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Boucaud-Maitre D, Simo N, Villeneuve R, Bonnet M, Dramé M, Tabué-Teguo M. Comparison of quality of life of older adults living in foster families versus nursing homes. Results from the KASA studies. J Nutr Health Aging 2024; 28:100358. [PMID: 39244789 DOI: 10.1016/j.jnha.2024.100358] [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: 07/11/2024] [Revised: 09/02/2024] [Accepted: 09/02/2024] [Indexed: 09/10/2024]
Abstract
OBJECTIVES Professional foster families for dependent older adults could be an alternative to nursing homes. Engagement in the family life and close contact with a single reference person could enhance their quality of life (QOL). This study aimed to compare the Health-Related Quality of Life (HrQOL) and subjective QOL among older adults living in foster families versus those in nursing homes. DESIGN Cross-sectional analysis from twin studies conducted in foster families (the KASAF study) and nursing homes (the KASEHPAD study). SETTING AND PARTICIPANTS Older adults (aged 60 years or older) in French Caribbean Islands living in foster families or nursing homes. MEASUREMENTS HrQOL was measured using the EuroQol-five dimensions (EQ5D-3L) and QOL was assessed using a Visual Analog Scale (QOL-VAS). For older adults unable to complete these scales, proxy EQ-5D-3L assessments were conducted by paramedical staff or foster caregivers. RESULTS A total of 439 older adults, with 107 in foster families and 332 in nursing homes were included. Participants living in foster families were less often male, had less often hypertension, were more dependent or physical impaired and had lower score of cognition. In multivariate analyses, factors associated with low self-reported HRQoL (n = 240) were Mini Mental State Examination (MMSE) score (β: -0.011; p = 0.003) and Activities of Daily Living (ADL) score (β: 0.014; p < 0.001). A lower QOL-VAS score (n = 150) was associated with living in a nursing home compared to living in a foster family (β: -19.48 points; p < 0.001) and with the ADL score (2.94 points; p = 0.019). In older adults with major cognitive disorders, the only factor associated with low proxy EQ-5D proxy index score (n = 136) was dependency (β: 0.167; p < 0.001). CONCLUSION HrQOL was similar between older adults living in nursing homes and foster families. Additionally, older adults reported a better subjective quality of life when residing in foster families. These findings suggest that the foster family model may meet the social and environmental needs of dependent older adults for whom nursing homes are not suitable.
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Affiliation(s)
- Denis Boucaud-Maitre
- Centre Hospitalier Le Vinatier, Bron, France; Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique.
| | - Nadine Simo
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique; Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
| | - Roxane Villeneuve
- Centre Hospitalo-Universitaire de Guadeloupe, Pointe-à-Pitre, Guadeloupe
| | - Michel Bonnet
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
| | - Moustapha Dramé
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique; Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
| | - Maturin Tabué-Teguo
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique; Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
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Read S, Hicks B, Budden E, Douglass J, Grahamslaw A, Herrero E, Joseph G, Kirkup C, Pusey M, Russell A, Sondh H, Sondh S, Storey B, Towson G, Baxter K, Birks Y, Brayne C, Colclough C, Dangoor M, Dixon J, Donaghy P, Gridley K, Harris PR, Hu B, King D, Knapp M, Miles E, Mueller C, Perach R, Robinson L, Rusted J, Thomas AJ, Wittenberg R, Banerjee S. Long-term impact of the COVID-19 pandemic on the quality of life of people with dementia and their family carers. Age Ageing 2024; 53:afad233. [PMID: 38275095 PMCID: PMC10811518 DOI: 10.1093/ageing/afad233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Few studies have longitudinally mapped quality of life (QoL) trajectories of newly diagnosed people with dementia and their carers, particularly during coronavirus disease-2019 (COVID-19). METHODS In a UK cohort study, 261 newly diagnosed people with dementia and 206 family carers were assessed prior to the pandemic (July 2019-March 2020), followed up after the first lockdown (July-October 2020) and then again a year and 2 years later. Latent growth curve modelling examined the level and change of QoL over the four time-points using dementia-specific QoL measures (DEMQOL and C-DEMQOL). RESULTS Despite variations in individual change scores, our results suggest that generally people with dementia maintained their QoL during the pandemic and experienced some increase towards the end of the period. This contrasted with carers who reported a general deterioration in their QoL over the same period. 'Confidence in future' and 'Feeling supported' were the only carer QoL subscales to show some recovery post-pandemic. DISCUSSION It is positive that even during a period of global disruption, decline in QoL is not inevitable following the onset of dementia. However, it is of concern that carer QoL declined during this same period even after COVID-19 restrictions had been lifted. Carers play an invaluable role in the lives of people with dementia and wider society, and our findings suggest that, post-pandemic, they may require greater support to maintain their QoL.
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Affiliation(s)
- Sanna Read
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Ben Hicks
- Brighton and Sussex Medical School, Centre for Dementia Studies, University of Sussex, Brighton, UK
| | - Emily Budden
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | | | | | - Elena Herrero
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Gregory Joseph
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Martha Pusey
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Alice Russell
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | | | - Sharon Sondh
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Bryony Storey
- Gateshead Health NHS Foundation Trust, Gateshead, UK
| | | | - Kate Baxter
- Social Policy Research Unit, Faculty of Social Sciences, University of York, York, UK
| | - Yvonne Birks
- Social Policy Research Unit, Faculty of Social Sciences, University of York, York, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | | | - Margaret Dangoor
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Josie Dixon
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Paul Donaghy
- Kings College London, Institute of Psychiatry, London, UK
| | - Kate Gridley
- Social Policy Research Unit, Faculty of Social Sciences, University of York, York, UK
| | - Peter R Harris
- School of Psychology, University of Sussex, Brighton, UK
| | - Bo Hu
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Derek King
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Eleanor Miles
- School of Psychology, University of Sussex, Brighton, UK
| | | | - Rotem Perach
- School of Psychology, University of Sussex, Brighton, UK
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | | | - Alan J Thomas
- Institute for Ageing, Newcastle University, Newcastle, UK
| | - Raphael Wittenberg
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, UK
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Joe E, Segal-Gidan F, Cummings JL, Galasko D, Tomaszewski Farias S, Johnson DK, Ross L, Yaffe K, Wang X, Schneider LS, Chui H, Ringman JM. Association Between Self- and Proxy-Reported Depression and Quality of Life in Mild-Moderate Alzheimer's Disease. Am J Geriatr Psychiatry 2024; 32:58-67. [PMID: 37827916 PMCID: PMC10843510 DOI: 10.1016/j.jagp.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Prior studies have reported an association between depression and quality of life (QOL) in Alzheimer's disease (AD), but the effect of self- versus proxy rating of mood and QOL has not been described. DESIGN In this secondary analysis of data from a cohort study, the authors used a linear mixed-effects model to determine if the association between depression and QOL is affected by whether both measures are assessed by the same member of the patient-caregiver dyad. SETTING Participants and caregiver informants were recruited from 10 California Alzheimer Disease Centers. PARTICIPANTS A total of 137 participants with mild-to-moderate Alzheimer's disease and their caregivers. MEASUREMENTS Self- and proxy-rated scores on both the Geriatric Depression Scale (GDS) and the Quality of Life in Alzheimer's Disease scale (QoL-AD). Multivariable linear mixed-effects models were used to estimate the association between depression and QOL. RESULTS Results of the multivariable linear mixed-effects models showed a significant association between self-rated QoL-AD and self-rated (B = -0.49, p <0.0001) but not proxy-rated GDS (B = -0.07, p = 0.19) after adjusting for confounders. Likewise, there was a significant association between proxy-rated QoL-AD and proxy-rated GDS (B = -0.48, p <0.0001) but not self-rated GDS (B = 0.05, p = 0.36). CONCLUSION Depression was associated with QOL in AD over short-term longitudinal follow-up, but the association was not statistically significant if both instruments are not administered to the same member of the patient-caregiver dyad. The choice of self- versus proxy-reported QOL should be intentionally considered in future studies as it may influence reported outcomes.
