The real and ideal in the evaluation of functional competence among demented patients

The progressive nature of the dementia of Alzheimer's disease has significant clinical, functional, legal and nursing implications. Traditionally, the grading of severity of the disease is based on evaluation of the patients' independence and competence. However, the term competence has been used in different respects, leading to obscuration and confusion. Moreover, the evaluation of competence is based on different tests and there is no single accepted method for this purpose. In the absence of such a criterion, there is a need for an objective test to evaluate the functional competence of the patient. This will be based on complex behavioral activities and instrumental activities of daily living in real situations, in the natural environment of the patient. The limits of available methods are discussed with practical suggestions for the development of such a test.