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Radakovic R, Radakovic C, Abrahams S, Simmons Z, Carroll A. Quality of life, cognitive and behavioural impairment in people with motor neuron disease: a systematic review. Qual Life Res 2024; 33:1469-1480. [PMID: 38345764 PMCID: PMC11116232 DOI: 10.1007/s11136-024-03611-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 05/24/2024]
Abstract
PURPOSE Motor neuron disease (MND) is a neurodegenerative disease, progressively impacting function and self-perceived quality of life (QoL). Up to 50% of people with MND can present with cognitive and behavioural impairment, with an associated increase in caregiver burden or strain. However, there has been no systematic exploration of the relationship between QoL and cognitive or behavioural impairment in MND. The aim was to determine if there is a relationship between QoL and cognitive/behavioural impairment in MND, while also supplementarily looking to determine the types of cognitive/behavioural and QoL measures utilised in these studies. METHODS A systematic search was performed across multiple databases (PsychINFO, Embase, Medline, AMED) for research published up to the date of February 22, 2023. Studies utilising quantitative methods of measuring QoL, cognitive/behavioural functioning/impairment were included. Findings examining relationships between QoL-cognitive/behavioural impairment were extracted and synthesised. RESULTS A total of 488 studies were identified, with 14 studies included in the systematic review. All 14 studies were observational (11 cross-sectional, 3 longitudinal). 13 studies utilised MND non-specific measures, particularly in relation to QoL and cognitive impairment. Of 8 studies measuring behavioural impairment 62.5% (N = 5) found either a lower QoL difference or association. Only 33.3% (N = 4) of 12 studies measuring cognitive impairment found a lower QoL difference or association. CONCLUSIONS This systematic review shows that behavioural impairment may have an impact on QoL in MND. There is variability in types of assessments used to measure QoL and also cognitive/behavioural impairment, most of which are disease-non-specific. Recommendations for future research are to use comprehensive disease-specific, multidomain measures to further elucidate the QoL-cognitive/behavioural impairment relationship.
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Affiliation(s)
- Ratko Radakovic
- Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, UK.
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
| | | | - Sharon Abrahams
- Human Cognitive Neuroscience-Psychology, School of Philosophy, Psychology and Language Science, University of Edinburgh, Edinburgh, UK
| | - Zachary Simmons
- Department of Neurology, Pennsylvania State University, Hershey, PA, USA
| | - Amy Carroll
- Norfolk and Norwich University Hospital, Norwich, UK
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
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Olesen LK, la Cour K, Thorne S, With H, Handberg C. Perceived benefits from peer-support among family caregivers of people with amyotrophic lateral sclerosis and cognitive impairments in a palliative rehabilitation blended online learning programme. J Eval Clin Pract 2023; 29:602-613. [PMID: 36703268 DOI: 10.1111/jep.13808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/28/2023]
Abstract
RATIONALE Family caregivers of persons with amyotrophic lateral sclerosis and cognitive and/or behavioural impairments (PALS/CIs) experience various challenges and needs, including emotional and practical support from peers. Various forms of peer-support have shown different strengths and weaknesses; however, little is known about how family caregivers of PALS/CIs interact with and perceive virtual face-to-face peer-support. AIMS AND OBJECTIVES The aim of this study was to understand how caregivers of PALS/CIs interact with and perceive virtual face-to-face peer-support in a palliative rehabilitation programme designed to promote targeted palliative rehabilitation initiatives for caregivers of PALS/CIs. METHOD A qualitative design using participant observations of 17 recorded virtual group-facilitated meetings from two rounds of a 4-month intervention was performed. The Medical Research Council framework, the inductive interpretive description methodology and the theoretical framework of Sense of Coherence guided the study. Nineteen participants, divided into four groups, were included. RESULTS Three themes emerged: 'Relating my situation to others', 'Making room for forbidden thoughts' and 'Longing for normalcy'. The themes reflected the various ways participants interacted in online group meetings and how the interactions evolved around practical, emotional and forbidden thoughts. Sharing personal and sorrowful concerns and frustrations engendered feelings of trust and a sense of belonging, which empowered the participants to address their genuine wish and longing for normalcy with all the trivialities of which ALS/CIs had robbed them. CONCLUSION Virtual face-to-face peer-support can enable caregivers of PALS/CIs to share experiences of everyday life challenges that cannot always be shared elsewhere. Being able to relate to and learn from other's experiences alleviated feelings of loneliness, frustration, and concerns and thereby enhanced comprehensibility, manageability and meaningfulness. Online palliative rehabilitation interventions should provide an opportunity for caregivers to meet regularly in interactive group meetings. Familiarization takes time online and is necessary to improve their sense of feeling safe to share their deepest thoughts. Such group interventions, facilitated by trained healthcare professionals, offer a means to support dynamic group interactions and discussion of sensitive topics.
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Affiliation(s)
- Lene Klem Olesen
- The National Rehabilitation Center for Neuromuscular Diseases, (RCFM), Aarhus, Denmark.,Department of Public Health, Faculty of Health, University of Aarhus, Aarhus, Denmark
| | - Karen la Cour
- Occupational Science, the Research Unit of User Perspectives and Community-based Interventions, University of Southern Denmark, Odense, Denmark
| | - Sally Thorne
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Heidi With
- The National Rehabilitation Center for Neuromuscular Diseases, (RCFM), Aarhus, Denmark
| | - Charlotte Handberg
- The National Rehabilitation Center for Neuromuscular Diseases, (RCFM), Aarhus, Denmark.,Department of Public Health, Faculty of Health, University of Aarhus, Aarhus, Denmark
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Wohnrade C, Velling AK, Mix L, Wurster CD, Cordts I, Stolte B, Zeller D, Uzelac Z, Platen S, Hagenacker T, Deschauer M, Lingor P, Ludolph AC, Lulé D, Petri S, Osmanovic A, Schreiber-Katz O. Health-Related Quality of Life in Spinal Muscular Atrophy Patients and Their Caregivers-A Prospective, Cross-Sectional, Multi-Center Analysis. Brain Sci 2023; 13:brainsci13010110. [PMID: 36672091 PMCID: PMC9857112 DOI: 10.3390/brainsci13010110] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Spinal muscular atrophy (SMA) is a disabling disease that affects not only the patient’s health-related quality of life (HRQoL), but also causes a high caregiver burden (CGB). The aim of this study was to evaluate HRQoL, CGB, and their predictors in SMA. In two prospective, cross-sectional, and multi-center studies, SMA patients (n = 39) and SMA patient/caregiver couples (n = 49) filled in the EuroQoL Five Dimension Five Level Scale (EQ-5D-5L) and the Short Form Health Survey 36 (SF-36). Caregivers (CGs) additionally answered the Zarit Burden Interview (ZBI) and the Hospital Anxiety and Depression Scale (HADS). Patients were clustered into two groups with either low or high HRQoL (EQ-5D-5L index value <0.259 or >0.679). The latter group was mostly composed of ambulatory type III patients with higher motor/functional scores. More severely affected patients reported low physical functioning but good mental health and vitality. The CGB (mean ZBI = 22/88) correlated negatively with patients’ motor/functional scores and age. Higher CGB was associated with a lower HRQoL, higher depression and anxiety, and more health impairments of the CGs. We conclude that patient and CG well-being levels interact closely, which highlights the need to consider the health of both parties while evaluating novel treatments.