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Affiliation(s)
- Elizabeth Joe
- Department of Neurology, Keck School of Medicine (EJ, FS-G, XW, LSS, HC, JMR), University of Southern California, Los Angeles, CA.
| | - Freddi Segal-Gidan
- Department of Neurology, Keck School of Medicine (EJ, FS-G, XW, LSS, HC, JMR), University of Southern California, Los Angeles, CA
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV
| | | | | | - David K Johnson
- UC Davis Alzheimer's Disease Research Center-East Bay (DKJ), Walnut Creek, CA
| | - Leslie Ross
- Institute for Health & Aging (LR), UCSF School of Nursing, San Francisco, CA
| | - Kristine Yaffe
- Weill Institute for Neurosciences and Departments of Psychiatry (KY), Neurology and Epidemiology, UCSF, San Francisco, CA
| | - Xinhui Wang
- Department of Neurology, Keck School of Medicine (EJ, FS-G, XW, LSS, HC, JMR), University of Southern California, Los Angeles, CA
| | - Lon S Schneider
- Department of Neurology, Keck School of Medicine (EJ, FS-G, XW, LSS, HC, JMR), University of Southern California, Los Angeles, CA
| | - Helena Chui
- Department of Neurology, Keck School of Medicine (EJ, FS-G, XW, LSS, HC, JMR), University of Southern California, Los Angeles, CA
| | - John M Ringman
- Department of Neurology, Keck School of Medicine (EJ, FS-G, XW, LSS, HC, JMR), University of Southern California, Los Angeles, CA
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King D, Farina N, Burgon C, Feeney Y, Berwald S, Bustard E, Gallaher L, Habibi R, Wittenberg R, Comas-Herrera A, Knapp M, Banerjee S. Factors associated with change over time in quality of life of people with dementia: longitudinal analyses from the MODEM cohort study. BMC Geriatr 2022; 22:469. [PMID: 35641909 PMCID: PMC9158343 DOI: 10.1186/s12877-022-03142-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Research to date offers mixed evidence about the relationship between quality of life and severity of cognitive impairment in people with dementia. We aimed to investigate longitudinal changes in patient- and proxy-rated health-related quality of life (HRQL) by severity of dementia and explore factors associated with changes in HRQL over a one-year period. We used data from the MODEM longitudinal cohort study which recruited dyads of persons with clinically diagnosed dementia and their principal carer and interviewed them face-to-face at baseline and again 1 year later. Methods Quota sampling was used to generate balanced numbers (target n = 100 for each severity level) of people with mild cognitive impairment (20+ on the standardised Mini-Mental State Examination (sMMSE)), moderate cognitive impairment (score 10 to 19), and severe cognitive impairment (score 0 to 9). Persons with dementia without an identifiable family carer or other informant (e.g., a formal/professional/paid carer) were excluded from the study. Participants answered a series of questions measuring their HRQL: DEMQOL, DEMQOL-proxy, EQ-5D-3 L, EQ-5D-3L proxy. Multiple regression models were built to understand the effects of baseline demographics and dementia symptoms (cognitive impairment, neuropsychiatric symptoms) on change in HRQL over 1 year. Results Two hundred and forty-three dyads of people with clinically diagnosed dementia and carers completed baseline and follow-up interviews. Most measures of HRQL remaining relatively stable between time-points, but one index of HRQL, EQ-5D proxy, significantly declined. Depending on the HRQL measure, different factors were associated with change in HRQL. The only factor consistently associated with decline in HRQL (when compared to improvement) was having a diagnosis of a non-Alzheimer’s dementia. Conclusions Deterioration in HRQL is not an inevitable part of the dementia journey. However, people with non-Alzheimer’s dementias may be more susceptible to HRQL decline. This may indicate that those with non-Alzheimer’s dementia may benefit from specific support focussed on maintaining their quality of life.
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Porffy LA, Mehta MA, Patchitt J, Boussebaa C, Brett J, D'Oliveira T, Mouchlianitis E, Shergill SS. A Novel Virtual Reality Assessment of Functional Cognition: Validation Study. J Med Internet Res 2022; 24:e27641. [PMID: 35080501 PMCID: PMC8829700 DOI: 10.2196/27641] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/05/2021] [Accepted: 10/05/2021] [Indexed: 01/29/2023] Open
Abstract
Background Cognitive deficits are present in several neuropsychiatric disorders, including Alzheimer disease, schizophrenia, and depression. Assessments used to measure cognition in these disorders are time-consuming, burdensome, and have low ecological validity. To address these limitations, we developed a novel virtual reality shopping task—VStore. Objective This study aims to establish the construct validity of VStore in relation to the established computerized cognitive battery, Cogstate, and explore its sensitivity to age-related cognitive decline. Methods A total of 142 healthy volunteers aged 20-79 years participated in the study. The main VStore outcomes included verbal recall of 12 grocery items, time to collect items, time to select items on a self-checkout machine, time to make the payment, time to order coffee, and total completion time. Construct validity was examined through a series of backward elimination regression models to establish which Cogstate tasks, measuring attention, processing speed, verbal and visual learning, working memory, executive function, and paired associate learning, in addition to age and technological familiarity, best predicted VStore performance. In addition, 2 ridge regression and 2 logistic regression models supplemented with receiver operating characteristic curves were built, with VStore outcomes in the first model and Cogstate outcomes in the second model entered as predictors of age and age cohorts, respectively. Results Overall VStore performance, as indexed by the total time spent completing the task, was best explained by Cogstate tasks measuring attention, working memory, paired associate learning, and age and technological familiarity, accounting for 47% of the variance. In addition, with λ=5.16, the ridge regression model selected 5 parameters for VStore when predicting age (mean squared error 185.80, SE 19.34), and with λ=9.49 for Cogstate, the model selected all 8 tasks (mean squared error 226.80, SE 23.48). Finally, VStore was found to be highly sensitive (87%) and specific (91.7%) to age cohorts, with 94.6% of the area under the receiver operating characteristic curve. Conclusions Our findings suggest that VStore is a promising assessment that engages standard cognitive domains and is sensitive to age-related cognitive decline.
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Affiliation(s)
- Lilla Alexandra Porffy
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Mitul A Mehta
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Joel Patchitt
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Trafford Centre for Medical Research, University of Sussex, Brighton, United Kingdom
| | - Celia Boussebaa
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Jack Brett
- Faculty of Media and Communications, Bournemouth University, Bournemouth, United Kingdom
| | - Teresa D'Oliveira
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | | | - Sukhi S Shergill
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Kent and Medway Medical School, Canterbuy, United Kingdom.,Kent and Medway National Heath Service and Social Care Partnership Trust, Gillingham, United Kingdom
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Ydstebø AE. Hjemmeboende personer med demens: Hva påvirker deres livskvalitet og bruk av helse- og omsorgsressurser? TIDSSKRIFT FOR OMSORGSFORSKNING 2022. [DOI: 10.18261/issn.2387-5984-2021-01-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Villars H, Cantet C, de Peretti E, Perrin A, Soto-Martin M, Gardette V. Impact of an educational programme on Alzheimer's disease patients' quality of life: results of the randomized controlled trial THERAD. ALZHEIMERS RESEARCH & THERAPY 2021; 13:152. [PMID: 34511121 PMCID: PMC8436545 DOI: 10.1186/s13195-021-00896-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although educational interventions are recommended in Alzheimer's disease (AD), studies assessing the impact of interventions such as "therapeutic patient education" are scarce. Indeed, the intrinsic nature of the disease is considered a barrier to patients' involvement in such approaches. We aimed to evaluate an intervention by using a "dyadic" approach (patient and caregiver) in both intervention and assessment. METHODS THERAD is a monocentric, randomized, controlled trial assessing the effects of a 2-month educational programme in mild to moderately severe AD patients among 98 dyads (caregiver/patient) on caregiver-reported patient quality of life (QOL) at 2 months. Community-dwelling patients and their caregivers were recruited in ambulatory units of the French Toulouse University Hospital. Self-reported patient QOL, autonomy, behavioural and psychological symptoms and caregiver QOL and burden were collected at 2, 6 and 12 months. Linear mixed models were used in modified intention-to-treat populations. We also performed sensitivity analysis. RESULTS A total of 196 dyads were included, 98 in each group. The mean age of the patients was 82 years, 67.7% were women, diagnosed with AD (+/- cerebrovascular component) (mean MMSE =17.6), and 56.9% lived with a partner. The mean age of the caregivers was 65.7 years, and 64.6% were women (52.3% offspring/42.6% spouses), with a moderate burden (mean Zarit score = 30.9). The mean caregiver-reported patient QOL was lower than the self-reported QOL (28.61 vs. 33.96). We did not identify any significant difference in caregiver-reported patients' QOL (p = 0.297) at 2 months, but there was a significant difference in self-reported patients' QOL at 2 months (p = 0.0483) or 6 months (p = 0.0154). No significant difference was found for the secondary outcomes. The results were stable in the sensitivity analyses. CONCLUSIONS This randomized controlled trial assessing an educational intervention in 196 dyads (Alzheimer's disease affected patient/caregiver) highlights the need to better consider the patient's point of view, since only the self-reported QOL was improved. Additional studies using this dyadic approach are necessary in targeted subpopulations of caregivers (spouse vs. child, gender) and of patients (severity of cognitive impairment or behavioural disturbances) TRIAL REGISTRATION: THERAD study NCT01796314 . Registered on February 19, 2013.
