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Hu CJ, Chang LH, Lo YT, Wang JJ. Exploring Healthcare Providers' Difficulties and Strategies when Caring for Community-Dwelling People With Dementia Who are at Risk of Getting Lost. J Appl Gerontol 2024:7334648241261142. [PMID: 39023860 DOI: 10.1177/07334648241261142] [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: 07/20/2024] Open
Abstract
Caring for patients with dementia at risk of getting lost is challenging for community healthcare providers. Through semi-structured interviews with 25 participants, we examined the challenges faced by these providers and the strategies they employed. We identified the following themes of challenging parts: (a) the disturbance caused by behavioral and psychological symptoms in dementia; (b) difficulty in helping older family caregivers to keep the patient from going out; (c) difficulty in changing the attitudes of the family members; families' unawareness of the risk of getting lost. We also identified the following strategies to mitigate these themes: (a) detecting the risk of getting lost through early assessment; (b) encouraging the family to use resources or devices to prevent the patient from getting lost; (c) educating the family to manage behavior and psychological symptoms of dementia; (d) strengthening the patient's crisis awareness.
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Affiliation(s)
- Chia Jung Hu
- Department of Nursing, Da-Yeh University, Changhua, Taiwan
| | - Ling Hui Chang
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan (R.O.C.)
| | - Yu Tai Lo
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, Tainan, Taiwan (R.O.C.)
- College of Medicine, National Cheng Kung University, Tainan, Taiwan (R.O.C.)
| | - Jing Jy Wang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan (R.O.C.)
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Hoben M, Dymchuk E, Doupe MB, Keefe J, Aubrecht K, Kelly C, Stajduhar K, Banerjee S, O'Rourke HM, Chamberlain S, Beeber A, Salma J, Jarrett P, Arya A, Corbett K, Devkota R, Ristau M, Shrestha S, Estabrooks CA. Counting what counts: assessing quality of life and its social determinants among nursing home residents with dementia. BMC Geriatr 2024; 24:177. [PMID: 38383339 PMCID: PMC10880372 DOI: 10.1186/s12877-024-04710-1] [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: 09/28/2023] [Accepted: 01/15/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Maximizing quality of life (QoL) is a major goal of care for people with dementia in nursing homes (NHs). Social determinants are critical for residents' QoL. However, similar to the United States and other countries, most Canadian NHs routinely monitor and publicly report quality of care, but not resident QoL and its social determinants. Therefore, we lack robust, quantitative studies evaluating the association of multiple intersecting social determinants with NH residents' QoL. The goal of this study is to address this critical knowledge gap. METHODS We will recruit a random sample of 80 NHs from 5 Canadian provinces (Alberta, British Columbia, Manitoba, Nova Scotia, Ontario). We will stratify facilities by urban/rural location, for-profit/not-for-profit ownership, and size (above/below median number of beds among urban versus rural facilities in each province). In video-based structured interviews with care staff, we will complete QoL assessments for each of ~ 4,320 residents, using the DEMQOL-CH, a validated, feasible tool for this purpose. We will also assess resident's social determinants of QoL, using items from validated Canadian population surveys. Health and quality of care data will come from routinely collected Resident Assessment Instrument - Minimum Data Set 2.0 records. Knowledge users (health system decision makers, Alzheimer Societies, NH managers, care staff, people with dementia and their family/friend caregivers) have been involved in the design of this study, and we will partner with them throughout the study. We will share and discuss study findings with knowledge users in web-based summits with embedded focus groups. This will provide much needed data on knowledge users' interpretations, usefulness and intended use of data on NH residents' QoL and its health and social determinants. DISCUSSION This large-scale, robust, quantitative study will address a major knowledge gap by assessing QoL and multiple intersecting social determinants of QoL among NH residents with dementia. We will also generate evidence on clusters of intersecting social determinants of QoL. This study will be a prerequisite for future studies to investigate in depth the mechanisms leading to QoL inequities in LTC, longitudinal studies to identify trajectories in QoL, and robust intervention studies aiming to reduce these inequities.
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Affiliation(s)
- Matthias Hoben
- School of Health Policy and Management, Faculty of Health, York University, Room 301E Stong College, 4700 Keele StreetON, Toronto, M3J 1P3, Canada.
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada.