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Affiliation(s)
- Camilla Wohnrade
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | | | - Lucas Mix
- Department of Neurology, University of Ulm, 89081 Ulm, Germany
| | | | - Isabell Cordts
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Benjamin Stolte
- Department of Neurology and Center for Translational Neuro- and Behavioral Science, University Medicine Essen, 45147 Essen, Germany
| | - Daniel Zeller
- Department of Neurology, University of Wuerzburg, 97080 Wuerzburg, Germany
| | - Zeljko Uzelac
- Department of Neurology, University of Ulm, 89081 Ulm, Germany
| | - Sophia Platen
- Department of Neurology, University of Ulm, 89081 Ulm, Germany
| | - Tim Hagenacker
- Department of Neurology and Center for Translational Neuro- and Behavioral Science, University Medicine Essen, 45147 Essen, Germany
| | - Marcus Deschauer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Paul Lingor
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Albert C. Ludolph
- Department of Neurology, University of Ulm, 89081 Ulm, Germany
- German Center for Neurodegenerative Diseases, 89081 Ulm, Germany
| | - Dorothée Lulé
- Department of Neurology, University of Ulm, 89081 Ulm, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Alma Osmanovic
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
- Essen Center for Rare Diseases (EZSE), University Hospital Essen, 45147 Essen, Germany
| | - Olivia Schreiber-Katz
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
- Correspondence:
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Atoyebi O, Eng JJ, Routhier F, Bird ML, Mortenson WB. A systematic review of systematic reviews of needs of family caregivers of older adults with dementia. Eur J Ageing 2022; 19:381-396. [PMID: 36052180 PMCID: PMC9424446 DOI: 10.1007/s10433-021-00680-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 11/25/2022] Open
Abstract
Family caregivers provide vital assistance to older adults living with dementia. An accurate assessment of the needs of caregivers supports the development and provision of appropriate solutions to address these needs. This review of systematic reviews analyzes and synthesizes the needs identified by family caregivers. We conducted a systematic review of systematic reviews using the AMSTAR guideline. Electronic databases were searched for systematic reviews on the needs of caregivers in the context of dementia using a combination of keywords and medical subject headings. Records resulting from the search were screened by two reviewers. Data on the needs of caregivers were extracted from the articles and analyzed using a narrative synthesis approach. Out of the 17 potentially eligible systematic reviews obtained initially, 6 met the inclusion criteria. In total, 20 main needs were identified in the reviews included in this study. The need for information and social support were prominent in this review. Factors such as gender, resources available to the caregiver and the care recipient's health status may influence caregivers' needs. Interventions can be tailored toward addressing the most prominent needs of caregivers such as adequate information and resources and available programs may further accommodate and offer need-tailored support to them.
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Affiliation(s)
- Oladele Atoyebi
- Rehabilitation Sciences Program, University of British Columbia, Vancouver, BC Canada
- GF Strong Rehabilitation Research Program, University of British Columbia, Vancouver, BC Canada
| | - Janice J. Eng
- GF Strong Rehabilitation Research Program, University of British Columbia, Vancouver, BC Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, BC Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Quebec City, QC Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré de Santé Et de Services Sociaux de la Capitale-Nationale, Quebec City, QC Canada
| | - Marie-Louise Bird
- GF Strong Rehabilitation Research Program, University of British Columbia, Vancouver, BC Canada
- School of Health Sciences, University of Tasmania, Newnham, TAS Australia
| | - W. Ben Mortenson
- GF Strong Rehabilitation Research Program, University of British Columbia, Vancouver, BC Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC Canada
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Silverman HE, Ake JM, Manoochehri M, Appleby BS, Brushaber D, Devick KL, Dickerson BC, Fields JA, Forsberg LK, Ghoshal N, Graff‐Radford NR, Grossman M, Heuer HW, Kornak J, Lapid MI, Litvan I, Mackenzie IR, Mendez MF, Onyike CU, Pascual B, Tartaglia MC, Boeve BF, Boxer AL, Rosen HJ, Cosentino S, Huey ED, Barker MS, Goldman JS. The contribution of behavioral features to caregiver burden in FTLD spectrum disorders. Alzheimers Dement 2022; 18:1635-1649. [PMID: 34854532 PMCID: PMC9160199 DOI: 10.1002/alz.12494] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/09/2021] [Accepted: 09/07/2021] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Caregivers of patients with frontotemporal lobar degeneration (FTLD) spectrum disorders experience tremendous burden, which has been associated with the neuropsychiatric and behavioral features of the disorders. METHODS In a sample of 558 participants with FTLD spectrum disorders, we performed multiple-variable regressions to identify the behavioral features that were most strongly associated with caregiver burden, as measured by the Zarit Burden Interview, at each stage of disease. RESULTS Apathy and disinhibition, as rated by both clinicians and caregivers, as well as clinician-rated psychosis, showed the strongest associations with caregiver burden, a pattern that was consistent when participants were separated cross-sectionally by disease stage. In addition, behavioral features appeared to contribute most to caregiver burden in patients with early dementia. DISCUSSION Caregivers should be provided with early education on the management of the behavioral features of FTLD spectrum disorders. Interventions targeting apathy, disinhibition, and psychosis may be most useful to reduce caregiver burden.