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Affiliation(s)
- Hélène Villars
- Geriatric Department, Toulouse University Hospital, Hopital La Grave- Cité de la Santé Place Lange TSA 60 033, 31059, Toulouse Cedex 9, France.
| | - Christelle Cantet
- Inserm UMR 1295: Center for Research in Population Health (CERPOP) - Department of Epidemiology and Public Health, University of Toulouse, II F-31073, 37, allées Jules Guesde, 31073, Toulouse cedex, France
| | - Eva de Peretti
- Geriatric Department, Toulouse University Hospital, Hopital La Grave- Cité de la Santé Place Lange TSA 60 033, 31059, Toulouse Cedex 9, France
| | - Amelie Perrin
- Geriatric Department, Toulouse University Hospital, Hopital La Grave- Cité de la Santé Place Lange TSA 60 033, 31059, Toulouse Cedex 9, France
| | - Maria Soto-Martin
- Geriatric Department, Toulouse University Hospital, Hopital La Grave- Cité de la Santé Place Lange TSA 60 033, 31059, Toulouse Cedex 9, France
| | - Virginie Gardette
- Geriatric Department, Toulouse University Hospital, Hopital La Grave- Cité de la Santé Place Lange TSA 60 033, 31059, Toulouse Cedex 9, France
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Burton JK, Stott DJ, McShane R, Noel-Storr AH, Swann-Price RS, Quinn TJ. Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) for the early detection of dementia across a variety of healthcare settings. Cochrane Database Syst Rev 2021; 7:CD011333. [PMID: 34275145 PMCID: PMC8406787 DOI: 10.1002/14651858.cd011333.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) is a structured interview based on informant responses that is used to assess for possible dementia. IQCODE has been used for retrospective or contemporaneous assessment of cognitive decline. There is considerable interest in tests that may identify those at future risk of developing dementia. Assessing a population free of dementia for the prospective development of dementia is an approach often used in studies of dementia biomarkers. In theory, questionnaire-based assessments, such as IQCODE, could be used in a similar way, assessing for dementia that is diagnosed on a later (delayed) assessment. OBJECTIVES To determine the accuracy of the informant-based questionnaire IQCODE for the early detection of dementia across a variety of health care settings. SEARCH METHODS We searched these sources on 16 January 2016: ALOIS (Cochrane Dementia and Cognitive Improvement Group), MEDLINE Ovid SP, Embase Ovid SP, PsycINFO Ovid SP, BIOSIS Previews on Thomson Reuters Web of Science, Web of Science Core Collection (includes Conference Proceedings Citation Index) on Thomson Reuters Web of Science, CINAHL EBSCOhost, and LILACS BIREME. We also searched sources specific to diagnostic test accuracy: MEDION (Universities of Maastricht and Leuven); DARE (Database of Abstracts of Reviews of Effects, in the Cochrane Library); HTA Database (Health Technology Assessment Database, in the Cochrane Library), and ARIF (Birmingham University). We checked reference lists of included studies and reviews, used searches of included studies in PubMed to track related articles, and contacted research groups conducting work on IQCODE for dementia diagnosis to try to find additional studies. We developed a sensitive search strategy; search terms were designed to cover key concepts using several different approaches run in parallel, and included terms relating to cognitive tests, cognitive screening, and dementia. We used standardised database subject headings, such as MeSH terms (in MEDLINE) and other standardised headings (controlled vocabulary) in other databases, as appropriate. SELECTION CRITERIA We selected studies that included a population free from dementia at baseline, who were assessed with the IQCODE and subsequently assessed for the development of dementia over time. The implication was that at the time of testing, the individual had a cognitive problem sufficient to result in an abnormal IQCODE score (defined by the study authors), but not yet meeting dementia diagnostic criteria. DATA COLLECTION AND ANALYSIS We screened all titles generated by the electronic database searches, and reviewed abstracts of all potentially relevant studies. Two assessors independently checked the full papers for eligibility and extracted data. We determined quality assessment (risk of bias and applicability) using the QUADAS-2 tool, and reported quality using the STARDdem tool. MAIN RESULTS From 85 papers describing IQCODE, we included three papers, representing data from 626 individuals. Of this total, 22% (N = 135/626) were excluded because of prevalent dementia. There was substantial attrition; 47% (N = 295) of the study population received reference standard assessment at first follow-up (three to six months) and 28% (N = 174) received reference standard assessment at final follow-up (one to three years). Prevalence of dementia ranged from 12% to 26% at first follow-up and 16% to 35% at final follow-up. The three studies were considered to be too heterogenous to combine, so we did not perform meta-analyses to describe summary estimates of interest. Included patients were poststroke (two papers) and hip fracture (one paper). The IQCODE was used at three thresholds of positivity (higher than 3.0, higher than 3.12 and higher than 3.3) to predict those at risk of a future diagnosis of dementia. Using a cut-off of 3.0, IQCODE had a sensitivity of 0.75 (95%CI 0.51 to 0.91) and a specificity of 0.46 (95%CI 0.34 to 0.59) at one year following stroke. Using a cut-off of 3.12, the IQCODE had a sensitivity of 0.80 (95%CI 0.44 to 0.97) and specificity of 0.53 (95C%CI 0.41 to 0.65) for the clinical diagnosis of dementia at six months after hip fracture. Using a cut-off of 3.3, the IQCODE had a sensitivity of 0.84 (95%CI 0.68 to 0.94) and a specificity of 0.87 (95%CI 0.76 to 0.94) for the clinical diagnosis of dementia at one year after stroke. In generaI, the IQCODE was sensitive for identification of those who would develop dementia, but lacked specificity. Methods for both excluding prevalent dementia at baseline and assessing for the development of dementia were varied, and had the potential to introduce bias. AUTHORS' CONCLUSIONS Included studies were heterogenous, recruited from specialist settings, and had potential biases. The studies identified did not allow us to make specific recommendations on the use of the IQCODE for the future detection of dementia in clinical practice. The included studies highlighted the challenges of delayed verification dementia research, with issues around prevalent dementia assessment, loss to follow-up over time, and test non-completion potentially limiting the studies. Future research should recognise these issues and have explicit protocols for dealing with them.