| | - Emily Dymchuk
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Malcolm B Doupe
- Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Janice Keefe
- Nova Scotia Centre on Aging, Mount Saint Vincent University, Halifax, Canada
| | - Katie Aubrecht
- Department of Sociology, Faculty of Arts, St. Francis Xavier University, Antigonish, NS, Canada
| | - Christine Kelly
- Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Kelli Stajduhar
- School of Nursing, Faculty of Human & Social Development, University of Victoria, Victoria, BC, Canada
| | - Sube Banerjee
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Hannah M O'Rourke
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Stephanie Chamberlain
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Anna Beeber
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Jordana Salma
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Pamela Jarrett
- Faculty of Medicine, Dalhousie University, Horizon Health Network, Saint John, New Brunswick, Canada
| | - Amit Arya
- Freeman Centre for the Advancement of Palliative Care, North York General Hospital, Toronto, ON, Canada
- Specialist Palliative Care in Long-Term Care Outreach Team, Kensington Gardens Long-Term Care, Kensington Health, Toronto, ON, Canada
- Division of Palliative Care, Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Kyle Corbett
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Rashmi Devkota
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Melissa Ristau
- Dr. Gerald Zetter Care Centre, The Good Samaritan Society, Edmonton, AB, Canada
| | - Shovana Shrestha
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
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Hussain H, Keetharuth A, Rowen D, Wailoo A. Convergent validity of EQ-5D with core outcomes in dementia: a systematic review. Health Qual Life Outcomes 2022; 20:152. [DOI: 10.1186/s12955-022-02062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/24/2022] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objectives
To explore through a systematic review, the convergent validity of EQ-5D (EQ-5D-3L and EQ-5D-5L (total score and dimensions)) with core outcomes in dementia and investigate how this may be impacted by rater-type; with the aim of informing researchers when choosing measures to use in dementia trials.
Methods
To identify articles relevant to the convergent validity of EQ-5D with core dementia outcomes, three databases were electronically searched to September 2022. Studies were considered eligible for inclusion within the review if they included individual level data from people with dementia of any type, collected self and/or proxy reported EQ-5D and collected at least one core dementia outcome measure. Relevant data such as study sample size, stage of dementia and administration of EQ-5D was extracted, and a narrative synthesis was adopted.
Results
The search strategy retrieved 271 unique records, of which 30 met the inclusion criteria for the review. Twelve different core outcome measures were used to capture dementia outcomes: cognition, function, and behaviour/mood across the studies. Most studies used EQ-5D-3L (n = 27). Evidence related to the relationship between EQ-5D and measures of function and behaviour/mood was the most robust, with unanimous directions of associations, and more statistically significant findings. EQ-5D dimensions exhibited associations with corresponding clinical outcomes, whereby relationships were stronger with proxy-EQ-5D (than self-report).
Conclusion
Measuring health-rated quality of life in dementia populations is a complex issue, particularly when considering balancing the challenges associated with both self and proxy report. Published evidence indicates that EQ-5D shows evidence of convergent validity with the key dementia outcomes, therefore capturing these relevant dementia outcomes. The degree of associations with clinical measures was stronger when considering proxy-reported EQ-5D and differed by EQ-5D dimension type. This review has revealed that, despite the limited targeted psychometric evidence pool and reliance on clinical and observational studies, EQ-5D exhibits convergent validity with other dementia outcome measures.
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Eikelboom WS, den Teuling A, Pol DE, Coesmans M, Franzen S, Jiskoot LC, van Hemmen J, Singleton EH, Ossenkoppele R, de Jong FJ, van den Berg E, Papma JM. Biweekly fluctuations of neuropsychiatric symptoms according to the Neuropsychiatric Inventory: Erratic symptoms or scores? Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5770. [PMID: 35702994 PMCID: PMC9327507 DOI: 10.1002/gps.5770] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study investigates the stability of neuropsychiatric symptoms (NPS) assessed biweekly using the Neuropsychiatric Inventory (NPI) in a memory clinic population during a 6 week period. METHODS Twenty-three spousal caregivers (mean [SD] age = 69.7 [8.8], 82.6% female) of 23 patients (43.5% had dementia) completed all assessments. The NPI was assessed four times during 6 weeks. We examined whether NPI domains were present during all four assessments, studied within-person variation for each NPI domain, and calculated Spearman's correlations between subsequent time-points. Furthermore, we associated repeated NPI assessments with repeated measures of caregiver burden to examine the clinical impact of changes in NPI scores over time. RESULTS The course of NPS was highly irregular according to the NPI, with only 35.8% of the NPI domains that were present at baseline persisted during all 6 weeks. We observed large within-person variation in the presence of individual NPI domains (61.3%, range 37.5%-83.9%) and inconsistent correlations between NPI assessments (e.g., range rs = 0.20-0.57 for agitation, range rs = 0.29-0.59 for anxiety). Higher NPI total scores were related to higher caregiver burden (rs = 0.60, p < 0.001), but changes in NPI total scores were unrelated to changes in caregiver burden (rs = 0.16, p = 0.20). CONCLUSIONS We observed strong fluctuations in NPI scores within very short time windows raising the question whether this represents erratic symptoms and/or scores. Further studies are needed to investigate the origins of these fluctuations.
