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Souza NAPD, Simões Neto JP, Dourado MCN. The Relationship Between Decision-Making Capacity and Awareness in People with Young-Onset Alzheimer's Disease. J Alzheimers Dis 2024; 101:671-680. [PMID: 39213057 DOI: 10.3233/jad-231324] [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] [Indexed: 09/04/2024]
Abstract
Background Young-onset AD (YOAD) typically occurs before the age of 65 and affects less than 6% of all people diagnosed with AD. There is a lack of research on differences between decision-making capacity and awareness according to age at onset of dementia. Objective We investigated the relationship between decision-making capacity and awareness domains in people with young- (YOAD) and late-onset Alzheimer's disease (LOAD). Methods A cross-sectional study included 169 consecutively selected people with AD and their caregivers (124 people with LOAD and 45 people with YOAD). Results People with YOAD were more cognitively impaired, but more aware of their cognitive deficits and health condition, with moderate effect sizes. All people with AD presented deficits in the domains of decision-making capacity, with more impairment in understanding. There was a relationship between understanding and awareness domains, such that awareness was particularly important for decision-making capacity in the YOAD group. Conclusions Better awareness involved better understanding in the YOAD group. Clinically, our findings shed light on the need to consider the differences in the domains of awareness and their relationship with other clinical aspects such as decision-making capacity according to age at onset of AD. Furthermore, our data can suggest hypotheses for larger and more robust prospective studies.
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Affiliation(s)
- Natalie Aparecida Pereira de Souza
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Pedro Simões Neto
- Department of Sociology and Political Science, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Marcia Cristina Nascimento Dourado
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Belfort Almeida Dos Santos TT, Nogueira MML, Lacerda IB, Brandt M, de Lucena AT, Rangel R, Gaigher J, Oliveira F, Dourado MCN. A Longitudinal Evaluation of the Pattern of Social Cognition Impairment in Brazilians With Alzheimer's Disease. Alzheimer Dis Assoc Disord 2023; 37:363-369. [PMID: 37916936 DOI: 10.1097/wad.0000000000000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/06/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Social cognition (SC) impairments contribute to the dependence of people with Alzheimer disease (AD), influencing their functional disability and the burden on family members and caregivers. Our objective was to longitudinally investigate the relationship between SC and cognitive and clinical variables in persons with AD and their caregivers. We also evaluated the different SC predictors from 3 perspectives: people with AD, caregivers of people with AD, and discrepancy analysis. METHODS In all, 137 dyads (people with AD and their caregivers) underwent 2 assessments: at baseline (M1) and after 1 year (M2). During follow-up, 58 dyads were excluded, and the study was thus concluded with 79. RESULTS Longitudinal analysis of the people with AD showed that while some cognitive functions declined (which is consistent with disease progression), SC impairments showed a more stable pattern. Another interesting result was related to SC predictors. For people with AD, SC was associated with cognition at both time points. For caregivers, besides cognition, other predictors included reduced functional abilities and quality of life in people with AD. These results are consistent with the discrepancy predictors. CONCLUSION The stable pattern in SC functioning over 12 months in AD suggests that this neurocognitive domain may be influenced more by emotional processing than by cognitive impairment. In addition, the SC predictors showed that the investigation of different points of view enables a more global understanding, contributing to better and more targeted treatment for the patient.
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3
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Brennan S, Doan T, Osada H, Hashimoto Y. Validation of the Japanese version of the quality of life-Alzheimer's disease for nursing homes. Aging Ment Health 2023; 27:281-291. [PMID: 35585714 DOI: 10.1080/13607863.2022.2076209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES This study aims to validate the Japanese version of Quality of Life-Alzheimer's Disease for Nursing Homes (QOL-AD NH). This is the modified version of QOL-AD, initially developed for residents living with dementia in long-term care settings. METHODS Psychometric assessment was conducted in a sample of 101 residents and their professional care staff to obtain self-ratings and proxy-ratings of QOL, respectively. Residents' behavior was observed using Dementia Care Mapping (DCM) method, and their mood/engagement (ME) value was evaluated as a proxy measure of QOL. RESULTS Self-ratings were higher than proxy-ratings (t = 10.22, p<.001), with moderate correlation (r=.51, p<.001) and strong internal consistency (α=.87 for both). The exact agreement between the two groups was 38.23%. Convergent validity was confirmed with ME value and positive engagements of DCM. Exploratory factor analysis was performed for further validity testing. Three factors - self and life overall, social environment, and physical and psychological health, accounted for 85.9% of the total variance with Cronbach's α of .87, .73, .90, respectively. CONCLUSION Using a validated Japanese version of the QOL-AD NH may help assess the QOL of older residents living in long-term care settings to improve the continuum of care for dementia.
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Affiliation(s)
- Sumiyo Brennan
- Institute for Gerontology, J. F. Oberlin University, Tokyo, Japan
| | - Therese Doan
- School of Nursing, San Francisco State University, CA, USA
| | - Hisao Osada
- J. F. Oberlin University, Graduate School of International Advanced Studies MA&PhD Programs in Gerontology, Tokyo, Japan
| | - Yumiko Hashimoto
- Institute for Gerontology, J. F. Oberlin University, Tokyo, Japan
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4
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Wang K, Gao X, Sun F, De Fries CM, Levkoff SE. Evaluation of the Reliability and Validity of the Alzheimer's Disease-Related Quality of Life Instrument among Older Adults with Cognitive Impairment in Mainland China. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2022; 65:649-663. [PMID: 34889717 DOI: 10.1080/01634372.2021.2010856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 06/13/2023]
Abstract
The purpose of this study is to examine the reliability and validity of the ADRQL instrument among older adults with cognitive impairment in mainland China. Three hundred older adults with cognitive impairment and their primary family caregivers from Wuhan participated in structured interviews. Cronbach's α and Kuder-Richardson Formula 20 were used to examine internal consistency reliability. Confirmatory factor analysis, Heterotrait-Monotrait ratios, and ordinary least square regression were used to assess the factorial validity, discriminant validity, and criterion validity. The ADRQL had acceptable reliability and validity, which can be used to assess overall quality of life for this population.
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Affiliation(s)
- Kaipeng Wang
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Xiang Gao
- School of Sociology, Huazhong University of Science and Technology, Wuhan, China
| | - Fei Sun
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Carson M De Fries
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Sue E Levkoff
- College of Social Social Work, University of South Carolina, Columbia, South Carolina, USA
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5
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Hjort Telhede E, Arvidsson S, Karlsson S, Ivarsson A. Weighted Blankets' Effect on the Health of Older People Living in Nursing Homes. Geriatrics (Basel) 2022; 7:geriatrics7040079. [PMID: 36005255 PMCID: PMC9408528 DOI: 10.3390/geriatrics7040079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background: An increasingly aging population is a global phenomenon. While considered a positive step forward, vulnerability to age-related health problems increases along with the ageing population. The aim of the study was to investigate weighted blankets’ effect on health regarding quality of life (QoL), sleep, nutrition, cognition, activities of daily living ADL and medication in older people living in nursing homes. Methods: In total, 110 older people were involved in an intervention with weighted blankets, and 68 older people completed the intervention. Measures before and after were performed regarding quality of life; QoL-AD, EQ-VAS, sleep; MISS, nutrition; MNA, cognition; S -MMSE (ADL) and medication. Comparative statistical analyses were applied. Results: After intervention with weighted blankets, health in general, such as QoL, improved. Sleep also improved significantly, especially with respect to waking up during the night. Nutrition was enhanced, health as a cognitive ability improved, and medication in the psychoanaleptic group decreased. The effect size varied between small and large. Conclusions: A weighted blanket seems to be an effective and safe intervention for older people in nursing homes, as several improvements were made regarding the health of older people.
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Nora CD, de Lima JD, Teixeira IA, Silva FDO, de Almeida JS, Monteiro FC, Marinho V, Dourado MCN, Deslandes AC. Online physical exercise and the neuropsychiatric symptoms in patients with dementia: a cross-sectional study during the COVID-19 pandemic. Dement Neuropsychol 2022; 16:253-260. [PMID: 36619833 PMCID: PMC9762384 DOI: 10.1590/1980-5764-dn-2021-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/03/2021] [Accepted: 11/06/2021] [Indexed: 01/11/2023] Open
Abstract
Social isolation is necessary during the COVID-19 pandemic but can be harmful to mental health, especially in people with neurocognitive disorders. Although physical exercise can alleviate neuropsychiatric symptoms and improve quality of life (QoL), sedentary behavior increased during the pandemic. Online interventions can contribute to improving physical activity and mental health. Objective The objective of this study was to compare the neuropsychiatric symptoms and QoL of older adults with neurocognitive disorders who participated in an online physical exercise program with sedentary patients during the COVID-19 pandemic. Methods In this cross-sectional study, 25 older patients with neurocognitive disorders (control group=11; online exercise group=14) were evaluated based on Neuropsychiatric Inventory (NPI) and the Quality of Life in Alzheimer's Disease (QoL-AD) scale. Results There were differences between the two groups in the total NPI (U=36.50, p=0.025) and the nighttime behavior disturbances item (U=38.00, p=0.033), both with large effect sizes (ES=-1.03, 95% confidence interval [CI]:-1.83 to -0.16 and ES=-1.06, 95%CI -1.86 to -0.19, respectively). In terms of QoL-AD, a difference was identified only in the memory subitem (U=20.00, p=0.005), with a large ES (1.59, 95%CI 0.59-2.48). Conclusions Older adults with neurocognitive disorders who participated in an online physical exercise program, during the COVID-19 pandemic, showed fewer neuropsychiatric total symptoms, fewer nighttime disturbances episodes, and better subjective memory, compared to their physically inactive counterparts. Randomized controlled trials should be performed to better understand the effect of physical exercise in neuropsychiatric symptoms in dementia patients during periods of social isolation.