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Affiliation(s)
- Jennifer K Burton
- Academic Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow , UK
| | | | | | | | - Terry J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Almeida OP, Ford AH. Are We Getting Better at Managing Agitation in Dementia? Am J Geriatr Psychiatry 2020; 28:401-403. [PMID: 31812357 DOI: 10.1016/j.jagp.2019.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/11/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Osvaldo P Almeida
- WA Centre for Health and Ageing, Medical School, University of Western Australia, Perth, WA, Australia.
| | - Andrew H Ford
- WA Centre for Health and Ageing, Medical School, University of Western Australia, Perth, WA, Australia
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O'Shea E, Hopper L, Marques M, Gonçalves-Pereira M, Woods B, Jelley H, Verhey F, Kerpershoek L, Wolfs C, de Vugt M, Stephan A, Bieber A, Meyer G, Wimo A, Michelet M, Selbaek G, Portolani E, Zanetti O, Irving K. A comparison of self and proxy quality of life ratings for people with dementia and their carers: a European prospective cohort study. Aging Ment Health 2020; 24:162-170. [PMID: 30381955 DOI: 10.1080/13607863.2018.1517727] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objectives: To identify correlates of self-rated and proxy-rated quality of life (QoL) in people with dementia on (i) a dementia-specific and (ii) a capability-wellbeing QoL measure at baseline and 12-month follow-up, and to consider such factors in the context of QoL intervention development.Method: Prospective clinical and demographic data were collected from 451 community-dwelling dyads (mild-moderate dementia) across eight European countries. QoL was measured using the QOL-AD and the ICECAP-O. Multivariate modelling identified correlates of self- and proxy-rated QoL at baseline and at 12-month follow-up.Results: Carer's proxy-ratings of QoL were significantly lower than self-ratings at all time-points for both measures. Proxy-ratings declined over time, but self-ratings remained stable. Baseline predictors of greater self-rated QoL were education, and greater functional ability and relationship quality. Greater proxy-rated QoL was associated with education and greater functional ability, relationship quality, carer social support and carer QoL, lower carer anxiety/depression and less severe neuropsychiatric symptoms in people with dementia. At follow-up, greater self-rated QoL was predicted by greater functional ability, relationship quality, carer social support and having a spousal carer. Greater proxy-rated QoL at follow-up was associated with the same factors as at baseline; however, the dyad living together was an additional predictive factor.Conclusion: Both proxy-ratings and self-ratings of QoL should be interpreted with caution and in the context of each individual caregiving relationship. Different functional, psychosocial, relational and contextual factors influence self- and proxy-ratings, and both sets of factors should be considered in the context of QoL intervention development for the dyad.
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Affiliation(s)
- E O'Shea
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - L Hopper
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - M Marques
- CEDOC, Chronic Diseases Research Centre, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - M Gonçalves-Pereira
- CEDOC, Chronic Diseases Research Centre, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - B Woods
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - H Jelley
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - F Verhey
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - L Kerpershoek
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - C Wolfs
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - M de Vugt
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - A Stephan
- Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - A Bieber
- Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - G Meyer
- Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - A Wimo
- Department of Neurobiology, Care sciences and Society, Karolinska Institut, Stockholm, Sweden
| | - M Michelet
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - G Selbaek
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - E Portolani
- Alzheimer's Research Unit-Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - O Zanetti
- Alzheimer's Research Unit-Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - K Irving
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
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Monfort E, Besse P, Bellet A, Fontaine AC. Perceptions de la qualité de vie et de la bientraitance par des personnes âgées résidant en institution gériatrique et par leurs proches. PRAT PSYCHOL 2018. [DOI: 10.1016/j.prps.2017.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
UNLABELLED ABSTRACTObjective:To study longitudinal changes in the quality of life (QoL) in persons with and without dementia, and explore the factors associated with baseline QoL and changes of QoL over the follow-up period. DESIGN Prospective longitudinal study. SETTING Data were collected from 17 municipalities in Norway in the period from January 2009 to August 2012. A total of 412 persons were included, 254 (61.7 %) persons without dementia and 158 (38.3 %) with dementia at baseline. SUBJECTS Persons 70 years of age or older, receiving municipal care services. Main outcome measures include the following: self-rated and proxy-rated QoL over a period of 18 months, cognitive status, functional status, neuropsychiatric symptoms, and demographics. RESULTS Longitudinal changes in QoL were small, despite changes in clinical variables. Proxy ratings of patients QoL were lower than the patients' own ratings. Belonging to a group with low QoL trajectory was associated with symptoms of depression, reduced physical and instrumental functioning, and more severe dementia. CONCLUSION Patients and proxies evaluated the patients' QoL differently and QoL did not necessarily correspond with deterioration in clinical parameters. To prevent impaired QoL, we need to address identified factors and keep an approach open to the individual perceptions of QoL.
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Giil LM, Aarsland D, Hellton K, Lund A, Heidecke H, Schulze-Forster K, Riemekasten G, Vik-Mo AO, Kristoffersen EK, Vedeler CA, Nordrehaug JE. Antibodies to Multiple Receptors are Associated with Neuropsychiatric Symptoms and Mortality in Alzheimer’s Disease: A Longitudinal Study. J Alzheimers Dis 2018; 64:761-774. [DOI: 10.3233/jad-170882] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Lasse M. Giil
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Norway
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College, UK
- Centre for Age-Related Diseases (SESAM), Stavanger University Hospital, Norway
| | | | - Anders Lund
- Department of Clinical Science, University of Bergen, Norway
| | | | | | - Gabriela Riemekasten
- Department of Rheumatology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Audun Osland Vik-Mo
- Department of Clinical Science, University of Bergen, Norway
- Centre for Age-Related Diseases (SESAM), Stavanger University Hospital, Norway
| | - Einar K. Kristoffersen
- Department of Clinical Science, University of Bergen, Norway
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Christian A. Vedeler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
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Klapwijk MS, Caljouw MAA, Pieper MJC, Putter H, van der Steen JT, Achterberg WP. Change in quality of life after a multidisciplinary intervention for people with dementia: A cluster randomized controlled trial. Int J Geriatr Psychiatry 2018; 33:1213-1219. [PMID: 29892989 DOI: 10.1002/gps.4912] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 04/13/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to examine whether implementation of a stepwise multicomponent intervention (STA OP!) for challenging behavior and pain affects quality of life (QoL) of nursing home residents with moderate to severe dementia after 3 and 6 months. METHODS A cluster randomized controlled trial was conducted in 12 nursing homes. Both control (n = 140) and intervention group (=148) received training, the intervention group was also treated using the STA OP! INTERVENTION At baseline, 3 and 6 months QoL was assessed using the 6 QUALIDEM domains applicable to moderate and severe dementia. Linear mixed models were used to compare changes in QoL domains between the 2 groups over time. RESULTS After both 3 and 6 months, there was no change, and no difference in change, between the 2 groups in the domains Care relationship, Positive affect, Negative affect, and Social relations. Between 0 and 3 months, a positive effect was seen in the domain Restless tense behavior with a regression coefficient of β: 0.95 (95% confidence interval [CI], 0.36-1.54). Between 3 and 6 months, a negative effect was seen on the domain Restless tense behavior β: -0.98 (95% CI, -1.60 to -0.36) and a positive effect in the domain Social isolation, β: 0.64 (95% CI, 0.12-1.17). CONCLUSIONS The stepwise intervention STA OP! affects the QUALIDEM domains in different ways: there was a lowering of Restless tense behavior in the short term, which reverted back to the initial level in the longer term, and a lowering of Social isolation in the longer term.
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Affiliation(s)
- Maartje S Klapwijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Marente, Leiden, The Netherlands
| | - Monique A A Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Marjoleine J C Pieper
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Hein Putter
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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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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Oremus M, Sharafoddini A, Morgano GP, Jin X, Xie F. A Computer-Assisted Personal Interview App in Research Electronic Data Capture for Administering Time Trade-off Surveys (REDCap): Development and Pretest. JMIR Form Res 2018; 2:e3. [PMID: 30684429 PMCID: PMC6334703 DOI: 10.2196/formative.8202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 12/01/2017] [Accepted: 12/06/2017] [Indexed: 11/25/2022] Open
Abstract
Background The time trade-off (TTO) task is a method of eliciting health utility scores, which range from 0 (equivalent to death) to 1 (equivalent to perfect health). These scores numerically represent a person’s health-related quality of life. Software apps exist to administer the TTO task; however, most of these apps are poorly documented and unavailable to researchers. Objective To fill the void, we developed an online app to administer the TTO task for a research study that is examining general public proxy health-related quality of life estimates for persons with Alzheimer’s disease. This manuscript describes the development and pretest of the app. Methods We used Research Electronic Data Capture (REDCap) to build the TTO app. The app’s modular structure and REDCap’s object-oriented environment facilitated development. After the TTO app was built, we recruited a purposive sample of 11 members of the general public to pretest its functionality and ease of use. Results Feedback from the pretest group was positive. Minor modifications included clarity enhancements, such as rearranging some paragraph text into bullet points, labeling the app to delineate different question sections, and revising or deleting text. We also added a research question to enable the identification of respondents who know someone with Alzheimer’s disease. Conclusions We developed an online app to administer the TTO task. Other researchers may access and customize the app for their own research purposes.