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Affiliation(s)
- Hannah E. Silverman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain and Gertrude H. Sergievsky CenterDepartment of NeurologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Jeannie M. Ake
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain and Gertrude H. Sergievsky CenterDepartment of NeurologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Masood Manoochehri
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain and Gertrude H. Sergievsky CenterDepartment of NeurologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Brian S. Appleby
- Department of NeurologyCase Western Reserve UniversityClevelandOhioUSA
| | - Danielle Brushaber
- Division of Clinical Trials and BiostatisticsDepartment of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Katrina L. Devick
- Division of Clinical Trials and BiostatisticsDepartment of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Bradford C. Dickerson
- Department of NeurologyFrontotemporal Disorders UnitMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Julie A. Fields
- Division of Neurocognitive DisordersDepartment of Psychiatry and PsychologyMayo ClinicRochesterMinnesotaUSA
| | | | - Nupur Ghoshal
- Department of NeurologyWashington UniversitySt. LouisMissouriUSA
| | | | - Murray Grossman
- Penn Frontotemporal Degeneration CenterDepartment of NeurologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Hilary W. Heuer
- Department of NeurologyMemory and Aging CenterUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - John Kornak
- Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Maria I. Lapid
- Division of Neurocognitive DisordersDepartment of Psychiatry and PsychologyMayo ClinicRochesterMinnesotaUSA
| | - Irene Litvan
- Department of NeuroscienceUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - Ian R. Mackenzie
- Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Mario F. Mendez
- Department of NeurologyUniversity of CaliforniaLos AngelesCaliforniaUSA
- Department of Psychiatry and Biobehavioral SciencesUniversity of California, Los AngelesLos AngelesCaliforniaUSA
| | - Chiadi U. Onyike
- Division of Geriatric Psychiatry and NeuropsychiatryDepartment of Psychiatry and Behavioral SciencesJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Belen Pascual
- Stanley H. Appel Department of NeurologyHouston Methodist HospitalWeill Cornell MedicineHouston Methodist Neurological and Research InstituteHoustonTexasUSA
| | | | | | - Adam L. Boxer
- Department of NeurologyMemory and Aging CenterUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Howard J. Rosen
- Department of NeurologyMemory and Aging CenterUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Stephanie Cosentino
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain and Gertrude H. Sergievsky CenterDepartment of NeurologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Edward D. Huey
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain and Gertrude H. Sergievsky CenterDepartment of NeurologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Department of Psychiatry and New York Psychiatric InstituteColumbia University Medical CenterNew YorkUSA
| | - Megan S. Barker
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain and Gertrude H. Sergievsky CenterDepartment of NeurologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Jill S. Goldman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain and Gertrude H. Sergievsky CenterDepartment of NeurologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
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Bilenchi VA, Banfi P, Pagnini F, Volpato E. Psychoeducational groups for people with Amyotrophic Lateral Sclerosis and their caregiver: a qualitative study. Neurol Sci 2022; 43:4239-4255. [DOI: 10.1007/s10072-022-05930-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/03/2022] [Indexed: 11/30/2022]
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Olesen LK, la Cour K, With H, Handberg C. Reflections of family caregivers and health professionals on the everyday challenges of caring for persons with amyotrophic lateral sclerosis and cognitive impairments: a qualitative study. Palliat Care Soc Pract 2022; 16:26323524221077702. [PMID: 35187490 PMCID: PMC8855464 DOI: 10.1177/26323524221077702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 01/13/2022] [Indexed: 11/25/2022] Open
Abstract
Aims and objectives: To explore reflections of family caregivers and health professionals
regarding the challenges involved in caring for persons with amyotrophic
lateral sclerosis and cognitive and/or behavioral impairments
(PALS/CIs). Background: Family caregivers of PALS/CIs are highly burdened and at great risk of
psychological sequela. Professionals working with these families can be
negatively affected on their well-being and are at risk of burnout. Design: The design was a qualitative interview study. Methods: One focus group and 10 individual semi-structured interviews were conducted
with seven family caregivers and nine professionals after the death of a
PALS/CIs. The analysis was guided by the interpretive description
methodology and the theory of sense of coherence. This study adheres to the
COREQ guidelines and the ICMJE recommendations. Results: The family caregivers’ challenges regarding coping with everyday needs
related to the sick person were associated with ‘Accepting that nothing else
matters’, ‘Adjusting to new roles while balancing’, and ‘Realizing different
values in relationships’; whereas the professionals’ challenges were related
to ‘Collaboration a balancing act’, ‘Working in a home of sorrow’, and
‘Coordinating threads to tie’. Conclusion: Family caregivers found coping with the complexity of the diseases a
challenge, and their everyday life needed constant adjustment to new roles,
coping with inappropriate behavior, and navigating through the progression
of the diseases of their sick relatives while collaborating with numerous
professionals. The professionals struggled with coordinating and
collaborating with the families and with other colleagues due to the
severeness and complexity of diseases. Relevance to clinical practice: Findings point to the importance of relationships for caregivers and
professionals and a need to provide support through an online palliative
rehabilitation program that encompass coping strategies in relation to the
diseases. Trial registration details: Id no. NCT 04638608.
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Affiliation(s)
- Lene Klem Olesen
- National Rehabilitation Center for Neuromuscular Diseases (RCFM), Kongsvang Allé 23, 8000 Aarhus, Denmark
| | - Karen la Cour
- Research Unit of User Perspectives, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Heidi With
- National Rehabilitation Center for Neuromuscular Diseases (RCFM), Aarhus, Denmark
| | - Charlotte Handberg
- National Rehabilitation Center for Neuromuscular Diseases (RCFM), Aarhus, Denmark
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Abstract
BACKGROUND Frontotemporal lobar degeneration (FTLD) is the second-most common cause of young-onset dementia. Personality and behavior changes lead to high caregiver stress and burden, but little support is available. Our aim is to present the evidence on the characteristics, challenges and unmet needs of caregivers as well as on possible interventions. METHODS We conducted a scoping review on caregiver burden using PubMed, Web of Science and ScienceDirect. A total of 69 articles were considered eligible and were analyzed in the present study. RESULTS Through the analysis of 69 empirical articles, our results show that caregivers of patients with FTLD are often younger in age, have children and find behavioral disturbances to be the most burdensome. Nine studies assessed the needs of and support for caregivers. Ten studies compared the burden in different forms of FTLD, 19 compared FTLD to other types of dementia, and one compared the caregiver burden between two countries. Eight studies reported on interventions for caregivers or interventions taking burden into account. One study assessed the support structure for caregivers of FTLD patients. Five case reports, eight research overviews and three reviews addressed specific needs and challenges. CONCLUSIONS Further research should reproduce and validate efficacious interventions and focus on underage children of FTLD patients and findings from non-Western countries. Additionally, support structures for FTLD caregivers should be assessed and extended. Awareness both in the wider population and among healthcare professionals is an urgent need for the future.
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Guger M, Raschbacher S, Kellermair L, Vosko MR, Eggers C, Forstner T, Leitner K, Fuchs A, Fellner F, Ransmayr G. Caregiver burden in patients with behavioural variant frontotemporal dementia and non-fluent variant and semantic variant primary progressive aphasia. J Neural Transm (Vienna) 2021; 128:1623-1634. [PMID: 34282470 PMCID: PMC8528762 DOI: 10.1007/s00702-021-02378-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
Studies on caregiver burden in patients with frontotemporal lobar degeneration are rare, differ methodologically and show variable results. Single center longitudinal pilot study on caregiver burden and potential risk factors in patients with behavioural variant frontotemporal dementia (bvFTD) and semantic (svPPA) and non-fluent variants (nfvPPA) primary progressive aphasia. Forty-six bvFTD, nine svPPA, and six nfvPPA patients and caring relatives were analysed for up to 2 years using the Mini-Mental State Examination as global measure for cognitive performance, Frontal Assessment Battery (frontal lobe functions), Frontal Behavioural Inventory (personality and behaviour), Neuropsychiatric Inventory (dementia-related neuropsychiatric symptoms), Barthel Index and Lawton IADL Scale (basic and instrumental activities of daily living), the Caregiver Strain Index (CSI), and in most participants also the Zarit Burden Interview (ZBI). CSI baseline sum scores were highest in bvFTD (mean ± SD 5.5 ± 3.4, median 5, IQR 6), intermediate in svPPA (2.9 ± 2.3; 3; 3.5) and low in nfvPPA (1.6 ± 2.1; 1; 2). Similar differences of caregiver burden were found using the ZBI. During follow-up, CSI and ZBI sum scores deteriorated in svPPA, not in bvFTD and nfvPPA, and correlated significantly with personality and behaviour, neuropsychiatric symptoms, caregiver age, and instrumental, but not basic activities of daily living, Mini-Mental State Examination scores or frontal lobe functions. This study reveals differences in caregiver burden in variants of frontotemporal lobar degeneration. Caregivers should be systematically asked for caregiver burden from the time of the diagnosis to provide comprehensive support in time.