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Affiliation(s)
- Caroline Dalla Nora
- Universidade Federal do Rio de Janeiro, Instituto de
Psiquiatria, Rio de Janeiro RJ, Brazil
| | - Juliana Dias de Lima
- Universidade Federal do Rio de Janeiro, Instituto de
Psiquiatria, Rio de Janeiro RJ, Brazil
| | - Ivan Abdalla Teixeira
- Universidade Federal do Rio de Janeiro, Instituto de
Psiquiatria, Rio de Janeiro RJ, Brazil
| | | | - Júlia Silva de Almeida
- Universidade Federal do Rio de Janeiro, Instituto de
Psiquiatria, Rio de Janeiro RJ, Brazil
| | | | - Valeska Marinho
- Universidade Federal do Rio de Janeiro, Instituto de
Psiquiatria, Rio de Janeiro RJ, Brazil
| | | | - Andrea Camaz Deslandes
- Universidade Federal do Rio de Janeiro, Instituto de
Psiquiatria, Rio de Janeiro RJ, Brazil
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7
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Kimura NRS, Baptista MAT, Dourado MCN. Differences in the predictors of the resilience between carers of people with young- and late-onset dementia: a comparative study. Dement Neuropsychol 2022; 16:292-299. [PMID: 36619842 PMCID: PMC9762387 DOI: 10.1590/1980-5764-dn-2021-0093] [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: 11/03/2021] [Revised: 01/28/2022] [Accepted: 02/14/2022] [Indexed: 01/11/2023] Open
Abstract
Resilience is a subjective process related to both protective and risk factors, external and internal to the individual. Considering the psychosocial differences between young-onset dementia (YOD) and late-onset dementia (LOD) groups, carers' resilience may not be understood in the same way in both groups. Objective The aim of this study was to compare the resilience of carers in YOD and LOD and to examine which factors might be associated with resilience in both groups of carers. Methods The study was conducted with 120 people with dementia (49 YOD) and their primary carers. The carers had their resilience, quality of life, depressive symptoms, and burden assessed and answered the sociodemographic questionnaire. We assessed care recipients' global cognition, dementia severity, social cognition, facial expression recognition, awareness of disease, the ability to perform activities of daily living, depressive symptoms, and neuropsychiatric symptoms. For data analysis, unpaired two-tailed Student's t-test and linear regressions were conducted. Results Resilience did not differ between groups (p=0.865). Resilience was inversely related to carers' depressive symptoms in both YOD (p=0.028) and LOD (p=0.005) groups. The carers' schooling (p=0.005), duration of disease (p=0.019), and depressive symptoms of care recipient (p<0.001) were related to carers' resilience only in LOD group. Conclusions The context of care, clinical status of the care recipient, and mental health resources affected the carers' resilience in the LOD group. Conversely, resilience seems to be affected only by carers' mental health in the YOD group. The understanding of these differences is crucial for the developing of intervention strategies.
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Affiliation(s)
- Nathália Ramos Santos Kimura
- Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Centro de Doença de Alzheimer e Distúrbios Relacionados, Rio de Janeiro RJ, Brazil
| | - Maria Alice Tourinho Baptista
- Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Centro de Doença de Alzheimer e Distúrbios Relacionados, Rio de Janeiro RJ, Brazil
| | - Marcia Cristina Nascimento Dourado
- Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Centro de Doença de Alzheimer e Distúrbios Relacionados, Rio de Janeiro RJ, Brazil
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Santos RL, Simões Neto JP, Belfort T, Lacerda IB, Dourado MCN. Patterns of impairment in decision-making capacity in Alzheimer's disease and its relationship with cognitive and clinical variables. BRAZILIAN JOURNAL OF PSYCHIATRY 2022; 44:271-278. [PMID: 35239836 PMCID: PMC9169465 DOI: 10.1590/1516-4446-2021-2180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/16/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate the patterns of impairment in decision-making abilities and their relationship with cognitive and clinical symptoms in people with Alzheimer's disease. We hypothesized that decision-making abilities would not be impaired at the same level and would be related to impairment of global cognition and other clinical symptoms of the disease. METHODS Using a cross-sectional design, we included a consecutive sample of 102 people with Alzheimer's disease and their respective caregivers. We investigated the relationship between decision-making capacity and quality of life (QoL), disease awareness, mood, functionality, neuropsychiatric symptoms, and cognition. RESULTS Different levels of impairment were observed in the participants' decision-making abilities. Understanding, appreciation, and reasoning were correlated, but expressing a choice was only correlated with appreciation. Deficits in understanding were related to impaired disease awareness, lower self-reported QoL, and lower comprehension of spoken language. Better appreciation was related to better orientation and lower age. Better reasoning was related to better orientation and better self-reported QoL. Deficits in expressing a choice were related to lower self-reported QoL. CONCLUSION The pattern of impairment in decision-making abilities was not linear. Each decision-making ability was related to different cognitive and clinical deficits. Therefore, cognitive functioning is an insufficient criterion for judging an individual's decision-making ability.
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Affiliation(s)
- Raquel Luiza Santos
- Centro para Doenças de Alzheimer e Outros Transtornos Mentais na Velhice, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Departamento de Psicologia, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Departamento de Psicologia, Universidade do Grande Rio, Duque de Caxias, RJ, Brazil
| | - José Pedro Simões Neto
- Departamento de Sociologia e Ciência Política, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Tatiana Belfort
- Centro para Doenças de Alzheimer e Outros Transtornos Mentais na Velhice, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Isabel Barbeito Lacerda
- Centro para Doenças de Alzheimer e Outros Transtornos Mentais na Velhice, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marcia Cristina Nascimento Dourado
- Centro para Doenças de Alzheimer e Outros Transtornos Mentais na Velhice, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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9
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Aleixo MAR, Borges MBD, Gherman BR, Teixeira IA, Simões Neto JP, Santos RL, Dourado MCN, Marinho V. Active music therapy in dementia: results from an open-label trial. JORNAL BRASILEIRO DE PSIQUIATRIA 2022. [DOI: 10.1590/0047-2085000000363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective: Cognitive, neuropsychiatric and functional deficits are core symptoms of dementia. Non-pharmacological interventions, such as music therapy, when used in conjunction with pharmacological treatment, have the potential to alleviate these symptoms. The purpose of this preliminary study is to examine the active music therapy on cognition and neuropsychiatric symptoms in the elderly with mild and moderate dementia. Methods: The initial sample consisted of outpatients with dementia (N = 15) and their family members or caregivers (N = 15). Two dyads did not complete the assessments before intervention and were excluded from the analysis. Thirteen females (N = 13) comprised the final sampled and were diagnosed with Alzheimer’s disease (N = 10), vascular dementia (N = 2) and mixed dementia (N = 1), at mild (N = 11) and moderate (N = 2) dementia stage. Participants were enrolled in an open-label trial of active music therapy group, set to take place once weekly for 60 minutes over a period of 12 weeks. Results: Participants experienced a slight improvement on cognition measured with Mini-Mental State Examination (p = 0.41), although without statistical significance and a statistically significant decrease in anxiety (p = 0.042) in post-intervention. There were no significant effects on quality of life and caregiver burden. Conclusions: Active music therapy is a promising intervention with good acceptance among participants. More studies with larger sample sizes are needed to confirm its effects and efficacy in cognitive and neuropsychiatric symptoms in dementia.
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Ximenes VS, Queluz FNFR, Barham EJ. Relação entre Habilidades Sociais, Suporte Social e Qualidade de Vida em Cuidadores. PSICO-USF 2022. [DOI: 10.1590/1413-82712022270109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Os objetivos deste estudo foram: (a) realizar uma análise descritiva das habilidades sociais, suporte social e qualidade de vida de cuidadores de idosos e (b) avaliar a correlação entre cada um desses construtos. Participaram deste estudo 70 cuidadores familiares de idosos, com idade média de 57,3 anos (DP = 10,6), que responderam aos seguintes instrumentos: Questionário Sociodemográfico, Critério de Classificação Econômica Brasil, Inventário de Habilidades Sociais para Cuidadores de Idosos Familiares, Escala de Percepção do Suporte Social e Escala de Qualidade de Vida. Foram encontradas correlações positivas de magnitudes moderadas entre habilidades sociais, suporte social e qualidade de vida. Comunicar emoções de forma assertiva se correlacionou com a obtenção de suporte voltado ao enfrentamento de problemas, e esse apresentou correlação moderada com qualidade de vida. O aprimoramento do repertório de habilidades sociais pode favorecer a busca por suporte social, beneficiando a díade cuidador-idoso.
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Dourado MCN, Santos RL, Fischer A, Mograbi DC. Modeling Quality of Life in Alzheimer Disease: The Impact of Cognitive, Functional, and Mood Variables in Self and Carers' Perceptions. J Geriatr Psychiatry Neurol 2021; 34:668-674. [PMID: 32762396 DOI: 10.1177/0891988720944235] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Quality of life (QoL) includes complex interactions between objective and subjective factors. Through structural equation modeling, we analyzed people with Alzheimer disease (PwAD) and carers' ratings to identify the factors associated with PwAD QoL. We included 264 PwAD and their carers. Model 1, carers' ratings of PwAD QoL, showed a bidirectional association with worse depressive symptoms, lower functionality, and impairment on awareness being linked. These variables were associated with burden and all of them directly affecting carers' ratings of PwAD QoL. Model 2, PwAD self-reported QoL, had the same bidirectional associations among the same variables with all of them influencing PwAD self-reported QoL. However, the interpretations of these similar associations should be different. The path analysis increased the understanding of the relationship between QoL and cognition, functionality, mood, awareness, and burden. Our findings bring together a number of consistent predictors and confirm their different effects in PwAD and carers' point of view about QoL.
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Affiliation(s)
| | - Raquel Luiza Santos
- Department of Psychology, Universidade do Grande Rio-UNIGRANRIO, Duque de Caxias, Brazil
| | - Anna Fischer
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Gávea, Rio de Janeiro, Brazil
| | - Daniel C Mograbi
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Gávea, Rio de Janeiro, Brazil.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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12
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Kimura NRS, Simões JP, Santos RL, Baptista MAT, Portugal MDG, Johannessen A, Barca ML, Engedal K, Laks J, Rodrigues VM, Dourado MCN. Young- and Late-Onset Dementia: A Comparative Study of Quality of Life, Burden, and Depressive Symptoms in Caregivers. J Geriatr Psychiatry Neurol 2021; 34:434-444. [PMID: 32552216 DOI: 10.1177/0891988720933355] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To compare the quality of life, burden, and depressive symptoms of caregivers of individuals with young-onset dementia (YOD) and late-onset dementia (LOD). METHODS Using a cross-sectional design, a convenience sample of 110 dyads of individuals with dementia and their caregivers, all living in the community, was included. The care recipients completed assessments about cognition, quality of life, and awareness of disease. Caregivers' quality of life, resilience, depressive and anxiety symptoms, hopelessness, and burden of care were assessed. RESULTS A significant difference was found in caregivers' burden and depressive symptoms according to the age of onset. However, there was no difference in caregivers' quality of life between YOD and LOD groups. In both groups, a linear regression analysis indicated that caregivers' perspective of quality of life of care recipient and caregivers' hopelessness were associated with their quality of life. In addition, in the LOD group, caregivers' burden was associated with their perspective of the quality of life of care recipient, type of kinship, and presence of emotional problems. In the YOD group, caregivers' burden was associated with duration of caregiving role, cohabitating with care recipient, and their anxiety symptoms. Caregivers' depressive symptoms were associated with anxiety symptoms in the YOD group, whereas hopelessness was associated with caregivers' depressive symptoms in both the groups. CONCLUSION Our findings suggest that the factors that affect quality of life, burden, and depressive symptoms of caregivers of individuals with LOD differ from those that affect the caregivers of individuals with YOD.