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Affiliation(s)
- Willem S. Eikelboom
- Department of Neurology and Alzheimer Center Erasmus MCErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Amy den Teuling
- Department of Neurology and Alzheimer Center Erasmus MCErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Daphne E. Pol
- Department of Neurology and Alzheimer Center Erasmus MCErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Michiel Coesmans
- Department of PsychiatryErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Sanne Franzen
- Department of Neurology and Alzheimer Center Erasmus MCErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Lize C. Jiskoot
- Department of Neurology and Alzheimer Center Erasmus MCErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Judy van Hemmen
- Department of Neurology and Alzheimer Center Erasmus MCErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Ellen H. Singleton
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Rik Ossenkoppele
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam University Medical CentersAmsterdamThe Netherlands,Clinical Memory Research UnitLund UniversityMalmöSweden
| | - Frank Jan de Jong
- Department of Neurology and Alzheimer Center Erasmus MCErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MCErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Janne M. Papma
- Department of Neurology and Alzheimer Center Erasmus MCErasmus MC University Medical CenterRotterdamThe Netherlands
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5
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Wubben N, Haaksma M, Ramakers IHGB, van der Flier WM, Verhey FRJ, Olde Rikkert MGM, Melis RJF. A comparison of two approaches for modeling dementia progression in a changing patient context. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5706. [PMID: 35393705 PMCID: PMC9324834 DOI: 10.1002/gps.5706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/15/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To explain the heterogeneity in dementia disease trajectory, we studied the influence of changing patient characteristics on disease course by comparing the association of dementia progression with baseline comorbidity and frailty, and with time-varying comorbidity and frailty. METHODS We used individual growth models to study baseline and time-varying associations in newly diagnosed dementia patients (n = 331) followed for 3 years. We measured cognition using the Mini-Mental State Examination (MMSE), daily functioning using the Disability Assessment for Dementia (DAD), frailty using the Fried criteria and comorbidity using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). RESULTS Although baseline comorbidity and frailty were associated with decreased daily functioning at diagnosis, their effects clearly diminished over time. In contrast, when incorporating comorbidity and frailty as time-varying covariates, comorbidity was associated with lower daily functioning, and frailty with both lower cognition and daily functioning. Being frail was associated with a 0.9-point lower MMSE score (p = 0.03) and a 14.9-point lower DAD score (p < 0.01). A 1-point increase in CIRS-G score was associated with a 1.1-point lower DAD score (p < 0.01). CONCLUSIONS Time-varying comorbidity and frailty were more consistently associated with dementia disease course than baseline comorbidity and frailty. Therefore, modeling only baseline predictors is insufficient for understanding the course of dementia in a changing patient context.
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Affiliation(s)
- Nina Wubben
- Department of Geriatric Medicine & Radboudumc Alzheimer CenterRadboud Institute for Health SciencesRadboud University Medical CentreNijmegenThe Netherlands
| | - Miriam Haaksma
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenthe Netherlands
| | - Inez H. G. B. Ramakers
- Department of Psychiatry and NeuropsychologyMaastricht UniversitySchool for Mental Health and NeuroscienceAlzheimer Centre LimburgMaastrichtThe Netherlands
| | - Wiesje M. van der Flier
- Department of Neurology I Amsterdam NeuroscienceAlzheimer Center AmsterdamVrije Universiteit AmsterdamAmsterdam UMCAmsterdamNetherlands
| | - Frans R. J. Verhey
- Department of Psychiatry and NeuropsychologyMaastricht UniversitySchool for Mental Health and NeuroscienceAlzheimer Centre LimburgMaastrichtThe Netherlands
| | - Marcel G. M. Olde Rikkert
- Department of Geriatric MedicineDonders Institute for Brain, Cognition and BehaviourRadboudumc Alzheimer CenterRadboud University Medical CentreNijmegenThe Netherlands
| | - René J. F. Melis
- Department of Geriatric Medicine & Radboudumc Alzheimer CenterRadboud Institute for Health SciencesRadboud University Medical CentreNijmegenThe Netherlands
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6
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Looking for navigation charts for the journey through dementia. Int Psychogeriatr 2021; 33:747-749. [PMID: 34423753 DOI: 10.1017/s1041610220003889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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7
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Hoben M, Chamberlain SA, O'Rourke HM, Elliott B, Shrestha S, Devkota R, Thorne T, Lam J, Banerjee S, Hughes L, Estabrooks CA. Psychometric properties and use of the DEMQOL suite of instruments in research: a systematic review protocol. BMJ Open 2021; 11:e041318. [PMID: 33550240 PMCID: PMC7925918 DOI: 10.1136/bmjopen-2020-041318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/20/2020] [Accepted: 11/18/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Dementia is a public health issue and a major risk factor for poor quality of life among older adults. In the absence of a cure, enhancing health-related quality of life (HRQoL) of people with dementia is the primary goal of care. Robust measurement of HRQoL is a prerequisite to effective improvement. The DEMQOL suite of instruments is considered among the best available to measure HRQoL in people with dementia; however, no review has systematically and comprehensively examined the use of the DEMQOL in research and summarised evidence to determine its feasibility, acceptability and appropriateness for use in research and practice. METHODS AND ANALYSIS We will systematically search 12 electronic databases and reference lists of all included studies. We will include systematically conducted reviews, as well as, quantitative and qualitative research studies that report on the development, validation or use in research studies of any of the DEMQOL instruments. Two reviewers will independently screen all studies for eligibility, and assess the quality of each included study using one of four validated checklists appropriate for different study designs. Discrepancies at all stages of the review will be resolved by consensus. We will use descriptive statistics (frequencies, proportions, ranges), content analysis of narrative data and vote counting (for the measures of association) to summarise the data elements. Using narrative synthesis, we will summarise what is known about the development, validation, feasibility, acceptability, appropriateness and use of the DEMQOL. Our review methods will follow the reporting and conduct guidelines of the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. ETHICS AND DISSEMINATION Ethical approval is not required as this project does not involve primary data collection. We will disseminate our findings through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42020157851.
