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Huang MH, Tsai CF, Lin YS, Kuo YS, Hsu CC, Fuh JL. A national survey on health-related quality of life for people with dementia in residential long-term care institutions. J Formos Med Assoc 2024; 123:764-772. [PMID: 38072742 DOI: 10.1016/j.jfma.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/03/2023] [Accepted: 11/22/2023] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is an essential outcome parameter in geriatric research; however, the available evidence is mixed regarding the factors associated with HRQoL among people with dementia. We aimed to identify factors that contribute to HRQoL among people with dementia in residential long-term care (LTC) institutions. METHODS We randomly selected 299 of 1607 registered residential LTC institutions in Taiwan. A cross-sectional survey was conducted between 2019 and 2020, including items on demographic characteristics, comorbidities, the EuroQol-5 dimensions-5 levels (EQ-5D-5L; utility and visual analog scale [VAS] scores), the Mini-Mental State Examination (MMSE), the Clinical Dementia Rating (CDR), behavioral and psychological symptoms of dementia, activities of daily living (ADL), and instrumental ADL (IADL). RESULTS In total, 1313 people with dementia from 267 institutions were enrolled (mean age, 76.4 ± 12.7 years). The mean EQ-5D-5L utility and VAS scores were 0.10 (standard deviation [SD] = 0.48) and 66.57 (SD = 20.67), respectively. In multivariate linear regression analysis, higher scores for ADL, IADL, and CDR sum of boxes were associated with higher utility scores. Higher VAS scores were associated with higher ADL and MMSE scores. Lower utility scores and VAS scores were associated with more frequent depressive symptoms. CONCLUSION ADL, dementia severity, cognitive function, and depressive symptoms influenced the HRQoL of people with dementia in residential LTC institutions. Longitudinal studies should be conducted to better understand how HRQoL changes over time among people with disabilities.
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Affiliation(s)
- Mao-Hsuan Huang
- Department of Psychiatry, YuanShan and Suao Branches of Taipei Veterans General Hospital, Ilan, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Fen Tsai
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taiwan
| | - Yung-Shuan Lin
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Brain Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Shan Kuo
- Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan; Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan
| | - Jong-Ling Fuh
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Brain Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan.
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Kung PC, Huang HL, Hsu WC, Huang HL, Chang HJ, Shyu YIL. Coexisting with anomie: Experiences of persons living with early-stage dementia: A grounded theory study. Int J Ment Health Nurs 2024; 33:452-462. [PMID: 37985929 DOI: 10.1111/inm.13256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/19/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023]
Abstract
Individuals in the early stages of dementia often endure elevated levels of stress and anxiety, which can hinder their ability to adapt to the progression of dementia. To mitigate the negative impacts of dementia more effectively, it is necessary to explore the trajectory of the adaptation process of persons living with dementia. This study aimed to construct a theoretical framework for the adaptation process of individuals in the early stages of dementia. Participants were dyads of persons diagnosed with mild dementia or mild cognitive impairment (≥ 60 years of age) and their primary family caregivers. This longitudinal study used a grounded theory approach to explore the adaptation trajectory changes in persons with mild dementia over a 3-year period. Data were collected from dyads with face-to-face interviews. Analysis of the interview data revealed the core category was 'Coexisting with anomie: Progressive disappointment and striving', which was comprised of three categories: awareness of alienation, unsettled feelings, and restorative avoidance coping. Categories changed depending on levels of cognition and constituted progressive and cyclical dynamic processes. Four contextual factors positively or negatively influenced adaptation: level of insight about dementia, personal traits, caregiving style of the caregiver, and level of social interactions. These findings provide a new perspective about the mental health of persons in early-stage dementia. Understanding coexisting with anomie and related influencing factors could facilitate the development of support interventions by mental health nursing staff, which could improve emotional safety, promote psychological well-being, and increase quality of life for persons living with dementia.
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Affiliation(s)
- Pen-Chen Kung
- Department of Gerontology and Health Care Management, College of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Huei-Ling Huang
- Department of Gerontology and Health Care Management, College of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Wen-Chuin Hsu
- Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiu-Li Huang
- Department of Long-Term Care, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hong-Jer Chang
- National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Neurology, Dementia Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Marques-Aleixo I, Sampaio A, Bohn L, Machado F, Barros D, Ribeiro O, Carvalho J, Magalhães J. Neuropsychiatric Symptoms are Related to Blood-biomarkers in Major Neurocognitive Disorders. Curr Aging Sci 2024; 17:74-84. [PMID: 37904566 DOI: 10.2174/1874609816666230816090934] [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: 12/19/2022] [Revised: 05/19/2023] [Accepted: 07/19/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are highly prevalent among individuals with major neurocognitive disorders (MNCD). OBJECTIVE Here, we characterized blood biomarkers (metabolic, inflammatory, neurotrophic profiles and total antioxidant), body composition, physical fitness and quality of life (QoL) in individuals with MNCD according to NPS. METHODS The sample comprised 34 older adults (71.4% women; 74.06±6.03 yrs, with MNCD diagnosis) categorized according to 50th percentile [Low (≤12) or High (≥13)] for NPS (Neuropsychiatric Inventory Questionnaire). Sociodemographic, clinical data, body composition, anthropometric, cognitive assessment (ADAS-Cog), physical fitness (Senior Fitness Test), QoL (QoL-Alzheimer's Disease scale) were evaluated, and blood samples were collected for biochemical analysis. RESULTS Low compared to high NPS group showed higher levels of IL-6, IGF-1and neurotrophic zscore (composite of IGF-1, VEGF-1, BDNF). Additionally, low compared to high NPS group have higher QoL, aerobic fitness and upper body and lower body strength. CONCLUSION The severity of NPS seems to be related to modified neurotrophic and inflammatory outcomes, lower physical fitness, and poor QoL. Strategies to counteract NPS development may preserve the physical and mental health of individuals with MNCD..
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Affiliation(s)
- Inês Marques-Aleixo
- Interdisciplinary Research Centre for Education and Development, Lusófona University, Lisbon, Portugal
- Faculty of Psychology, Education and Sport, Lusófona University, Porto, Portugal
| | - Arnaldina Sampaio
- Research Centre in Physical Activity, Health, and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sport, University of Porto, Porto, Portugal
| | - Lucimére Bohn
- Interdisciplinary Research Centre for Education and Development, Lusófona University, Lisbon, Portugal
- Faculty of Psychology, Education and Sport, Lusófona University, Porto, Portugal
- Research Centre in Physical Activity, Health, and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sport, University of Porto, Porto, Portugal
| | - Flavia Machado
- Research Centre in Physical Activity, Health, and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sport, University of Porto, Porto, Portugal
| | - Duarte Barros
- Research Centre in Physical Activity, Health, and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sport, University of Porto, Porto, Portugal
| | - Oscár Ribeiro
- CINTESIS - Center for Health Technology and Services Research, Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Joana Carvalho
- Research Centre in Physical Activity, Health, and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sport, University of Porto, Porto, Portugal
| | - José Magalhães
- Research Centre in Physical Activity, Health, and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sport, University of Porto, Porto, Portugal
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Utianski RL, Martin PR, Duffy JR, Clark HM, Stierwalt JAG, Botha H, Ali F, Whitwell JL, Josephs KA. Assessing Patients and Care Partner Ratings of Communication-Related Participation Restrictions: Insights From Degenerative Disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1793-1805. [PMID: 36758199 PMCID: PMC10561959 DOI: 10.1044/2022_ajslp-22-00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/31/2022] [Accepted: 12/01/2022] [Indexed: 06/18/2023]
Abstract
PURPOSE Prior studies have shown that communication-related participation restrictions in patients with degenerative disease do not always match clinician judgment or objective indices of symptom severity. Although there is a growing body of literature documenting that discrepancies between patients with dementia and their care partners' perception of participation restrictions exist, it is not known how care partner perceptions of communication participation restrictions specifically match or diverge from the patients' experiences, which may inform the use of care partner proxy in the context of degenerative diseases. METHOD Thirty-eight patients with progressive neurologic conditions (progressive supranuclear palsy, corticobasal syndrome, and primary progressive aphasia or apraxia of speech) and, in most instances, focal cognitive-communication disorders were included. The patients and their accompanying care partners independently completed the Communicative Participation Item Bank, short form, a 10-question survey about communication participation restrictions in different contexts. Care partners were instructed to complete the form with their perception of the patient's experience. The difference between patient and care partner total scores were calculated and analyzed relative to clinical and demographic variables of interest. RESULTS Care partner ratings modestly tracked with patient experience and objective indices of symptom severity but did not exactly match patient ratings. The presence of aphasia increased, but did not fully account for, the likelihood of a discrepancy between care partner and patient ratings. CONCLUSION Although careful consideration should be given prior to using care-partner report as a proxy for patient experience, it is worthwhile to include care partner ratings as a means of supporting conversations about differing perceptions, guiding joint intervention planning, and monitoring care-partner perceptions of change along with the implementation of supported conversation strategies.
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Affiliation(s)
| | - Peter R. Martin
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN
| | - Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN
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Timmons S, Fox S. Palliative care for people with dementia. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:81-105. [PMID: 36599517 DOI: 10.1016/b978-0-12-824535-4.00013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Dementia is the most common neurologic disease, affecting approximately 55 million people worldwide. Dementia is a terminal illness, although not always recognized as such. This chapter discusses the key issues in providing palliative care for people with living with dementia and their families. Common palliative care needs and symptoms are presented, including psychosocial, physical, emotional, and spiritual, and the need to actively anticipate and seek symptoms according to the dementia type and stage is emphasized. Families are hugely impacted by a dementia diagnosis, and throughout this chapter, they are considered in the unit of care, and also as a member of the care team. Multiple challenges particular to dementia palliative care are highlighted throughout, such as the lack of timely dementia diagnoses, difficulty with symptom prognostication, the person's inability to verbally express their symptoms and care preferences, and a low threshold for medication side effects. Finally, service models for dementia palliative care in community, residential, and acute hospital settings are discussed, along with the evidence for each. Overall, this chapter reinforces that the individual needs of the person living with dementia and their family must be considered to provide person-centered and comprehensive palliative care, enabling them to live well until death.
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Affiliation(s)
- Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland; Department of Geriatric Medicine, Mercy University Hospital & St. Finbarr's Hospital, Cork, Ireland.
| | - Siobhan Fox
- Centre for Gerontology and Rehabilitation, School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland
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Dufour I, Vedel I, Quesnel-Vallée A. Identification of Major Cognitive Disorders in Self-Reported versus Administrative Health Data: A Cohort Study in Quebec. J Alzheimers Dis 2022; 89:1091-1101. [PMID: 35964188 DOI: 10.3233/jad-220327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The first imperative in producing the relevant and needed knowledge about major neurocognitive disorder (MNCD) is to identify people presenting with the condition adequately. To document potential disparities between administrative health databases and population-based surveys could help identify specific challenges in this population and methodological shortfalls. OBJECTIVE To describe and compare the characteristics of community-dwelling older adults according to four groups: 1) No MNCD; 2) Self-reported MNCD only; 3) MNCD in administrative health data only; 4) MNCD in both self-reported and administrative health data. METHODS This retrospective cohort study used the Care Trajectories-Enriched Data (TorSaDE) cohort, a linkage between five waves of the Canadian Community Health Survey (CCHS) and health administrative health data. We included older adults living in the community who participated in at least one cycle of the CCHS. We reported on positive and negative MNCD in self-reported versus administrative health data. We then compared groups' characteristics using chi-square tests and ANOVA. RESULTS The study cohort was composed of 25,125 older adults, of which 784 (3.12%) had MNCD. About 70% of people with an MNCD identified in administrative health data did not report it in the CCHS. The four groups present specific challenges related to the importance of perception, timely diagnosis, and the caregivers' roles in reporting health information. CONCLUSION To a certain degree, both data sources fail to consider subgroups experiencing issues related to MNCD; studies like ours provide insight to understand their characteristics and needs better.
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Affiliation(s)
- Isabelle Dufour
- Department of Epidemiology, Biostatistics, andOccupational Health, Faculty of Medicine, McGill University, Montreal, Canada
| | - Isabelle Vedel
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Faculty of Medicine, McGill University, Montréal, Canada
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Hutchinson C, Worley A, Khadka J, Milte R, Cleland J, Ratcliffe J. Do we agree or disagree? A systematic review of the application of preference-based instruments in self and proxy reporting of quality of life in older people. Soc Sci Med 2022; 305:115046. [PMID: 35636050 DOI: 10.1016/j.socscimed.2022.115046] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/04/2022] [Accepted: 05/14/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Quality of life is an important person-centred outcome in health and aged care settings. Due to an increasing prevalence of cognitive decline and dementia in ageing populations, a proportion of older people receiving health and aged care services may not be able to reliably assess their own quality of life, highlighting the need for proxy assessment. This systematic review sought to investigate the level of agreement between self and proxy-report of older people's quality of life using established preference-based instruments of quality of life suitable for economic evaluation. METHODS A systematic review was conducted following PRISMA guidelines. Eight databases were searched: Web of Science, Scopus, Medline, Econlit, PsychINFO, CINAHL, Ageline and Cochrane Library. Information was extracted on the instruments, population samples (including any cognitive thresholds applied), mean scores, type of proxy, and measures of inter-rater agreement. RESULTS A total of 50 studies using eight different preference-based quality of life instruments were identified. Most studies were cross-sectional (72%) with a wide variety of cognitive assessments and thresholds applied to define older participants with cognitive impairment. The most common proxies were family members, mostly spouses. The level of agreement between self and proxy-report was generally poor - irrespective of the instrument applied or type of proxy - with proxy-report generally indicating lower levels of quality of life than self-report. There was some evidence of stronger agreement on more observable quality of life domains e.g., physical health and mobility, relative to less observable domains e.g. emotional well-being. Few studies tracked self and/or proxy-report of quality of life longitudinally. CONCLUSIONS More research is needed to develop evidence to inform guidance on self-report versus proxy-report of quality of life for older people receiving health and aged care services. Until then, the collection of both self and proxy reports as complementary measures is indicated.