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Affiliation(s)
- Nathália R S Kimura
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, 28125Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Pedro Simões
- Department of Sociology and Political Science, Center for Philosophy and Human Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Raquel Luiza Santos
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, 28125Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Alice Tourinho Baptista
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, 28125Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria da Glória Portugal
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, 28125Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aud Johannessen
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Campus Vestfold, University of South-Eastern Norway, Tønsberg, Norway
| | - Maria Lage Barca
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Jerson Laks
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, 28125Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Postgraduation Program of Translational Biomedicine, Universidade do Grande Rio (Unigranrio), Duque de Caxias, Rio de Janeiro, Brazil
| | - Valeska Marinho Rodrigues
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, 28125Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia C N Dourado
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, 28125Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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13
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Baptista MAT, Kimura N, Lacerda IB, Silva FDO, Dourado MCN. Domains of Awareness in Young and Late Onset Dementia. J Alzheimers Dis 2021; 81:169-178. [PMID: 33749654 DOI: 10.3233/jad-201603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a lack of research investigating whether there are differences in the domains of awareness according to the age at onset of dementia. OBJECTIVE This study is designed to investigate differences in awareness of cognitive functioning and health condition, functional activity impairments, emotional state, and social functioning and relationships among people with young onset (YOD) and late onset dementia (LOD); and examine associations between awareness and its domains with cognition, functionality, neuropsychiatric symptoms, social and emotional functioning, and quality of life (QoL) in both groups. METHODS A group of 136 people with dementia and their respective caregivers (YOD = 50 and LOD = 86) were consecutively selected. We assessed awareness of disease, dementia severity, cognition, functionality, neuropsychiatric symptoms, social and emotional functioning, and QoL. RESULTS People with YOD had more neuropsychiatric symptoms than people with LOD. People with YOD were more aware of disease (total score), of their cognitive functioning and health condition and of their functional activity impairments, even if this group was more severely cognitive impaired and had a worse level of functionality than LOD group. Multivariate linear regressions showed that functionality has a wide relationship to awareness for people with YOD. While neuropsychiatric symptoms and QoL has a greater relation to awareness for people with LOD. CONCLUSION Different clinical variables are associated to different domains in YOD and LOD groups, reinforcing the heterogeneity of awareness in dementia.
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Affiliation(s)
- Maria Alice Tourinho Baptista
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Nathália Kimura
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Isabel Barbeito Lacerda
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Felipe de Oliveira Silva
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marcia Cristina Nascimento Dourado
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Du B, Lakshminarayanan M, Krishna M, Vaitheswaran S, Chandra M, Kunnukattil Sivaraman S, Goswami SP, Rangaswamy T, Spector A, Stoner CR. Psychometric properties of outcome measures in non-pharmacological interventions of persons with dementia in low-and middle-income countries: A systematic review. Psychogeriatrics 2021; 21:220-238. [PMID: 33336529 PMCID: PMC7986620 DOI: 10.1111/psyg.12647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/07/2020] [Accepted: 11/26/2020] [Indexed: 02/06/2023]
Abstract
Despite high burden of dementia in low-and middle-income countries (LMICs), only a small number of clinical trials of psychosocial interventions for persons with dementia (PwD) have been conducted in these settings. It is essential that such trials use appropriate outcome measures that are methodologically robust and culturally appropriate to evaluate the effectiveness of interventions. We carried out a systematic review to examine the evidence base and psychometric properties of measures employed in these studies in LMICs. A systematic search of published literature on randomised controlled trials (RCT) of psychosocial interventions for PwD in LMICs between 2008 and April 2020 was carried out. Measures employed in each of the eligible studies were identified and through a focused search, we further explored the evidence base and psychometric properties employing Terwee criteria. Data extraction and quality appraisal were conducted by two independent reviewers. The review identified 41 measures from 17 RCTS which fulfilled eligibility criteria and they examined effectiveness across the domains of cognition (n = 16), behaviour and psychological symptoms (n = 11) and quality of life (n = 8). Of these 41, we were able to access relevant literature only for 18 and they were subject to psychometric analysis. Psychometric properties of these 18 instruments were at best modest, with Terwee scores ranging from 3 (low) to 15 (moderate). A majority of the studies were from China (n = 5) and Brazil (n = 6). The evidence base for the routinely employed measures in RCTs of non-pharmacological interventions for PwD in LMICs is limited. The quality of adaptation and validation of these instruments is variable and studies are largely uninformative about their psychometric properties and cultural appropriateness to the study setting. There is an urgent need to develop scientifically robust instruments in LMIC settings that can be confidently employed to measure outcomes in trials of psychosocial interventions for PwD.
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Affiliation(s)
- Bharath Du
- Foundation for Research and Advocacy in Mental health (FRAMe), Mysore, India
| | | | - Murali Krishna
- Foundation for Research and Advocacy in Mental health (FRAMe), Mysore, India
| | | | - Mina Chandra
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
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15
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Stoner CR, Lakshminarayanan M, Durgante H, Spector A. Psychosocial interventions for dementia in low- and middle-income countries (LMICs): a systematic review of effectiveness and implementation readiness. Aging Ment Health 2021; 25:408-419. [PMID: 31814427 PMCID: PMC8026009 DOI: 10.1080/13607863.2019.1695742] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Despite wide uptake in high-income countries (HICs), less is known about the effectiveness and implementation of psychological, social and cognitive interventions in low- and middle-income countries (LMICs). Despite this, such interventions are increasingly used. The aim of this review was to appraise the effectiveness and implementation readiness of psychosocial interventions for people with dementia in LMICs. METHODS A systematic search of databases from 1998-2019. Studies were rated on two scales assessing quality and implementation readiness. RESULTS Seventeen articles describing 11 interventions in six countries were evaluated. Interventions included Cognitive Stimulation Therapy (CST), a Multidisciplinary Cognitive Rehabilitation Programme (MCRP), singing interventions, occupational therapy and reminiscence therapy. The quality of included studies was variable, and many had low sample sizes. Evidence for improving both cognition and quality of life was found in two interventions: Cognitive Stimulation Therapy (CST) and a Multidisciplinary Cognitive Rehabilitation Programme (MCRP). Implementation issues were more likely to be explored in studies of Cognitive Stimulation Therapy (CST) than in any other intervention. CONCLUSIONS Of the included studies here, CST appears to be the most implementation ready, improving both cognition and quality of life with implementation readiness effectively explored in two LMIC countries: India and Tanzania.
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Affiliation(s)
- Charlotte R. Stoner
- Research Department of Clinical Educational and Health Psychology, University College London (UCL), London, UK,CONTACT Charlotte R. Stoner
| | - Monisha Lakshminarayanan
- Dementia Care in Schizophrenia Research Foundation (DEMCARES in SCARF), Chennai, Tamil Nadu, India
| | - Helen Durgante
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Aimee Spector
- Research Department of Clinical Educational and Health Psychology, University College London (UCL), London, UK
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16
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Nogueira MML, Neto JPS, Dourado MCN. Quality of Life of People With Alzheimer Disease: Comparison Between Dyads Degree of Kinship. J Geriatr Psychiatry Neurol 2021; 34:119-127. [PMID: 32223501 DOI: 10.1177/0891988720915521] [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] [Indexed: 11/17/2022]
Abstract
The quality of life (QoL) of people with Alzheimer disease (PwAD) may be influenced by the type of relationship between carer and the PwAD. Dyads of 98 PwAD/carers (N = 49 spouse-carers; N = 49 nonspouses carers) were measured about QoL, cognition, dementia severity, awareness of disease, functionality, depression, anxiety, and burden of care. Univariate and multivariate regression analyses were conducted to identify the factors that influenced the spouse and nonspouse self-report PwAD QoL (PQOL) and to compare carers' ratings of PwAD QoL (C-PQOL). The total score of QoL for spouse and nonspouse PwAD showed no significant difference (P = .29). The linear regression demonstrated that higher awareness of disease was significantly related to spouse PQOL (P = .001). Nonspouse PQOL was negatively related to lower depression (P = .007). The total score of QoL for spouse and nonspouse C-PQOL showed no significant difference (P = .14). The linear regression demonstrated that depression of spouse-PwAD (P < .001) and burden of care (P = .001) were negatively related to spouse-dyads' C-PQOL. The nonspouse-dyads C-PQOL was negatively related to depression of nonspouse-PwAD (P < .001), awareness of disease (P = .001), and the mood of the carer (P = .01). Spouse and nonspouse PwAD evaluate PQOL better than carers (C-PQOL). No significant difference was found in the total PQOL and C-PQOL of spouse and nonspouse, but dyads evaluated differently about what is important to assess QoL.
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Affiliation(s)
- Marcela Moreira Lima Nogueira
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, 28125Universidade Federal do Rio de Janeiro, Brazil
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17
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Marinho V, Bertrand E, Naylor R, Bomilcar I, Laks J, Spector A, Mograbi DC. Cognitive stimulation therapy for people with dementia in Brazil (CST-Brasil): Results from a single blind randomized controlled trial. Int J Geriatr Psychiatry 2021; 36:286-293. [PMID: 32881071 DOI: 10.1002/gps.5421] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/31/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The prevalence of dementia has been increasing particularly in developing countries but care provision is still limited in these regions. Psychosocial interventions are recognized as useful tools to improve cognitive and behavioral difficulties, as well as quality of life of people with dementia (PwD) and their caregivers. Cognitive stimulation therapy (CST) is an evidence-based psychosocial intervention, recommended and implemented in many countries. In Brazil, there is no validated psychosocial intervention for dementia care. The present study aims to explore feasibility and obtain preliminary data on the efficacy of CST-Brasil in a sample of 47 people with mild to moderate dementia attending an outpatient unit. METHODS A single-blind design was used, with participants being randomly allocated to either 14 sessions of CST + treatment as usual (TAU; n = 23) or TAU (n = 24) during 7 weeks. Changes in cognition, quality of life, depressive symptoms, caregiver burden and functionality were measured. RESULTS PwD receiving CST and their family caregivers expressed good acceptance of the intervention, with low attrition and high attendance. Participants receiving CST exhibited significant improvements in mood and in activities of daily living compared to TAU. There were no significant effects in cognition, quality of life and caregiver burden. CONCLUSIONS CST-Brasil proved to be a feasible and useful intervention to improve mood in PwD, with high acceptance between study participators. CST-Brasil is a promising psychosocial intervention for dementia and should be explored in other clinical settings to allow generalization to a wider Brazilian context.