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Affiliation(s)
- Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Hannah M O'Rourke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Brittany Elliott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Shovana Shrestha
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Rashmi Devkota
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Trina Thorne
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Jenny Lam
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sube Banerjee
- Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| | - Laura Hughes
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
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8
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Sutin AR, Stephan Y, Terracciano A. Self-Reported Personality Traits and Informant-Rated Cognition: A 10-Year Prospective Study. J Alzheimers Dis 2020; 72:181-190. [PMID: 31561364 DOI: 10.3233/jad-190555] [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: 12/26/2022]
Abstract
Personality traits, such as higher Neuroticism and lower Conscientiousness, are associated with risk of Alzheimer's disease and other dementias. A diagnosis of dementia relies, in part, on informant ratings of the individual's cognitive status. Here we examine whether self-reported personality traits are associated with four measures of informant-rated cognition up to a decade later. Participants from the Health and Retirement Study (N = 2,536) completed a five-factor model measure of personality in 2006 or 2008. Informants completed the 2016 Harmonized Cognitive Assessment Protocol (HCAP), which included ratings of the participant's current cognitive functioning and change in cognitive function over the last decade assessed with the IQCODE, Blessed, 1066, and CSID. Controlling for characteristics of the participant, informant, and their relationship, higher Neuroticism and lower Conscientiousness were associated consistently with worse informant-rated cognition. The association between Openness and better informant-rated cognition was due primarily to higher baseline cognitive function. Extraversion and Agreeableness were associated with better informant-rated cognition only among participants who were cognitively intact at follow-up. The present research suggests that knowledgeable informants are able to detect cognitive deficits associated with personality.
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Affiliation(s)
- Angelina R Sutin
- Florida State University College of Medicine, Tallahassee, FL, USA
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van de Beek M, van Steenoven I, Ramakers IHGB, Aalten P, Koek HL, Olde Rikkert MGM, Manniën J, Papma JM, de Jong FJ, Lemstra AW, van der Flier WM. Trajectories and Determinants of Quality of Life in Dementia with Lewy Bodies and Alzheimer's Disease. J Alzheimers Dis 2020; 70:389-397. [PMID: 31177218 PMCID: PMC6839497 DOI: 10.3233/jad-190041] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Quality of Life (QoL) is an important outcome measure in dementia, particularly in the context of interventions. Research investigating longitudinal QoL in dementia with Lewy bodies (DLB) is currently lacking. Objective: To investigate determinants and trajectories of QoL in DLB compared to Alzheimer’s disease (AD) and controls. Methods: QoL was assessed annually in 138 individuals, using the EQ5D-utility-score (0–100) and the health-related Visual Analogue Scale (VAS, 0–100). Twenty-nine DLB patients (age 69±6), 68 AD patients (age 70±6), and 41 controls (age 70±5) were selected from the Dutch Parelsnoer Institute-Neurodegenerative diseases and Amsterdam Dementia Cohort. We examined clinical work-up over time as determinants of QoL, including cognitive tests, neuropsychiatric inventory, Geriatric Depression Scale (GDS), and disability assessment of dementia (DAD). Results: Mixed models showed lower baseline VAS-scores in DLB compared to AD and controls (AD: β±SE = -7.6±2.8, controls: β±SE = -7.9±3.0, p < 0.05). An interaction between diagnosis and time since diagnosis indicated steeper decline on VAS-scores for AD patients compared to DLB patients (β±SE = 2.9±1.5, p < 0.1). EQ5D-utility-scores over time did not differ between groups. Higher GDS and lower DAD-scores were independently associated with lower QoL in dementia patients (GDS: VAS β±SE = -1.8±0.3, EQ5D-utility β±SE = -3.7±0.4; DAD: VAS = 0.1±0.0, EQ5D-utility β±SE = 0.1±0.1, p < 0.05). No associations between cognitive tests and QoL remained in the multivariate model. Conclusion: QoL is lower in DLB, while in AD QoL shows steeper decline as the disease advances. Our results indicate that non-cognitive symptoms, more than cognitive symptoms, are highly relevant as they impact QoL.