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Affiliation(s)
- Claire Hutchinson
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia.
| | - Anthea Worley
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Australia
| | - Jyoti Khadka
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
| | - Jenny Cleland
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
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Mayelle A, Hazebrouck C, El Haj M, Mograbi DC, Antoine P. Awareness for People With Alzheimer’s Disease: Profiles and Weekly Trajectories. Front Aging Neurosci 2022; 13:781426. [PMID: 35095469 PMCID: PMC8792992 DOI: 10.3389/fnagi.2021.781426] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: To understand awareness and fluctuations of awareness in Alzheimer’s disease (AD), it is fruitful to consider the objects of awareness, e.g., cognitive functioning or recognition of the disease, as well as the mechanisms and modes of expression underlying awareness. With a holistic and discourse-centered approach, we aimed to identify different awareness profiles and test whether these profiles were stable or whether transitions from one profile to another occurred over short time intervals. Methods: Twenty-eight residents of nursing homes with a diagnosis of AD participated in four semistructured interviews at biweekly intervals. These interviews were cluster analyzed to determine profiles of awareness. A Markov chain was applied to model their fluctuation. Results: Five awareness profiles were observed that differed in terms of objects and underlying processes. Awareness proved to be quite stable for four of the five profiles. Interindividual variability in awareness was also observed through numerous different trajectories that were identified. Discussion: Self-awareness and disease awareness are characterized by profiles that vary subtly between individuals. Fluctuations in awareness underscore the need to employ assessment intervals that closely reflect daily life in institutions.
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Affiliation(s)
- Amandine Mayelle
- Univ. Lille, CNRS, UMR 9193—SCALab—Sciences Cognitives et Sciences Affectives, Lille, France
| | - Capucine Hazebrouck
- Etablissements Pour Personnes Âgées Dépendantes La Colombe, Roncq and L’Orée du Monde, Halluin, France
| | - Mohamad El Haj
- Nantes Université, Univ Angers, Laboratoire de Psychologie des Pays de la Loire (LPPL—EA 4638), Nantes, France
- Unité de Gériatrie, Centre Hospitalier de Tourcoing, Tourcoing, France
- Institut Universitaire de France, Paris, France
| | - Daniel C. Mograbi
- Pontifical Catholic University, Rio de Janeiro, Brazil
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Pascal Antoine
- Univ. Lille, CNRS, UMR 9193—SCALab—Sciences Cognitives et Sciences Affectives, Lille, France
- *Correspondence: Pascal Antoine,
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Endreddy A, Chennareddy L, Harshitha V. The association of depression and quality of life in patients with neurocognitive disorder in a tertiary care center: An observational study. TAIWANESE JOURNAL OF PSYCHIATRY 2022. [DOI: 10.4103/tpsy.tpsy_34_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Cacciamani F, Houot M, Gagliardi G, Dubois B, Sikkes S, Sánchez-Benavides G, Denicolò E, Molinuevo JL, Vannini P, Epelbaum S. Awareness of Cognitive Decline in Patients With Alzheimer's Disease: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2021; 13:697234. [PMID: 34413767 PMCID: PMC8370471 DOI: 10.3389/fnagi.2021.697234] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Identifying a poor degree of awareness of cognitive decline (ACD) could represent an early indicator of Alzheimer's disease (AD). Objectives: (1) to understand whether there is evidence of poor ACD in the pre-dementia stages of AD; (2) to summarize the main findings obtained investigating ACD in AD; (3) to propose a conceptual framework. Data Sources: We searched Scopus, Pubmed, and the reference lists for studies published up to August 2020. Original research articles must report a measure of ACD and included individuals with AD dementia, or prodromal AD (or MCI), or being at risk for AD. Data Synthesis: All studies covering preclinical, prodromal, and AD dementia were systematically reviewed. We intended to perform a meta-analysis of empirical studies on preclinical AD or prodromal AD (or MCI), to compare ACD between clinical groups. Due to the paucity of literature on preclinical AD, meta-analysis was only possible for prodromal AD (or MCI) studies. Results: We systematically reviewed 283 articles, and conducted a meta-analysis of 18 articles on prodromal AD (or MCI), showing that ACD was not significantly different between patients with amnestic and non-amnestic MCI (SMD = 0.09, p = 0.574); ACD was significantly poorer in amnestic MCI (SMD = -0.56, p = 0.001) and mild AD (SMD = -1.39, p < 0.001) than in controls; ACD was also significantly poorer in mild AD than in amnestic MCI (SMD = -0.75, p < 0.001), as well as poorer than in non-amnestic MCI (SMD = -1.00, p < 0.001). We also discuss key findings on ACD in AD, such as its neural and cognitive correlates. Conclusions and Implications: We propose that patients may be complaining of their initial subtle cognitive changes, but ACD would soon start to decrease. The individual would show mild anosognosia in the MCI stage, and severe anosognosia in dementia. The evaluation of ACD (comparing self-report to cognitive scores or to informant-report) could be useful to guide the clinician toward a timely diagnosis, and in trials targeting early-stage AD.
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Affiliation(s)
- Federica Cacciamani
- Institut du Cerveau, ICM, Hôpital de la Pitié-Salpêtrière, Paris, France
- Inserm, U 1127, Paris, France
- CNRS, UMR 7225, Paris, France
- Sorbonne Université, Paris, France
- Inria, ARAMIS-Project Team, Paris, France
| | - Marion Houot
- Institut du Cerveau, ICM, Hôpital de la Pitié-Salpêtrière, Paris, France
- Sorbonne Université, Paris, France
- Institute of Memory and Alzheimer's Disease (IM2A), Centre of Excellence of Neurodegenerative Disease (CoEN), ICM, CIC Neurosciences, AP-HP, Department of Neurology, Hôpital de la Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - Geoffroy Gagliardi
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Bruno Dubois
- Institut du Cerveau, ICM, Hôpital de la Pitié-Salpêtrière, Paris, France
- Inserm, U 1127, Paris, France
- CNRS, UMR 7225, Paris, France
- Sorbonne Université, Paris, France
- Institute of Memory and Alzheimer's Disease (IM2A), Centre of Excellence of Neurodegenerative Disease (CoEN), ICM, CIC Neurosciences, AP-HP, Department of Neurology, Hôpital de la Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - Sietske Sikkes
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Gonzalo Sánchez-Benavides
- BarcelonaBeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Elena Denicolò
- Department of Biomedical Science and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - José Luis Molinuevo
- BarcelonaBeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
| | - Patrizia Vannini
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Stéphane Epelbaum
- Institut du Cerveau, ICM, Hôpital de la Pitié-Salpêtrière, Paris, France
- Inserm, U 1127, Paris, France
- CNRS, UMR 7225, Paris, France
- Sorbonne Université, Paris, France
- Inria, ARAMIS-Project Team, Paris, France
- Institute of Memory and Alzheimer's Disease (IM2A), Centre of Excellence of Neurodegenerative Disease (CoEN), ICM, CIC Neurosciences, AP-HP, Department of Neurology, Hôpital de la Pitié-Salpêtrière, Sorbonne University, Paris, France
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Ayton DR, Gardam ML, Pritchard EK, Ruseckaite R, Ryan J, Robinson SJ, Brodaty H, Ward SA, Ahern S. Patient-Reported Outcome Measures to Inform Care of People With Dementia-A Systematic Scoping Review. THE GERONTOLOGIST 2021; 61:e185-e194. [PMID: 32369109 DOI: 10.1093/geront/gnz179] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Patient-reported outcome measures (PROMs) captures the patient's perspective regarding quality of life, daily functioning, symptom severity, and overall health, and how these may be impacted by health care or other interventions. PROMs are used in clinical quality registries (CQRs) for a number of diseases to assess the patient's perspective of the impact of clinical care on quality-of-life. This scoping review aimed to identify dementia-specific PROMs, determine how the PROMs are being used, and whether they are used within dementia registries. RESEARCH DESIGN AND METHODS Three electronic databases were searched using Medical Subject Heading terms for dementia, quality of life, and patient-reported outcomes. Data were extracted on the PROMs used and the methods and mode of administering the PROM. RESULTS Seven dementia-specific PROMs were identified, however none were used in a dementia registry. All the PROMs were used at the patient level to identify patient needs and health service impacts. Three PROMs were also used at a system level to examine difference in care models. The majority of the PROMs were administered via a researcher or clinician and were predominantly completed by a proxy. DISCUSSION AND IMPLICATIONS PROMs provide an opportunity for a patient with dementia to share experiences and perspectives of care. A number of dementia-specific PROMs exist, yet none are used in dementia registries and the majority of studies utilize PROMs via a proxy. The use of PROM for patients with dementia, particularly in the context of dementia registries, requires further exploration and consideration.
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Affiliation(s)
- Darshini R Ayton
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Madeleine L Gardam
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Elizabeth K Pritchard
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne Ryan
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sandra J Robinson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Stephanie A Ward
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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12
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Lacerda IB, Santos RL, Belfort T, Neto JPS, Dourado MCN. Domains of awareness in Alzheimer's disease: The influence of executive function. Int J Geriatr Psychiatry 2021; 36:926-934. [PMID: 33382108 DOI: 10.1002/gps.5495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/29/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Awareness is a developing area in dementia research and the evaluation of its domains has been increasingly included as part of care for people with Alzheimer's disease (PwAD). Our aim is to examine whether executive dysfunction is associated with awareness domains. METHODS A consecutive series of 75 people with mild-to-moderate Alzheimer's disease completed assessments about global cognitive function, executive functioning, and their awareness of disease. Their primary caregivers' dyad provided information about demographics, awareness of disease, dementia severity, neuropsychiatric symptoms, and functional status. RESULTS Different types of executive dysfunction were presented as a predictor for awareness of disease (cognitive flexibility, inhibitory control, and working memory), of emotional state (short-term memory and attention) and of social functioning and relationships (visuospatial organization, integrative functions, and abstract thinking). Awareness of cognitive functioning and health condition and of functional activity impairments exhibit only global cognitive function as a predictor. CONCLUSIONS Findings confirm some degree of independence between awareness domains. The importance of identifying differences in domains of awareness relies in the understanding of awareness as a clinical phenomenon in order to guide the management and support of PwAD and their caregivers.
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Affiliation(s)
- Isabel B Lacerda
- Center for Alzheimer's Disease, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Raquel L Santos
- Center for Alzheimer's Disease, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tatiana Belfort
- Center for Alzheimer's Disease, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Pedro S Neto
- Sociology and Political Science Department, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Marcia C N Dourado
- Center for Alzheimer's Disease, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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13
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O'Shaughnessy NJ, Chan JE, Bhome R, Gallagher P, Zhang H, Clare L, Sampson EL, Stone P, Huntley J. Awareness in severe Alzheimer's disease: a systematic review. Aging Ment Health 2021; 25:602-612. [PMID: 31942805 DOI: 10.1080/13607863.2020.1711859] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 12/13/2019] [Accepted: 12/31/2019] [Indexed: 12/26/2022]
Abstract
Objective: There is limited understanding about how people in the severe stages of Alzheimer's disease (AD) experience and demonstrate awareness. We synthesised all available evidence with the aim of understanding how awareness is preserved or impaired in severe AD and what evidence there is for different levels of awareness according to the levels of awareness framework.Method: A systematic search of the following databases: Embase, PsycINFO, MEDLINE and Web of Science was carried out. A narrative synthesis and analysis was conducted of all included studies. All studies were assessed for quality using the AXIS and CASP tools.Results: Our findings suggest that lower level sensory awareness is relatively maintained in severe AD. Findings for higher level awareness are variable and this may be related to the diversity of methods that have been used to explore awareness in these circumstances.Conclusion: Awareness is complex, heterogeneous and varies significantly between individuals. Environmental and contextual factors have a significant impact on whether awareness is observed in people with severe AD. Adaptation of the environment has the potential to facilitate the expression of awareness while education of caregivers may increase understanding of people with severe AD and potentially improve the quality of care that is received.
