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Montesinos R, Custodio B, Malaga M, Chambergo-Michilot D, Verastegui-Aranda G, Agüero K, Alejos-Zirena J, Andamayo-Villalba L, Seminario G W, Custodio N. Influence of Behavioral and Psychological Symptoms on Caregiver Burden for Different Types of Dementia: Clinical Experience in Lima, Peru. Dement Geriatr Cogn Disord 2024; 53:229-236. [PMID: 38768581 DOI: 10.1159/000539335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION People caring for patients with dementia are prone to suffering from burden. Behavioral and psychological symptoms of dementia (BPSD) may have an impact on caregiver burden. In Latin American countries, there is a lack of research on caregiver burden. We aimed to determine which BPSD have the greatest impact on caregiver burden among Peruvian patients with dementia and to compare the effects of BPSD on caregiver burden across different types of dementia. METHODS A cross-sectional study was conducted on 231 patients living with Alzheimer's dementia (AD), behavioral variant frontotemporal dementia (bvFTD), dementia with Lewy bodies (DLB), and vascular dementia (VD) and their caregivers who attended a Peruvian memory clinic. BPSD were assessed with the Neuropsychiatric Inventory (NPI). Caregiver burden was assessed with the Zarit Burden Inventory. We used analysis of variance to compare the AD, bvFTD, DLB, and VD groups. Correlations between Zarit Burden Inventory and NPI subscale scores were assessed with Spearman's correlation. RESULTS DLB caregivers had significantly higher levels of burden than the other patient groups (p < 0.05) and higher total NPI scores than caregivers for other patient groups (p < 0.05). bvFTD caregivers had significantly higher total NPI scores than AD and VD caregivers (p < 0.05). Hallucinations, aberrant motor behavior, and apathy were the symptoms most significantly correlated with caregiver burden in those caring for DLB, bvFTD, and AD patients, respectively. CONCLUSION Neuropsychiatric symptoms are higher in DLB caregivers. Hallucinations, aberrant motor behavior, and apathy are the main symptoms correlated with burden.
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Affiliation(s)
- Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Belen Custodio
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Marco Malaga
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Grupo de Investigación Neurociencia Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru
| | - Diego Chambergo-Michilot
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
| | - Graciet Verastegui-Aranda
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Katherine Agüero
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | | | | | - Wendy Seminario G
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Hospital IV EsSalud Augusto Hernández Mendoza, Ica, Peru
| | - Nilton Custodio
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Escuela profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Peru
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Jönsson L, Ivkovic M, Atri A, Handels R, Gustavsson A, Hahn-Pedersen JH, León T, Lilja M, Gundgaard J, Raket LL. Progression analysis versus traditional methods to quantify slowing of disease progression in Alzheimer's disease. Alzheimers Res Ther 2024; 16:48. [PMID: 38424559 PMCID: PMC10903002 DOI: 10.1186/s13195-024-01413-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The clinical meaningfulness of the effects of recently approved disease-modifying treatments (DMT) in Alzheimer's disease is under debate. Available evidence is limited to short-term effects on clinical rating scales which may be difficult to interpret and have limited intrinsic meaning to patients. The main value of DMTs accrues over the long term as they are expected to cause a delay or slowing of disease progression. While awaiting such evidence, the translation of short-term effects to time delays or slowing of progression could offer a powerful and readily interpretable representation of clinical outcomes. METHODS We simulated disease progression trajectories representing two arms, active and placebo, of a hypothetical clinical trial of a DMT. The placebo arm was simulated based on estimated mean trajectories of clinical dementia rating scale-sum of boxes (CDR-SB) recordings from amyloid-positive subjects with mild cognitive impairment (MCI) from Alzheimer's Disease Neuroimaging Initiative (ADNI). The active arm was simulated to show an average slowing of disease progression versus placebo of 20% at each visit. The treatment effects in the simulated trials were estimated with a progression model for repeated measures (PMRM) and a mixed model for repeated measures (MMRM) for comparison. For PMRM, the treatment effect is expressed in units of time (e.g., days) and for MMRM in units of the outcome (e.g., CDR-SB points). PMRM results were implemented in a health economics Markov model extrapolating disease progression and death over 15 years. RESULTS The PMRM model estimated a 19% delay in disease progression at 18 months and 20% (~ 7 months delay) at 36 months, while the MMRM model estimated a 25% reduction in CDR-SB (~ 0.5 points) at 36 months. The PMRM model had slightly greater power compared to MMRM. The health economic model based on the estimated time delay suggested an increase in life expectancy (10 months) without extending time in severe stages of disease. CONCLUSION PMRM methods can be used to estimate treatment effects in terms of slowing of progression which translates to time metrics that can be readily interpreted and appreciated as meaningful outcomes for patients, care partners, and health care practitioners.