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Affiliation(s)
- Michael Guger
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Krankenhausstr. 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Stefan Raschbacher
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Krankenhausstr. 9, 4021, Linz, Austria
| | - Lukas Kellermair
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Krankenhausstr. 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Milan R Vosko
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Krankenhausstr. 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Christian Eggers
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Krankenhausstr. 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Thomas Forstner
- Department of Applied Systems Research and Statistics, Johannes Kepler University, Linz, Austria
| | - Karin Leitner
- Clinical and Health Psychology Unit, Med Campus III, Kepler University Hospital GmbH, Linz, Austria
| | - Alexandra Fuchs
- Clinical and Health Psychology Unit, Med Campus III, Kepler University Hospital GmbH, Linz, Austria
| | - Franz Fellner
- Medical Faculty, Johannes Kepler University, Linz, Austria
- Central Radiology Institute, Med Campus III, Kepler University Hospital GmbH, Linz, Austria
| | - Gerhard Ransmayr
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Krankenhausstr. 9, 4021, Linz, Austria.
- Medical Faculty, Johannes Kepler University, Linz, Austria.
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Piña-Escudero SD, Aguirre GA, Javandel S, Longoria-Ibarrola EM. Caregiving for Patients With Frontotemporal Dementia in Latin America. Front Neurol 2021; 12:665694. [PMID: 34305781 PMCID: PMC8292669 DOI: 10.3389/fneur.2021.665694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022] Open
Abstract
Latin America is a vast heterogeneous territory where chronic diseases such as mild cognitive impairment or dementia are becoming higher. Frontotemporal dementia (FTD) prevalence in this region is estimated to be around 12-18 cases per thousand persons. However, this prevalence is underestimated given the lack of awareness of FTD even among healthcare professionals. Family members are responsible for the care of patients with FTD at home. These caregivers deliver care despite being ill-equipped and living in the context of austerity policies and social inequities. They often face unsurmountable financial and social burdens that are specific to the region. The most important step to support caregivers in Latin America is to increase awareness of the disease at all levels. Healthcare diplomacy is fundamental to create joint efforts that push policies forward to protect caregivers of FTD patients.
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Affiliation(s)
- Stefanie Danielle Piña-Escudero
- The Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United Statesand Trinity College, Dublin, Ireland
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Gloria Annette Aguirre
- The Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United Statesand Trinity College, Dublin, Ireland
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Shireen Javandel
- The Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United Statesand Trinity College, Dublin, Ireland
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Erika Mariana Longoria-Ibarrola
- The Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United Statesand Trinity College, Dublin, Ireland
- Instituto Nacional de Neurología y Neurocirugía José Velazco Suárez, Mexico City, Mexico
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Nguyen C, Caga J, Mahoney CJ, Kiernan MC, Huynh W. Behavioural changes predict poorer survival in amyotrophic lateral sclerosis. Brain Cogn 2021; 150:105710. [PMID: 33725515 DOI: 10.1016/j.bandc.2021.105710] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The Motor Neuron Disease Behavioural Scale (MiND-B) is a clinically validated tool that was developed to detect behavioural dysfunction in patients with amyotrophic lateral sclerosis (ALS). The current study aimed to evaluate behavioural impairment using MiND-B, as well as cognitive dysfunction in ALS patients, and to determine their prognostic implications. METHOD Patients with a clinical diagnosis of ALS were prospectively recruited from a specialised multidisciplinary ALS clinic. Patients underwent behavioural assessment with the Motor Neuron Disease Behavioural Scale (MiND-B) and cognitive evaluation using the Addenbrooke's Cognitive Examination (ACE). Primary outcome measure was selected as survival time, defined by time from assessment to time of death or censor date. Univariate assessment of survival effect was carried out using Kaplan-Meier survival analysis followed by cox regression analysis to assess the effect of MiND-B and ACE scores on survival time. RESULTS A total of 134 patients were included in the study. MiND-B testing determined that 59% were classified as having behavioural dysfunction, with deficits associated with a significantly shorter survival time (HR 2.53, p = 0.003, 95% CI 1.3-4.6). Furthermore, regression analysis demonstrated that for every 1-point reduction in the MiND-B score, risk of death increased by 3%. ACE testing established that 33% of the cohort had evidence of cognitive dysfunction. Patients with cognitive dysfunction on ACE testing had a significantly shorter survival time than patients without cognitive impairment (HR 2.0, p = 0.042, 95% CI 1.04-3.3). CONCLUSION The presence of behavioural and cognitive impairments in ALS patients was associated with poor survival. The MiND-B and ACE inventories are simple and efficient clinical tools that can be administered in the multidisciplinary ALS clinic, that aid in the prognostication of this patient population.
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Affiliation(s)
- Chilan Nguyen
- School of Medicine, University of Notre Dame, NSW, Australia
| | - Jashelle Caga
- Brain and Mind Centre, University of Sydney, NSW, Australia
| | | | | | - William Huynh
- Brain and Mind Centre, University of Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, NSW, Australia.