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Affiliation(s)
| | - J E Chan
- Division of Psychiatry, University College London, London, UK
| | - R Bhome
- Division of Psychiatry, University College London, London, UK
| | - P Gallagher
- Division of Psychiatry, University College London, London, UK
| | - H Zhang
- Division of Psychiatry, University College London, London, UK
- National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
| | - L Clare
- Centre for Research for Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - E L Sampson
- Division of Psychiatry, University College London, London, UK
| | - P Stone
- Division of Psychiatry, University College London, London, UK
| | - J Huntley
- Division of Psychiatry, University College London, London, UK
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14
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Huntley JD, Fleming SM, Mograbi DC, Bor D, Naci L, Owen AM, Howard R. Understanding Alzheimer's disease as a disorder of consciousness. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12203. [PMID: 34877398 PMCID: PMC8630359 DOI: 10.1002/trc2.12203] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/28/2021] [Accepted: 07/28/2021] [Indexed: 11/07/2022]
Abstract
People with Alzheimer's disease (AD) demonstrate a range of alterations in consciousness. Changes in awareness of cognitive deficit, self-awareness, and introspection are seen early in AD, and dysfunction of awareness and arousal progresses with increasing disease severity. However, heterogeneity of deficits between individuals and a lack of empirical studies in people with severe dementia highlight the importance of identifying and applying biomarkers of awareness in AD. Impairments of awareness in AD are associated with neuropathology in regions that overlap with proposed neural correlates of consciousness. Recent developments in consciousness science provide theoretical frameworks and experimental approaches to help further understand the conscious experience of people with AD. Recognition of AD as a disorder of consciousness is overdue, and important to both understand the lived experience of people with AD and to improve care.
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Affiliation(s)
- Jonathan D. Huntley
- Division of PsychiatryUniversity College LondonLondonUK
- Wellcome Centre for Human NeuroimagingUniversity College LondonLondonUK
| | - Stephen M. Fleming
- Wellcome Centre for Human NeuroimagingUniversity College LondonLondonUK
- Department of Experimental PsychologyUniversity College LondonLondonUK
- Max Planck‐UCL Centre for Computational Psychiatry and Ageing ResearchUniversity College LondonLondonUK
| | - Daniel C. Mograbi
- Department of PsychologyPontifical Catholic University of Rio de JaneiroRio de JaneiroBrazil
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Daniel Bor
- Department of PsychologyUniversity of CambridgeCambridgeUK
| | - Lorina Naci
- School of PsychologyGlobal Brain Health InstituteTrinity College DublinDublinIreland
| | - Adrian M. Owen
- Brain and Mind InstituteDepartment of Physiology and Pharmacology and Department of PsychologyUniversity of Western OntarioLondonOntarioCanada
| | - Robert Howard
- Division of PsychiatryUniversity College LondonLondonUK
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15
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Hendriks I, Demetrio R, Meiland FJM, Chattat R, Szcześniak D, Rymaszewska J, Ettema TP, Evans SB, Brooker D, Evans SC, Atkinson T, Farina E, Saibene FL, Gerritsen DL, Dröes RM. Value of Personalized Dementia-Specific Quality of Life Scales: An Explorative Study in 3 European Countries. Am J Alzheimers Dis Other Demen 2021; 36:15333175211033721. [PMID: 34424058 PMCID: PMC10581102 DOI: 10.1177/15333175211033721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Measuring Quality of Life (QOL) can be difficult due to its individual character. To explore the value of personalized QOL measurement for people with dementia, personalized versions of two dementia-specific QOL scales (Dementia quality of Life (DQoL) and Quaility of Life in Alzheimer's Disease (QoL-AD)) were constructed. This study investigated whether the personalized measures are more valid to detect variations in QOL than their standard versions for people with mild to moderate dementia, with sufficient internal consistency. Moreover, the relationship between the personalized QOL measures and severity of dementia was investigated. Finally, the study explored the differences between countries regarding the personalized overall QOL and differences in the importance of QOL domains. This explorative one-group design study used baseline data from the MEETINGDEM study into the implementation of the Meeting Centres Support Programme in Italy, Poland and the UK. The personalized versions of the DQoL and QoL-AD were reliable, but not more valid than their standard versions. No relationship between severity of dementia and personalized QOL was found. While no differences were found between countries for the overall QOL score, some QOL domains were valued differently: people with dementia from the UK rated self-esteem, mood, physical health, energy level and the ability to do chores around the house significantly less important than people from Italy and Poland. The personalized versions of the DQoL and QoL-AD may offer dementia care practice important insights into what domains contribute most to an individual's QOL.
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Affiliation(s)
- Iris Hendriks
- Department of Psychiatry, Amsterdam UMC, Location VUmc GGZ-inGeest Dienst Onderzoek en Innovatie, Amsterdam, The Netherlands
| | - Raquel Demetrio
- Department of Psychology, University of Leiden, Wassenaarseweg, The Netherlands
| | - Franka J. M. Meiland
- Department of Psychiatry, Amsterdam UMC, Location VUmc GGZ-inGeest Dienst Onderzoek en Innovatie, Amsterdam, The Netherlands
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Dorota Szcześniak
- Department of Psychiatry, Wroclaw Medical University, Wrocław, Poland
| | | | - Teake P. Ettema
- Department of Psychiatry, Amsterdam UMC, Location VUmc GGZ-inGeest Dienst Onderzoek en Innovatie, Amsterdam, The Netherlands
| | - Shirley B. Evans
- Association for Dementia Studies, John’s Campus, University of Worcester, Worcester, UK
| | - Dawn Brooker
- Association for Dementia Studies, John’s Campus, University of Worcester, Worcester, UK
| | - Simon C. Evans
- Association for Dementia Studies, John’s Campus, University of Worcester, Worcester, UK
| | - Teresa Atkinson
- Association for Dementia Studies, John’s Campus, University of Worcester, Worcester, UK
| | | | | | - Debby L. Gerritsen
- Department of Primary and Community Care, Nijmegen Medical Centre, Radboud Alzheimer Centre, Radboud University, Nijmegen, The Netherlands
| | - Rose-Marie Dröes
- Department of Psychiatry, Amsterdam UMC, Location VUmc GGZ-inGeest Dienst Onderzoek en Innovatie, Amsterdam, The Netherlands
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16
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Shikimoto R, Nakaaki S, Sato J, Sato H, Mimura M. Comparison of various items of the quality of life in Alzheimer's disease scale (QOL-AD) in patients with mild or moderate stages of dementia: a cross-sectional study. Psychogeriatrics 2020; 20:926-928. [PMID: 32770609 DOI: 10.1111/psyg.12595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ryo Shikimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Sakuragaoka Memorial Hospital, Tokyo, Japan
| | - Shutaro Nakaaki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Junko Sato
- Speech Language Hearing Therapy, School of Rehabilitation Science Seirei Christopher University, Shizuoka, Japan
| | | | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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17
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Turró-Garriga O, Conde-Sala JL, Viñas V, Turon-Estrada A, Cullell-Juncà M, Calvó-Perxas L, Juvinyà-Canal D, Mioshi E, Garre-Olmo J. Antonovsky's sense of coherence and resistance resources reduce perception of burden in family carers of people with Alzheimer's disease. Aging Ment Health 2020; 24:1717-1725. [PMID: 31559837 DOI: 10.1080/13607863.2019.1667297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Taking care of people with dementia (PWD) has been associated with some degree of burden. The variability of the carer's burden can be partially explained by their personal characteristics. Antonovsky's model of health defined the resistance resources (RRs) as essential mechanisms to cope with stressors, and to shape the personal sense of coherence (SOC). This study identifies the RRs related with carer's SOC, and their implications in the perception of burden in family dementia carers.Methods: A sample of 308 participants from the 'SOC & DEM study' (154 carers and 154 PWD) was recruited from two memory clinics. Carer's personal characteristics of burden, SOC, self-efficacy, coping strategies, perceived social support, and depression were evaluated using standardized instruments. PWD's degree of dependence and behaviour and psychological symptoms of dementia (BPSD) were assessed too. A path analysis was used to test the relationship between caregiver burden and SOC including the personal RRs of the carers and clinical data of PWD.Results: The path model identified SOC as a major factor related to carer's burden perception (r = -.327). Self-efficacy (r = .285), two coping strategies, 'use instrumental support' (r = -.235) and 'behavioural disengagement' (r = -.219), and social support perceived (r = .304) were the main carer's personal characteristics directly related with SOC. Caring experience (r = -.281) was the main carer factor related with burden while dependence (r = .156) and BPSD (r = .157) were the dementia factors.Conclusion: The SOC has previously related with carer's burden. The results contributed to identify relevant and modifiable personal characteristics as RRs that could reduce this burden.
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Affiliation(s)
- Oriol Turró-Garriga
- Aging, Disability and Health Research Group, Girona's Biomedical Research Institute (IdIBGI), Salt, Catalonia, Spain.,Registry of Dementias of Girona, Catalan Health System, Girona, Catalonia, Spain
| | - Josep Lluís Conde-Sala
- Aging, Disability and Health Research Group, Girona's Biomedical Research Institute (IdIBGI), Salt, Catalonia, Spain.,Faculty of Psychology, University of Barcelona, Barcelona, Catalonia, Spain
| | - Vanesa Viñas
- Faculty of Psychology, University of Barcelona, Barcelona, Catalonia, Spain
| | - Antoni Turon-Estrada
- Registry of Dementias of Girona, Catalan Health System, Girona, Catalonia, Spain
| | | | - Laia Calvó-Perxas
- Aging, Disability and Health Research Group, Girona's Biomedical Research Institute (IdIBGI), Salt, Catalonia, Spain
| | | | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Josep Garre-Olmo
- Aging, Disability and Health Research Group, Girona's Biomedical Research Institute (IdIBGI), Salt, Catalonia, Spain.,Registry of Dementias of Girona, Catalan Health System, Girona, Catalonia, Spain.,Department of Medical Sciences, University of Girona, Girona, Catalonia, Spain
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18
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Voros V, Fekete S, Tenyi T, Rihmer Z, Szili I, Osvath P. Untreated depressive symptoms significantly worsen quality of life in old age and may lead to the misdiagnosis of dementia: a cross-sectional study. Ann Gen Psychiatry 2020; 19:52. [PMID: 32944058 PMCID: PMC7493324 DOI: 10.1186/s12991-020-00302-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Several studies demonstrated the role of depressive mood and cognitive impairment in the background of elevated mortality and decreased Quality of Life (QoL) in old age. Our aim was to assess depressive and cognitive symptoms among older people in order to determine if those are recognized and treated or not, to elucidate the association between them and to investigate their impact on QoL. METHODS In the framework of the ICT4Life project self-administered questionnaires and clinical screening tools were used to assess QoL, depressive symptoms and cognitive functions of 60 older persons over the age of 65. RESULTS Males found to be depressed (53.8 vs. 40.4%) and cognitively declined (53.8 vs. 48.9%) more frequently; and had higher scores on the depression (6.85 vs. 5.32) and lower on the QoL (47.38 vs. 50.19) scales. Depressed older persons had lower cognitive levels (24.39 vs. 21.52) and their QoL was significantly poorer (53.97 vs. 43.85) than that of the non-depressed subjects. Depressive symptoms were detected in almost half of the older adults (43.9%), and the majority (80.77%) did not receive antidepressant medication. CONCLUSIONS Depressive and cognitive symptoms found to be common among older people, but were not recognized and treated in most cases. Close correlation between depression and cognitive impairment was also confirmed, as well as the key role of depression in the background of pseudo-dementia and QoL decline. Early recognition of depressive symptoms is important not only to treat the underlying mood disorder, but also to improve QoL of older persons.
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Affiliation(s)
- Viktor Voros
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Pecs, Pecs, Hungary
| | - Sandor Fekete
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Pecs, Pecs, Hungary
| | - Tamas Tenyi
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Pecs, Pecs, Hungary
| | - Zoltan Rihmer
- Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of Medicine, Budapest, Hungary
- Laboratory for Suicide Research and Prevention, National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Ilona Szili
- Department of Clinical Psychology, Karoli Gaspar University of the Reformed Church, Budapest, Hungary
| | - Peter Osvath
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Pecs, Pecs, Hungary
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19
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Akpınar Söylemez B, Küçükgüçlü Ö, Akyol MA, Işık AT. Quality of life and factors affecting it in patients with Alzheimer's disease: a cross-sectional study. Health Qual Life Outcomes 2020; 18:304. [PMID: 32912233 PMCID: PMC7488137 DOI: 10.1186/s12955-020-01554-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background Quality of life (QoL) is a growing area of interest in dementia research. However, it remains a controversial topic. This study aimed to determine the QoL of people with Alzheimer’s disease (PwAD) and investigate the factors affecting patients’ and caregivers’ QoL scores. Methods A cross-sectional study design was used. A total of 98 home-dwelling PwADs and their primary caregivers were recruited in the study. Sociodemographic characteristics and QoL scores, activities of daily living (ADL) and instrumental ADL (IADL), Mini-mental State Examination (MMSE) scores, neuropsychiatric inventory (NPI), and NPI–distress were determined to assess the relevant outcomes. All statistical analyses were performed using SPSS version 22.0. Descriptive statistics, t-test, Pearson correlation, and multinomial regression were used for analysis. Results The patients’ ratings of their QoL were higher than those of the caregivers. Caregiver education, patients’ ADL, and IADL were associated with the patients’ score on the Quality of Life in Alzheimer’s Disease (QoL-AD) scale. In addition to these variables, MMSE, NPI, and NPI–distress were associated with the caregiver scores on QoL-AD. Conclusion From a clinical point of view, the proxy-rated scores of QoL cannot replace the self-ratings of the patients. This study suggests that both self- and proxy-rated QoL scores should be applied whenever possible. Focusing on the management of behavioral problems and supporting functionality and cognitive functions may be modifiable factors that may represent targets for intervention to improve the QoL. The findings of this study should also be used to design caregiver educational programs about the determinants of QoL.