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Affiliation(s)
- Marleen van de Beek
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inger van Steenoven
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inez H G B Ramakers
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Pauline Aalten
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Huiberdina L Koek
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marcel G M Olde Rikkert
- Department of Geriatrics & Radboud UMC Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Janne M Papma
- Department of Neurology and Alzheimer Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frank Jan de Jong
- Department of Neurology and Alzheimer Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Afina W Lemstra
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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Roitto HM, Öhman H, Salminen K, Kautiainen H, Laurila J, Pitkälä KH. Neuropsychiatric Symptoms as Predictors of Falls in Long-Term Care Residents With Cognitive Impairment. J Am Med Dir Assoc 2020; 21:1243-1248. [PMID: 32467074 DOI: 10.1016/j.jamda.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Falls and neuropsychiatric symptoms (NPS) are common among long-term care residents with cognitive impairment. Despite the high prevalence of falls and NPS, little is known about their association. The aim of our study was to explore how NPS, particularly the severity of NPS and specific NPS subgroups, are associated with falls and how psychotropics modify this association. DESIGN Longitudinal cohort study. SETTING AND PARTICIPANTS In total, 532 long-term care residents aged 65 years or older in Helsinki, Finland. METHODS NPS were measured with Neuropsychiatric Inventory (NPI) at baseline. Participants were grouped into 3 groups: no significant NPS (NPI points 0‒3), low NPS burden (NPI 4‒12), and high NPS burden (NPI >12). The number of falls, injuries, fractures, and hospitalizations were collected from medical records over 12 months following baseline assessment. RESULTS Altogether, 606 falls occurred during the follow-up year. The falls led to 121 injuries, 42 hospitalizations, and 20 fractures. Falls and injuries increased significantly with NPS burden (P < .001): 330 falls in the high NPS group (n = 184), 188 falls in the low NPS group (n = 181), and 88 falls in the no significant NPS group (n = 167). The risk of falling showed a curvilinear association with NPI total score. Of NPS subgroups, psychosis and hyperactivity were associated with a higher incidence rate ratio of falls, whereas apathy had a protective association even after adjustment for age, sex, and mobility. Affective symptoms were not associated with falls. Psychotropics did not modify the association between NPS burden and falls. CONCLUSIONS AND IMPLICATIONS The results of this study show that NPS, especially NPS severity, may predict falls and fall-related negative consequences. Severity of NPS should be taken into account when assessing fall risk in long-term care residents with cognitive impairment.
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Affiliation(s)
- Hanna-Maria Roitto
- Department of General Practice, University of Helsinki, Helsinki, Finland; Department of Social Services and Health Care, Helsinki Hospital, Helsinki, Finland.
| | - Hannareeta Öhman
- Department of General Practice, University of Helsinki, Helsinki, Finland; Department of Social Services and Health Care, Helsinki Hospital, Helsinki, Finland
| | - Karoliina Salminen
- Department of General Practice, University of Helsinki, Helsinki, Finland
| | - Hannu Kautiainen
- Department of General Practice, University of Helsinki, Helsinki, Finland; Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| | - Jouko Laurila
- Center for Life-Course Health Research, University of Oulu, Oulu, Finland
| | - Kaisu H Pitkälä
- Department of General Practice, University of Helsinki, Helsinki, Finland; Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
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11
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Vik-Mo AO, Giil LM, Borda MG, Ballard C, Aarsland D. The individual course of neuropsychiatric symptoms in people with Alzheimer's and Lewy body dementia: 12-year longitudinal cohort study. Br J Psychiatry 2020; 216:43-48. [PMID: 31506117 DOI: 10.1192/bjp.2019.195] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Understanding the natural course of neuropsychiatric symptoms (NPS) in dementia is important for planning patient care and trial design, but few studies have described the long-term course of NPS in individuals. METHOD Primary inclusion of 223 patients with suspected mild dementia from general practice were followed by annual assessment, including the Neuropsychiatric Inventory (NPI), for up to 12 years. Total and item NPI scores were classified as stable, relapsing, single episodic or not present based on 4.96 (s.d. 2.3) observations (98% completeness of longitudinal data) for 113 patients with Alzheimer's disease and 84 patients with LBD (68 dementia with Lewy bodies and 16 Parkinson's disease dementia). RESULTS We found that 80% had stable NPI total ≥1, 50% had stable modest NPI total ≥12 and 25% had stable NPI total ≥24 scores. Very severe NPS (≥48) were mostly single episodes, but 8% of patients with Alzheimer's disease had stable severe NPS. Patients with Alzheimer's disease and the highest 20% NPI total scores had a more stable or relapsing course of four key symptoms: aberrant motor behaviour, aggression/agitation, delusions and irritability (odds ratio 55, P < 0.001). This was not seen in LBD. Finally, 57% of patients with Alzheimer's disease and 84% of patients with LBD had reoccurring psychotic symptoms. CONCLUSIONS We observed a highly individual course of NPS, with most presenting as a single episode or relapsing; a stable course was less common, especially in LBD. These findings demonstrate the importance of an individualised approach (i.e. personalised medicine) in dementia care.