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Affiliation(s)
- Valeska Marinho
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elodie Bertrand
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renata Naylor
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Iris Bomilcar
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jerson Laks
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Translational Biomedicine Postgraduate Programme, Universidade do Grande Rio (Unigranrio), Duque de Caxias, Brazil
| | - Aimee Spector
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Daniel C Mograbi
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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18
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Belfort T, Simões JP, Santos RL, Lacerda I, Dourado MCN. Social cognition: Patterns of impairments in mild and moderate Alzheimer's disease. Int J Geriatr Psychiatry 2020; 35:1385-1392. [PMID: 32662123 DOI: 10.1002/gps.5379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/22/2020] [Accepted: 07/06/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Social cognition (SC) deficits in Alzheimer's Disease (AD) are commonly associated with the progression of the disease, and mainly as a result of global cognition deterioration. We aimed to investigate the relationship between SC, global cognition, and other clinical variables in mild and moderate people with AD and their caregivers. We also investigated the differences between self-reported SC and family caregivers' ratings of SC. METHODS We included 137 dyads of people with AD (87 mild and 50 moderate) and caregivers. We evaluated social cognition, global cognition, quality of life, dementia severity, mood, functionality, neuropsychiatric symptoms, and caregiver burden. RESULTS SC presented a specific pattern of impairment, especially when related to global cognition deficits. Although the moderate AD group showed significant worsening in cognition, functionality and neuropsychiatric symptoms, when compared to the mild group, SC did not present significant differences between the groups. The multivariate regression analysis showed that in the mild group, self-reported SC was related to age and years of education. In the moderate group, SC was related to gender. For caregivers, in the mild group, SC was related to functionality and quality of life, while in the moderate group, was associated with quality of life. CONCLUSION The pattern of impairment of SC may be more stable as it implies interaction with cognition, mainly in the mild stage, but also include subjective factors as a personal perception about oneself and others, values, and beliefs that evokes individual, social, cultural, and contextual factors.
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Affiliation(s)
- Tatiana Belfort
- Center for Alzheimer's disease, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Pedro Simões
- Department of Sociology and Political Science, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Raquel Luiza Santos
- Center for Alzheimer's disease, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isabel Lacerda
- Center for Alzheimer's disease, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Lima S, Sevilha S, Pereira MG. Quality of life in early-stage Alzheimer's disease: the moderator role of family variables and coping strategies from the patients' perspective. Psychogeriatrics 2020; 20:557-567. [PMID: 32212217 DOI: 10.1111/psyg.12544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/16/2019] [Accepted: 02/22/2020] [Indexed: 11/30/2022]
Abstract
AIM This study assessed the effects of sociodemographic and psychological variables on quality of life (QOL), as well as the moderator role of family variables and coping strategies in the relationship between psychological morbidity and QOL, based on patients' perspective. METHODS This study used a cross-sectional design. A total of 158 patients with early Alzheimer's disease completed the Mini-Mental State Examination, the Montreal Cognitive Assessment, the Hospital Anxiety and Depression Scale, the Ways of Coping Questionnaire, the Spiritual and Religious Attitudes in Dealing with Illness, the Family Adaptability and Cohesion Evaluation Scales, the Family Satisfaction Scale, the Family Communication Scale, the Barthel Index, and the Quality of Life in Alzheimer's Disease Scale. RESULTS Being a man, having a higher education, and engaging in more exercise activity were associated with better QOL. Lower levels of cognitive impairment, psychological morbidity, and spirituality predicted better QOL. Also, lower levels of functionality, family communication, family satisfaction, and family functioning contributed to worse QOL. Gender, psychological morbidity, and functionality contributed significantly to QOL. Family satisfaction, family communication, and coping strategies moderated the relationship between psychological morbidity and QOL. CONCLUSION Intervention in early-stage Alzheimer's disease should focus on patients' coping strategies and family context, particularly family satisfaction and communication, to foster QOL.
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Affiliation(s)
- Sara Lima
- School of Psychology, University of Minho, Braga, Portugal
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20
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Möhler R, Renom A, Renom H, Meyer G. Personally tailored activities for improving psychosocial outcomes for people with dementia in community settings. Cochrane Database Syst Rev 2020; 8:CD010515. [PMID: 32786083 PMCID: PMC8094398 DOI: 10.1002/14651858.cd010515.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND People with dementia living in the community, that is in their own homes, are often not engaged in meaningful activities. Activities tailored to their individual interests and preferences might be one approach to improve quality of life and reduce challenging behaviour. OBJECTIVES To assess the effects of personally tailored activities on psychosocial outcomes for people with dementia living in the community and their caregivers. To describe the components of the interventions. To describe conditions which enhance the effectiveness of personally tailored activities in this setting. SEARCH METHODS We searched ALOIS: the Cochrane Dementia and Cognitive Improvement Group's Specialized Register on 11 September 2019 using the terms: activity OR activities OR occupation* OR "psychosocial intervention" OR "non-pharmacological intervention" OR "personally-tailored" OR "individually-tailored" OR individual OR meaning OR involvement OR engagement OR occupational OR personhood OR "person-centred" OR identity OR Montessori OR community OR ambulatory OR "home care" OR "geriatric day hospital" OR "day care" OR "behavioural and psychological symptoms of dementia" OR "BPSD" OR "neuropsychiatric symptoms" OR "challenging behaviour" OR "quality of life" OR depression. ALOIS contains records of clinical trials identified from monthly searches of a number of major healthcare databases, numerous trial registries and grey literature sources. SELECTION CRITERIA We included randomised controlled trials and quasi-experimental trials including a control group offering personally tailored activities. All interventions comprised an assessment of the participant's present or past interests in, or preferences for, particular activities for all participants as a basis for an individual activity plan. We did not include interventions offering a single activity (e.g. music or reminiscence) or activities that were not tailored to the individual's interests or preferences. Control groups received usual care or an active control intervention. DATA COLLECTION AND ANALYSIS Two review authors independently checked the articles for inclusion, extracted data, and assessed the methodological quality of all included studies. We assessed the risk of selection bias, performance bias, attrition bias, and detection bias. In case of missing information, we contacted the study authors. MAIN RESULTS We included five randomised controlled trials (four parallel-group studies and one cross-over study), in which a total of 262 participants completed the studies. The number of participants ranged from 30 to 160. The mean age of the participants ranged from 71 to 83 years, and mean Mini-Mental State Examination (MMSE) scores ranged from 11 to 24. One study enrolled predominantly male veterans; in the other studies the proportion of female participants ranged from 40% to 60%. Informal caregivers were mainly spouses. In four studies family caregivers were trained to deliver personally tailored activities based on an individual assessment of interests and preferences of the people with dementia, and in one study such activities were offered directly to the participants. The selection of activities was performed with different methods. Two studies compared personally tailored activities with an attention control group, and three studies with usual care. Duration of follow-up ranged from two weeks to four months. We found low-certainty evidence indicating that personally tailored activities may reduce challenging behaviour (standardised mean difference (SMD) -0.44, 95% confidence interval (CI) -0.77 to -0.10; I2 = 44%; 4 studies; 305 participants) and may slightly improve quality of life (based on the rating of family caregivers). For the secondary outcomes depression (two studies), affect (one study), passivity (one study), and engagement (two studies), we found low-certainty evidence that personally tailored activities may have little or no effect. We found low-certainty evidence that personally tailored activities may slightly improve caregiver distress (two studies) and may have little or no effect on caregiver burden (MD -0.62, 95% CI -3.08 to 1.83; I2 = 0%; 3 studies; 246 participants), caregivers' quality of life, and caregiver depression. None of the studies assessed adverse effects, and no information about adverse effects was reported in any study. AUTHORS' CONCLUSIONS Offering personally tailored activities to people with dementia living in the community may be one approach for reducing challenging behaviour and may also slightly improve the quality of life of people with dementia. Given the low certainty of the evidence, these results should be interpreted with caution. For depression and affect of people with dementia, as well as caregivers' quality of life and burden, we found no clear benefits of personally tailored activities.
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Affiliation(s)
- Ralph Möhler
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Anna Renom
- Department of Geriatrics, Parc de Salut Mar, Barcelona, Spain
| | - Helena Renom
- Physical Medicine and Rehabilitation (MFRHB), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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21
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Stypa V, Haussermann P, Fleiner T, Neumann S. Validity and Reliability of the German Quality of Life-Alzheimer's Disease (QoL-AD) Self-Report Scale. J Alzheimers Dis 2020; 77:581-590. [PMID: 32675413 DOI: 10.3233/jad-200400] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Quality of Life-Alzheimer's Disease (QoL-AD) scale is a widely used measure of quality of life (QoL) in dementia. Although the instrument has been validated in several languages, the psychometric properties of the German self-report version have not yet been analyzed. OBJECTIVE This study examines the internal consistency, test-retest reliability, and construct validity of the German QoL-AD self-report scale. METHODS The sample included 30 patients suffering from mild to moderate Alzheimer's disease or vascular dementia (19 females; mean age 77.3 years; mean Mini-Mental State Examination (MMSE) score 19.7 points). To determine test-retest reliability, the QoL-AD self-report scale was re-administered four to seven days apart. For construct validity analysis, the Dementia Quality of Life instrument (DQoL), Geriatric Depression Scale (GDS), MMSE, and an adapted short form of the Neuropsychiatric Inventory (NPI) were used. RESULTS The German QoL-AD self-report scale shows an internal consistency of α= 0.79 and a test-retest reliability of r = 0.75 (p < 0.01). Regarding construct validity, there was a significant positive correlation between the total scores of the QoL-AD and DQoL (r = 0.47, p < 0.05). The analysis revealed no significant correlations with the GDS or the adapted NPI. No association could be observed between the QoL-AD and the MMSE (r = 0.01), confirming divergent validity. CONCLUSION The results indicate that the German QoL-AD self-report scale is a suitable instrument for assessing QoL in patients suffering from mild to moderate dementia, thus supporting its use in clinical practice and research.