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Affiliation(s)
- Burcu Akpınar Söylemez
- Department of Internal Medicine Nursing, Dokuz Eylul University Faculty of Nursing, Inciralti, Izmir, Turkey.
| | - Özlem Küçükgüçlü
- Department of Internal Medicine Nursing, Dokuz Eylul University Faculty of Nursing, Inciralti, Izmir, Turkey
| | - Merve Aliye Akyol
- Department of Internal Medicine Nursing, Dokuz Eylul University Faculty of Nursing, Inciralti, Izmir, Turkey
| | - Ahmet Turan Işık
- Department of Geriatrics, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
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20
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Voros V, Martin Gutierrez D, Alvarez F, Boda-Jorg A, Kovacs A, Tenyi T, Fekete S, Osvath P. The impact of depressive mood and cognitive impairment on quality of life of the elderly. Psychogeriatrics 2020; 20:271-277. [PMID: 31811691 DOI: 10.1111/psyg.12495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/19/2019] [Accepted: 11/08/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The quality of life (QOL) of the elderly can be influenced by numerous factors. We assessed QOL, cognitive functions, depression and clinical data in elderly aged 65 and over with the aim of analysing factors affecting their QOL. METHODS Semi-structured interviews were conducted with elderly over the age of 65, and their QOL, cognitive functions and depressive symptoms were assessed by validated clinical tests and screening tools. RESULTS The correlation between QOL scales and cognitive tests was not significant. In contrast, the results of depression scales showed significant negative correlation with the scores of the QOL scales. A better QOL was determined by lower age, lack of depressive symptoms, and higher scores in the QOL-AD (Alzheimer's disease) scale. Depressive mood has much more negative impact on the QOL of the elderly than cognitive impairment. CONCLUSIONS Our results demonstrated a close correlation between QOL and depressive mood in the elderly. The early detection and effective management of affective and cognitive symptoms in the elderly can not only restore mental health but may also improve their QOL.
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Affiliation(s)
- Viktor Voros
- Department of Psychiatry and Psychotherapy, University of Pecs, Pecs, Hungary
| | - David Martin Gutierrez
- Department of Signals, Systems and Radiocommunications, Universidad Politecnica, Madrid, Spain
| | - Federico Alvarez
- Department of Signals, Systems and Radiocommunications, Universidad Politecnica, Madrid, Spain
| | - Adrienn Boda-Jorg
- Department of Psychiatry and Psychotherapy, University of Pecs, Pecs, Hungary
| | - Attila Kovacs
- Department of Psychiatry and Psychotherapy, University of Pecs, Pecs, Hungary
| | - Tamas Tenyi
- Department of Psychiatry and Psychotherapy, University of Pecs, Pecs, Hungary
| | - Sandor Fekete
- Department of Psychiatry and Psychotherapy, University of Pecs, Pecs, Hungary
| | - Peter Osvath
- Department of Psychiatry and Psychotherapy, University of Pecs, Pecs, Hungary
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21
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Yang S, Zhang Y, Xie S, Chen Y, Jiang D, Luo Y, Zhao Q, Yang B. Predictors of Perceived Social Support for Patients with Dementia: A Mixed-Methods Study. Clin Interv Aging 2020; 15:595-607. [PMID: 32431493 PMCID: PMC7201008 DOI: 10.2147/cia.s249223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/11/2020] [Indexed: 01/26/2023] Open
Abstract
Purpose Perceived social support (PSS) is closely linked to health outcomes in dementia patients. However, its continuous benefits are unclear. This mixed-methods study examined the impact of social support perceptions and differentiation among patients and carers during disease progression. Patients and Methods Persons with dementia (PWDs), family caregivers, and community family physicians were recruited from nine community health centers. Semi-structured interviews conducted with 12 PWDs (7 PWDs in mild dementia and 5 in moderate dementia), 12 family caregivers, and 6 community family physicians and conventional content analysis were used to explore social support perspectives at different dementia stages. A total of 470 PWDs were divided into mild (n=224), moderate (n=190), and severe (n=56) groups. Demographic, physical, and psychological factors related to PSS were examined by the group using multiple regression analysis. The group-based characteristics were entered into three prediction models. Results In the qualitative study, three themes of social support were identified: two viewpoints refer to social support; different needs and preferences in each stage; non-personalized support services. Quantitatively, the mild group scored lowest in perceived social support, while the severe group scored highest (χ2=64.70, P<0.001). The mild group PSS was predicted by depression (β=−0.07, P=0.04), cognitive capacity (β=−0.18, P<0.001), and instrumental ability (β=−0.78, P<0.001), which differed from the moderate and severe groups. Conclusion This study provided comprehensive insight into PSS from PWDs’ perspective at different stages of the disease. Results indicated the need for a stratified care approach and direction for further research on intervention.
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Affiliation(s)
- Siyuan Yang
- Nursing Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Yuzhong District, People's Republic of China
| | - Yunmei Zhang
- School of Nursing, Chongqing Medical University, Chongqing, Yuzhong District, People's Republic of China
| | - Shiqi Xie
- School of Nursing, Chongqing Medical University, Chongqing, Yuzhong District, People's Republic of China
| | - Yanhan Chen
- School of Nursing, Chongqing Medical University, Chongqing, Yuzhong District, People's Republic of China
| | - Dengbi Jiang
- Community Health Center of Daxigou, Chongqing, Yuzhong District, People's Republic of China
| | - Yetao Luo
- Department of Biostatistics, School of Public Health and Management, Chongqing Medical University, Chongqing, Yuzhong District, People's Republic of China
| | - Qinghua Zhao
- Nursing Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Yuzhong District, People's Republic of China
| | - Bing Yang
- School of Nursing, Chongqing Medical University, Chongqing, Yuzhong District, People's Republic of China
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22
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Wu YT, Nelis SM, Quinn C, Martyr A, Jones IR, Victor CR, Knapp M, Henderson C, Hindle JV, Jones RW, Kopelman MD, Morris RG, Pickett JA, Rusted JM, Thom JM, Litherland R, Matthews FE, Clare L. Factors associated with self- and informant ratings of quality of life, well-being and life satisfaction in people with mild-to-moderate dementia: results from the Improving the experience of Dementia and Enhancing Active Life programme. Age Ageing 2020; 49:446-452. [PMID: 32037460 DOI: 10.1093/ageing/afz177] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/13/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND a large number of studies have explored factors related to self- and informant ratings of quality of life in people with dementia, but many studies have had relatively small sample sizes and mainly focused on health conditions and dementia symptoms. The aim of this study is to compare self- and informant-rated quality of life, life satisfaction and well-being, and investigate the relationships of the two different rating methods with various social, psychological and health factors, using a large cohort study of community-dwelling people with dementia and carers in Great Britain. METHODS this study included 1,283 dyads of people with mild-to-moderate dementia and their primary carers in the Improving the experience of Dementia and Enhancing Active Life study. Multivariate modelling was used to investigate associations of self- and informant-rated quality of life, life satisfaction and well-being with factors in five domains: psychological characteristics and health; social location; capitals, assets and resources; physical fitness and health; and managing everyday life with dementia. RESULTS people with dementia rated their quality of life, life satisfaction and well-being more highly than did the informants. Despite these differences, the two approaches had similar relationships with social, psychological and physical health factors in the five domains. CONCLUSION although self- and informant ratings differ, they display similar results when focusing on factors associated with quality of life, life satisfaction and well-being. Either self- or informant ratings may offer a reasonable source of information about people with dementia in terms of understanding associated factors.
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Affiliation(s)
- Yu-Tzu Wu
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
| | - Catherine Quinn
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
- Centre of Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
| | - Ian R Jones
- Wales Institute for Social and Economic Research, Data and Methods, Cardiff University, Cardiff, UK
| | - Christina R Victor
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Catherine Henderson
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - John V Hindle
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Michael D Kopelman
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | | | - Jeanette M Thom
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | | | - Fiona E Matthews
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
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23
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Differences in Awareness of Disease Between Young-onset and Late-onset Dementia. Alzheimer Dis Assoc Disord 2020; 33:129-135. [PMID: 30870144 DOI: 10.1097/wad.0000000000000299] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Awareness of disease is the ability to acknowledge changes caused by deficits related to the disease process. We aimed to investigate whether there are differences in awareness of disease between young-onset dementia (YOD) and late-onset dementia (LOD) and examined how awareness interacts with cognitive and clinical variables. MATERIALS AND METHODS Using a cross-sectional design, 49 people with YOD and 83 with LOD and their caregivers were included. We assessed awareness of disease, cognition, functionality, stage of dementia, mood, neuropsychiatric symptoms, and caregivers' quality of life (QoL) and burden. RESULTS We found that people with YOD were more aware of the disease than people with LOD (P<0.005). Multivariate linear regression revealed that higher impairment in functional level was associated with unawareness in both groups (YOD=P<0.001; LOD=P<0.001). In the YOD group, preserved awareness was related to worse self-reported QoL (P<0.05), whereas, in LOD, deficits in awareness were related to caregivers' worst perceptions about people with dementia QoL (P<0.001). CONCLUSIONS The findings highlight the distinct nature of awareness between YOD and LOD. The YOD group had higher levels of disease awareness compared with the LOD group, even though the first group had a greater impairment in functionality.
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24
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Chapman S, Colvin LE, Cosentino S. Translational Aspects of the Multidisciplinary Study of Metacognition. TRANSLATIONAL ISSUES IN PSYCHOLOGICAL SCIENCE 2020; 6:26-31. [PMID: 33728364 DOI: 10.1037/tps0000224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Metacognition, self-awareness, self-knowledge, and insight each refer to the process by which individuals reflect upon and appraise their own abilities. Self-awareness is a complex, dynamic, and multifactorial construct that spans various domains such as motor, sensory, functional and cognitive abilities. Various disciplines including cognitive psychology, neuropsychology, psychiatry and neurology have attempted to understand healthy and pathologic self-awareness of cognition in particular. Although intrinsically connected, the study of healthy and pathologic states of self-awareness have remained relatively discrete from one another. Indeed, different disciplines examining self-awareness of cognition have operationalized and measured awareness through distinct theoretical frameworks. More recently, however, various authors have attempted to bridge constructs across disciplines in an effort to develop a unitary theoretical model for self-awareness of cognitive abilities. In this commentary, we summarize the study of self-awareness of cognitive abilities across various disciplines, highlighting translational aspects between them.
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Affiliation(s)
- Silvia Chapman
- Cognitive Neuroscience Section of the Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, and the Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Leigh E Colvin
- Cognitive Neuroscience Section of the Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, and the Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Teachers College, Columbia University, New York, NY, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Section of the Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, and the Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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25
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Yamada T, Nakaaki S, Sato J, Sato H, Shikimoto R, Furukawa TA, Mimura M, Akechi T. Factor structure of the Japanese version of the Quality of Life in Alzheimer's Disease Scale (QOL-AD). Psychogeriatrics 2020; 20:79-86. [PMID: 31020753 DOI: 10.1111/psyg.12459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/16/2019] [Accepted: 04/01/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The Quality of Life in Alzheimer's Disease Scale (QOL-AD) developed by Logsdon et al. in1999 is believed to be useful for evaluating responses from both patients and their caregivers. We previously confirmed both the reliability and the validity of the Japanese version of the QOL-AD. However, the factor structure of this scale should be confirmed because the QOL-AD covers multiple facets of dementia patients' lives. Thus, we performed a factor analysis of the Japanese QOL-AD. Then, we examined the correlations between each of the identified QOL factor scores and the results of other scales. METHODS The Japanese version of the QOL-AD was given to 132 AD patients and 132 caregivers. Four other tests were also performed at the same time: the Mini-Mental State Examination, the Neuropsychiatric Inventory (NPI), the Hyogo Activities of Daily Living Scale (HADL), and the Short Memory Questionnaire. A factor analysis using Varimax rotation was used to examine the dimensions underlying the QOL-AD. In addition, we examined the Pearson correlations between each of the identified QOL factor scores and the results of the other four tests. RESULTS Factor analyses of both versions of the Japanese QOL-AD (both the patients' and the caregivers' responses) revealed three factors that were named 'psychological wellbeing', 'human relationships', and 'physical and social environment'. The 'psychological wellbeing' factor was significantly correlated with the Mood factor of the NPI. The 'human relationships' factor was significantly correlated with the Psychosis factor of the NPI. The 'physical and social environment' factor was significantly correlated with the HADL. CONCLUSIONS Both the patients' and the caregivers' responses to the Japanese version of the QOL-AD were composed of three factors: 'psychological wellbeing', 'human relationships', and 'physical and social environment'. The present results support the multi-domain concept of QOL proposed by Lawton.