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Affiliation(s)
- Mark Oremus
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Anis Sharafoddini
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Gian Paolo Morgano
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Xuejing Jin
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Program for Health Economics and Outcome Measures, Hamilton, ON, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Program for Health Economics and Outcome Measures, Hamilton, ON, Canada.,Centre for Evaluation of Medicines, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
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White CL, Overbaugh KJ, Pickering CEZ, Piernik-Yoder B, James D, Patel DI, Puga F, Ford L, Cleveland J. Advancing Care for Family Caregivers of persons with dementia through caregiver and community partnerships. RESEARCH INVOLVEMENT AND ENGAGEMENT 2018; 4:1. [PMID: 29387453 PMCID: PMC5776762 DOI: 10.1186/s40900-018-0084-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/08/2018] [Indexed: 05/27/2023]
Abstract
BACKGROUND There are currently 15 million Americans who provide over 80% of the care required by their family members with Alzheimer's disease and other dementias. Yet care for caregivers continues to be fragmented and few evidence-based interventions have been translated into routine clinical care and therefore remain inaccessible to most family caregivers. To address this gap, the Caring for the Caregiver program is being developed at UT Health San Antonio, School of Nursing to improve support services and health outcomes for family caregivers. Our purpose is to describe the engagement process undertaken to assess caregiver and community needs and how findings are informing program development. METHODS We are using a model of public engagement that consists of communication of information, collection of information from stakeholders, and collaboration where stakeholders are partners in an exchange of information to guide program activities. An assessment of the community was undertaken to identify resources/services for family caregivers. Subsequently, stakeholders were invited to a community-academic forum to discuss strategies to build on existing strengths for family caregiving and to identify gaps in care. Detailed notes were taken and all discussions were recorded and transcribed for analysis. Data were analyzed using thematic content analysis. RESULTS We conducted site visits with 15 community agencies, interviewed 13 family caregivers, and attended community events including support groups and health and senior fairs. Fifty-three diverse stakeholders attended the community-academic forum. Participants identified existing assets within our community to support family caregivers. Consistent among groups was the need to increase awareness in our community about family caregivers. Themes identified from the discussion were: making the invisible visible, you don't know what you don't know, learning too late, and anticipating and preparing for the future. CONCLUSIONS Incorporating caregiver and community stakeholders was critical to ensure that the priorities of our community are addressed in a culturally responsive accessible program for family caregivers. The forum served as important mechanism to partner with the community and will be an annual event where we can continue to work with our stakeholders around needs for practice, education, and research.
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Affiliation(s)
- Carole L. White
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
| | - Kristen J. Overbaugh
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
| | | | - Bridgett Piernik-Yoder
- School of Health Professions, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
| | - Debbie James
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
| | - Darpan I. Patel
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
| | - Frank Puga
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
| | - Lark Ford
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
| | - James Cleveland
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
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Harrison JK, Stott DJ, McShane R, Noel‐Storr AH, Swann‐Price RS, Quinn TJ. Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) for the early diagnosis of dementia across a variety of healthcare settings. Cochrane Database Syst Rev 2016; 11:CD011333. [PMID: 27869298 PMCID: PMC6477966 DOI: 10.1002/14651858.cd011333.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) is a structured interview based on informant responses that is used to assess for possible dementia. IQCODE has been used for retrospective or contemporaneous assessment of cognitive decline. There is considerable interest in tests that may identify those at future risk of developing dementia. Assessing a population free of dementia for the prospective development of dementia is an approach often used in studies of dementia biomarkers. In theory, questionnaire-based assessments, such as IQCODE, could be used in a similar way, assessing for dementia that is diagnosed on a later (delayed) assessment. OBJECTIVES To determine the diagnostic accuracy of IQCODE in a population free from dementia for the delayed diagnosis of dementia (test accuracy with delayed verification study design). SEARCH METHODS We searched these sources on 16 January 2016: ALOIS (Cochrane Dementia and Cognitive Improvement Group), MEDLINE Ovid SP, Embase Ovid SP, PsycINFO Ovid SP, BIOSIS Previews on Thomson Reuters Web of Science, Web of Science Core Collection (includes Conference Proceedings Citation Index) on Thomson Reuters Web of Science, CINAHL EBSCOhost, and LILACS BIREME. We also searched sources specific to diagnostic test accuracy: MEDION (Universities of Maastricht and Leuven); DARE (Database of Abstracts of Reviews of Effects, in the Cochrane Library); HTA Database (Health Technology Assessment Database, in the Cochrane Library), and ARIF (Birmingham University). We checked reference lists of included studies and reviews, used searches of included studies in PubMed to track related articles, and contacted research groups conducting work on IQCODE for dementia diagnosis to try to find additional studies. We developed a sensitive search strategy; search terms were designed to cover key concepts using several different approaches run in parallel, and included terms relating to cognitive tests, cognitive screening, and dementia. We used standardised database subject headings, such as MeSH terms (in MEDLINE) and other standardised headings (controlled vocabulary) in other databases, as appropriate. SELECTION CRITERIA We selected studies that included a population free from dementia at baseline, who were assessed with the IQCODE and subsequently assessed for the development of dementia over time. The implication was that at the time of testing, the individual had a cognitive problem sufficient to result in an abnormal IQCODE score (defined by the study authors), but not yet meeting dementia diagnostic criteria. DATA COLLECTION AND ANALYSIS We screened all titles generated by the electronic database searches, and reviewed abstracts of all potentially relevant studies. Two assessors independently checked the full papers for eligibility and extracted data. We determined quality assessment (risk of bias and applicability) using the QUADAS-2 tool, and reported quality using the STARDdem tool. MAIN RESULTS From 85 papers describing IQCODE, we included three papers, representing data from 626 individuals. Of this total, 22% (N = 135/626) were excluded because of prevalent dementia. There was substantial attrition; 47% (N = 295) of the study population received reference standard assessment at first follow-up (three to six months) and 28% (N = 174) received reference standard assessment at final follow-up (one to three years). Prevalence of dementia ranged from 12% to 26% at first follow-up and 16% to 35% at final follow-up.The three studies were considered to be too heterogenous to combine, so we did not perform meta-analyses to describe summary estimates of interest. Included patients were poststroke (two papers) and hip fracture (one paper). The IQCODE was used at three thresholds of positivity (higher than 3.0, higher than 3.12 and higher than 3.3) to predict those at risk of a future diagnosis of dementia. Using a cut-off of 3.0, IQCODE had a sensitivity of 0.75 (95%CI 0.51 to 0.91) and a specificity of 0.46 (95%CI 0.34 to 0.59) at one year following stroke. Using a cut-off of 3.12, the IQCODE had a sensitivity of 0.80 (95%CI 0.44 to 0.97) and specificity of 0.53 (95C%CI 0.41 to 0.65) for the clinical diagnosis of dementia at six months after hip fracture. Using a cut-off of 3.3, the IQCODE had a sensitivity of 0.84 (95%CI 0.68 to 0.94) and a specificity of 0.87 (95%CI 0.76 to 0.94) for the clinical diagnosis of dementia at one year after stroke.In generaI, the IQCODE was sensitive for identification of those who would develop dementia, but lacked specificity. Methods for both excluding prevalent dementia at baseline and assessing for the development of dementia were varied, and had the potential to introduce bias. AUTHORS' CONCLUSIONS Included studies were heterogenous, recruited from specialist settings, and had potential biases. The studies identified did not allow us to make specific recommendations on the use of the IQCODE for the future diagnosis of dementia in clinical practice. The included studies highlighted the challenges of delayed verification dementia research, with issues around prevalent dementia assessment, loss to follow-up over time, and test non-completion potentially limiting the studies. Future research should recognise these issues and have explicit protocols for dealing with them.