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12
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Sakuta S, Hashimoto M, Ikeda M, Koyama A, Takasaki A, Hotta M, Fukuhara R, Ishikawa T, Yuki S, Miyagawa Y, Hidaka Y, Kaneda K, Takebayashi M. Clinical features of behavioral symptoms in patients with semantic dementia: Does semantic dementia cause autistic traits? PLoS One 2021; 16:e0247184. [PMID: 33600474 PMCID: PMC7891790 DOI: 10.1371/journal.pone.0247184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/02/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the behavioral characteristics of semantic dementia (SD) using an instrument originally developed for patients with autism spectrum disorder. Methods The behavioral symptoms of 20 patients with SD and 20 patients with Alzheimer’s disease (AD) in both the preclinical state and the dementia state were evaluated using the Pervasive Developmental Disorders Autism Society Japan Rating Scale (PARS). Results The SD group showed high prevalence in four behaviors related to stereotypy and social impairment: eating very few food items, selfishness, difficulty in recognizing others’ feeling and thoughts, and interpreting language literally. Scores on the PARS short version, which is sensitive for diagnosis of autism spectrum disorder, were significantly higher in the dementia state than in the preclinical state in both the SD (11.5 ± 6.0 and 1.7 ± 2.5, respectively; t (19) = 6.7, p < 0.001) and AD (6.9 ± 4.6 and 1.7 ± 2.0, respectively; t (19) = 5.1, p < 0.001) groups. PARS short version scores after dementia onset increased in both the SD and AD groups, although the increase was significantly larger in the SD group (F = 5.6, p = 0.023). Additionally, a significantly higher rate of patients exceeded the cutoff score for autism diagnosis in the dementia state in the SD group (75%) than in the AD group (40%; χ2 = 5.0, p = 0.025). PARS scores in the dementia state were significantly correlated with illness duration (r = 0.46, p = 0.04) and Mini-Mental State Examination scores (r = −0.75, p < 0.001) in the SD group only. Conclusions Although SD and autism spectrum disorder are etiologically distinct diseases, patients with semantic dementia behave like those with autism spectrum disorder. Our findings suggest the symptomatic similarity of the two disorders.
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Affiliation(s)
- Shizuka Sakuta
- Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Mamoru Hashimoto
- Faculty of Life Sciences, Department of Neuropsychiatry, Kumamoto University, Kumamoto, Japan
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- * E-mail:
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Asuka Koyama
- Faculty of Life Sciences, Department of Neuropsychiatry, Kumamoto University, Kumamoto, Japan
| | - Akihiro Takasaki
- Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Maki Hotta
- Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Suita, Osaka, Japan
| | - Ryuji Fukuhara
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Tomohisa Ishikawa
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Seiji Yuki
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Yusuke Miyagawa
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Yosuke Hidaka
- Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | - Minoru Takebayashi
- Faculty of Life Sciences, Department of Neuropsychiatry, Kumamoto University, Kumamoto, Japan
- Division of Psychiatry and Neuroscience, Institute for Clinical Research, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan
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13
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Caga J, Zoing MC, Foxe D, Ramsey E, D'Mello M, Mioshi E, Ahmed RM, Kiernan MC, Piguet O. Problem-focused coping underlying lower caregiver burden in ALS-FTD: implications for caregiver intervention. Amyotroph Lateral Scler Frontotemporal Degener 2021; 22:434-441. [PMID: 33438449 DOI: 10.1080/21678421.2020.1867180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Amyotrophic lateral sclerosis (ALS) is a multisystem neurodegenerative disorder which includes cognitive and behavioral symptoms akin to frontotemporal dementia (FTD). Despite the necessity of caregiver intervention to assist with the management of cognitive and behavioral symptoms, there has been a lack of research on the topic. A focus on caregiver coping may offer a promising foundation to guide the development of interventions as part of ALS care. Accordingly, the aim of the present study was to examine the relationships between caregiver coping, psychological morbidity and burden of care in the context of ALS cognitive and behavioral symptoms. Methods: Fifty-five patient-caregiver dyads were recruited from specialized ALS and FTD clinics. Specific coping strategies were examined using the COPE Inventory/Brief COPE and psychological morbidity and burden were assessed using the Depression, Anxiety, and Stress Scale-21 and Zarit Burden Interview. The relationship between coping, psychological morbidity and burden of care were analyzed using univariate and multivariate methods. Results: High-burden caregivers were more likely to be caring for patients with a diagnosis of ALS-FTD (p =.0001). Caregivers used problem-focused strategies (particularly planning) more frequently (M = 71.4, SD = 15.3) compared to emotion-focused (M = 60.8, SD = 12.3) and dysfunctional coping strategies (M = 42.2, SD = 8.6). A diagnosis of ALS-FTD (p=.0001) and problem-focused strategies (p=.024) emerged as significant predictors of caregiver burden. Caregiver anxiety, depression and stress were not predictive of caregiver burden (p=.151). Conclusions: Timely provision of caregiver support optimizing problem-focused coping strategies as part of multidisciplinary ALS care, particularly for caregivers of ALS-FTD patients may mitigate caregiver burden.
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Affiliation(s)
- Jashelle Caga
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia.,Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - Margaret C Zoing
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - David Foxe
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia.,School of Psychology, The University of Sydney, Camperdown, Australia, and
| | - Eleanor Ramsey
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - Mirelle D'Mello
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia.,School of Psychology, The University of Sydney, Camperdown, Australia, and
| | - Eneida Mioshi
- School of Health Sciences, The University of East Anglia, Norwich, UK
| | - Rebekah M Ahmed
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia.,Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - Matthew C Kiernan
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia.,Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - Olivier Piguet
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia.,School of Psychology, The University of Sydney, Camperdown, Australia, and
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14
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Hodges JR, Piguet O. Progress and Challenges in Frontotemporal Dementia Research: A 20-Year Review. J Alzheimers Dis 2019; 62:1467-1480. [PMID: 29504536 PMCID: PMC5870022 DOI: 10.3233/jad-171087] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The landscape of frontotemporal dementia (FTD) has evolved remarkably in recent years and is barely recognizable from two decades ago. Knowledge of the clinical phenomenology, cognition, neuroimaging, genetics, pathology of the different subtypes of FTD, and their relations to other neurodegenerative conditions, has increased rapidly, due in part, to the growing interests into these neurodegenerative brain conditions. This article reviews the major advances in the field of FTD over the past 20 years, focusing primarily on the work of Frontier, the frontotemporal dementia clinical research group, based in Sydney, Australia. Topics covered include clinical presentations (cognition, behavior, neuroimaging), pathology, genetics, and disease progression, as well as interventions and carer directed research. This review demonstrates the improvement in diagnostic accuracy and capacity to provide advice on genetic risks, prognosis, and outcome. The next major challenge will be to capitalize on these research findings to develop effective disease modifying drugs, which are currently lacking.
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Affiliation(s)
- John R Hodges
- The University of Sydney, Sydney Medical School and Brain and Mind Centre, Sydney, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia
| | - Olivier Piguet
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia.,The University of Sydney, School of Psychology, and Brain and Mind Centre, Sydney, Australia
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15
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Caga J, Hsieh S, Lillo P, Dudley K, Mioshi E. The Impact of Cognitive and Behavioral Symptoms on ALS Patients and Their Caregivers. Front Neurol 2019; 10:192. [PMID: 30915018 PMCID: PMC6421295 DOI: 10.3389/fneur.2019.00192] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/14/2019] [Indexed: 12/11/2022] Open
Abstract
Previously thought to be a pure motor disease, amyotrophic lateral sclerosis (ALS) is now established as multisystem neurodegenerative disorder that lies on a continuum with frontotemporal dementia (FTD). Cognitive and behavioral symptoms primarily extend to executive function, personality, social conduct, and emotion processing. The assessment and management of cognitive and behavioral symptoms is complicated as they must be differentiated from psychological responses to a terminal diagnosis and progressive physical impairment. This is made more difficult by the limited number of studies investigating how these symptoms specifically affect patients and caregivers well-being. The current review focuses on the impact of cognitive and behavioral symptoms on patient and caregiver well-being and their implications for future research and interventions in ALS. This is an important area of research that could form the basis for more tailored, and potentially more successful, non-pharmacological interventions to improve psychological well-being among patients with ALS and their caregivers.