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Affiliation(s)
- Takahiro Yamada
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shutaro Nakaaki
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Junko Sato
- Department of Speech-Language-Hearing Therapy, School of Rehabilitation Science Seirei Christopher University, Japan
| | - Hirofumi Sato
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryo Shikimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior (Cognitive-Behavioral Medicine), Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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26
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Huang CH, Umegaki H, Kamitani H, Asai A, Kanda S, Maeda K, Nomura H, Kuzuya M. Change in quality of life and potentially associated factors in patients receiving home-based primary care: a prospective cohort study. BMC Geriatr 2019; 19:21. [PMID: 30678632 PMCID: PMC6345012 DOI: 10.1186/s12877-019-1040-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 01/17/2019] [Indexed: 11/21/2022] Open
Abstract
Background The trajectories for health-related quality of life of patients receiving home-based primary care are not well identified. Our objective was to investigate changes in the quality of life (QOL) and factors that affected the QOL of patients receiving home-based primary care. Methods Our prospective cohort study, the Observational study of Nagoya Elderly with HOme MEdical (ONE HOME) study, recruited 184 patients undergoing home-based primary care with a 5-year follow-up period. Patients’ demographic data, socioeconomic status, physical diseases, medication use, feeding intake status, nutritional status, and functional status were measured annually. The 4-item quality of life index (QOL-HC [home care]) including self-perceived and family-reported QOL ratings that had been developed and previously validated in home care settings was used. Linear regression models were used for cross-sectional and longitudinal analyses. Results The participants’ mean age was 78.8 ± 10.8 years, and 55.9% of the sample was male. Most patients were frail, disabled, and/or malnourished. Self-perceived and family-reported QOL scores dropped sequentially on annual follow-ups. In the multivariate longitudinal analysis, patients who were divorced (β = 1.74) had high baseline QOL scores (β = 0.75) and reported higher QOL ratings. In addition, high functional dependency was associated with a low self-perceived QOL rating, with a β-value of − 1.24 in the pre-bedridden group and − 1.39 in the bedridden group. Given the family-reported QOL rating, the baseline QOL scores (β = 0.50) and Mini-Nutritional Assessment–Short-Form scores (β = 0.37) were found to have positive associations with the QOL rating. Conclusions For the disabled receiving home-based primary care, independent functional status and divorce were positively associated with better self-perceived QOL, whereas nutritional status was correlated with better family-reported QOL.
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Affiliation(s)
- Chi-Hsien Huang
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Department of Family Medicine, E-Da Hospital, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan, Republic of China.,School of Medicine for International Students, I-Shou University, No.8, Yida Rd., Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan, Republic of China
| | - Hiroyuki Umegaki
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Hiroko Kamitani
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Atushi Asai
- Sanei Clinic, 3-560 Komaki, Komaki, Aichi, 485-0041, Japan
| | - Shigeru Kanda
- Minami Health-Medical Cooperative Kaname Hospital, 1-5 Tenpaku, Minami, Nagoya, Aichi, 457-0803, Japan
| | - Keiko Maeda
- Mokuren Clinic, Department of Home Medical Care, 2-21-25 Izumi, Higashi-ku, Nagoya, Aichi, 461-001, Japan
| | - Hideki Nomura
- Aichi Clinic, 2-330 Fukuike, Tenpaku, Nagoya, Aichi, 468-0049, Japan
| | - Masafumi Kuzuya
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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27
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Abstract
UNLABELLED ABSTRACTObjective:To study longitudinal changes in the quality of life (QoL) in persons with and without dementia, and explore the factors associated with baseline QoL and changes of QoL over the follow-up period. DESIGN Prospective longitudinal study. SETTING Data were collected from 17 municipalities in Norway in the period from January 2009 to August 2012. A total of 412 persons were included, 254 (61.7 %) persons without dementia and 158 (38.3 %) with dementia at baseline. SUBJECTS Persons 70 years of age or older, receiving municipal care services. Main outcome measures include the following: self-rated and proxy-rated QoL over a period of 18 months, cognitive status, functional status, neuropsychiatric symptoms, and demographics. RESULTS Longitudinal changes in QoL were small, despite changes in clinical variables. Proxy ratings of patients QoL were lower than the patients' own ratings. Belonging to a group with low QoL trajectory was associated with symptoms of depression, reduced physical and instrumental functioning, and more severe dementia. CONCLUSION Patients and proxies evaluated the patients' QoL differently and QoL did not necessarily correspond with deterioration in clinical parameters. To prevent impaired QoL, we need to address identified factors and keep an approach open to the individual perceptions of QoL.
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28
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Evaluation of depression in patients with alzheimer's disease according to the location of medical care. Arch Psychiatr Nurs 2018; 32:688-694. [PMID: 30201196 DOI: 10.1016/j.apnu.2018.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 02/09/2018] [Accepted: 03/11/2018] [Indexed: 11/22/2022]
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Dewitte L, Vandenbulcke M, Dezutter J. Cognitive functioning and quality of life: Diverging views of older adults with Alzheimer and professional care staff. Int J Geriatr Psychiatry 2018; 33:1074-1081. [PMID: 29869400 DOI: 10.1002/gps.4895] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 04/03/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Staff ratings of quality of life (QOL) in dementia are often lower and more strongly related to the cognitive functioning of the person with dementia than self-ratings. However, cognition-related items in QOL measures and limited cognitive screening measures hamper a clear understanding of the relationship, 2 issues we addressed in the current study. METHODS We collected data of 88 pairs of older adults with Alzheimer disease and their professional caregivers in 9 residential care settings. Both self-report and staff report of the QOL of residents were assessed with the Quality of Life in Alzheimer's Disease. Cognitive functioning was assessed with the Mini-Mental State Examination and a battery of specific cognitive measures. RESULTS Intraclass correlations and a paired sample t test confirmed a discrepancy between self-rating and staff rating, with staff significantly underestimating QOL as experienced by the resident. After removing the possibly confounding memory item of the Quality of Life in Alzheimer's Disease, Mini-Mental State Examination score remained a significant predictor of staff ratings but not self-ratings in regression analyses. Exploratory analyses of specific cognitive measures showed a significant contribution of a memory test of intentional visual association learning in the prediction of staff-rated QOL. CONCLUSIONS Staff reports cannot simply substitute reports of the subjective experience of residents with Alzheimer, so both judgments should be taken into account to form an adequate picture of QOL. Staff might be guided more strongly by a cognitive point of view when evaluating QOL of residents with Alzheimer disease, while the latter might have shifted their evaluation standards to cope adequately with the challenges posed by their disease.
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Affiliation(s)
- Laura Dewitte
- KU Leuven-University of Leuven, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belgium
| | - Mathieu Vandenbulcke
- KU Leuven-University of Leuven, Leuven, Belgium.,University Psychiatric Centre KU Leuven, Leuven, Belgium
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30
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Römhild J, Fleischer S, Meyer G, Stephan A, Zwakhalen S, Leino-Kilpi H, Zabalegui A, Saks K, Soto-Martin M, Sutcliffe C, Rahm Hallberg I, Berg A. Inter-rater agreement of the Quality of Life-Alzheimer's Disease (QoL-AD) self-rating and proxy rating scale: secondary analysis of RightTimePlaceCare data. Health Qual Life Outcomes 2018; 16:131. [PMID: 29954384 PMCID: PMC6022444 DOI: 10.1186/s12955-018-0959-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 06/20/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To assess the quality of life of people with dementia, measures are required for self-rating by the person with dementia, and for proxy rating by others. The Quality of Life in Alzheimer's Disease scale (QoL-AD) is available in two versions, QoL-AD-SR (self-rating) and QoL-AD-PR (proxy rating). The aim of our study was to analyse the inter-rater agreement between self- and proxy ratings, in terms of both the total score and the items, including an analysis specific to care setting, and to identify factors associated with this agreement. METHODS Cross-sectional QoL-AD data from the 7th Framework European RightTimePlaceCare study were analysed. A total of 1330 cases were included: n = 854 receiving home care and n = 476 receiving institutional long-term nursing care. The proxy raters were informal carers (home care) and best-informed professional carers (institutional long-term nursing care). Inter-rater agreement was investigated using Bland-Altman plots for the QoL-AD total score and by weighted kappa statistics for single items. Associations were investigated by regression analysis. RESULTS The overall QoL-AD assessment of those with dementia revealed a mean value of 33.2 points, and the proxy ratings revealed a mean value of 29.8 points. The Bland-Altman plots revealed a poor agreement between self- and proxy ratings for the overall sample and for both care settings. With one exception (item 'Marriage' weighted kappa 0.26), the weighted kappa values for the single QoL-AD items were below 0.20, indicating poor agreement. Home care setting, dementia-related behavioural and psychological symptoms, and the functional status of the person with dementia, along with the caregiver burden, were associated with the level of agreement. Only the home care setting was associated with an increase larger than the predefined acceptable difference between self- and proxy ratings. CONCLUSIONS Proxy quality of life ratings from professional and informal carers appear to be lower than the self-ratings of those with dementia. QoL-AD-SR and QoL-AD-PR are therefore not interchangeable, as the inter-rater agreement differs distinctly. Thus, a proxy rating should be judged as a complementary perspective for a self-assessment of quality of life by those with dementia, rather than as a valid substitute.
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Affiliation(s)
- Josephine Römhild
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Steffen Fleischer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Astrid Stephan
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Sandra Zwakhalen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Helena Leino-Kilpi
- Department of Nursing Science, Faculty of Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Kai Saks
- Department of Internal Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Maria Soto-Martin
- Geriatrics Department, Gerontôpole, Toulouse University Hospital, INSERM UMR 1027, Toulouse, France
| | - Caroline Sutcliffe
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Almuth Berg
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - on behalf of the RightTimePlaceCare Consortium
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
- School of Nursing Science, Witten/Herdecke University, Witten, Germany
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Nursing Science, Faculty of Medicine, University of Turku and Turku University Hospital, Turku, Finland
- Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Internal Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
- Geriatrics Department, Gerontôpole, Toulouse University Hospital, INSERM UMR 1027, Toulouse, France
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Health Sciences, Medical Faculty, Lund University, Lund, Sweden
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dos Santos SB, Rocha GP, Fernandez LL, de Padua AC, Reppold CT. Association of Lower Spiritual Well-Being, Social Support, Self-Esteem, Subjective Well-Being, Optimism and Hope Scores With Mild Cognitive Impairment and Mild Dementia. Front Psychol 2018; 9:371. [PMID: 29666594 PMCID: PMC5891611 DOI: 10.3389/fpsyg.2018.00371] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/06/2018] [Indexed: 01/08/2023] Open
Abstract
Introduction: Positive psychology (PP) constructs contribute significantly to a better quality of life for people with various diseases. There are still few studies that have evaluated the evolution of these aspects during the progression of dementia. Objective: To compare the scores for self-esteem, life satisfaction, affect, spirituality, hope, optimism and perceived support network between elderly people with mild cognitive impairment (MCI), mild dementia and moderate dementia and control group. Methods: Cross-sectional study. The sample consisted of 66 healthy controls, 15 elderly people with MCI, 25 with mild dementia and 22 with moderate dementia matched by age, gender, and schooling. The instruments used were: Spirituality Self Rating Scale (SSRS), Rosenberg Self-Esteem Scale, Medical Outcomes Study's Social Support Scale, Life Satisfaction Scale (LSS), Positive and Negative Affect Schedule (PANAS), Revised Life Orientation Test (LOT-R), and Adult Dispositional Hope Scale (ADHS). Results: The scores for spiritual well-being, social support, self-esteem, life satisfaction, positive affect, optimism, negative affect, and hope differed significantly between the groups (p < 0.05). The individuals with MCI and mild dementia had lower spiritual well-being, social support, self-esteem, life satisfaction, positive affect, optimism and hope scores, and higher negative affect scores compared with the controls. The scores for PP constructs did not differ between the group of people with moderate dementia and the control group. Conclusion: Dementia was found to impact several PP constructs in the early stages of the disease. For individuals with greater cognitive impairment, anosognosia appears to suppress the disease's impact on these constructs.
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Affiliation(s)
- Sabrina B. dos Santos
- Postgraduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Gabrielli P. Rocha
- Department of Psychology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Liana L. Fernandez
- Department of Basic Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Analuiza C. de Padua
- Department of Medical Clinics, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Caroline T. Reppold
- Department of Psychology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Jacob L, Han JW, Kim TH, Park JH, Lee SB, Lee JJ, Ryu SH, Kim SK, Yoon JC, Jhoo JH, Kim JL, Kwak KP, Moon SW, Kim BJ, Lee DY, Kim KW. How Different are Quality of Life Ratings for People with Dementia Reported by Their Family Caregivers from Those Reported by the Patients Themselves? J Alzheimers Dis 2018; 55:259-267. [PMID: 27662302 DOI: 10.3233/jad-160538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Measurements of patient quality of life (QoL) play a major role in the management of dementia. OBJECTIVE We investigated the self-proxy discrepancy of QoL ratings in the elderly and the impact of dementia severity on the discrepancy. METHODS QoL of 718 patients with dementia and 651 non-demented elderly were rated by themselves and their caregivers (CG) using the Quality of Life-Alzheimer's Disease (QoL-AD). The impact of the rater on the total and item scores of QoL-AD was analyzed using repeated measures ANOVA and differential response patterns between self and proxy were analyzed using differential item functioning (DIF) analysis. RESULTS Self-rated scores were higher than CG-rated scores in all diagnostic groups. The interaction between rater and diagnostic group was significant in total QoL-AD score and 5 item scores ('memory', 'marriage', 'chores around the house', 'do things for fun', and 'life as a whole'). The strength of the DIF increased with advancing dementia in these items. CONCLUSION Self-proxy rating discrepancy of QoL was influenced by the presence and severity of dementia only in five items.
