CHU Nice—PACA, Ho ˆpital Pasteur, Nice, France 4 CHU de Toulouse, Toulouse, France SUMMARY Background Cognitive impairment is associated with functional impairment in patients with Alzheimer’s disease (AD). Behavioural disturbance is very common in these patients. Nevertheless, there has been very little research into the relations between behavioural disturbance and functional status in AD. The purpose of this study is to investigate the relationship between behavioural disturbance and functional status after taking account of cognitive impairment. Material and methods 579 patients were prospectively evaluated at 16 French hospitals, all referents for AD, and were diagnosed with possible or probable AD. These patients were assessed with NeuroPsychiatric Inventory (NPI), cognitive subscales of the Alzheimer’s Disease Assessment Scale (ADAS-cog), Clinical Dementia Rating scale (CDR) and Instrumen- tal Activities of Daily Living scale (IADL). Results The number of men with available data for IADL total score was too small to make any analysis. ‘Group A’ gath- ered 256 women for whom the relation between autonomy for Activities of Daily Living (ADL) and the other variables were determined. ‘Group B’, pooled 85 women for whom relations found were verified. Linear regression was used for the ana- lysis. With age, cognitive impairment allows us to explain best (38%) the loss of autonomy for ADL. Conclusion The role of behavioural disturbances in the loss of autonomy for ADL was not determinant in our study, whereas cognitive impairment and age were better able to determine the loss of autonomy for ADL. Further study is needed to explain the decline of functional status in AD patients. Copyright # 2003 John Wiley & Sons, Ltd. key words — Alzheimer’s disease; functional status; behavioural disturbance INTRODUCTION In France, Alzheimer’s disease (AD) is the major etiology of dementia (60%) and affects 300 000 to 400 000 patients. The incidence is about 100 000 cases per year and significantly increases with age. The constant aging of the population gives rise to the increasing prevalence of AD. This fact is one of the most relevant problems for public health in France as in other Western countries. (Gao et al., 1998; Ritchie et al., 1992; Dartigues, 1997; Jorm and Jolley et al., 1998). AD causes disturbance of memory and cognitive dysfunction correlated with progression of the disease and behavioural disturbances (Frisoni et al., 1999). These behavioural disturbances are present in 90% of patients, and are moderate or severe in 40% of cases (Teri et al., 1989; Marin et al., 1997; Gormley et al., 1998; Devanand, 1999). These symptoms are commonly episodic and fluctuating, and do not increase with the severity of the disease (Mohs et al., 2000; Marin et al., 1997; Devanand, 1999; Received 24 March 2003 Copyright # 2003 John Wiley & Sons, Ltd. Accepted 15 July 2003 *Correspondence to: Dr L. Lechowski, Service de Ge ´rontologie II, Assistance Publique—Ho ˆpitaux de Paris, Ho ˆpital Sainte-Pe ´rine, 11, rue Chardon-Lagache, 75781 Paris, Cedex 16, France. Tel: þ33 1 44 96 32 66. Fax: þ33 1 44 96 31 80. E-mail: laurent.lechowski@spr.ap-hop-paris.fr Contract/grant sponsor: Clinical Research Hospital Program from the French Ministry of Health; contract/grant number: PHRC N  98-47N, PHRC N  0101001.