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Affiliation(s)
- Jashelle Caga
- Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.,Brain & Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Sharpley Hsieh
- Faculty of Health and Behavioural Sciences, School of Psychology, University of Queensland, QLD, Australia
| | - Patricia Lillo
- Departamento de Neurología Sur/Neurociencia, Facultad de Medicina, Universidad de Chile & Geroscience Center for Brain Health and Metabolism, Santiago, Chile
| | - Kaitlin Dudley
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
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16
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Sidani MA, Reed BC, Steinbauer J. Geriatric Care Issues. PHYSICIAN ASSISTANT CLINICS 2019. [DOI: 10.1016/j.cpha.2018.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Caga J, Hsieh S, Highton-Williamson E, Zoing MC, Ramsey E, Devenney E, Ahmed RM, Hogden A, Kiernan MC. The burden of apathy for caregivers of patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:599-605. [PMID: 30369270 DOI: 10.1080/21678421.2018.1497659] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Apathy is the most common behavioral symptom of amyotrophic lateral sclerosis (ALS). Despite its known impact on caregiver wellbeing, apathy is typically considered a unitary construct making assessment and targeting treatment problematic. The aim of this study was to explore the relationship between caregiver burden and the behavioral, cognitive, and emotional symptoms of apathy in ALS. METHODS Fifty-one ALS patient-caregiver dyads from an ALS/frontotemporal dementia Clinic were assessed with the Apathy Evaluation Scale which measured the cognitive, behavioral, emotional, and nonspecific symptoms of apathy as well as the Zarit Burden Interview, a measure of perceived burden among caregivers of cognitively impaired older adults. The relationship between apathy and caregiver burden were analyzed using univariate and multivariate methods. RESULTS Apathy was identified in 18% of ALS patients. Greater behavioral (p = 0.011) and nonspecific (p = 0.010) symptoms of apathy exhibited by patients were reported by caregivers with higher levels of burden compared to caregivers with lower levels of burden. Of the cognitive, behavioral, emotional, and nonspecific symptoms of apathy, only the behavioral symptoms explained a significant amount of variance in caregiver burden (p = 0.031). CONCLUSIONS Apathy, specifically the behavioral symptoms of apathy was associated with higher burden of care among ALS caregivers, highlighting the importance of multidimensional assessment of apathy and provision of behavior management support as part of ALS care.
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Affiliation(s)
- Jashelle Caga
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and.,b Sydney Medical School University of Sydney , Camperdown , NSW , Australia
| | - Sharpley Hsieh
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and
| | | | - Margaret C Zoing
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and
| | - Eleanor Ramsey
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and
| | - Emma Devenney
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and
| | - Rebekah M Ahmed
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and
| | - Anne Hogden
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and
| | - Matthew C Kiernan
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and.,b Sydney Medical School University of Sydney , Camperdown , NSW , Australia
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18
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Koyama A, Hashimoto M, Fukuhara R, Ichimi N, Takasaki A, Matsushita M, Ishikawa T, Tanaka H, Miyagawa Y, Ikeda M. Caregiver Burden in Semantic Dementia with Right- and Left-Sided Predominant Cerebral Atrophy and in Behavioral-Variant Frontotemporal Dementia. Dement Geriatr Cogn Dis Extra 2018; 8:128-137. [PMID: 29706989 PMCID: PMC5921212 DOI: 10.1159/000487851] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 02/16/2018] [Indexed: 12/13/2022] Open
Abstract
Background Caregiver burden is a serious concern for family caregivers of dementia patients, but its nature is unclear in patients with semantic dementia (SD). This study aimed to clarify caregiver burden for right- (R > L) and left-sided (L > R) predominant SD versus behavioral-variant frontotemporal dementia (bvFTD) patients. Methods Using the Japanese version of the Zarit Burden Interview (ZBI) and the Neuropsychiatric Inventory, we examined caregiver burden and behavioral and psychological symptoms of dementia (BPSD) in 43 first-visit outpatient/family caregiver dyads (bvFTD, 20 dyads; SD [L > R], 13 dyads; SD [R > L], 10 dyads). Results We found a significant difference in ZBI score between the 3 diagnostic groups. Post hoc tests revealed a significantly higher ZBI score in the bvFTD than in the SD (L > R) group. The ZBI scores in the SD (L > R) and SD (R > L) groups were not significantly different, although the effect size was large. Caregiver burden was significantly correlated with BPSD scores in all groups and was correlated with activities of daily living and instrumental activities of daily living decline in the bvFTD and SD (R > L) groups. Conclusion Caregiver burden was highest in the bvFTD group, comparatively high in the SD (R > L) group, and lowest in the SD (L > R) group. Adequate support and intervention for caregivers should be tailored to differences in caregiver burden between these patient groups.
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Affiliation(s)
- Asuka Koyama
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Mamoru Hashimoto
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Ryuji Fukuhara
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Naoko Ichimi
- Department of Medical Quality and Safety Management, Kumamoto University Hospital, Kumamoto, Japan
| | - Akihiro Takasaki
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Masateru Matsushita
- Center for Medical Education and Research, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomohisa Ishikawa
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hibiki Tanaka
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yusuke Miyagawa
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Manabu Ikeda
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
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Yassuda MS, Lima da Silva TB, O'Connor CM, Mekala S, Alladi S, Bahia VS, Amaral-Carvalho V, Guimaraes HC, Caramelli P, Balthazar MLF, Damasceno B, Brucki SMD, Nitrini R, Hodges JR, Piguet O, Mioshi E. Apathy and functional disability in behavioral variant frontotemporal dementia. Neurol Clin Pract 2018; 8:120-128. [PMID: 29708208 DOI: 10.1212/cpj.0000000000000429] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 01/29/2018] [Indexed: 12/13/2022]
Abstract
Background Behavioral variant frontotemporal dementia (bvFTD) has profound consequences on patients and their families. In this multicenter study, we investigated the contribution of cognitive and neuropsychiatric factors to everyday function at different levels of overall functional impairment. Methods In a retrospective cross-sectional study, 109 patients with bvFTD from 4 specialist frontotemporal dementia centers (Australia, England, India, and Brazil) were included. The measures administered evaluated everyday function (Disability Assessment for Dementia [DAD]), dementia staging (Clinical Dementia Rating [CDR]), general cognition (Addenbrooke's Cognitive Examination-revised [ACE-R]), and neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI]). Patients were then subdivided according to functional impairment on the DAD into mild, moderate, severe, and very severe subgroups. Three separate multiple linear regression analyses were run, where (1) total DAD, (2) basic activities of daily living (BADL), and (3) instrumental activities of daily living (IADL) scores were dependent variables; ACE-R total score and selected NPI domains (agitation/aggression, euphoria, apathy, disinhibition, irritability, aberrant motor behavior) were used as independent variables. Age, sex, education, and country of origin were controlled for in the analyses. Results Cognitive deficits were similar across the mild, moderate, and severe subgroups but significantly worse in the very severe subgroup. NPI domain scores (agitation/aggression, euphoria, apathy, disinhibition, irritability, aberrant motor behavior) did not differ across the DAD subgroups. In the multiple regression analyses, a model including ACE-R and NPI apathy explained 32.5% of the variance for total DAD scores. For IADL, 35.6% of the variance was explained by the ACE-R only. No model emerged for BADL scores. Conclusions Cognitive deficits and apathy are key contributors to functional disability in bvFTD but factors underlying impairment in BADLs remain unclear. Treatments targeting reduction of disability need to address apathy and cognitive impairment to ensure greater efficacy, especially in regards to IADLs.