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Affiliation(s)
- Louis Jacob
- Department of Biology, École Normale Supérieure de Lyon, Lyon, France
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju-si, Gangwon-do, Korea
| | - Joon Hyuk Park
- Department of Neuropsychiatry, Jeju National University Hospital, Jeju Self-Governing Province, Korea
| | - Seok Bum Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan-si, Chungcheongnam-do, Korea
| | - Jung Jae Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan-si, Chungcheongnam-do, Korea
| | - Seung-Ho Ryu
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Gwangjin-gu, Seoul, Korea
| | - Shin-Kyeom Kim
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Wonmi-gu, Bucheon-si, Gyeonggi-do, Korea
| | - Jong Chul Yoon
- Department of Neuropsychiatry, Kyunggi Provincial Hospital for the Elderly, Giheung-gu, Yongin-si, Gyeonggi-do, Korea
| | - Jin Hyeong Jhoo
- Department of Neuropsychiatry, Kangwon National University Hospital, Chuncheon-si, Gangwon-do, Korea
| | - Jeong Lan Kim
- Department of Psychiatry, Chungnam National University Hospital, Jung-gu, Daejeon, Korea
| | - Kyung Phil Kwak
- Department of Psychiatry, Dongguk Medical Center, Seokjang-dong, Gyeongju-si, Gyeongsangbuk-do, Korea
| | - Seok Woo Moon
- Department of Psychiatry, Konkuk University Chungju Hospital, Chungju-si, Chungcheongbuk-do, Korea
| | - Bong Jo Kim
- Department of Psychiatry, Gyeongsang National University, School of Medicine, Jinju-si, Gyeongnam-do, Korea
| | - Dong Young Lee
- Department of Psychiatry, Seoul National University, College of Medicine, Jongno-gu, Seoul, Korea
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea.,Department of Psychiatry, Seoul National University, College of Medicine, Jongno-gu, Seoul, Korea.,Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Gwanak-gu, Seoul, Korea
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Chapman S, Colvin LE, Vuorre M, Cocchini G, Metcalfe J, Huey ED, Cosentino S. Cross domain self-monitoring in anosognosia for memory loss in Alzheimer's disease. Cortex 2018. [PMID: 29518705 DOI: 10.1016/j.cortex.2018.01.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Anosognosia for memory loss is a common feature of Alzheimer's disease (AD). Recent theories have proposed that anosognosia, a disruption in awareness at a global level, may reflect specific deficits in self-monitoring, or local awareness. Though anosognosia for memory loss has been shown to relate to memory self-monitoring, it is not clear if it relates to self-monitoring deficits in other domains (i.e., motor). The current study examined this question by analyzing the relationship between anosognosia for memory loss, memory monitoring, and motor monitoring in 35 individuals with mild to moderate AD. Anosognosia was assessed via clinical interview before participants completed a metamemory task to measure memory monitoring, and a computerized agency task to measure motor monitoring. Cognitive and psychological measures included memory, executive functions, and mood. Memory monitoring was associated with motor monitoring; however, anosognosia was associated only with memory monitoring, and not motor monitoring. Cognition and mood related differently to each measure of self-awareness. Results are interpreted within a hierarchical model of awareness in which local self-monitoring processes are associated across domain, but appear to only contribute to a global level awareness in a domain-specific fashion.
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Affiliation(s)
- Silvia Chapman
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer's Disease and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States; Goldsmiths College, University of London, London, United Kingdom.
| | - Leigh E Colvin
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer's Disease and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States; Teachers College, Columbia University, New York, NY, United States
| | - Matti Vuorre
- Department of Psychology, Columbia University, New York, NY, United States
| | - Gianna Cocchini
- Goldsmiths College, University of London, London, United Kingdom
| | - Janet Metcalfe
- Department of Psychology, Columbia University, New York, NY, United States
| | - Edward D Huey
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer's Disease and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States; Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer's Disease and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States; Department of Neurology, Columbia University Medical Center, New York, NY, United States
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Perales J, Turró-Garriga O, Gascón-Bayarri J, Reñé-Ramírez R, Conde-Sala JL. The Longitudinal Association Between a Discrepancy Measure of Anosognosia in Patients with Dementia, Caregiver Burden and Depression. J Alzheimers Dis 2018; 53:1133-43. [PMID: 27258415 DOI: 10.3233/jad-160065] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND According to cross-sectional studies, there is an association between anosognosia in people with dementia and caregiver's burden and depression. Anosognosia in patients may be a cause of caregiver burden and depression. However, variability in caregiver anosognosia ratings may exist as caregivers with burden and depression may have a more pessimistic view of the patients' health. OBJECTIVE To assess the variability of caregiver anosognosia ratings of patients with dementia using a widely used anosognosia scale and its longitudinal relationship with caregiver burden and depression. METHODS A convenience cohort of 221 consecutive dementia outpatient and caregiver dyads was followed up at 12 and 24 months. The main instruments used were the Anosognosia Questionnaire-Dementia (AQ-D), Caregiver Burden Interview, and Geriatric Depression Scale. Linear mixed models were used including time as a factor in every model. Multivariate analyses controlled for caregiver's socio-demographic and possible confounding factors. RESULTS Attrition at 12 and 24 months was 24.9% and 42.5% respectively. Patients at baseline were on average 77.8 years of age, 63.3% were women, and 63.3% had < 5 years of education. In the bivariate analyses, caregiver burden, depression, and gender were associated with caregiver ratings of total, cognitive, and personality AQ-D of the patient at different time points. Multivariate analyses revealed burden as the caregiver variable most consistently associated with total, cognitive, and personality caregiver AQ-D ratings of the patient. CONCLUSION Some caregiver characteristics, especially burden, are associated with caregiver ratings of AQ-D with regard to the patient.
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Affiliation(s)
- Jaime Perales
- University of Kansas Medical Center, Department of Preventive Medicine and Public Health, Kansas, USA
| | - Oriol Turró-Garriga
- Research Unit, Santa Caterina Hospital, Institut d'Assistència Sanitària, Salt, Spain
| | - Jordi Gascón-Bayarri
- Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Ramón Reñé-Ramírez
- Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
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Yildirim-Gorter M, Groot D, Hermens L, Diesfeldt H, Scherder E. [Self- and informant-rating mood scales applied in elderly persons with Alzheimer's dementia, with or without a language disorder]. Tijdschr Gerontol Geriatr 2018; 49:103-116. [PMID: 29349659 DOI: 10.1007/s12439-017-0246-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Alzheimer's Dementia (AD) may be associated with symptoms of depression. In AD, problems of language expression or understanding will arise sooner or later. The aim of this study was to determine whether elderly persons with AD, with or without a language disorder, experience difficulties understanding and answering mood related questions. In addition to this, it was our object to test the validity of the answers of nurses as informants, on the mood of an elderly client. METHODS 53 elderly persons, living in care homes, and their nurses, took part in the study. 25 participants had been diagnosed with Alzheimer's disease, 28 participants had no cognitive impairment. Language skills were tested using the SAN-test (Stichting Afasie Nederland) and subtests of the Aachen Aphasia Test (AAT). Mood was assessed with the Beck Depression Inventory-second edition (BDI-II-NL) and the Geriatric Depression Scale (GDS-30). RESULTS There were no significant differences in scores on the mood related questionnaires between participants without cognitive impairment and participants with Alzheimer's disease, with or without a language disorder. The correlation between self- and informant-rating was very limited. In general, nurses reported more depressive symptoms than the elderly persons did themselves. Disparities between self- and informant-ratings varied from informant scores overestimating low self-ratings of depression to informant scores underestimating high self-ratings. CONCLUSION Alzheimer's disease, whether or not it is complicated by a language disorder, does not disturb the normal score distribution on either test (BDI or GDS). This means that elderly persons with Alzheimer's disease are capable of adequately answering questions related to their own mood. However, considerable discrepancies were found between observer- and self-ratings of emotional wellbeing. Therefore it is important to not only take into account the information of an informant when testing for depression, but also the elderly person's own assessment of their mood.
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Affiliation(s)
| | | | - Linda Hermens
- Stichting Verpleeghuis Het Parkhuis, Dordrecht, Nederland
| | | | - Erik Scherder
- Department of Clinical Neuropsychology and Clinical Psychology, Vrije Universiteit, Amsterdam, Nederland
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Abstract
OBJECTIVE Existing evidence indicates that a younger subjective age is a marker of successful aging, including better health and cognition. Building upon this evidence, it is likely that individuals with dementia might feel older. However, subjective evaluation of age might not be affected by dementia because these individuals tend to be anosognosic and report positive health-related quality of life. METHODS Data from two cross-sectional samples from France and the United States were used to compare the subjective age ratings of individuals with and without dementia. RESULTS Results from both samples revealed that individuals with dementia felt younger than their age but did not differ from the controls, even after controlling for sex, chronological age, education, and self-rated health. CONCLUSION The present study suggests that there are no large differences in the subjective experience of age between healthy individuals and those with dementia.
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Affiliation(s)
| | - Antonio Terracciano
- b Florida State University College of Medicine , Tallahassee , Florida , USA
| | - Angelina R Sutin
- b Florida State University College of Medicine , Tallahassee , Florida , USA
| | | | - Stéphane Raffard
- c University of Montpellier , Montpellier , France.,d University Department of Adult Psychiatry , La Colombière Hospital , CHRU Montpellier, Montpellier , France
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Heßmann P, Seeberg G, Reese JP, Dams J, Baum E, Müller MJ, Dodel R, Balzer-Geldsetzer M. Health-Related Quality of Life in Patients with Alzheimer's Disease in Different German Health Care Settings. J Alzheimers Dis 2016; 51:545-61. [PMID: 26890754 DOI: 10.3233/jad-150835] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The purpose of this study is to evaluate the health-related quality of life (HrQoL) of patients with Alzheimer's disease (AD) in different care settings (institutionalized versus community-dwelling) across all severity stages of dementia. Patients were consecutively recruited with their primary caregivers (123 inpatients and 272 outpatients), and the impact of patient-related parameters such as behavioral and psychological symptoms of dementia (BPSD) (Geriatric Depression Scale [GDS] and Neuropsychiatric Inventory [NPI]) and functional capacity (Alzheimer's Disease Cooperative Study-Activities of Daily Living [ADCS-ADL]) on HrQoL was analyzed. Patients' HrQoL was assessed using self-reported and caregiver-rated generic (EuroQoL Instrument) and dementia-specific (Quality of Life-Alzheimer's Disease [Qol-AD]) scales. Patients reported a considerably higher HrQoL than their caregivers on the QoL-AD, EQ-5D, and EQ VAS (p < 0.001). Different dementia severity groups showed significantly worse results in HrQoL for patients with lower MMSE scores. The mean self-reported QoL-AD decreased from 32.3±5.7 in the group with the highest MMSE scores to 27.1±5.5 in patients with the lowest MMSE scores (p < 0.001). A considerably lower HrQoL was shown for institutionalized patients versus participants in outpatient settings (proxy-rated QoL-AD 19.7±4.6 versus 26.0±7.1, p < 0.001). Depressive symptoms (GDS), BPSD (NPI), and reduced functional capacity (ADCS-ADL) were evaluated for their impact on patients' HrQoL. Multivariate models explained between 22% and 54% of the variance in patients' HrQoL. To analyze the causative direction of the reported associations, further longitudinal studies should be conducted.
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Affiliation(s)
- Philipp Heßmann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Greta Seeberg
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Jens Peter Reese
- Department of Neurology, Philipps-University Marburg, Marburg, Germany.,Institute of Medical Sociology and Social Medicine, Philipps-University Marburg, Marburg, Germany
| | - Judith Dams
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Erika Baum
- Department of Family Medicine, Philipps-University Marburg, Marburg, Germany
| | - Matthias J Müller
- Vitos Clinic for Psychiatry and Psychotherapy, Marburg and Justus-Liebig-University, Giessen, Germany
| | - Richard Dodel
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
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Klapwijk MS, Caljouw MA, Pieper MJ, van der Steen JT, Achterberg WP. Characteristics Associated with Quality of Life in Long-Term Care Residents with Dementia: A Cross-Sectional Study. Dement Geriatr Cogn Disord 2016; 42:186-197. [PMID: 27668927 PMCID: PMC5290445 DOI: 10.1159/000448806] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To determine which characteristics are associated with quality of life (QOL) in residents with moderate to very severe dementia in long-term care facilities (LTCFs). MATERIAL AND METHODS This was a cross-sectional analysis of a cluster randomized controlled study in 12 Dutch LTCFs that enrolled 288 residents, with moderate to severe dementia assessed with the Reisberg Global Deterioration Scale (Reisberg GDS) and QOL with the QUALIDEM. Characteristics that were hypothesized to be associated with the six domains of QOL (applicable to very severe dementia) included demographic variables, activities of daily living (Katz ADL), cognitive performance (Cognitive Performance Scale; CPS), pain (Pain Assessment Checklist for Seniors with Limited Ability to Communicate; PACSLAC-D), neuropsychiatric symptoms (Neuropsychiatric Inventory-Nursing Home Version; NPI-NH) and comorbidities. RESULTS Multivariate logistic regression modelling showed associations with age in the domain Social isolation [odds ratio, OR, 0.95 (95% confidence interval, CI, 0.91-0.99)], ADL level in the domain Positive affect [OR 0.89 (95% CI 0.83-0.95)] and the domain Social relations [OR 0.87 (95% CI 0.81-0.93)], severity of dementia in the domain Social relations [OR 0.28 (95% CI 0.12-0.62)] and in the domain Social isolation [OR 2.10 (95% CI 1.17-3.78)], psychiatric disorders in the domain Positive affect [OR 0.39 (95% CI 0.17-0.87)] and pulmonary diseases in the domain Negative affect [OR 0.14 (95% CI 0.03-0.61)] of the QUALIDEM. Neuropsychiatric symptoms were independently associated with all six domains of the QUALIDEM [OR 0.93 (95% CI 0.90-0.96) to OR 0.97 (95% CI 0.95-0.99)]. Pain was associated with the domains Care relationship [OR 0.92 (95% CI 0.84-1.00)] and Negative affect [OR 0.92 (95% CI 0.85-1.00)]. CONCLUSION QOL in dementia is independently associated with age, ADL, dementia severity, pain, psychiatric disorders, pulmonary diseases and neuropsychiatric symptoms. It is possible to detect persons with dementia at risk for a lower QOL. This information is important for developing personalized interventions to improve QOL in persons with dementia in LTCFs.