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Affiliation(s)
- Audun Osland Vik-Mo
- Senior Consultant, Centre for Age-Related Medicine (SESAM), Stavanger University Hospital; and Researcher, Department of Clinical Science, University of Bergen, Norway
| | - Lasse Melvaer Giil
- Researcher, Department of Clinical Science, University of Bergen; and Resident, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Norway
| | - Miguel Germán Borda
- PhD student, Centre for Age-Related Medicine (SESAM); PhD student, Stavanger University Hospital; and Faculty of Health Sciences, University of Stavanger, Norway
| | - Clive Ballard
- Professor, Pro-Vice Chancellor and Executive Dean, Institute for Health Research, University of Exeter Medical School, UK
| | - Dag Aarsland
- Head of Research, Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Norway; and Professor, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Estabrooks CA, Straus SE, Flood CM, Keefe J, Armstrong P, Donner GJ, Boscart V, Ducharme F, Silvius JL, Wolfson MC. Restoring trust: COVID-19 and the future of long-term care in Canada. Facets (Ott) 2020. [DOI: 10.1139/facets-2020-0056] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The Royal Society of Canada Task Force on COVID-19 was formed in April 2020 to provide evidence-informed perspectives on major societal challenges in response to and recovery from COVID-19. The Task Force established a series of working groups to rapidly develop policy briefings, with the objective of supporting policy makers with evidence to inform their decisions. This paper reports the findings of the COVID-19 Long-Term Care (LTC) working group addressing a preferred future for LTC in Canada, with a specific focus on COVID-19 and the LTC workforce. First, the report addresses the research context and policy environment in Canada’s LTC sector before COVID-19 and then summarizes the existing knowledge base for integrated solutions to challenges that exist in the LTC sector. Second, the report outlines vulnerabilities exposed because of COVID-19, including deficiencies in the LTC sector that contributed to the magnitude of the COVID-19 crisis. This section focuses especially on the characteristics of older adults living in nursing homes, their caregivers, and the physical environment of nursing homes as important contributors to the COVID-19 crisis. Finally, the report articulates principles for action and nine recommendations for action to help solve the workforce crisis in nursing homes.
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Affiliation(s)
| | - Sharon E. Straus
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Janice Keefe
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS, Canada
| | - Pat Armstrong
- Department of Sociology, York University, Toronto, ON, Canada
| | - Gail J. Donner
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Véronique Boscart
- CIHR/Schlegel Industrial Research Chair for Colleges in Seniors Care, Conestoga College, Kitchener, ON, Canada
| | | | - James L. Silvius
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael C. Wolfson
- School of Epidemiology and Public Health and Faculty of Law, University of Ottawa, Ottawa, ON, Canada
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Haaksma ML, Rizzuto D, Leoutsakos JMS, Marengoni A, Tan EC, Olde Rikkert MG, Fratiglioni L, Melis RJ, Calderón-Larrañaga A. Predicting Cognitive and Functional Trajectories in People With Late-Onset Dementia: 2 Population-Based Studies. J Am Med Dir Assoc 2019; 20:1444-1450. [DOI: 10.1016/j.jamda.2019.03.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/20/2019] [Accepted: 03/22/2019] [Indexed: 10/26/2022]
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The clinical course and interrelations of dementia related symptoms - CORRIGENDUM. Int Psychogeriatr 2019; 31:1377. [PMID: 30520402 DOI: 10.1017/s1041610218001771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
PURPOSE OF REVIEW To date, most research in dementia has focused either on the identification of dementia risk prediction or on understanding changes and predictors experienced by individuals before diagnosis. Despite little is known about how individuals change after dementia diagnosis, there is agreement that changes occur over different time scales and are multidomain. In this study, we present an overview of the literature regarding the longitudinal course of dementia. RECENT FINDINGS Our review suggests the evidence is scarce and findings reported are often inconsistent. We identified large heterogeneity in dementia trajectories, risk factors considered and modelling approaches employed. The heterogeneity of dementia trajectories also varies across outcomes and domains investigated. SUMMARY It became clear that dementia progresses very differently, both between and within individuals. This implies an average trajectory is not informative to individual persons and this needs to be taken into account when communicating prognosis in clinical care. As persons with dementia change in many more ways during their patient journey, heterogeneous disease progressions are the result of disease and patient characteristics. Prognostic models would benefit from including variables across a number of domains. International coordination of replication and standardization of the research approach is recommended.
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Abstract
All life requires the capacity to recover from challenges that are as inevitable as they are unpredictable. Understanding this resilience is essential for managing the health of humans and their livestock. It has long been difficult to quantify resilience directly, forcing practitioners to rely on indirect static indicators of health. However, measurements from wearable electronics and other sources now allow us to analyze the dynamics of physiology and behavior with unsurpassed resolution. The resulting flood of data coincides with the emergence of novel analytical tools for estimating resilience from the pattern of microrecoveries observed in natural time series. Such dynamic indicators of resilience may be used to monitor the risk of systemic failure across systems ranging from organs to entire organisms. These tools invite a fundamental rethinking of our approach to the adaptive management of health and resilience.