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Affiliation(s)
- Mônica S Yassuda
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Thais B Lima da Silva
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Claire M O'Connor
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Shailaja Mekala
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Suvarna Alladi
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Valeria S Bahia
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Viviane Amaral-Carvalho
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Henrique C Guimaraes
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Paulo Caramelli
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Marcio L F Balthazar
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Benito Damasceno
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Sonia M D Brucki
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Ricardo Nitrini
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - John R Hodges
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Olivier Piguet
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Eneida Mioshi
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
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20
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Kaizik C, Caga J, Camino J, O'Connor CM, McKinnon C, Oyebode JR, Piguet O, Hodges JR, Mioshi E. Factors Underpinning Caregiver Burden in Frontotemporal Dementia Differ in Spouses and their Children. J Alzheimers Dis 2018; 56:1109-1117. [PMID: 28106550 PMCID: PMC5302027 DOI: 10.3233/jad-160852] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The objectives of this observational study were to (1) compare spousal and child caregiver burden; (2) compare co-resident and live-out child caregiver burden; and (3) investigate factors influencing spousal and child caregiver burden. Data was collected from 90 caregivers of people with frontotemporal degeneration (FTD) recruited from the Frontotemporal Dementia Research Group (Frontier) at Neuroscience Research, Australia. Of this caregiver group, 43 were spousal caregivers and 47 were child caregivers. Caregiver burden and emotional state were evaluated using the short Zarit Burden Interview and the short version of the Depression, Anxiety and Stress Scale-21. The Social Network Index was applied to ascertain the social network of the caregiver, while the Intimate Bond Measure was used to evaluate the current quality of the relationship between the caregiver and the person with dementia. The Frontotemporal Dementia Rating Scale was used to assess severity of dementia. Spousal and child caregivers experienced similar levels of burden, depression, anxiety, and stress, regardless of disease severity. Co-resident child caregivers had smaller social networks and greater burden than live-out caregivers. Dementia severity was key in spousal caregiver burden, whereas caregiver depression was most important in child caregiver burden. Child and spousal caregivers of individuals with FTD share similar levels of burden, influenced by different factors. Future interventions need to account for these differences.
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Affiliation(s)
| | - Jashelle Caga
- Sydney Medical School, Brain and Mind Research Institute, University of Sydney, Camperdown, Australia
| | - Julieta Camino
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Claire M O'Connor
- Ageing, Work & Health Research Unit, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Colleen McKinnon
- Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Jan R Oyebode
- School of Dementia Studies, University of Bradford, UK
| | - Olivier Piguet
- Neuroscience Research Australia, Sydney, Australia.,School of Medical Sciences, University of New South Wales, Sydney, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia
| | - John R Hodges
- Neuroscience Research Australia, Sydney, Australia.,School of Medical Sciences, University of New South Wales, Sydney, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia
| | - Eneida Mioshi
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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21
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O'Connor CM, Clemson L, Flanagan E, Kaizik C, Brodaty H, Hodges JR, Piguet O, Mioshi E. The Relationship between Behavioural Changes, Cognitive Symptoms, and Functional Disability in Primary Progressive Aphasia: A Longitudinal Study. Dement Geriatr Cogn Disord 2018; 42:215-226. [PMID: 27684067 DOI: 10.1159/000449283] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The contribution of behavioural changes to functional decline is yet to be explored in primary progressive aphasia (PPA). OBJECTIVES (1) investigate functional changes in two PPA variants [semantic (svPPA) and non-fluent (nfvPPA)], at baseline and after 12 months; (2) investigate baseline differences in behavioural changes between groups, and (3) explore predictors of functional decline after a 12-month period. METHODS A longitudinal study involving 29 people with PPA (18 svPPA; 11 nfvPPA) seen annually in Sydney/Australia was conducted. A total of 114 functional and behavioural assessments were included for within-group (repeated-measures ANOVA; annual rate of change; multiple regression analyses) and between-group analyses (pairwise comparisons). RESULTS Functional profiles in svPPA and nfvPPA were similar in people with up to 5 years of disease duration. Behavioural changes were marked in svPPA patients (stereotypical behaviour and apathy) but did not predict annual rate of change of functional abilities; global cognitive scores at baseline did. Despite mild behavioural changes in nfvPPA (disinhibition, apathy), these were significant predictors of annual rate of functional change. CONCLUSIONS The presentation and interplay of behavioural changes and functional disability differ in svPPA and nfvPPA. These varying factors should be taken into account when considering prognosis, disease management, and selection of outcome measures for interventions.
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Affiliation(s)
- Claire M O'Connor
- Ageing, Work & Health Research Unit, Faculty of Health Sciences, University of Sydney, Sydney, N.S.W., Australia
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22
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Bock M, Duong YN, Kim A, Allen I, Murphy J, Lomen-Hoerth C. Progression and effect of cognitive-behavioral changes in patients with amyotrophic lateral sclerosis. Neurol Clin Pract 2017; 7:488-498. [PMID: 29431172 DOI: 10.1212/cpj.0000000000000397] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background To prospectively evaluate the progression of cognitive-behavioral function in amyotrophic lateral sclerosis (ALS) and examine the association of cognitive-behavioral deficits with disease progression, patient quality of life (QOL), and caregiver burden. Methods We evaluated cognitive-behavioral function using the Amyotrophic Lateral Sclerosis Cognitive Behavioral Screen at enrollment and after 7 months in a cohort of patients with ALS. Paired t tests were used to evaluate the change in the 2 assessments. Linear regression and Kruskal-Wallis tests were applied to investigate how initial cognitive or behavioral status related to outcomes. Results The mean test-retest interval was 6.8 months (SD 1.6). Cognitive status of the study population (n = 49) overall did not change over the study period (p = 0.06) despite progression of motor weakness (p < 0.001), though small subsets of the sample demonstrate cognitive change. Patients initially classified as behaviorally normal showed increased behavioral problems over time (t = -2.8, p = 0.009). Decline in cognitive (β = -1.3, p = 0.03) and behavioral (β = -0.76, p = 0.002) status predicted increasing caregiver burden. Behavioral abnormalities predicted decline in forced vital capacity and ALS Functional Rating Scale-Revised score (p = 0.008, 0.012) in the study population and patient QOL in the most severely affected group (t = 4.3, p = 0.003). Conclusions Cognitive-behavioral change is a key aspect of disease heterogeneity in ALS. Executive function in ALS overall remains stable over 7 months as detected by an administered screening tool. However, patients may develop caregiver-reported behavioral symptoms in that time period. Screening for caregiver-reported symptoms has a particular utility in predicting future clinical decline, increased caregiver burden, and worsening patient QOL.
