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Dickerson — Dementia: Function and Neuropsychiatric Symptoms (Harvard CME 2025)

Dickerson, B.C. "Dementia: A Comprehensive Update — Assessment of daily function & neuropsychiatric symptoms of dementia in practice." Massachusetts General Hospital, Harvard Medical School, Harvard CME Dementia Course, 2025.

Key findings used in wiki

Dementia is staged by function, not by diagnosis alone

  • Cognitive functional status is defined by loss of independent function due to cognitive or behavioral impairment, not by a test score in isolation.
  • The clinical staging framework moves through three levels of independent function, and loss typically proceeds in this order:
  • Advanced ADLs — working, managing complex finances, community leadership, sustained engagement with media, complex games, navigating unfamiliar areas, organizing mail, planning ahead, using technology.
  • Instrumental ADLs — managing medications, handling basic household finances, transportation, food preparation, shopping, using the phone, housekeeping, laundry.
  • Basic ADLs — eating, dressing, grooming, ambulation, bathing, toileting.
  • Care planning should track which level of ADL is currently at risk, because adaptations, supervision, and external supports differ dramatically at each stage.

Many widely used function scales have weak psychometric properties

  • Dickerson's slides document that most common functional-assessment questionnaires (ADCS-ADL, Bayer-ADL, Bristol ADL, DAD, Lawton IADL, etc.) have incomplete or weak psychometric properties on content validity, reliability, responsiveness, and interpretability.
  • Practical implication: clinical function staging is useful but scale scores should be read cautiously, especially for tracking small changes over time.

Care planning in dementia balances independence and safety

  • A core goal of dementia care is maximizing independence while maintaining safety, not simply protecting the person from risk at the cost of autonomy.
  • Adaptations and supports need to be re-evaluated regularly as function changes.
  • Many patients with dementia have reduced insight (awareness and appreciation of the illness), and insight typically worsens with disease stage — so creative approaches to implementing care plans are often necessary.

Why it matters for the wiki

  • Gives a citable functional-staging vocabulary for caregivers reading conditions/dementia.md — "advanced ADLs are slipping" is actionable in a way that "moderate dementia" is not.
  • Supports the planning-early passage on conditions/dementia.md and guides/end-of-life.md: function decline is predictable in order, even if pace varies, so many decisions can be anticipated rather than discovered in crisis.