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Helvik AS, Selbæk G, Šaltytė Benth J, Røen I, Bergh S. The course of neuropsychiatric symptoms in nursing home residents from admission to 30-month follow-up. PLoS One 2018; 13:e0206147. [PMID: 30335840 PMCID: PMC6193723 DOI: 10.1371/journal.pone.0206147] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/08/2018] [Indexed: 12/27/2022] Open
Abstract
Aim The aim of this study was to describe the prevalence and persistence of clinically significant neuropsychiatric symptoms (NPS) in nursing home residents with dementia, and to study the association between severity of dementia and specific neuropsychiatric sub-syndromes over time. Methods In total, 583 residents with dementia were included at admission to a nursing home and followed with biannual assessments until death, or to 30-month follow-up. At the end of the 30-month follow-up, 305 participants had died and 57 had left the study for other reasons, leaving 221 residents in the study. We collected data on demographics, cognition, severity of dementia, NPS, personal activities of daily living (P-ADL), physical health, medication and type of nursing home unit. NPS was assessed using the Neuropsychiatric Inventory (NPI), the Nursing Home version. Results The prevalence and persistence at two consecutive time-points of clinically significant NPS was high during the study period. The mean NPI agitation sub-syndrome score increased during the study period, while the NPI affective and psychosis sub-syndrome scores remained unchanged. More severe dementia was associated with higher NPI agitation, psychosis and affective sub-syndrome scores. The association remained unchanged over time for agitation and psychosis. For the NPI affective sub-syndrome, the association was stronger at the beginning, and declined towards the end of the study period. Conclusion The findings of high prevalence and persistence at two consecutive time points of clinically significant NPS over time, and the associations between severity of dementia and NPI sub-syndromes shed light on the burden and care needs of nursing home residents with dementia after admission to nursing home care. This information is of interest to health care planners and providers to enable them to increase the quality of care for nursing home residents.
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Affiliation(s)
- Anne-Sofie Helvik
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Health Trust, Tønsberg, Norway
- St Olavs University Hospital, Trondheim, Norway
- * E-mail:
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Health Trust, Tønsberg, Norway
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
- HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Irene Røen
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Sverre Bergh
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Health Trust, Tønsberg, Norway
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
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Thoma MV, Forstmeier S, Schmid R, Kellner O, Xepapadakos F, Gasser US, Blessing A, Ropohl A, Bieri-Brüning G, Debeer D, Maercker A. Preliminary evidence for an increased likelihood of a stable trajectory in mild cognitive impairment in individuals with higher motivational abilities. BMC Geriatr 2018; 18:181. [PMID: 30103681 PMCID: PMC6090725 DOI: 10.1186/s12877-018-0865-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 07/25/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Motivational abilities (MA), that describe skills in relation to goal-oriented behavior, have recently been found to be associated with neuropathological aging. Here we examine the impact of MA on the long-term course of mild cognitive impairment (MCI). METHODS We followed-up N = 64 individuals diagnosed with MCI (Mage = 73 years, 44% female) for 3 years. MA were assessed by long-term informants of the participants using two scales: motivation and decision regulation [Volitional Components Questionnaires, VCQ, (Kuhl and Fuhrmann, Decomposing self-regulation and self-control: the volitional components inventory, 1998)]. Cognitive abilities were assessed with the Mini Mental State Examination (J Psychiatr Res 12:189-98, 1975). Survival analyses and multilevel modeling (MLM) were applied to determine the predicting effect of informant-rated MA at baseline on the likelihood of MCI stability and on the trajectory of cognitive abilities. RESULTS Fifty percent (n = 32) of the MCI participants remained stable, while 32.8% (n = 21) and 17.2% (n = 11) converted to Alzheimer's disease (AD) or dropped-out, respectively. Survival analyses revealed that MCI cases with higher-rated MA at baseline were more likely to exert a stable course in MCI over 3 years (p = 0.036) when controlling for demographic characteristics and executive function. MLM analyses indicated that higher informant-rated MA at baseline were significantly related to higher cognitive abilities, even when controlling for MCI subtype (p = 0.030). CONCLUSIONS This study provides preliminary longitudinal evidence for a lower risk of conversion to AD and higher cognitive abilities by higher rated MA at an early stage of MCI.
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Affiliation(s)
- Myriam V. Thoma
- University of Zurich, Binzmuehlestr, 14, 8050 Zurich, Switzerland
- University Research Priority Program “Dynamics of Healthy Aging”, University of Zurich, Zurich, Switzerland
- Psychopathology and Clinical Intervention, University of Zurich, Binzmuehlestr. 14/17, CH-8050 Zurich, Switzerland
| | - Simon Forstmeier
- University of Zurich, Binzmuehlestr, 14, 8050 Zurich, Switzerland
- University of Siegen, Faculty II, Developmental Psychology, Adolf-Reichwein-Str. 2, 57068 Siegen, Germany
| | - Roger Schmid
- Psychiatrische Klinik Zugersee, Zug, Switzerland
| | - Oliver Kellner
- Integrierte Psychiatrie Winterthur, Winterthur, Switzerland
- Present Address: Alterspsychiatrische Praxis, Buehlach, Switzerland
| | | | | | | | - Axel Ropohl
- Sanatorium Kilchberg AG, Kilchberg, Switzerland
- Present Address: KMG – Kompetenz mentale Gesundheit GmbH, Baar, Switzerland
| | | | - Dries Debeer
- University of Zurich, Binzmuehlestr, 14, 8050 Zurich, Switzerland
| | - Andreas Maercker
- University of Zurich, Binzmuehlestr, 14, 8050 Zurich, Switzerland
- University Research Priority Program “Dynamics of Healthy Aging”, University of Zurich, Zurich, Switzerland
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Haaksma ML, Calderón-Larrañaga A, Olde Rikkert MG, Melis RJ, Leoutsakos JS. Cognitive and functional progression in Alzheimer disease: A prediction model of latent classes. Int J Geriatr Psychiatry 2018; 33:1057-1064. [PMID: 29761569 PMCID: PMC6039270 DOI: 10.1002/gps.4893] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/13/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE We sought to replicate a previously published prediction model for progression, developed in the Cache County Dementia Progression Study, using a clinical cohort from the National Alzheimer's Coordinating Center. METHODS We included 1120 incident Alzheimer disease (AD) cases with at least one assessment after diagnosis, originating from 31 AD centres from the United States. Trajectories of the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating sum of boxes (CDR-sb) were modelled jointly over time using parallel-process growth mixture models in order to identify latent classes of trajectories. Bias-corrected multinomial logistic regression was used to identify baseline predictors of class membership and compare these with the predictors found in the Cache County Dementia Progression Study. RESULTS The best-fitting model contained 3 classes: Class 1 was the largest (63%) and showed the slowest progression on both MMSE and CDR-sb; classes 2 (22%) and 3 (15%) showed moderate and rapid worsening, respectively. Significant predictors of membership in classes 2 and 3, relative to class 1, were worse baseline MMSE and CDR-sb, higher education, and lack of hypertension. Combining all previously mentioned predictors yielded areas under the receiver operating characteristic curve of 0.70 and 0.75 for classes 2 and 3, respectively, relative to class 1. CONCLUSIONS Our replication study confirmed that it is possible to predict trajectories of progression in AD with relatively good accuracy. The class distribution was comparable with that of the original study, with most individuals being members of a class with stable or slow progression. This is important for informing newly diagnosed AD patients and their caregivers.