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Affiliation(s)
- Meredith Bock
- Departments of Neurology (MB, Y-ND, AK, JM, CL-H) and Epidemiology and Biostatistics (IA), University of California, San Francisco
| | - Y-Nhy Duong
- Departments of Neurology (MB, Y-ND, AK, JM, CL-H) and Epidemiology and Biostatistics (IA), University of California, San Francisco
| | - Anthony Kim
- Departments of Neurology (MB, Y-ND, AK, JM, CL-H) and Epidemiology and Biostatistics (IA), University of California, San Francisco
| | - Isabel Allen
- Departments of Neurology (MB, Y-ND, AK, JM, CL-H) and Epidemiology and Biostatistics (IA), University of California, San Francisco
| | - Jennifer Murphy
- Departments of Neurology (MB, Y-ND, AK, JM, CL-H) and Epidemiology and Biostatistics (IA), University of California, San Francisco
| | - Catherine Lomen-Hoerth
- Departments of Neurology (MB, Y-ND, AK, JM, CL-H) and Epidemiology and Biostatistics (IA), University of California, San Francisco
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23
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Geng D, Ou R, Miao X, Zhao L, Wei Q, Chen X, Liang Y, Shang H, Yang R. Patients’ self-perceived burden, caregivers’ burden and quality of life for amyotrophic lateral sclerosis patients: a cross-sectional study. J Clin Nurs 2017; 26:3188-3199. [PMID: 27874996 DOI: 10.1111/jocn.13667] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Dan Geng
- Department of Neurology; West China Hospital of Sichuan University; Chengdu Sichuan China
| | - RuWei Ou
- Department of Neurology; West China Hospital of Sichuan University; Chengdu Sichuan China
| | - XiaoHui Miao
- Department of Neurology; West China Hospital of Sichuan University; Chengdu Sichuan China
| | - LiHong Zhao
- Department of Neurology; West China Hospital of Sichuan University; Chengdu Sichuan China
| | - QianQian Wei
- Department of Neurology; West China Hospital of Sichuan University; Chengdu Sichuan China
| | - XuePing Chen
- Department of Neurology; West China Hospital of Sichuan University; Chengdu Sichuan China
| | - Yan Liang
- Department of Neurology; West China Hospital of Sichuan University; Chengdu Sichuan China
| | - HuiFang Shang
- Department of Neurology; West China Hospital of Sichuan University; Chengdu Sichuan China
| | - Rong Yang
- Department of Neurology; West China Hospital of Sichuan University; Chengdu Sichuan China
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24
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Sidani MA, Reed BC, Steinbauer J. Geriatric Care Issues: An American and an International Perspective. Prim Care 2017; 44:e15-e36. [PMID: 28164825 DOI: 10.1016/j.pop.2016.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
As the global population ages, there is an opportunity to benefit from the increased longevity of a healthy older adult population. Healthy older individuals often contribute financially to younger generations by offering financial assistance, paying more in taxes than benefits received, and providing unpaid childcare and voluntary work. Governments must address the challenges of income insecurity, access to health care, social isolation, and neglect that currently face elderly adults in many countries. A reduction in disparities in these areas can lead to better health outcomes and allow societies to benefit from longer, healthier lives of their citizens.
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Affiliation(s)
- Mohamad A Sidani
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Brian C Reed
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey Steinbauer
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
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25
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O'Connor CM, Clemson L, Hornberger M, Leyton CE, Hodges JR, Piguet O, Mioshi E. Longitudinal change in everyday function and behavioral symptoms in frontotemporal dementia. Neurol Clin Pract 2016; 6:419-428. [PMID: 27847684 PMCID: PMC5100706 DOI: 10.1212/cpj.0000000000000264] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: The relationship between behavioral changes and functional decline in frontotemporal dementia (FTD) is not well understood. Methods: Thirty-nine patients (21 behavioral variant FTD [bvFTD], 18 semantic variant primary progressive aphasia [svPPA]) were followed up longitudinally (2–4 years follow-up). Functional (Disability Assessment for Dementia) and behavioral (Cambridge Behavioural Inventory Revised) assessments were included for between-group (pairwise comparisons, mixed model analysis) and within-group analyses (bivariate correlations). Results: Functionally, patients with bvFTD were more impaired than patients with svPPA at baseline and continued to be at follow-up, despite similar disease duration. By contrast, behavioral impairments differed between patient groups at baseline and at follow-up. At baseline, patients with bvFTD exhibited higher levels of apathy and changes in eating than patients with svPPA; disinhibited and stereotypical behaviors were similar. Over the years, patients with bvFTD showed reduction in disinhibition and stereotypical behavior while apathy and eating changes increased. By contrast, all measured behaviors increased in patients with svPPA over time. Finally, only apathy made longitudinal contributions to functional disability in patients with svPPA, whereas apathy and stereotypical behavior were associated with increased disability in patients with bvFTD. Conclusions: Despite shared overlapping baseline behavioral symptoms, patients with bvFTD are more functionally impaired than patients with svPPA. Apathy has a strong role in disability for both bvFTD and svPPA, but stereotypical behaviors only contributed to functional deficits in patients with bvFTD. Our findings suggest that rigid/compulsive behaviors may in fact support activity engagement in patients with svPPA. Taken together, our results indicate that interventions to reduce disability in the FTD spectrum require an alternative rationale in comparison to Alzheimer disease dementia, and should carefully weigh the interaction of behavioral symptoms and functional status.
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Affiliation(s)
- Claire M O'Connor
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
| | - Lindy Clemson
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
| | - Michael Hornberger
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
| | - Cristian E Leyton
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
| | - John R Hodges
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
| | - Olivier Piguet
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
| | - Eneida Mioshi
- Ageing, Work & Health Research Unit (CMO, LC) and Speech Pathology (CEL), Faculty of Health Sciences, University of Sydney, Australia; Faculty of Medicine and Health Sciences (MH, EM), University of East Anglia, UK; Neuroscience Research Australia (CEL, JRH, OP); and ARC Centre of Excellence in Cognition and its Disorders (JRH, OP) and School of Medical Sciences (JRH, OP), University of New South Wales, Australia
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