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Affiliation(s)
- Linus Jönsson
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, 171 64, Sweden.
| | | | - Alireza Atri
- Banner Sun Health Research Institute and Banner Alzheimer's Institute, Banner Health, Sun City and Phoenix, AZ, USA
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ron Handels
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, 171 64, Sweden
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre+, Maastricht, MD, 6200, The Netherlands
| | - Anders Gustavsson
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, 171 64, Sweden
- Quantify Research, Hantverkargatan 8, Stockholm, 112 21, Sweden
| | | | | | - Mathias Lilja
- Quantify Research, Hantverkargatan 8, Stockholm, 112 21, Sweden
| | | | - Lars Lau Raket
- Novo Nordisk A/S, Søborg, Denmark
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
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Shankar R, Luo N, Lim YW, Khatri P, Leong L, Teo GYX, Mukhopadhyay A, Choo J, Chua HR, Teng GG, Phua J, Hong WZ. Assessing caregiver burden in advanced kidney disease: protocol for a systematic review of the measurement properties of instruments and tools. BMJ Open 2024; 14:e078767. [PMID: 38413158 PMCID: PMC10900375 DOI: 10.1136/bmjopen-2023-078767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/08/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Caregiver burden is a significant issue in the care of patients with advanced kidney disease. Its assessment is crucial for evaluating the needs of caregivers and for the development of interventions to support them. Several instruments have been developed to measure caregiver burden in these patients. However, the measurement properties of these instruments have not been systematically reviewed. METHODS AND ANALYSIS This systematic review will include a comprehensive search of databases including PubMed, CINAHL, Embase, Cochrane Library, SCOPUS and Web of Science by using keywords and MeSH terms to identify relevant studies starting from each database inception to 1 January 2024 and covering papers in English. The search strategy will combine relevant keywords and database-specific subject headings related to the following concepts: (1) caregivers, (2) burden, stress, distress, (3) chronic kidney disease, end-stage kidney disease, dialysis. Reference lists of eligible articles will also be hand searched. We will include quantitative and qualitative studies evaluating measurement properties of instruments assessing caregiver burden in caregivers of adult patients (aged ≥18 years). Data will be extracted from the selected studies and analysed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist as the study quality assessment tool. Subsequently, the van der Vleuten utility index will be used to critique and categorise the instruments. A narrative that synthesises the utility of all instruments will be presented along with recommendations for the selection of instruments depending on specific clinical contexts. This systematic review will provide an overview of the measurement properties of available instruments, including discussion on reliability, validity and responsiveness. Results from the review may give rise to the subsequent development of most appropriate instrument that could be applied to the assessment of caregiver burden in advanced kidney disease. ETHICS AND DISSEMINATION Ethics approval is not required as this study will merely synthesise data from published studies. The results will be disseminated through peer-reviewed publications as well as conference presentations. PROSPERO REGISTRATION NUMBER CRD42023433906.
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Affiliation(s)
- Ravi Shankar
- Medical Affairs - Research, Innovation and Enterprise, Alexandra Hospital, National University Health System, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Yee Wei Lim
- Medical Affairs - Research, Innovation and Enterprise, Alexandra Hospital, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Priyanka Khatri
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Nephrology, Department of Medicine, National University Hospital, National University Health System, Singapore
- Chronic Programme, Alexandra Hospital, National University Health System, Singapore
- Fast Programme, Alexandra Hospital, National University Health System, Singapore
| | - Leanne Leong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Nephrology, Department of Medicine, National University Hospital, National University Health System, Singapore
- Chronic Programme, Alexandra Hospital, National University Health System, Singapore
- Fast Programme, Alexandra Hospital, National University Health System, Singapore
| | - Geraldine Yu-Xuan Teo
- Chronic Programme, Alexandra Hospital, National University Health System, Singapore
- Fast Programme, Alexandra Hospital, National University Health System, Singapore
| | - Amartya Mukhopadhyay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Chronic Programme, Alexandra Hospital, National University Health System, Singapore
- Fast Programme, Alexandra Hospital, National University Health System, Singapore
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Jason Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Horng Ruey Chua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Nephrology, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Gim-Gee Teng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Chronic Programme, Alexandra Hospital, National University Health System, Singapore
- Fast Programme, Alexandra Hospital, National University Health System, Singapore
- Division of Rheumatology, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Jason Phua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Chronic Programme, Alexandra Hospital, National University Health System, Singapore
- Fast Programme, Alexandra Hospital, National University Health System, Singapore
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Wei Zhen Hong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Nephrology, Department of Medicine, National University Hospital, National University Health System, Singapore
- Chronic Programme, Alexandra Hospital, National University Health System, Singapore
- Fast Programme, Alexandra Hospital, National University Health System, Singapore
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