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Affiliation(s)
- Vanessa Stypa
- Department of Geriatric Psychiatry and Psychotherapy, LVR-Hospital Cologne, Cologne, Germany
| | - Peter Haussermann
- Department of Geriatric Psychiatry and Psychotherapy, LVR-Hospital Cologne, Cologne, Germany
| | - Tim Fleiner
- Department of Geriatric Psychiatry and Psychotherapy, LVR-Hospital Cologne, Cologne, Germany.,Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany
| | - Sandra Neumann
- Inclusive Education of Children with Communication Needs, University Erfurt, Erfurt, Germany
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22
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Lacerda IB, Santos RL, Belfort T, Neto JPS, Dourado MCN. Patterns of discrepancies in different objects of awareness in mild and moderate Alzheimer's disease. Aging Ment Health 2020; 24:789-796. [PMID: 30474400 DOI: 10.1080/13607863.2018.1544219] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Awareness is considered a heterogeneous and non-linear phenomenon in dementia. We aim to investigate patterns of change of different domains of awareness (awareness of cognitive functioning and health condition, activities of daily living, emotional state, social functioning, and relationships) in people with mild and moderate Alzheimer's disease (AD) and aspects related to each domain.Method: Cross-sectional assessment of dyads of people with AD (PwAD) and caregivers (n = 128; CDR1 = 74, CDR2 = 54). PwAD completed assessments about quality of life, cognition and their awareness of disease. Caregivers provided information about PwAD and received quality of life and burden of care assessments.Results: Mild AD group showed a mildly impaired awareness (n = 40; 54.05%), while moderate AD group, showed higher presence of moderately impaired awareness (n = 22; 40.74%). There was a significant difference between groups in awareness of cognitive functioning and health condition (p < 0.004), functional activity impairments (p < 0.001) and total score of awareness (p < 0.01). Conversely, awareness of emotional state (p = 0.22) and of social functioning and relationship (p = 0.44) presented no significant difference between groups. Unawareness of functional activity impairments showed higher discrepancy scores between PwAD and caregivers in both groups.Conclusions: Significant differences were found only in patterns of discrepancies in awareness of cognitive functioning and health condition, of ADL and socio-emotional functioning. Different factors are related to different domains in mild and moderate group, reinforcing the heterogeneity of awareness in dementia. ADL deficits have an important role in awareness phenomenon, independent of the severity of disease.
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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, SC, 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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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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Tedrus GMAS, Fonseca LC, Ciancaglio JCB, Mônico GS, Zamperi C. Religiosity and quality of life of individuals with Alzheimer's disease and of caregivers: Relationship with clinical aspects. Dement Neuropsychol 2020; 14:69-74. [PMID: 32206201 PMCID: PMC7077857 DOI: 10.1590/1980-57642020dn14-010011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
There are few studies on the religiosity of people with Alzheimer’s disease
(PwAD) and caregivers, relation with quality of life (QoL) and clinical
aspects.
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Affiliation(s)
- Gloria Maria A S Tedrus
- Postgraduate Program in Health Sciences, Pontifícia Universidade Católica de Campinas, Campinas SP, Brazil
| | - Lineu Correa Fonseca
- Postgraduate Program in Health Sciences, Pontifícia Universidade Católica de Campinas, Campinas SP, Brazil
| | | | - Gabriela Scartezini Mônico
- Undergraduate student. School of Medicine, Pontifícia Universidade Católica de Campinas, Campinas SP, Brazil
| | - Carolina Zamperi
- Undergraduate student. School of Medicine, Pontifícia Universidade Católica de Campinas, Campinas SP, Brazil
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25
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Rosa RDLD, Simões-Neto JP, Santos RL, Torres B, Baptista MAT, Kimura NRS, Dourado MCN. Caregivers' resilience in mild and moderate Alzheimer's disease. Aging Ment Health 2020; 24:250-258. [PMID: 30499333 DOI: 10.1080/13607863.2018.1533520] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: To investigate the resilience of caregivers of people with mild and moderate Alzheimer's disease (PwAD) and the related sociodemographic and clinical characteristics.Methods: Cross-sectional assessment of dyads of PwAD and family caregivers (N = 106). Caregivers were assessed for resilience, depression, anxiety, hopelessness, quality of life, burden and cognition. PwAD were assessed for severity of dementia, cognition, neuropsychiatric symptoms, functionality, quality of life and awareness of disease.Results: Most of the caregivers (51.1%) reported emotional problems (symptoms of anxiety, stress and depression). In both mild (p < 0.05) and moderate (p < 0.05) PwAD groups, resilience was inversely related to self-reported emotional problems. There was not a significant difference between caregivers of mild and moderate PwAD resilience (p < 0.05). Upon analyzing the factors related to resilience, we found some differences between the groups of caregivers of mild and moderate PwAD. Neuropsychiatric symptoms of PwAD (p < 0.05) and caregiver's depressive symptoms (p < 0.05) were related to resilience of caregivers of mild PwAD. In the moderate group, caregivers' higher levels of quality of life (p < 0.05) and co-residing with PwAD (p < 0.05) were related to resilience.Conclusion: Caregivers' resilience is driven by different factors according to disease severity. The findings suggest that resilience allows caregivers to manage and respond positively to stressful demands of care.
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Affiliation(s)
- Rachel Dias Lopes da Rosa
- Center for Alzheimer's disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Pedro Simões-Neto
- Departament of Political Sociology, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Raquel Luiza Santos
- Center for Alzheimer's disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bianca Torres
- Center for Alzheimer's disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Alice Tourinho Baptista
- Center for Alzheimer's disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nathália Ramos Santos Kimura
- Center for Alzheimer's disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Cristina Nascimento Dourado
- Center for Alzheimer's disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Effects of the Tailored Activity Program in Brazil (TAP-BR) for Persons With Dementia: A Randomized Pilot Trial. Alzheimer Dis Assoc Disord 2019; 32:339-345. [PMID: 29698251 DOI: 10.1097/wad.0000000000000256] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objectives of this study were to evaluate the effects of the Tailored Activity Program-Brazilian version (TAP-BR), on behavioral symptoms and the quality of life (QOL) in persons with dementia, as well as on their caregivers, and on caregiver burden. MATERIALS AND METHODS A 2-group randomized controlled trial with 30 dyads was conducted: the experimental group (n=15) received TAP-BR over 4 months, and a wait-list control group (n=15) received usual care. Dyads were recruited from the community of Santos City, Brazil. RESULTS For persons with dementia, 50% were female individuals, the average age was 81.37 (±7.57), and the educational level was 9.97 (±5.32) years. For caregivers, 83.33% were female, the average age was 65.97 (±10.13), and the educational level was 12.10 (±4.44) years. At posttest, in comparison with the wait-list control group, experimental group caregivers reported greater reductions in number (P<0.001; Cohen d=0.93), frequency (P<0.001; Cohen d=1.12), and intensity (P<0.001; Cohen d=0.77) of the behavioral psychological symptoms of dementia, and caregiver distress (P<0.001; Cohen d=0.87). Caregivers also reported improvement in their own QOL (P<0.05; Cohen d=0.57) and that of the person with dementia (P<0.01; Cohen d=0.56); no differences were found in the ratings of QOL by the person with dementia themselves. CONCLUSIONS The results provide compelling evidence that the TAP-BR is an effective strategy to support dementia caregivers in other cultures (cross-validation).
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Dourado MCN, Torres Mendonça de Melo Fádel B, Simões Neto JP, Alves G, Alves C. Facial Expression Recognition Patterns in Mild and Moderate Alzheimer’s Disease. J Alzheimers Dis 2019; 69:539-549. [DOI: 10.3233/jad-181101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
| | | | - José Pedro Simões Neto
- Department of Sociology and Political Science, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Gilberto Alves
- Post Graduation in Psychiatry and Mental Health (PROPSAM), Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
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Awareness in Dementia: Development and Evaluation of a Short Version of the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD-s) in Brazil. Alzheimer Dis Assoc Disord 2019; 33:220-225. [PMID: 30958416 DOI: 10.1097/wad.0000000000000306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Awareness of disease is defined as the recognition of changes caused by the deficits related to the disease process. We aimed to examine the psychometric properties of the short versions of the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD-s), a multidimensional awareness scale. Using a cross-sectional design, we included 201 people with dementia and their family caregivers. The creation of the short versions was based on items with higher loadings on each factor, the correlations between the short versions and demographic or clinical variables and the relevance of the item to the respondent population. Three short versions were created: version 1 and 3, with 12 items and version 2, with 16 items. The short versions correlated very strongly with the full scale and with the 4 factors of the original scale, maintaining the multidimensional nature of the ASPIDD. Loss of awareness was associated with worse quality of life, decreased functionality and cognitive level, and higher caregiver burden across the short versions. Considering the appropriateness of the items and their clinical relevance, we recommend version 3 for use. With only 12 items, the time required for the completion of the scale is short, while maintaining robust psychometric properties.
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Kimura NRS, Neto JPS, Santos RL, Baptista MAT, Portugal G, Johannessen A, Barca ML, Engedal K, Laks J, Rodrigues VM, Dourado MCN. Resilience in Carers of People With Young-Onset Alzheimer Disease. J Geriatr Psychiatry Neurol 2019; 32:59-67. [PMID: 30651027 DOI: 10.1177/0891988718824039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Young-onset Alzheimer disease (YOAD) causes psychological and emotional difficulties for carers. However, even in the face of considerable caregiving demands and burden, some carers are resistant to stress, which may be a sign of resilience. This study investigated whether the clinical symptoms of the person with YOAD might be associated with resilience in their carers. A consecutive series of 43 persons with YOAD and their 43 family caregivers were assessed. The carers showed moderate to high level of resilience, low level of anxiety and depressive symptoms, and moderate level of burden. No relationship was found between resilience and sociodemographic characteristics of both carers and care recipient and with clinical characteristics of persons with YOAD. A linear regression analysis showed that resilience was inversely associated with carers' depressive symptoms. The findings suggest that resilience may mainly be related to carers' mental health.
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Affiliation(s)
- Nathália R S Kimura
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Pedro Simões Neto
- Department of Political Sociology, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Raquel Luiza Santos
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Alice Tourinho Baptista
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Glória Portugal
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aud Johannessen
- Norwegian Advisory Unit for Aging and Health Vestfold Health Trust, Tønsberg, Norway.,VID Specialized University College, Oslo, Norway
| | - Maria Lage Barca
- Norwegian Advisory Unit for Aging and Health Vestfold Health Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Knut Engedal
- Norwegian Advisory Unit for Aging and Health Vestfold Health Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Jerson Laks
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Post-graduation Program of Translational Biomedicine, Universidade do Grande Rio (Unigranrio), Duque de Caxias, Brazil
| | - Valeska Marinho Rodrigues
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia C N Dourado
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Pessotti CFC, Fonseca LC, Tedrus GMDAS, Laloni DT. Family caregivers of elderly with dementia Relationship between religiosity, resilience, quality of life and burden. Dement Neuropsychol 2018; 12:408-414. [PMID: 30546852 PMCID: PMC6289474 DOI: 10.1590/1980-57642018dn12-040011] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
There are gaps in knowledge regarding how the family caregiver deals with the burden of caring for elderly people with dementia.