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Affiliation(s)
- Jennifer K Harrison
- University of EdinburghCentre for Cognitive Ageing and Cognitive Epidemiology and the Alzheimer Scotland Dementia Research CentreDepartment of Geriatric Medicine, The Royal Infirmary of Edinburgh, Room S164251 Little France CrescentEdinburghUKEH16 4SB
| | - David J Stott
- University of GlasgowInstitute of Cardiovascular and Medical SciencesNew Lister BuildingGlasgow Royal InfirmaryGlasgowStrathclydeUKG4 0SFR
| | - Rupert McShane
- University of OxfordRadcliffe Department of MedicineJohn Radcliffe HospitalLevel 4, Main Hospital, Room 4401COxfordOxfordshireUKOX3 9DU
| | - Anna H Noel‐Storr
- University of OxfordRadcliffe Department of MedicineJohn Radcliffe HospitalLevel 4, Main Hospital, Room 4401COxfordOxfordshireUKOX3 9DU
| | | | - Terry J Quinn
- University of GlasgowInstitute of Cardiovascular and Medical SciencesNew Lister BuildingGlasgow Royal InfirmaryGlasgowStrathclydeUKG4 0SFR
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Oremus M, Xie F, Gaebel K. Development of Clinical Vignettes to Describe Alzheimer's Disease Health States: A Qualitative Study. PLoS One 2016; 11:e0162422. [PMID: 27589604 PMCID: PMC5010212 DOI: 10.1371/journal.pone.0162422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/26/2016] [Indexed: 12/02/2022] Open
Abstract
Aims To develop clinical descriptions (vignettes) of life with Alzheimer’s disease (AD), we conducted focus groups of persons with AD (n = 14), family caregivers of persons with AD (n = 20), and clinicians who see persons with AD in their practices (n = 5). Methods Group participants read existing descriptions of AD and commented on the realism and comprehensibility of the descriptions. We used thematic framework analysis to code the comments into themes and develop three new vignettes to describe mild, moderate, and severe AD. Results Themes included the types of symptoms to mention in the new vignettes, plus the manner in which the vignettes should be written. Since the vignette descriptions were based on focus group participants’ first-hand knowledge of AD, the descriptions can be said to demonstrate content validity. Conclusion Members of the general public can read the vignettes and estimate their health-related quality-of-life (HRQoL) as if they had AD based on the vignette descriptions. This is especially important for economic evaluations of new AD medications, which require HRQoL to be assessed in a manner that persons with AD often find difficult to undertake. The vignettes will allow the general public to serve as a proxy and provide HRQoL estimates in place of persons with AD.
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Affiliation(s)
- Mark Oremus
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- * E-mail:
| | - Feng Xie
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Program for Health Economics and Outcome Measures (PHENOM), Hamilton, Ontario, Canada
- Centre for Evaluation of Medicines of St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Kathryn Gaebel
- Centre for Evaluation of Medicines of St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
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Nakanishi K, Mutai H, Hanihara T. Change in quality of life of people with dementia in residential care facilities: a 3-year follow-up study. Psychogeriatrics 2016; 16:336-8. [PMID: 26550996 DOI: 10.1111/psyg.12170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kosuke Nakanishi
- Department of Occupational Therapy, Faculty of Health Science, Health Science University, Yamanashi, Japan
| | - Hitoshi Mutai
- School of Health Sciences, Shinshu University, Matsumoto, Japan
| | - Tokiji Hanihara
- School of Health Sciences, Shinshu University, Matsumoto, Japan.
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Miguel S, Alvira M, Farré M, Risco E, Cabrera E, Zabalegui A. Quality of life and associated factors in older people with dementia living in long-term institutional care and home care. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Polypharmacy and medication regimen complexity as factors associated with staff informant rated quality of life in residents of aged care facilities: a cross-sectional study. Eur J Clin Pharmacol 2016; 72:1117-24. [DOI: 10.1007/s00228-016-2075-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 05/24/2016] [Indexed: 12/20/2022]
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Conde-Sala JL, Turró-Garriga O, Portellano-Ortiz C, Viñas-Diez V, Gascón-Bayarri J, Reñé-Ramírez R. Self-Perceived Quality of Life Among Patients with Alzheimer’s Disease: Two Longitudinal Models of Analysis. J Alzheimers Dis 2016; 52:999-1012. [DOI: 10.3233/jad-160040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Josep L. Conde-Sala
- Faculty of Psychology, University of Barcelona, Spain
- Aging, Disability and Health Research Group, Biomedical Research Institute of Girona (IdIBGi), Catalonia, Spain
| | - Oriol Turró-Garriga
- Aging, Disability and Health Research Group, Biomedical Research Institute of Girona (IdIBGi), Catalonia, Spain
| | | | - Vanesa Viñas-Diez
- Department of Neurology, Dementia Unit, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Jordi Gascón-Bayarri
- Department of Neurology, Dementia Unit, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Ramón Reñé-Ramírez
- Department of Neurology, Dementia Unit, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
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Oremus M, Xie F, Pullenayegum E, Gaebel K. Can the general public use vignettes to discriminate between Alzheimer's disease health states? BMC Geriatr 2016; 16:36. [PMID: 26842500 PMCID: PMC4738787 DOI: 10.1186/s12877-016-0207-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/26/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Valid estimates of health-related quality-of-life (HRQoL) are often difficult to obtain from persons with Alzheimer's disease (AD) and family caregiver proxies. To help assess whether the general public can serve as an alternate source of proxy HRQoL estimates in AD, we examined whether the general public can use vignettes to discriminate between AD health states. METHODS We administered a telephone survey to randomly recruited participants from the general public who were aged 18 years or older. Interviewers read vignettes describing the mild, moderate, and severe AD health states to the participants, who answered the EQ-5D-5L and Quality of Life-Alzheimer's Disease (QoL-AD) scales as if they had AD based on the vignette descriptions. Participants also answered the EQ-5D-5L for their current health states. We converted EQ-5D-5L responses into health utility scores using Canadian preference weights. We employed the Wilcoxon signed rank test to examine whether mean health utility scores and mean QoL-AD scores differed between health states. We used Pearson's r to assess correlations between health utility and QoL-AD scores. RESULTS Forty-eight participants (median age = 53 years; 25 female) completed the telephone interview; health utility and QoL-AD scores decreased as AD severity increased (p <0.0001). Mean health utility scores were 0.65 (mild), 0.51 (moderate), and 0.25 (severe). Mean QoL-AD scores were 26.7 (mild), 23.0 (moderate), and 17.4 (severe). The correlations between health utility and QoL-AD scores were moderate to strong (r ≥ 0.62). CONCLUSIONS Using the vignettes, the general public provided HRQoL estimates that discriminated between the three AD health states. This finding suggests the general public may be a promising source of proxy HRQoL estimates in place of persons with AD.
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Affiliation(s)
- Mark Oremus
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada.
| | - Feng Xie
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, Canada. .,Program for Health Economics and Outcome Measures (PHENOM), 50 Charlton Avenue East, Hamilton, ON, Canada. .,Centre for Evaluation of Medicines, St. Joseph's Healthcare Hamilton, 25 Main Street West, Hamilton, ON, Canada.
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.
| | - Kathryn Gaebel
- Centre for Evaluation of Medicines, St. Joseph's Healthcare Hamilton, 25 Main Street West, Hamilton, ON, Canada.
