Date Presented 04/22/2023

In this study, we conducted the path analysis for identifying the mediating effect of activities of daily living (ADL) dependence on the path from cognitive function to behavioral and psychological symptoms of dementia for older adults with dementia.

Primary Author and Speaker: Jiin Jeong

Contributing Authors: Eunyong Yoo

PURPOSE: Cognitive decline and increasing activity of daily life (ADL) dependence, major characteristics of dementia along with behavioral and psychological symptoms of dementia (BPSD), are known as negatively affecting each other and tend to deteriorate over a long time (D'Onofrio et al., 2012). This study attempted to identify the relationship between cognitive function, ADL dependence, and BPSD of the older adults with dementia, and the mediating effect of ADL dependence.

DESIGN: This study was a cross-sectional secondary research design. The 2015 data from the older adults cohort database (DB) provided by the Korea National Health Insurance Service was used for the study. In this study, among the people included in the DB only those who had received diagnosis of dementia and had grade 1 to 5 of long-term care service were selected.

METHODS: A total of 12,363 data were used for analysis. A path model was established to analyze relationship between the three major variables and the mediating effect of ADL dependence. The direct effects of each path, the total effect and indirect effect of the entire model were calculated.

RESULTS: The direct effect between cognitive function and ADL dependence was .616 (p < .0001), between cognitive function and BPSD was .199 (p < .0001), and between ADL dependence and BPSD was .039 (p = .0005). The total effect of the entire path model was .223 (p < .0001), and the indirect effect was .024 (p = .0005).

CONCLUSION: In this study, the ADL dependence partially mediated the effect of cognitive function on BPSD. These results suggest that participation in ADL can prevent some deterioration of BPSD due to cognitive decline. Therefore, an approach to promote ADL function which is the important area of the occupation may be useful to alleviate BPSD of the people with dementia, and hope that this study will be used as a evidence for the intervention with ADL function (American Occupational Therapy Association [AOTA], 2020).


D’Onofrio, G., Sancarlo, D., Panza, F., Copetti, M., Cascavilla, L., Paris, F., ... & Pilotto, A. (2012). Neuropsychiatric symptoms and functional status in Alzheimer’s disease and vascular dementia patients. Current Alzheimer Research, 9(6), 759–771.

American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl.2), 7412410010.