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Affiliation(s)
| | - Lineu Corrêa Fonseca
- Professor of the Graduate Program in Health Sciences, Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil
| | | | - Diana Tosello Laloni
- Professor of the School of Psychology, Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil
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Kisvetrová H, Školoudík D, Herzig R, Vališ M, Jurašková B, Krulová P, Langová K, Bermellová J, Yamada Y. Psychometric Validation of the Czech Version of the Quality of Life - Alzheimer's Disease Scale in Patients with Early-Stage Dementia. Dement Geriatr Cogn Disord 2018; 46:109-118. [PMID: 30145599 DOI: 10.1159/000492490] [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: 04/23/2018] [Accepted: 07/26/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND/AIMS The aim of this study was to perform a psychometric validation of the Czech version of the Quality of Life - Alzheimer's Disease scale (QoL-AD) for patients with early-stage dementia. METHODS The sample included 212 patient-proxy pairs. For convergent validity, the Czech version of the Bristol Activities of Daily Living Scale (BADLS-CZ), the Short Physical Performance Battery (SPPB), and the Geriatric Depression Scale (GDS) were used. RESULTS The reliability of the QoL-AD for patients and caregivers was good (Cronbach's α = 0.85, ICC = 0.25-0.54). A positive correlation existed between the QoL-AD and the SPPB, and negative correlations existed between the QoL-AD and the BADLS-CZ as well as between the QoL-AD and the GDS. Factor analysis resulted in a three-factor solution (physical and mental health, family life, and social security). CONCLUSION The Czech version of the QoL-AD has good psychometric properties in compliance with international recommendations.
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Affiliation(s)
- Helena Kisvetrová
- Center for Research and Science, Faculty of Health Sciences, Palacký University, Olomouc, Czech Republic
| | - David Školoudík
- Center for Research and Science, Faculty of Health Sciences, Palacký University, Olomouc, Czech Republic
| | - Roman Herzig
- Neurology Clinic, University Hospital, Hradec Králové, Czech Republic
| | - Martin Vališ
- Neurology Clinic, University Hospital, Hradec Králové, Czech Republic
| | - Božena Jurašková
- Third Internal Clinic of Gerontology and Metabolism, University Hospital, Hradec Králové, Czech Republic
| | - Petra Krulová
- Neurology Clinic, University Hospital, Ostrava, Czech Republic
| | - Kateřina Langová
- Center for Research and Science, Faculty of Health Sciences, Palacký University, Olomouc, Czech Republic
| | - Jana Bermellová
- Center for Research and Science, Faculty of Health Sciences, Palacký University, Olomouc, Czech Republic
| | - Yukari Yamada
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Discrepancies Between Alzheimer’s Disease Patients’ and Caregivers’ Ratings About Patients’ Quality of Life. Alzheimer Dis Assoc Disord 2018; 32:240-246. [DOI: 10.1097/wad.0000000000000232] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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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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Dow J, Robinson J, Robalino S, Finch T, McColl E, Robinson L. How best to assess quality of life in informal carers of people with dementia; A systematic review of existing outcome measures. PLoS One 2018. [PMID: 29538433 PMCID: PMC5851581 DOI: 10.1371/journal.pone.0193398] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In the UK, there are currently 800 000 people living with dementia. This number is expected to double in the next 20 years. Two-thirds of people with dementia live in the community supported by informal carers. Caring for a person with dementia has adverse effects on psychological, physical, social wellbeing and quality of life. The measurement of quality of life of carers of people with dementia is increasingly of interest to health and social care practitioners and commissioners, policymakers, and carers themselves. However, there is lack of consensus on the most suitable instrument(s) for undertaking this. METHODS A systematic review of the literature using COSMIN methodology. Searching of electronic databases (Medline, PsycINFO, CINAHL and Web of Science), reference list and citation searching of key papers was undertaken. COSMIN methodology was used to simultaneously extract data from and assess methodological quality of included studies, and make a recommendation for the instrument with the most high quality evidence for its measurement properties. RESULTS Ten instruments were suitable for inclusion in this review. The Carer well-being and support questionnaire (CWS) has the best quality evidence for the greatest number of measurement of properties. The Caregiver Well-Being Scale is also worthy of consideration. There is not presently a measure which could be recommended for use in economic evaluations, however the Impact of Alzheimer's Disease on the Caregiver questionnaire (IADCQ) could potentially be used following further investigation of its measurement properties in a representative population. CONCLUSION The CWS is the most appropriate instrument to recommend for the assessment of quality of life in informal carers of people with dementia at present. All instruments included in this review would benefit from more rigorous evaluation of their measurement properties.
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Affiliation(s)
- Johanne Dow
- Institute of Health & Society, Newcastle University, Newcastle, United Kingdom
- * E-mail:
| | - Jonah Robinson
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Shannon Robalino
- Institute of Health & Society, Newcastle University, Newcastle, United Kingdom
| | - Tracy Finch
- Institute of Health & Society, Newcastle University, Newcastle, United Kingdom
| | - Elaine McColl
- Institute of Health & Society, Newcastle University, Newcastle, United Kingdom
| | - Louise Robinson
- Institute of Health & Society, Newcastle University, Newcastle, United Kingdom
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Kimura NRS, Baptista MAT, Santos RL, Portugal MDG, Johannenssen A, Barca ML, Engedal K, Laks J, Simões JP, Rodrigues VM, Dourado MCN. Caregivers' Perspectives of Quality of Life of People With Young- and Late-Onset Alzheimer Disease. J Geriatr Psychiatry Neurol 2018; 31:76-83. [PMID: 29658428 DOI: 10.1177/0891988718759601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Quality of life (QoL) is a growing area of interest in dementia research. This study aims to investigate the caregivers' perspective about the QoL of people with young-onset Alzheimer disease (YOAD) and late-onset Alzheimer disease (LOAD). We also aim to investigate factors that might be associated to caregivers' perspective in YOAD and LOAD. METHODS We included 110 people with Alzheimer disease (PwAD; 53 YOAD) and their primary caregivers. The PwAD completed assessments about their QoL and cognition. The caregivers provided information about the PwAD (demographics, QoL, ability to perform activities of daily living, mood, and dementia severity) and had burden of care assessed. RESULTS We did not find a difference in caregivers' perspectives of PwAD QoL according to the age at onset. However, the linear regression analysis indicated that caregivers' burden ( P < .01) and PwAD depressive symptoms ( P < .05) were significantly related to the caregivers' perspective of YOAD QoL. Caregivers' burden ( P < .01), years of education ( P < .05), and self-reported QoL ( P < .01) were significantly related to the caregivers' perspective of LOAD QoL. CONCLUSIONS The factors that drive the perceptions of caregivers of PwAD QoL may vary according to the age at onset. The study provides basic information on caregivers' perspectives of PwAD QoL to create more effective interventions according to the age at onset.
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Affiliation(s)
- Nathália R S Kimura
- 1 Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Maria Alice T Baptista
- 1 Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Raquel L Santos
- 1 Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Maria da Gloria Portugal
- 1 Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Aud Johannenssen
- 2 Norwegian Advisory Unit for Aging and Health, Vestfold Health Trust, Tønsberg, Norway
| | - Maria L Barca
- 2 Norwegian Advisory Unit for Aging and Health, Vestfold Health Trust, Tønsberg, Norway.,3 Department of Geriatric Medicine, Ullevaal University Hospital, Oslo, Norway
| | - Knut Engedal
- 2 Norwegian Advisory Unit for Aging and Health, Vestfold Health Trust, Tønsberg, Norway.,3 Department of Geriatric Medicine, Ullevaal University Hospital, Oslo, Norway
| | - Jerson Laks
- 1 Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,4 Universidade do Grande Rio (Unigranrio), Postgraduation Program of Translational Biomedicine, Duque de Caxias, Brazil
| | - José Pedro Simões
- 5 Department of Political Sociology, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Valeska Marinho Rodrigues
- 1 Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Marcia C N Dourado
- 1 Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Belfort T, Simões P, de Sousa MFB, Santos RL, Barbeito I, Torres B, Dourado MCN. The Relationship Between Social Cognition and Awareness in Alzheimer Disease. J Geriatr Psychiatry Neurol 2018; 31:27-33. [PMID: 29187026 DOI: 10.1177/0891988717743587] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A large body of evidence highlights the social cognitive impairment in neurodegenerative diseases such Alzheimer disease (AD). This study investigated the relationship among social and emotional functioning (SEF), awareness of disease, and other clinical aspects in people with AD (PwAD). A consecutive series of 50 people with mild to moderate AD and their 50 family caregivers were assessed. There was a significant difference between self-rated SEF and informant-rated SEF. In 56% of PwAD, self-rated SEF is lower than informant-rated SEF. People with AD mostly presented with mildly impaired awareness of the disease (56%), 20% had moderately impaired awareness of the disease, and 6% were unaware of the disease. The multivariate linear regression showed that informant-rated SEF was related to the social functioning, and relationships, domains of awareness of disease, and the PwAD informant-rated quality of life. The relationship between SEF and awareness of social functioning and relationship domain shows that they are comprised of judgments related to perceptions about oneself, values, and beliefs qualitatively different from awareness of memory or functionality, which can be directly observed.
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Affiliation(s)
- Tatiana Belfort
- 1 Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Botafogo, Rio de Janeiro, Brazil
| | - Pedro Simões
- 2 Department of Sociology and Political Science, Universidade Federal de Santa Catarina (UFSC), Campus Universitário Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
| | - Maria Fernanda Barroso de Sousa
- 1 Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Botafogo, Rio de Janeiro, Brazil
| | - Raquel Luiza Santos
- 1 Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Botafogo, Rio de Janeiro, Brazil
| | - Isabel Barbeito
- 1 Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Botafogo, Rio de Janeiro, Brazil
| | - Bianca Torres
- 1 Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Botafogo, Rio de Janeiro, Brazil
| | - Marcia Cristina N Dourado
- 1 Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Botafogo, Rio de Janeiro, Brazil
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Perception of change in sexual activity in Alzheimer's disease: views of people with dementia and their spouse-caregivers. Int Psychogeriatr 2017; 29:185-193. [PMID: 27719688 DOI: 10.1017/s1041610216001642] [Citation(s) in RCA: 7] [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
INTRODUCTION The onset of Alzheimer's disease (AD) affects couples' relationship. We investigated the perception of change and sexual satisfaction in spouse-caregivers and their partners diagnosed with AD. METHODS We compared 74 dyads of people with Alzheimer's disease (PwAD)/spouse-caregivers and 21 elderly dyads control. We assessed sexual satisfaction with Questionnaire on Sexual Experience and Satisfaction (QSES), cognition using a Mini-Mental State Examination (MMSE), disease severity using a Clinical Dementia Rating scale (CDR), awareness of disease with Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), functionality with Pfeffer Functional Activities Questionnaire (FAQ), depressive symptoms with Cornell Scale for Depression in Dementia (CSDD), quality of life using a Quality of Life in Alzheimer's Disease Scale (QoL-AD), and burden using a Zarit Burden Interview (ZBI). RESULTS We found differences between the perception and no perception of change in sexual activity of PwAD (p < 0.001), spouse-caregivers (p < 0.01), and controls (p < 0.05). Moderate to severe sexual dissatisfaction was observed in 36.5% of PwAD, 65% of spouse-caregivers, and 31% of controls. PwAD sexual satisfaction was related to cognitive impairment (p < 0.05). Spouse-caregivers sexual satisfaction was related to gender (p < 0.05) and the presence of sexual activity (p < 0.001). CONCLUSIONS The perception of change with higher sexual dissatisfaction, were significant in PwAD and their spouse-caregivers, in comparison with couples of elderly without dementia.