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Teipel S, Babiloni C, Hoey J, Kaye J, Kirste T, Burmeister OK. Information and communication technology solutions for outdoor navigation in dementia. Alzheimers Dement 2016; 12:695-707. [DOI: 10.1016/j.jalz.2015.11.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/21/2015] [Accepted: 11/12/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Stefan Teipel
- Department of Psychosomatic Medicine University of Rostock Rostock Germany
- DZNE German Center for Neurodegenerative Diseases Rostock Germany
| | - Claudio Babiloni
- Department of Physiology and Pharmacology “V. Erspamer” University of Rome “La Sapienza” Rome Italy
- IRCCS San Raffaele Pisana of Rome Rome Italy
| | - Jesse Hoey
- School of Computer Science University of Waterloo Waterloo Ontario Canada
| | - Jeffrey Kaye
- NIA ‐ Layton Aging & Alzheimer's Disease Center and ORCATECH, the Oregon Center for Aging & Technology Oregon Health & Science University Portland OR USA
| | - Thomas Kirste
- Department of Computer Science University of Rostock Rostock Germany
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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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Andrieu S, Coley N, Rolland Y, Cantet C, Arnaud C, Guyonnet S, Nourhashemi F, Grand A, Vellas B. Assessing Alzheimer's disease patients' quality of life: Discrepancies between patient and caregiver perspectives. Alzheimers Dement 2015; 12:427-37. [DOI: 10.1016/j.jalz.2015.09.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/17/2015] [Accepted: 09/03/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Sandrine Andrieu
- Inserm‐Toulouse University UMR1027 Toulouse France
- CHU Toulouse Department of Epidemiology and Public Health Toulouse France
| | - Nicola Coley
- Inserm‐Toulouse University UMR1027 Toulouse France
- CHU Toulouse Department of Epidemiology and Public Health Toulouse France
| | - Yves Rolland
- Inserm‐Toulouse University UMR1027 Toulouse France
- Gerontopole, CHU Toulouse Department of Geriatric Medicine Toulouse France
| | - Christelle Cantet
- Inserm‐Toulouse University UMR1027 Toulouse France
- Gerontopole, CHU Toulouse Department of Geriatric Medicine Toulouse France
| | - Catherine Arnaud
- Inserm‐Toulouse University UMR1027 Toulouse France
- CHU Toulouse Department of Epidemiology and Public Health Toulouse France
| | - Sophie Guyonnet
- Inserm‐Toulouse University UMR1027 Toulouse France
- Gerontopole, CHU Toulouse Department of Geriatric Medicine Toulouse France
| | - Fati Nourhashemi
- Inserm‐Toulouse University UMR1027 Toulouse France
- Gerontopole, CHU Toulouse Department of Geriatric Medicine Toulouse France
| | - Alain Grand
- Inserm‐Toulouse University UMR1027 Toulouse France
- CHU Toulouse Department of Epidemiology and Public Health Toulouse France
| | - Bruno Vellas
- Inserm‐Toulouse University UMR1027 Toulouse France
- Gerontopole, CHU Toulouse Department of Geriatric Medicine Toulouse France
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Holston EC. The Electrophysiological Phenomenon of Alzheimer's Disease: A Psychopathology Theory. Issues Ment Health Nurs 2015; 36:603-13. [PMID: 26379134 DOI: 10.3109/01612840.2015.1015696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The current understanding of Alzheimer's disease (AD) is based on the Aβ and tau pathology and the resulting neuropathological changes, which are associated with manifested clinical symptoms. However, electrophysiological brain changes may provide a more expansive understanding of AD. Hence, the objective of this systematic review is to propose a theory about the electrophysiological phenomenon of Alzheimer's disease (EPAD). The review of literature resulted from an extensive search of PubMed and MEDLINE databases. One-hundred articles were purposively selected. They provided an understanding of the concepts establishing the theory of EPAD (neuropathological changes, neurochemical changes, metabolic changes, and electrophysiological brain changes). Changes in the electrophysiology of the brain are foundational to the association or interaction of the concepts. Building on Berger's Psychophysical Model, it is evident that electrophysiological brain changes occur and affect cortical areas to generate or manifest symptoms from onset and across the stages of AD, which may be prior to pathological changes. Therefore, the interaction of the concepts demonstrates how the psychopathology results from affected electrophysiology of the brain. The theory of the EPAD provides a theoretical foundation for appropriate measurements of AD without dependence on neuropathological changes. Future research is warranted to further test this theory. Ultimately, this theory contributes to existing knowledge because it shows how electrophysiological changes are useful in understanding the risk and progression of AD across the stages.
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Affiliation(s)
- Ezra C Holston
- a University of Tennessee-Knoxville , College of Nursing , Knoxville , Tennessee , USA
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Beerens HC, Zwakhalen SMG, Verbeek H, Ruwaard D, Ambergen AW, Leino-Kilpi H, Stephan A, Zabalegui A, Soto M, Saks K, Bökberg C, Sutcliffe CL, Hamers JPH. Change in quality of life of people with dementia recently admitted to long-term care facilities. J Adv Nurs 2014; 71:1435-47. [PMID: 25403506 DOI: 10.1111/jan.12570] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2014] [Indexed: 11/27/2022]
Abstract
AIM To assess which factors are associated with change in quality of life of people with dementia who have recently been admitted to long-term care facilities. BACKGROUND Many people with dementia will be admitted to long-term care facilities at some point during their disease. It is currently unknown which factors are associated with improvement and/or deterioration of quality of life immediately following admission. DESIGN An observational and longitudinal survey. METHODS Data on 343 people with dementia who have been recently admitted to long-term care facilities across eight European countries were collected between November 2010-April 2012. Quality of life was assessed by people with dementia and their proxies using the 'Quality of Life-Alzheimer's Disease scale'. Explanatory variables included cognitive status, comorbidities, activities of daily living, depressive symptoms and neuropsychiatric symptoms. Descriptive and multilevel regression analyses were performed. RESULTS Better cognitive abilities at baseline were associated with a decrease in self-reported quality of life. Greater dependency and more depressive symptoms at baseline were associated with declined proxy-reported quality of life. Furthermore, an increased dependency and an increase of depressive symptoms between baseline and follow-up were associated with a decreased proxy-reported quality of life. On an individual level, three groups were identified, namely people whose quality of life: (1) decreased; (2) stayed the same; and (3) increased. CONCLUSION Cognitive functioning, functional rehabilitation and treatment of depressive symptoms should receive special attention. However, quality of life of people with dementia does not necessarily decrease after institutionalization.
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Affiliation(s)
- Hanneke C Beerens
- Department of Health Services Research, CAPHRI, Maastricht University, The Netherlands
| | - Sandra M G Zwakhalen
- Department of Health Services Research, CAPHRI, Maastricht University, The Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, CAPHRI, Maastricht University, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, CAPHRI, Maastricht University, The Netherlands
| | - Antonius W Ambergen
- Department of Methodology & Statistics, CAPHRI, Maastricht University, The Netherlands
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku University Hospital, Finland
| | - Astrid Stephan
- Department: Faculty of Health, School of Nursing Science, Witten/Herdecke University, Germany
| | | | - Maria Soto
- Geriatrics Department, Toulouse University Hospital, France
| | - Kai Saks
- Department of Internal Medicine, University of Tartu, Estonia
| | - Christina Bökberg
- Department of Health Sciences, Faculty of Medicine, Lund University, The Swedish Institute for Health Sciences, Sweden
| | - Caroline L Sutcliffe
- Personal Social Services Research Unit, School of Nursing, Midwifery and Social Work, University of Manchester, UK
| | - Jan P H Hamers
- Department of Health Services Research, CAPHRI, Maastricht University, The Netherlands
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Villars H, Gardette V, Perrin A, Hein C, Elmalem S, de Peretti E, Zueras A, Vellas B, Nourhashémi F. Study protocol: Randomised controlled trial to evaluate the impact of an educational programme on Alzheimer's disease patients' quality of life. ALZHEIMERS RESEARCH & THERAPY 2014; 6:66. [PMID: 25478028 PMCID: PMC4255540 DOI: 10.1186/s13195-014-0066-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 09/08/2014] [Indexed: 11/10/2022]
Abstract
Introduction Therapeutic education is expanding in the management of Alzheimer’s disease (AD) patients. Several studies have revealed a positive impact of therapeutic educational programmes on the caregiver’s burden and/or quality of life. However, to date, no study has evaluated its impact on the quality of life of the AD patient. Methods The THERAD study (THerapeutic Education in Alzheimer’s Disease) is a 12-month randomised controlled trial that started in January 2013. This paper describes the study protocol. THERAD plans to enroll 170 dyads (AD patient and caregiver) on the basis of the following criteria: patient at a mild to moderately severe stage of AD, living at home, receiving support from a family caregiver. The main outcome is the patient’s quality of life assessed by the Logsdon QoL-AD scale at 2 months, reported by the caregiver. The study is being led by geriatricians trained in therapeutic education at Toulouse University Hospital in France. To date, 107 caregiver/patient dyads have been recruited. Conclusion This is the first trial designed to assess the specific impact of a therapeutic educational programme on the AD patient’s quality of life. The final results will be available in 2015. Trial registration [ClinicalTrials.gov: NCT01796314] Registered 19 February 2013