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Affiliation(s)
- Maartje S. Klapwijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Leiden, The Netherlands,Marente, LTCF ‘van Wijckerslooth’, Oegstgeest, Leiden, The Netherlands,*Maartje S. Klapwijk, MD, Department of Public Health and Primary Care Leiden University Medical Center PO Box 9600, NL-2300 RC Leiden (The Netherlands) E-Mail
| | - Monique A.A. Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Leiden, The Netherlands
| | - Marjoleine J.C. Pieper
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Leiden, The Netherlands,Topaz, LTCF ‘Zuydtwijck’, Leiden, The Netherlands
| | - Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Leiden, The Netherlands
| | - Wilco P. Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Leiden, The Netherlands
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Giebel CM, Challis DJ, Montaldi D. A revised interview for deterioration in daily living activities in dementia reveals the relationship between social activities and well-being. DEMENTIA 2016; 15:1068-81. [DOI: 10.1177/1471301214553614] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The ability to perform instrumental activities of daily living deteriorates early in dementia and affects people with dementia and their carers. However, little is known about individual instrumental activities of daily living impairments. This study therefore investigated instrumental activities of daily living deficits in mild dementia by exploring the relationship between instrumental activities of daily living initiative and performance and general cognition, people with dementia quality of life and carer stress. Moreover, this study explored the contribution of social instrumental activities of daily livings, which to date have received little or no attention. Methods: Twenty carers were administered a revised Interview for Deterioration for Daily Living Activities in Dementia and measures of carer stress (General Health Questionnaire-12) and quality of life in dementia (Quality of Life in Alzheimer’s Disease). The people with dementia completed measures of general cognition (Mini-Mental State Examination and Montreal Cognitive Assessment). Data were analysed using frequency and bivariate correlation analyses and basic thematic analysis was employed to the qualitative data on carer stress. Results: Carer interviews showed that instrumental activities of daily living impairments were associated more with performance than with initiative deficits. Increased social isolation and reluctance to engage in hobbies were particularly stressful to carers and impacted negatively on the people with dementia quality of life, yet were not reported as critical in the qualitative assessment. Conclusions: This study shows that people with mild dementia are impaired to different degrees on their initiative and performance of instrumental activities of daily livings and that impairments relating to social activities particularly relate to well-being. The revised Interview for Deterioration for Daily Living Activities in Dementia with its social instrumental activities of daily livings can help shift the focus of interventions to address those activities that are frequently impaired in mild dementia and relate to people with dementia and carer well-being.
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Affiliation(s)
- Clarissa M Giebel
- School of Psychological Sciences, University of Manchester, Manchester, UK; Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - David J Challis
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Daniela Montaldi
- School of Psychological Sciences, University of Manchester, Manchester, UK
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Conde-Sala JL, Turró-Garriga O, Portellano-Ortiz C, Viñas-Diez V, Gascón-Bayarri J, Reñé-Ramírez R. Self-Perceived Quality of Life Among Patients with Alzheimer’s Disease: Two Longitudinal Models of Analysis. J Alzheimers Dis 2016; 52:999-1012. [DOI: 10.3233/jad-160040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Josep L. Conde-Sala
- Faculty of Psychology, University of Barcelona, Spain
- Aging, Disability and Health Research Group, Biomedical Research Institute of Girona (IdIBGi), Catalonia, Spain
| | - Oriol Turró-Garriga
- Aging, Disability and Health Research Group, Biomedical Research Institute of Girona (IdIBGi), Catalonia, Spain
| | | | - Vanesa Viñas-Diez
- Department of Neurology, Dementia Unit, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Jordi Gascón-Bayarri
- Department of Neurology, Dementia Unit, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Ramón Reñé-Ramírez
- Department of Neurology, Dementia Unit, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
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Lacerda IB, Sousa MFB, Santos RL, Nogueira MML, Dourado MCN. Concepts and objects of awareness in Alzheimer’s disease: an updated systematic review. JORNAL BRASILEIRO DE PSIQUIATRIA 2016. [DOI: 10.1590/0047-2085000000110] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objectives To compare and discuss the objects of awareness in Alzheimer’s disease (AD): awareness of cognitive deficits, of functional activities, of social-emotional functioning and behavioral impairment. Methods A search in the PsycINFo, Pilots, PubMed/Medline and ISI electronic databases according to Prisma methodology was performed. We included studies about awareness in people with AD published between 2010 and 2015, with the combination of keywords: “Alzheimer AND awareness of deficits”, “Alzheimer AND anosognosia”, “Alzheimer AND insight”, “dementia AND awareness of deficits”, “dementia AND anosognosia”, “dementia AND insight”. The articles were categorized according to the specific object of awareness. Results Seven hundred and ten records were identified and, after application of the exclusion criteria, 191 studies were retrieved for potential use. After excluding the duplicates, 46 studies were included. Most studies assessed the cognitive domain of awareness, followed by the functional, social-emotional, and behavioral impairment domains. Memory deficits were not sufficient to explain impaired awareness in AD. Longitudinal studies did not find discrepancies between patients and caregivers’ reports, indicating that awareness is not related to cognition. Conflicting findings were observed, including the relation between awareness, mood, severity of disease, and personal characteristics. Conclusions The studies show lack of conceptual consensus and significant methodological differences. The inclusion of samples without differentiation of dementia etiology is associated to symptomatic differences, which affect awareness domains. Awareness in AD is a complex and multidimensional construct. Different objects elicit different levels of awareness.
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Conde-Sala JL, Turró-Garriga O, Piñán-Hernández S, Portellano-Ortiz C, Viñas-Diez V, Gascón-Bayarri J, Reñé-Ramírez R. Effects of anosognosia and neuropsychiatric symptoms on the quality of life of patients with Alzheimer's disease: a 24-month follow-up study. Int J Geriatr Psychiatry 2016; 31:109-19. [PMID: 25963296 DOI: 10.1002/gps.4298] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/15/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Neuropsychiatric symptoms and anosognosia are known to influence the perceived quality of life of patients (QoL-p) with Alzheimer's disease (AD). This study analysed their impact on patient and caregiver ratings of QoL-p and how these ratings changed in relation to the severity of dementia. METHODS A baseline sample of 221 patients and caregivers was followed up over 24 months. Instruments: Neuropsychiatric Inventory (NPI), Anosognosia Questionnaire-Dementia (AQ-D), Quality of life-Alzheimer's Disease (QoL-AD) and the Global Deterioration Scale (GDS). Longitudinal data were analysed using generalized linear models. RESULTS In the multivariate analysis, greater anosognosia was always associated with higher ratings of QoL-p among patients, especially at 24 months (p < 0.001), and with more negative ratings among caregivers, especially at baseline (p < 0.001). A higher total NPI score was associated with a more negative rating of QoL-p among caregivers (p < 0.001), and it also had a smaller negative effect on patients' self-ratings (p = 0.001). The neuropsychiatric symptoms (NPI) associated with a more negative view of QoL-p were depression, for patients' self-ratings, and apathy and agitation for caregiver ratings. The discrepancy between patient and caregiver ratings increased in line with the severity of dementia. CONCLUSION Neuropsychiatric symptoms had a similarly negative effect on the QoL-p ratings of both patients and caregivers, whereas the effect of anosognosia differed according to the rater (positive for patients, negative for caregivers).
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Affiliation(s)
| | - Oriol Turró-Garriga
- Research Unit, Santa Caterina Hospital, Institut d'Assistència Sanitària, Salt, Spain
| | | | | | - Vanesa Viñas-Diez
- Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Jordi Gascón-Bayarri
- Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Ramón Reñé-Ramírez
- Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
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Dourado MC, Sousa MFD, Santos RL, Simões JP, Nogueira ML, Belfort TT, Torres B, Dias R, Laks J. Quality of life in mild dementia: patterns of change in self and caregiver ratings over time. ACTA ACUST UNITED AC 2016; 38:294-300. [PMID: 26785107 PMCID: PMC7111349 DOI: 10.1590/1516-4446-2014-1642] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/23/2015] [Indexed: 11/22/2022]
Abstract
Objectives: To determine changes over time in self and caregiver ratings of quality of life (QoL) in people with dementia (PwD) and to identify factors associated with changes in QoL ratings. Methods: In this longitudinal study, 69 people with mild Alzheimer’s disease and their caregivers were assessed at baseline and after 1 year. We examined the association of QoL ratings with the following variables at the two time points: awareness of disease, cognitive status, mood, functionality, neuropsychiatric symptoms, and caregiver burden. Multivariate regression analyses were conducted to examine the contribution of co-factors. Results: At baseline, PwD self-ratings of QoL were associated with caregiver ratings of PwD QoL (p = 0.001). Caregiver ratings were associated with PwD mood (p = 0.001) and self-rated QoL (p = 0.001). After 1 year, caregiver ratings of PwD QoL changed significantly (p = 0.049, d = -0.27), whereas PwD self-ratings did not (p = 0.89, d = 0.09). PwD awareness of disease changed significantly (p = 0.001) at 1 year, having declined in 25.4% and improved in 12.3% of participants. PwD QoL self-ratings were associated with caregiver ratings (p = 0.001). Caregiver ratings of PwD QoL after 1 year were associated with PwD mood (p = 0.029), self-reported QoL (p = 0.001), and awareness of disease (p = 0.033). Conclusions: The association between self and caregiver ratings of PwD QoL was maintained over 1 year. The primary factors accounting for the change in caregiver ratings were PwD mood and awareness of disease. QoL and cognitive impairment seem to be relatively independent in mild dementia.
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Affiliation(s)
- Marcia C Dourado
- Centro para Doença de Alzheimer e Outros Transtornos Mentais na Velhice, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Maria F de Sousa
- Centro para Doença de Alzheimer e Outros Transtornos Mentais na Velhice, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Raquel L Santos
- Centro para Doença de Alzheimer e Outros Transtornos Mentais na Velhice, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - José P Simões
- Centro de Estudos e Pesquisa do Envelhecimento, Instituto Vital Brazil, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Marcela L Nogueira
- Centro para Doença de Alzheimer e Outros Transtornos Mentais na Velhice, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Tatiana T Belfort
- Centro para Doença de Alzheimer e Outros Transtornos Mentais na Velhice, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Bianca Torres
- Centro para Doença de Alzheimer e Outros Transtornos Mentais na Velhice, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Rachel Dias
- Centro para Doença de Alzheimer e Outros Transtornos Mentais na Velhice, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Jerson Laks
- Centro para Doença de Alzheimer e Outros Transtornos Mentais na Velhice, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Centro de Estudos e Pesquisa do Envelhecimento, Instituto Vital Brazil, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Abstract
BACKGROUND The goal of the study was to analyze the factors associated with quality of life (QoL) in institutionalized older adults with dementia, based on self and proxy ratings, and if these characteristics differ by dementia severity. METHODS Cross-sectional study of 525 people with dementia (PwD) and their caregivers (professional or family caregivers). Two different QoL questionnaires, leading to three measures, were used: QoL in Alzheimer's disease scale (QOL-AD), self and proxy-rated, and QoL in late-stage dementia scale (QUALID), proxy-rated. Multivariate linear regression models were tested for each QoL measure and for mild/moderate and severe stages of dementia. RESULTS Multiple regression analyses showed a significant association between the three QoL measures and depression. Functional ability was significantly associated with QoL when assessed by proxy. Other factors such as education level, leisure activities and frequency of visits were significantly related with QOL-AD by proxy. The associated factors that differed by dementia severity were education level for moderate dementia, and frequency of visits and who answered the questionnaire (professional vs. family member) for severe dementia. CONCLUSIONS QoL was consistently associated with depressive symptoms independently of the measures as well as functional ability and social leisure activities when the QoL questionnaire was rated by proxy. Treating depressive symptoms, increasing social activities and maintaining the functional ability may decrease the deterioration of QoL in institutionalized older adults with dementia.
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Gambina G, Valbusa V, Corsi N, Ferrari F, Sala F, Broggio E, Condoleo MT, Surdo V, Errera P, Cagnin AC, Moretto G, Moro V. The Italian validation of the Anosognosia Questionnaire for Dementia in Alzheimer's disease. Am J Alzheimers Dis Other Demen 2015; 30:635-44. [PMID: 25792664 PMCID: PMC10852577 DOI: 10.1177/1533317515577185] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although the Anosognosia Questionnaire-Dementia (AQ-D) is one of the main instruments for assessing awareness in Alzheimer's disease (AD), the normative data were until now limited to people from Argentina and Japan. This study aims to validate this instrument in an European context, in particular in an Italian sample. In a multicenter project (Verona, Padova, and Trapani), 130 patients with AD and their caregivers participated in the study. Psychometric characteristics of AQ-D are confirmed indicating that the scale permits the early identification of anosognosia and the correct care management of patients. Indeed, anosognosia results to be present also in patients with very mild AD (moderate: 44.44%; mild: 47.17%; and very mild: 23.73%). Moreover, the results indicate that deficits in awareness may vary in severity and that different types of anosognosia may be identified.