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Dias R, Simões-Neto JP, Santos RL, Sousa MFBD, Baptista MAT, Lacerda IB, Kimura NRS, Dourado MCN. Caregivers’ resilience is independent from the clinical symptoms of dementia. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:967-973. [DOI: 10.1590/0004-282x20160162] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/14/2016] [Indexed: 11/22/2022]
Abstract
ABSTRACT Resilience is the capacity for successful adaptation when faced with the stress of adversity. We aimed to investigate the relationship between caregivers’ resilience and the sociodemographic and clinical factors of people with dementia. Cross-sectional assessment of 58 people with dementia and their caregiver dyads showed that most caregivers were female adult children. The caregivers reported moderate to higher levels of resilience, lower levels of anxiety and depressive symptoms and moderate levels of burden. Resilience was not related to the caregiver’s gender (p = 0.883), nor clinical (p = 0.807) or emotional problems (p = 0.420). The regression showed that resilience was related to the caregiver’s quality of life (p < 0.01) and inversely associated with their depressive symptoms (p < 0.01). There was no relationship between caregivers’ resilience and the sociodemographic and clinical characteristics of people with dementia. We can assume that resilience is an individual characteristic. Support groups should also focus on the factors that may increase resilience among caregivers.
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Dourado MCN, Laks J, Mograbi D. Functional Status Predicts Awareness in Late-Onset but not in Early-Onset Alzheimer Disease. J Geriatr Psychiatry Neurol 2016; 29:313-319. [PMID: 27048588 DOI: 10.1177/0891988716640372] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This study aims to assess whether there are differences between the level of awareness in early-onset Alzheimer disease (EOAD) and late-onset Alzheimer disease (LOAD) and to test its association with quality of life (QOL). A consecutive series of 207 people with Alzheimer disease and their caregivers were selected from an outpatient unit. There were no significant differences in awareness. In LOAD, impairment on awareness was predicted by functional level (β = .37, P < .001), self ( P = .006), and informant report of QOL ( P = .010). The predictors of unawareness in EOAD were self ( P = .002) and informant report of QOL ( P < .001). There is a specific profile of functional deficits underlying awareness in people with LOAD. Additionally, reports of EOAD QOL were more strongly related to awareness than in people with LOAD.
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Affiliation(s)
- Marcia C N Dourado
- 1 Center for Alzheimer's Disease, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jerson Laks
- 1 Center for Alzheimer's Disease, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,2 Centre for Studies and Research on Aging, Institute Vital Brazil, Brazil.,3 Medicine School, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,4 Postgraduate Program in Translational Biomedicine-Biotrans, Unigranrio University, Rio de Janeiro, Brazil
| | - Daniel Mograbi
- 5 Department of Psychology, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil.,6 Department of Psychology, Institute of Psychiatry, King's College London, London, United Kingdom
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Torisson G, Stavenow L, Minthon L, Londos E. Reliability, validity and clinical correlates of the Quality of Life in Alzheimer's disease (QoL-AD) scale in medical inpatients. Health Qual Life Outcomes 2016; 14:90. [PMID: 27301257 PMCID: PMC4908755 DOI: 10.1186/s12955-016-0493-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 06/07/2016] [Indexed: 11/14/2022] Open
Abstract
Background There is a lack of standardisation in quality of life (QoL) measurements to be used in older multimorbid patients. An ideal QoL measurement should be reliable, valid, subjective, multidimensional, feasible and generic. We hypothesised that the QoL-AD (Quality of Life in Alzheimer’s Disease) scale could have these properties. Our aim was to determine the psychometric properties and clinical correlations of QoL-AD in a population of elderly, multimorbid medical inpatients. Methods QoL-AD was performed in 200 medical inpatients, and available caregivers. Reliability was determined using cronbach’s alpha and corrected item-total correlations. The agreement between patient and proxy ratings were examined using intra-class correlations (ICC). Correlations between QoL-AD and demographic data, comorbidity, cognitive tests, ADL (activities of daily living) and depression were examined. To characterise the underlying constructs of QoL-AD, an exploratory factor analysis was performed. Results In total, 199 patients fulfilled the QoL-AD rating, with 139 proxy ratings. Cronbach’s alpha (95 % CI) was 0.74 (0.68–0.79) for patients and 0.86 (0.83–0.90) for proxies. Patient-proxy ICC (95 % CI) was 0.31 (0.16–0.46). Lower QoL was correlated to depression, cognitive impairment, ADL impairment and solitary living, but not with comorbidity. The factor analysis gave a three-factor solution, with factors representing phsyical, social and psychological well-being. Conclusion The QoL-AD scale showed some promising properties but more research is needed before it can be recommended in this setting. If replicated, the finding that cognitive impairment, depression and ADL impairment were more associated with lower QoL than somatic comorbidity could have clinical implications for further studies aiming to improve QoL in this population. Electronic supplementary material The online version of this article (doi:10.1186/s12955-016-0493-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gustav Torisson
- Clinical Memory Research Unit, Lund University, Simrisbanvägen 14, S 20502, Malmö, Sweden.
| | - Lars Stavenow
- Deparment of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Lennart Minthon
- Clinical Memory Research Unit, Lund University, Simrisbanvägen 14, S 20502, Malmö, Sweden
| | - Elisabet Londos
- Clinical Memory Research Unit, Lund University, Simrisbanvägen 14, S 20502, Malmö, Sweden
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da Silva Serelli L, Reis RC, Laks J, de Pádua AC, Bottino CM, Caramelli P. Effects of the Staff Training for Assisted Living Residences protocol for caregivers of older adults with dementia: A pilot study in the Brazilian population. Geriatr Gerontol Int 2016; 17:449-455. [PMID: 26847046 DOI: 10.1111/ggi.12742] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/19/2015] [Accepted: 12/08/2015] [Indexed: 11/30/2022]
Abstract
AIM To investigate the effects of the Staff Training for Assisted Living Residences administered to formal caregivers of older adults with behavioral and psychological symptoms of dementia in the institutional environment. METHODS The project was developed in two long-term care institutions in Belo Horizonte, Brazil, with 25 formal caregivers and 46 older adults with dementia. The training was carried out over 6 weeks. Evaluations were carried out with the caregivers and the elderly residents, using specific instruments to evaluate different domains (demographic data, etiological diagnoses of dementia, severity of dementia, global cognition, functional performance, quality of life, behavior, burden of caregiver, depression and anxiety). The total time for data collection was 6 months. RESULTS A significant improvement in behavioral and psychological symptoms of dementia, as assessed by the Neuropsychiatric Inventory, was observed (P < 0.008), with no changes in the other indexes. No significant changes were observed in parameters related to caregivers. CONCLUSIONS The Staff Training for Assisted Living Residences protocol was effective in reducing neuropsychiatric symptoms in dementia patients, and might be a feasible and positive strategy to train formal caregivers in long-term care institutions in Brazil. Geriatr Gerontol Int 2017; 17: 449-455.
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Affiliation(s)
- Larissa da Silva Serelli
- Department of Internal Medicine, Post-Graduate Program in Adult Health Applied Sciences, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG
| | - Ramon Castro Reis
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS
| | - Jerson Laks
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ.,Center for Studies and Research on Aging, Institute Vital Brazil, Rio de Janeiro, RJ
| | | | - Cássio Mc Bottino
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, SP
| | - Paulo Caramelli
- Department of Internal Medicine, Post-Graduate Program in Adult Health Applied Sciences, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG
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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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Measuring the impact of informal elderly caregiving: a systematic review of tools. Qual Life Res 2015; 25:1059-92. [PMID: 26475138 DOI: 10.1007/s11136-015-1159-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To classify and identify the main characteristics of the tools used in practice to assess the impact of elderly caregiving on the informal carers' life. METHODS A systematic review of literature was performed searching in Embase, MEDLINE, PsycINFO, CINAHL, IBECS, LILACS, SiiS, SSCI and Cochrane Library from 2009 to 2013 in English, Spanish, Portuguese and French, and in reference lists of included papers. RESULTS The review included 79 studies, among them several in languages other than English. Their inclusion increased the variety of identified tools to measure this impact (n = 93) and allowed a wider analysis of their geographical use. While confirming their overlapping nature, instruments were classified according to the degree of integration of dimensions they evaluated and their specificity to the caregiving process: caregiver burden (n = 20), quality of life and well-being (n = 11), management and coping (n = 21), emotional and mental health (n = 29), psychosocial impact (n = 10), physical health and healthy habits (n = 2), and other measures. A high use in practice of tools not validated yet and not caregiver-specific was identified. CONCLUSIONS The great variety and characteristics of instruments identified in this review confirm the complexity and multidimensionality of the effects of elderly caregiving on the informal carer's life and explain the difficulties to assess these effects in practice. According to the classification provided, caregiver burden and emotional and mental health are the most evaluated dimensions. However, further work is required to develop integrated and caregiving focused procedures that can appraise this complexity across different countries and cultures.
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Torres B, Santos RL, Sousa MFBD, Simões Neto JP, Nogueira MML, Belfort TT, Dias R, Dourado MCN. Facial expression recognition in Alzheimer's disease: a longitudinal study. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:383-9. [PMID: 26017202 DOI: 10.1590/0004-282x20150009] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 12/29/2014] [Indexed: 11/22/2022]
Abstract
Facial recognition is one of the most important aspects of social cognition. In this study, we investigate the patterns of change and the factors involved in the ability to recognize emotion in mild Alzheimer's disease (AD). Through a longitudinal design, we assessed 30 people with AD. We used an experimental task that includes matching expressions with picture stimuli, labelling emotions and emotionally recognizing a stimulus situation. We observed a significant difference in the situational recognition task (p ≤ 0.05) between baseline and the second evaluation. The linear regression showed that cognition is a predictor of emotion recognition impairment (p ≤ 0.05). The ability to perceive emotions from facial expressions was impaired, particularly when the emotions presented were relatively subtle. Cognition is recruited to comprehend emotional situations in cases of mild dementia.