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Affiliation(s)
- Hélène Villars
- Geriatric Department, University Hospital, 170 avenue de Casselardit, Toulouse Cedex, 31059, France
| | - Virginie Gardette
- Department of Epidemiology and Public Health, Adresse 37, allées Jules Guesde, Toulouse Cedex, 31073, France ; Inserm U 1027, University Toulouse III, Toulouse, F-31073, France
| | - Amélie Perrin
- Geriatric Department, University Hospital, 170 avenue de Casselardit, Toulouse Cedex, 31059, France
| | - Christophe Hein
- Geriatric Department, University Hospital, 170 avenue de Casselardit, Toulouse Cedex, 31059, France
| | - Sophie Elmalem
- Geriatric Department, University Hospital, 170 avenue de Casselardit, Toulouse Cedex, 31059, France
| | - Eva de Peretti
- Geriatric Department, University Hospital, 170 avenue de Casselardit, Toulouse Cedex, 31059, France
| | - Audrey Zueras
- Geriatric Department, University Hospital, 170 avenue de Casselardit, Toulouse Cedex, 31059, France
| | - Bruno Vellas
- Geriatric Department, University Hospital, 170 avenue de Casselardit, Toulouse Cedex, 31059, France ; Inserm U 1027, University Toulouse III, Toulouse, F-31073, France
| | - Fati Nourhashémi
- Geriatric Department, University Hospital, 170 avenue de Casselardit, Toulouse Cedex, 31059, France ; Inserm U 1027, University Toulouse III, Toulouse, F-31073, France
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Bosboom PR, Almeida OP. Cognitive Domains and Health-Related Quality of Life in Alzheimer's Disease. J Gerontol B Psychol Sci Soc Sci 2014; 71:275-87. [PMID: 25098526 DOI: 10.1093/geronb/gbu090] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 06/14/2014] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The nature of the association between the cognitive decline and quality of life (QoL) during the course of Alzheimer's disease (AD) has not been studied in detail. We designed this study to determine if the association between cognitive domains in AD and health-related quality of life (HRQoL) changed over 18 months. METHODS We recruited 80 community-dwelling older adults with mild to moderate AD and 61 healthy elderly controls as well as their next-of-kin. The primary outcome measure was the QoL-AD. Specific cognitive functions were assessed with a broad range of neuropsychological measures, which were later grouped into cognitive domains following factor analyses at the baseline and 18-month assessments. Other explanatory variables included demographics, psychopathology, burden of care, and use of medication. RESULTS Self-reported QoL-AD scores were not associated with any of the identified cognitive domains at either assessment. The cognitive domains of people with AD changed between baseline and the 18-month assessment, as did the association of these factors with carer-rated HRQoL. The HRQoL scores assigned by the next-of-kin declined alongside a general measure of cognitive function. DISCUSSION These results indicate that HRQoL is not consistently associated with specific cognitive domains in AD and that cognitive-enhancing focused therapies may fail to affect the HRQoL of people with AD.
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Affiliation(s)
- Pascalle R Bosboom
- Western Australian Centre for Health and Ageing, Centre for Health Research and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia.
| | - Osvaldo P Almeida
- Western Australian Centre for Health and Ageing, Centre for Health Research and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
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Almeida OP, MacLeod C, Flicker L, Ford A, Grafton B, Etherton-Beer C. RAndomised controlled trial to imProve depressIon and the quality of life of people with Dementia using cognitive bias modification: RAPID study protocol. BMJ Open 2014; 4:e005623. [PMID: 25056981 PMCID: PMC4120303 DOI: 10.1136/bmjopen-2014-005623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Depressive symptoms are common and undermine the quality of life of people with Alzheimer's disease (AD). Cholinesterase inhibitors and antidepressants have all but no effect on the mood of patients, and their use increases adverse events. Cognitive bias modification (CBM) targets attentional and interpretative biases associated with anxiety, dysphoria and depression and may be useful to treat depression in AD (DAD). This trial aims to determine the effect of CBM on depression scores and the quality of life of people with DAD. METHODS AND ANALYSIS Randomised, double-blind, parallel, controlled trial of CBM (1:1 allocation ratio). Participants will be 80 adults with probable AD living in the Western Australian community who score 8 or more on the Cornell Scale for Depression in Dementia (CSDD). They will have mild to moderate dementia (Mini-Mental State Examination-MMSE score ≥15) and will be free of severe sensory impairment or suicidal intent. The intervention will consist of 10 40 min sessions of CBM delivered over 2 weeks using a high-resolution monitor using a local computer station at the Western Australian Centre for Health and Ageing. The primary outcomes of interest are the 2-week change, from baseline, in the severity of CSDD scores and the Quality of Life AD (QoL-AD) scores. Secondary outcomes include changes in the CSDD, QoL-AD after 12 weeks, and changes in MMSE scores, negative attentional and interpretative bias and the proportion of participants with CSDD <8 after 2 and 12 weeks. ETHICS AND DISSEMINATION The study will comply with the principles of the Declaration of Helsinki and participants will provide written informed consent. The Ethics Committee of the Royal Perth Hospital will approve and oversee the study (REG14-036). The results of this trial will provide level 2 evidence of efficacy for CBM as a treatment of DAD. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trials Registry number ACTRN12614000420640, date registered 06/04/2014.
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Affiliation(s)
- Osvaldo P Almeida
- Western Australian Centre for Heath & Ageing (M573), Centre for Medical Research of the Perkins Institute for Medical Research, University of Western Australia, Perth, Western Australia, Australia
- School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Western Australia, Australia
- Department of Psychiatry, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Colin MacLeod
- School of Psychology, University of Western Australia, Perth, Western Australia, Australia
| | - Leon Flicker
- Western Australian Centre for Heath & Ageing (M573), Centre for Medical Research of the Perkins Institute for Medical Research, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
- Department of Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Andrew Ford
- Western Australian Centre for Heath & Ageing (M573), Centre for Medical Research of the Perkins Institute for Medical Research, University of Western Australia, Perth, Western Australia, Australia
- School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Western Australia, Australia
- Department of Psychiatry, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ben Grafton
- School of Psychology, University of Western Australia, Perth, Western Australia, Australia
| | - Christopher Etherton-Beer
- Western Australian Centre for Heath & Ageing (M573), Centre for Medical Research of the Perkins Institute for Medical Research, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
- Department of Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
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Bosboom PR, Almeida OP. Do changes in specific cognitive functions predict changes in health-related quality of life in people with Alzheimer's disease? Int J Geriatr Psychiatry 2014; 29:694-703. [PMID: 24273030 DOI: 10.1002/gps.4050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 10/24/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Currently available pharmacological treatments in Alzheimer's disease (AD) have been associated with modest benefits to cognition, but the impact on health-related quality of life (HRQoL) is less well established. Our aim was to determine if decline of specific cognitive functions commonly associated with AD predict which patients maintain or experience a deterioration of their HRQoL over 18 months. METHODS We completed an 18-month longitudinal study of 47 community-dwelling older adults diagnosed with probable AD of mild or moderate severity (NINCDS-ADRD criteria) and their family carers. The primary outcomes of interest were 18-month change in self-reported and carer-reported ratings on the quality of life-AD (QoL-AD). The main explanatory variables were 18-month change in specific cognitive functions using a broad range of established tests. Because of multiple comparisons, alpha was set at 1%. RESULTS Twenty six of 47 and 20/47 participants with AD showed evidence of stable or increased QoL-AD over 18 months according to self report and carer report. Logistic regression analyses showed that for every increase in one standardized score of California Verbal Learning Test-II short delay free recall the odds of stable/increased self-rated QoL-AD over 18 months were 0.27 (95%CI: 0.11, 0.67; p = 0.005). After adjustment for anxiety and depression, this inverse association no longer met the study criteria for statistical significance (adjusted OR: 0.31, 95%CI: 0.11, 0.86; p = 0.025). None of the other standardized changes of cognitive scores were associated with self-rated or carer-rated QoL-AD grouping. CONCLUSION Changes in specific cognitive functions are not associated with changes in HRQoL ratings in AD. Findings suggest that interventions that limit their focus to improving cognitive functions of people with mild to moderate AD living in the community might fail to have an impact on participants' HRQoL.
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Affiliation(s)
- Pascalle R Bosboom
- Western Australian Centre for Health and Ageing, Centre for Health Research, University of Western Australia, Perth, WA, Australia; School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia
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