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Affiliation(s)
- G Gambina
- Department of Neuroscience, Alzheimer's Disease Center, Neurology d.O., University Hospital of Verona, Verona, Italy
| | - V Valbusa
- Department of Neuroscience, Alzheimer's Disease Center, Neurology d.O., University Hospital of Verona, Verona, Italy
| | - N Corsi
- Department of Neuroscience, Alzheimer's Disease Center, Neurology d.O., University Hospital of Verona, Verona, Italy
| | - F Ferrari
- Department of Neuroscience, Alzheimer's Disease Center, Neurology d.O., University Hospital of Verona, Verona, Italy
| | - F Sala
- Department of Neuroscience, Alzheimer's Disease Center, Neurology d.O., University Hospital of Verona, Verona, Italy
| | - E Broggio
- Department of Neuroscience, Alzheimer's Disease Center, Neurology d.O., University Hospital of Verona, Verona, Italy
| | - M T Condoleo
- Department of Neuroscience, Alzheimer's Disease Center, Neurology d.O., University Hospital of Verona, Verona, Italy
| | - V Surdo
- Psychogeriatric and Alzheimer Unit, ASP Trapani, Trapani, Italy
| | - P Errera
- Psychogeriatric and Alzheimer Unit, ASP Trapani, Trapani, Italy
| | - A C Cagnin
- Department of Neuroscience, Neurology Clinic, University Medical School of Padova, Padova, Italy
| | - G Moretto
- Department of Neuroscience, Alzheimer's Disease Center, Neurology d.O., University Hospital of Verona, Verona, Italy
| | - V Moro
- Department of Philosophy, Education and Psychology, NPSY.Lab-VR, University of Verona, Verona, Italy
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Baloyannis SJ, Mavroudis I, Mitilineos D, Baloyannis IS, Costa VG. The hypothalamus in Alzheimer's disease: a Golgi and electron microscope study. Am J Alzheimers Dis Other Demen 2015; 30:478-87. [PMID: 25380804 PMCID: PMC10852817 DOI: 10.1177/1533317514556876] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disorder, characterized by irreversible decline of mental faculties, emotional and behavioral changes, loss of motor skills, and dysfunction of autonomic nervous system and disruption of circadian rhythms (CRs). We attempted to describe the morphological findings of the hypothalamus in early cases of AD, focusing our study mostly on the suprachiasmatic nucleus (SCN), the supraoptic nucleus (SON), and the paraventricular nucleus (PVN). Samples were processed for electron microscopy and silver impregnation techniques. The hypothalamic nuclei demonstrated a substantial decrease in the neuronal population, which was particularly prominent in the SCN. Marked abbreviation of dendritic arborization, in association with spinal pathology, was also seen. The SON and PVN demonstrated a substantial number of dystrophic axons and abnormal spines. Alzheimer's pathology, such as deposits of amyloid-β peptide and neurofibrillary degeneration, was minimal. Electron microscopy revealed mitochondrial alterations in the cell body and the dendritic branches. The morphological alterations of the hypothalamic nuclei in early cases of AD may be related to the gradual alteration of CRs and the instability of autonomic regulation.
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Affiliation(s)
- Stavros J Baloyannis
- Department of Neurology, Laboratory of Neuropathology and Electron Microscopy, Aristotelian University, Thessaloniki, Greece Laboratory of Neuropathology, Institute for Research on Alzheimer's Disease, Iraklion, Greece
| | - Ioannis Mavroudis
- Department of Neurology, Laboratory of Neuropathology and Electron Microscopy, Aristotelian University, Thessaloniki, Greece
| | - Demetrios Mitilineos
- Department of Neurology, Laboratory of Neuropathology and Electron Microscopy, Aristotelian University, Thessaloniki, Greece
| | - Ioannis S Baloyannis
- Department of Neurology, Laboratory of Neuropathology and Electron Microscopy, Aristotelian University, Thessaloniki, Greece
| | - Vassiliki G Costa
- Department of Neurology, Laboratory of Neuropathology and Electron Microscopy, Aristotelian University, Thessaloniki, Greece Laboratory of Neuropathology, Institute for Research on Alzheimer's Disease, Iraklion, Greece
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Randhawa H, Jiwa A, Oremus M. Identifying the components of clinical vignettes describing Alzheimer's disease or other dementias: a scoping review. BMC Med Inform Decis Mak 2015; 15:54. [PMID: 26174660 PMCID: PMC4502543 DOI: 10.1186/s12911-015-0179-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 07/06/2015] [Indexed: 11/17/2022] Open
Abstract
Background Clinical vignettes are often used to elicit information about health conditions in research studies. This review summarizes the components of clinical vignettes describing Alzheimer’s disease (AD) or other dementias. The purpose is to provide recommendations for the development of standardized vignettes that may be used in future studies. Methods MEDLINE, EMBASE, PsycINFO, ASSIA, CINAHL were searched from their inception to June 2014. Primary English-language studies employing vignettes to describe AD or similar disorders (including other dementias and Parkinson’s disease) were included in the review. Included studies had to describe the content of the vignettes in the published manuscripts. The characteristics of the included studies and the vignettes were extracted in tabular form and summarized qualitatively. Results Forty-two studies were included in the review. Twenty-four of the studies contained at least one AD vignette, 11 had vignettes focusing on non-AD dementias, and seven contained vignettes describing conditions other than dementia. In total, 58 vignettes were obtained from the 42 included studies. Conclusions Key aspects to consider when constructing vignettes for AD or other dementias include writing the vignettes from a third-person perspective and presenting hypothetical patients as being at least 65 years of age. Researchers should develop standardized vignettes for use across studies. Electronic supplementary material The online version of this article (doi:10.1186/s12911-015-0179-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Harkanwal Randhawa
- Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, Canada
| | - Aalim Jiwa
- Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, Canada
| | - Mark Oremus
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada.
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Predictors of self- and caregiver-rated quality of life for people with dementia living in the community and in nursing homes in northern Taiwan. Int Psychogeriatr 2015; 27:825-36. [PMID: 25465381 DOI: 10.1017/s1041610214002506] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Factors affecting quality of life (QOL) ratings for people with dementia (PWD) have been well studied, but few studies have examined the effect of residence on PWD- and caregiver-rated QOL for PWDs. We designed this study to determine the factors related to PWD- and caregiver-rated QOL in dementia as well as factors related to the discrepancy in these ratings. METHODS For this cross-sectional study, we analyzed data from a convenience sample of 106 PWD-family caregiver dyads (58 community-dwelling dyads and 48 nursing-home dyads). PWDs' data included socio-demographic variables, QOL (assessed by the Quality of Life-Alzheimer's Disease [QOL-AD] scale), cognition, dementia severity, depression, comorbidities, and quality of the dyadic relationship. Caregivers' data included socio-demographic variables, depressive symptoms, and mutuality of the dyadic relationship. RESULTS QOL-AD scores were lower when rated by caregivers than by PWDs. The key factors positively related to both PWD- and caregiver-rated QOL for PWDs were fewer PWD depressive symptoms and higher quality of the PWD-caregiver relationship. The key factors related to the discrepancy in PWD- and caregiver-rated QOL in dementia were PWD residence in a nursing home and lower dementia severity, as well as higher caregiver depression, being an adult child caregiver, and lower caregiver-PWD mutuality. CONCLUSION Caregiver-rated QOL for PWDs and the discrepancy in rated QOL were significantly associated with PWD residence. If caregiver-rated QOL is needed, the effect of residence of PWD should be taken into consideration. Caregivers' depressive status and mutuality with PWD must be also carefully assessed.
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Depressive symptomatology in severe dementia in a European sample: prevalence, associated factors and prescription rate of antidepressants. Int Psychogeriatr 2015; 27:657-67. [PMID: 25497829 DOI: 10.1017/s1041610214002610] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Depression is a common comorbid disorder of dementia. This study explores the prevalence of and factors associated with depressive symptomatology, and antidepressant prescription rates in severe dementia across eight European countries. METHODS In total, 414 people with severe dementia completed measures of cognition and quality of life (QoL), whilst carers completed proxy measures of activities of daily living (ADLs), depression, neuropsychiatric symptoms, QoL and comorbidity. RESULTS Findings indicated that 30% of the sample had depression, whilst the highest and lowest prevalence of depression was reported in Germany and Finland, respectively. Lower QoL, the presence of pain and more frequent neuropsychiatric symptoms were associated with depressive symptomatology, whilst no significant relationship between impairment of ADLs, comorbidity, and depression emerged. Spain and Estonia had the highest and lowest rates of antidepressant prescribing, respectively, whilst Germany had the highest discrepancy between depressive symptomatology and prescription. CONCLUSIONS The study highlights variations across countries in the prevalence of depressive symptomatology in severe dementia and prescription of antidepressants. Information about factors associated with depressive symptomatology may help to better identify and manage depression.
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El Kadmiri N, Zaid Y, Hamzi K, Nadifi S, Slassi I, El Moutawakil B. [Clinical presentation of Moroccan cases with Alzheimer's disease]. Encephale 2014; 40:481-6. [PMID: 25127896 DOI: 10.1016/j.encep.2014.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 03/03/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The diagnostic approach for Alzheimer's disease is based on the presence of cerebral atrophy combined with the score of the mini-examination of the mental state. In this context, this study was conducted to assess the correlation between imaging and neuropsychological testing for cases of early-onset and late-onset Alzheimer's disease. AIM OF THE STUDY Analysis of the clinical and paraclinical aspects of Moroccan cases with Alzheimer's disease. METHODS Seventeen sporadic cases and 8 family cases were seen at the memory clinic of the Neurology Department of the University of Casablanca Ibn Rochd Hospital. A family history was obtained through a clinical interview of the patient and a yes or no self-reporting questionnaire from the guardian or other family member. The disease was considered familial if at least one additional first degree relative suffered from early-onset AD-type dementia. All patients underwent standard somatic neurological examination, cognitive function assessment, brain imaging and laboratory tests. Written consent was obtained from the patients and their guardians prior to the study. RESULTS In our study of 25 individuals, the observed mean age of AD patients was 64.52 ± 9.30 and we observed a slight female predominance (56% versus 44%). In addition, we found a prevalence of AD of approximately 20%, increasing with age, in the population below 60 years of age. Approximately half of our patients (48%) had a score lower than 10 and were affected by severe insanity, while 28% were affected by moderate severe insanity and 24% were light to moderately insane. Twenty-five patients underwent neuroimaging, 18 of whom were assessed by MRI, while 7 were assessed by CT. All patients had hippocampal atrophy, which progressed to affect others brain regions. The blood tests showed no abnormalities in the 25 enrolled AD cases. DISCUSSION Age is undoubtedly the main risk factor for AD; this is also the true for our cases where advanced age was responsible for the exponential increase of the disease's frequency; it reached a peak in the age group of 60-69 years. The AD diagnosis approach is based on the presence of cerebral atrophy combined with the score of the mini-examination of the mental state (MMSE). In our study, in addition to the MMSE, depending on the level of education, the clinician used other tests that do not necessarily require a level of education such as the BEC96, visual short-term or digital memory assessment, work memory assessment, language assessment test (DO80) and apraxia. Neuropsychological examination of the cases with a score of less than 10 showed severe cognitive impairment. The cases presented memory and language impairments, aphasia, visual spatial disorientation, decreased autonomy, executive dysfunction and praxis deficits, all major causes of severe dementia. Neuroimaging revealed hippocampal and cortical atrophy. Correlated with the other studies that aimed to establish links between brain alterations and neuropsychological disorders, we can conclude that a higher level of atrophy reflects a decrease in neuropsychological performance.
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Affiliation(s)
- N El Kadmiri
- Laboratoire de génétique médicale et pathologies moléculaires (LPGM), faculté de médecine et de pharmacie, université Hassan II, 19, rue Tarik Ibnou Ziad, BP 9154, Casablanca 20000, Maroc; Service de neurologie, CHU Ibn Rochd, 1, rue des Hôpitaux, Casablanca, Maroc.
| | - Y Zaid
- Laboratoire de thrombose hémostase, institut de cardiologie de Montréal, 5000 Belanger, H1T1C8 Montréal, Québec, Canada
| | - K Hamzi
- Laboratoire de génétique médicale et pathologies moléculaires (LPGM), faculté de médecine et de pharmacie, université Hassan II, 19, rue Tarik Ibnou Ziad, BP 9154, Casablanca 20000, Maroc
| | - S Nadifi
- Laboratoire de génétique médicale et pathologies moléculaires (LPGM), faculté de médecine et de pharmacie, université Hassan II, 19, rue Tarik Ibnou Ziad, BP 9154, Casablanca 20000, Maroc
| | - I Slassi
- Laboratoire de génétique médicale et pathologies moléculaires (LPGM), faculté de médecine et de pharmacie, université Hassan II, 19, rue Tarik Ibnou Ziad, BP 9154, Casablanca 20000, Maroc; Service de neurologie, CHU Ibn Rochd, 1, rue des Hôpitaux, Casablanca, Maroc
| | - B El Moutawakil
- Laboratoire de génétique médicale et pathologies moléculaires (LPGM), faculté de médecine et de pharmacie, université Hassan II, 19, rue Tarik Ibnou Ziad, BP 9154, Casablanca 20000, Maroc; Service de neurologie, CHU Ibn Rochd, 1, rue des Hôpitaux, Casablanca, Maroc
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