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Affiliation(s)
- Bianca Torres
- Centro de Doença de Alzheimer e Outros Transtornos Mentais da Velhice (CDA), Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Raquel Luiza Santos
- Centro de Doença de Alzheimer e Outros Transtornos Mentais da Velhice (CDA), Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Maria Fernanda Barroso de Sousa
- Centro de Doença de Alzheimer e Outros Transtornos Mentais da Velhice (CDA), Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - José Pedro Simões Neto
- Departamento de Sociologia Política, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Marcela Moreira Lima Nogueira
- Centro de Doença de Alzheimer e Outros Transtornos Mentais da Velhice (CDA), Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Tatiana T Belfort
- Centro de Doença de Alzheimer e Outros Transtornos Mentais da Velhice (CDA), Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Rachel Dias
- Centro de Doença de Alzheimer e Outros Transtornos Mentais da Velhice (CDA), Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marcia Cristina Nascimento Dourado
- Centro de Doença de Alzheimer e Outros Transtornos Mentais da Velhice (CDA), Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Dichter MN, Schwab CGG, Meyer G, Bartholomeyczik S, Halek M. Linguistic validation and reliability properties are weak investigated of most dementia-specific quality of life measurements-a systematic review. J Clin Epidemiol 2015; 70:233-45. [PMID: 26319270 DOI: 10.1016/j.jclinepi.2015.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 07/20/2015] [Accepted: 08/11/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE For people with dementia, the concept of quality of life (Qol) reflects the disease's impact on the whole person. Thus, Qol is an increasingly used outcome measure in dementia research. This systematic review was performed to identify available dementia-specific Qol measurements and to assess the quality of linguistic validations and reliability studies of these measurements (PROSPERO 2013: CRD42014008725). STUDY DESIGN AND SETTING The MEDLINE, CINAHL, EMBASE, PsycINFO, and Cochrane Methodology Register databases were systematically searched without any date restrictions. Forward and backward citation tracking were performed on the basis of selected articles. RESULTS A total of 70 articles addressing 19 dementia-specific Qol measurements were identified; nine measurements were adapted to nonorigin countries. The quality of the linguistic validations varied from insufficient to good. Internal consistency was the most frequently tested reliability property. Most of the reliability studies lacked internal validity. CONCLUSION Qol measurements for dementia are insufficiently linguistic validated and not well tested for reliability. None of the identified measurements can be recommended without further research. The application of international guidelines and quality criteria is strongly recommended for the performance of linguistic validations and reliability studies of dementia-specific Qol measurements.
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Affiliation(s)
- Martin Nikolaus Dichter
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Straße 12, 58453 Witten, Germany; School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453 Witten, Germany.
| | - Christian G G Schwab
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Straße 12, 58453 Witten, Germany; School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453 Witten, Germany
| | - Gabriele Meyer
- School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453 Witten, Germany; Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112 Halle (Saale), Germany
| | - Sabine Bartholomeyczik
- School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453 Witten, Germany
| | - Margareta Halek
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Straße 12, 58453 Witten, Germany; School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453 Witten, Germany
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Fonseca LC, Tedrus GMAS, Rezende ALRA, Giordano HF. Coherence of brain electrical activity: a quality of life indicator in Alzheimer’s disease?Coerência da atividade elétrica cerebral: indicador da qualidade de vida na doença de Alzheimer? ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:396-401. [DOI: 10.1590/0004-282x20150035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 01/08/2015] [Indexed: 11/21/2022]
Abstract
Objective To investigate the relationships between quality of life (QOL) and clinical and electroencephalogram (EEG) aspects in patients with Alzheimer’s disease (AD). Method Twenty-eight patients with mild or moderate AD, 31 with Parkinson’s disease (PD), and 27 normal controls (NC) were submitted to: CERAD neuropsychological battery, Hamilton Depression and Anxiety Rating Scales, Functional Activities Questionnaire, QOL scale for patients with AD, and quantitative EEG measures. Results AD and PD patients had similar QOL (31.0 ± 5.8; 31.7 ± 4.8, respectively), worse than that of NC (37.5 ± 6.3). AD patients had lower global interhemispheric theta coherence (0.49 ± 0.04; 0.52 ± 0.05; 0.52 ± 0.05; respectively) than PD and NC. Multiple linear regression for QOL of AD patients revealed that global interhemispheric theta coherence, and Hamilton depression scores were significant factors (coefficients; 58.2 and -0.27, respectively; R2, 0.377). Conclusion Interhemispheric coherence correlates with QOL regardless of cognitive and functional variables and seems to be a neurophysiological indicator of QOL in AD patients.
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Abstract
BACKGROUND The relationship between sexuality and quality of life (QoL) of spouse-caregivers remains unclear. We designed this study to evaluate the relationship between sexual satisfaction and spouse-caregivers' QoL, and to determine the influence of the clinical characteristics of people with dementia (PWD) on spouse-caregivers' self-reported QoL. METHODS Using a cross-sectional design, 54 PWD and their spouse-caregivers completed the QoL in Alzheimer's Disease scale (QoL-AD), questionnaire on sexual experience and satisfaction (QSES), Mini-Mental State Examination (MMSE), Clinical Dementia Rating scale (CDR), Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), Pfeffer functional activities questionnaire (FAQ), the Cornell scale for depression in dementia (CSDD) and Zarit burden interview (ZBI). Univariate and multivariate regression analyses were conducted to identify the factors that influenced the spouse-caregivers' QoL ratings. RESULTS We did not find a significant difference in QoL between male and female spouse-caregivers (p = 0.71). We also found that 13% of males and 48.1% of females demonstrated moderate to severe sexual dissatisfaction. However, we did not find a significant correlation between spouse-caregivers' QoL and sexual satisfaction (p = 0.41). The linear regression indicated that impaired awareness and lower QoL of PWD were significantly related to spouse-caregivers' QoL (p = 0.000). CONCLUSIONS The spouse-caregivers' QoL is influenced by awareness of disease and PWD QoL. Our study would be helpful for the development of adequate psycho-educational approaches to increase spouse-caregivers' QoL, considering the specificities of the couples' relationship.
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Crocker TF, Smith JK, Skevington SM. Family and professionals underestimate quality of life across diverse cultures and health conditions: systematic review. J Clin Epidemiol 2014; 68:584-95. [PMID: 25662007 DOI: 10.1016/j.jclinepi.2014.12.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 11/27/2014] [Accepted: 12/23/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine how accurately proxies evaluate quality of life (QoL) in people they know, using cross-cultural data from the multidimensional, multilingual World Health Organization Quality of Life assessment short-form (the WHOQOL-BREF) and whether accuracy varies by health condition or proxy type (eg, family/professional). STUDY DESIGN AND SETTING Systematic review with meta-analysis: We searched five databases for reports of proxy-completed WHOQOL-BREF scores and aggregated results using a random-effects model. Minimal clinically important difference values were calculated. RESULTS Analyses included nine studies (1980 dyads) of physical (n = 762) or mental (n = 604) health conditions, or intellectual disability (n = 614), in 10 countries. Mean person-proxy correlations ranged from 0.28 (social QoL) to 0.44 (physical QoL). Proxy measures were underestimates (ie, significantly lower than persons reported for themselves) for social [mean difference (MD) = 4.7, 95% confidence interval (CI): 1.8, 7.6], psychological (MD = 3.7, 95% CI: 0.6, 6.8), and physical (MD = 3.1, 95% CI: 0.6, 5.6) QoL. Underestimates varied significantly between health conditions for social (P < 0.001), psychological (P = 0.009), and physical (P = 0.02) QoL. Family members assessed psychological and environmental QoL better than professionals. CONCLUSION Proxies tend to be imprecise, underestimating QoL, and should be aware of this tendency. Where health care is decided for others, family members' views about QoL should be prioritized.
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Affiliation(s)
- Thomas F Crocker
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK.
| | - Jaime K Smith
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK; Caudwell Children, Minton Hollins Building, Shelton Old Road, Stoke-On-Trent ST4 7RY, UK
| | - Suzanne M Skevington
- Manchester Centre for Health Psychology, School of Psychological Sciences, Coupland 1 Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK
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Santos RL, Sousa MFBD, Simões-Neto JP, Nogueira ML, Belfort TT, Torres B, Rosa RDLD, Laks J, Dourado MCN. Caregivers’ quality of life in mild and moderate dementia. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:931-7. [DOI: 10.1590/0004-282x20140155] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 08/27/2014] [Indexed: 11/22/2022]
Abstract
Objective To investigate quality of life (QoL) of caregivers of mild and moderate dementia and the aspects related to QoL. Method Cross-sectional assessment of dyads of people with dementia (PwD) and family caregivers (n=88). Results Burden (p<0.05) and depressive symptoms (p<0.001) were related to caregivers’ QoL in both stages of dementia. In mild dementia, caregivers’ depressive symptoms (p<0.001) and PwD neuropsychiatric symptoms (p<0.001) were related to burden. PwD aberrant motor activity (p<0.001) and anxiety (p<0.001), and caregiver-reported QoL domains of friends (p<0.001) and mood (p<0.05) were related to depressive symptoms. In moderate dementia, self-reported QoL (p<0.01) and anxiety (p<0.01), and PwD anxiety (p<0.01) were related to burden. Caregivers’ anxiety (p<0.001) and self-reported QoL (p<0.001) were related to depressive symptoms. Conclusion Burden and depressive symptoms were related to QoL of caregivers of mild and moderate dementia. However, they are driven by different factors according to dementia severity.
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Affiliation(s)
| | | | | | | | | | | | | | - Jerson Laks
- Universidade Federal do Rio de Janeiro, Brazil
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Yu HM, He RL, Ai YM, Liang RF, Zhou LY. Reliability and validity of the quality of life-Alzheimer disease Chinese version. J Geriatr Psychiatry Neurol 2013; 26:230-6. [PMID: 23970459 DOI: 10.1177/0891988713500586] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the psychometric properties of the quality of life-Alzheimer disease (QOL-AD) Chinese version in patients with dementia in mainland, China and to compare patient and caregiver reports of patient QOL. METHODS The QOL-AD Chinese version was established following standard guidelines for cross-cultural adaptation of measures. The reliability was assessed by internal consistency and test-retest reliability. The validity included construct and convergent validity. A paired Student t test was performed to determine differences between patient reports and caregiver reports. RESULTS The reliability for both patient and caregiver reports on the QOL-AD was good (Cronbach α values of 0.66 and 0.87; intraclass correlation coefficients of 0.84 and 0.90 for patient and caregiver reports, respectively). The validity of patient and caregiver reports was supported by correlation with domain measures. All of the multitrait-multimethod correlations demonstrated a high relationship between patient reports and caregiver reports, ranging from 0.26 to 0.55. The caregivers rated patient QOL significantly higher than did the patients. CONCLUSION The findings support the use of the Chinese version of the QOL-AD as a generic instrument to measure QOL of AD in mainland China. Further research is needed to clarify the relationship between patient and caregiver reports of patient QOL.
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Affiliation(s)
- Hong-Mei Yu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, People's Republic of China
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