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Affiliation(s)
- Miriam L. Haaksma
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical CenterNijmegenThe Netherlands,Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm UniversityStockholmSweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm UniversityStockholmSweden
| | - Marcel G.M. Olde Rikkert
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical CenterNijmegenThe Netherlands
| | - René J.F. Melis
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical CenterNijmegenThe Netherlands
| | - Jeannie‐Marie S. Leoutsakos
- Department of Psychiatry, Division of Geriatric Psychiatry and NeuropsychiatryJohns Hopkins University School of MedicineBaltimoreMDUSA
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Abstract
The notion of social health (Huber et al., 2011) as applied to dementia care research was introduced to redress the balance of empirical studies that tended to focus on biomedical, cognitive, and functional status in dementia (Vernooij-Dassen and Jeon, 2016). The introduction of social health has followed the zeitgeist of campaigners for a better life for those living with dementia, with initiatives to improve the social images of dementia (Alzheimers.org, 2017). Examples from social research in dementia to examine friendships and the social environments of people with dementia exist (Medeiros et al., 2012), but introduction of the paradigm of social health in dementia (Vernooij-Dassen and Jeon, 2016) has harnessed a growing research agenda (de Vugt and Dröes, 2017). This paradigm provides an umbrella concept to study how social aspects influence the dynamic balance between opportunities and limitations in dementia. Social health goes beyond the neuropathology of dementia, to understand how people, their social networks and wider society with its norms, interact with the condition (Vernooij-Dassen and Jeon, 2016). It is not far removed from the ideas of Tom Kitwood, the pioneer of person-centered dementia care, who noted that "personhood is a standing or status that is bestowed upon one human being, by others, in the context of relationship and social being" (Kitwood, 1997). The INTERDEM (Early detection and timely INTERvention in DEMentia, www.interdem.org) psychosocial research agenda aspired to improve knowledge about social inclusion and reciprocal relationships for people with dementia (Moniz-Cook et al., 2011). The concept of social health (Vernooij-Dassen and Jeon, 2016) with its dimensions for dementia research (Dröes et al., 2017) has begun to develop this knowledge-base.
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Kok JS, Nielen MMA, Scherder EJA. Quality of life in small-scaled homelike nursing homes: an 8-month controlled trial. Health Qual Life Outcomes 2018; 16:38. [PMID: 29486788 PMCID: PMC5830070 DOI: 10.1186/s12955-018-0853-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 01/24/2018] [Indexed: 01/20/2023] Open
Abstract
Background Quality of life is a clinical highly relevant outcome for residents with dementia. The question arises whether small scaled homelike facilities are associated with better quality of life than regular larger scale nursing homes do. Methods A sample of 145 residents living in a large scale care facility were followed over 8 months. Half of the sample (N = 77) subsequently moved to a small scaled facility. Quality of life aspects were measured with the QUALIDEM and GIP before and after relocation. Results We found a significant Group x Time interaction on measures of anxiety meaning that residents who moved to small scale units became less anxious than residents who stayed on the regular care large-scale units. No significant differences were found on other aspects of quality of life. Conclusions This study demonstrates that residents who move from a large scale facility to a small scale environment can improve an aspect of quality of life by showing a reduction in anxiety. Trial registration Current Controlled Trials ISRCTN11151241. registration date: 21–06-2017. Retrospectively registered.
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Affiliation(s)
- Jeroen S Kok
- Lentis
- Dignis, Mental Health Care Institute, PO Box 128, 9470 AC, Zuidlaren, The Netherlands.
| | - Marjan M A Nielen
- ZINN, Mental Health Care Institute, PO Box 51, 9750 AB, Haren, The Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, VU University Amsterdam, van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
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