Validation of the Thai QOL-AD version in Alzheimer's patients and caregivers

A proof of concept phase II study with the PDE-4 inhibitor roflumilast in patients with mild cognitive impairment or mild Alzheimer's disease dementia (ROMEMA): study protocol of a double-blind, randomized, placebo-controlled, between-subjects trial

BACKGROUND

Research into the neurobiological underpinnings of learning and memory has demonstrated the cognitive-enhancing effects associated with diverse classes of phosphodiesterase (PDE) inhibitors. Specific PDE inhibitors have been identified to improve neuronal communication through selective inhibition of PDE activity. Roflumilast, a PDE4 inhibitor, has demonstrated efficacy in enhancing episodic memory in healthy adults and elderly participants with pronounced memory impairment, indicative of amnestic mild cognitive impairment (aMCI). In alignment with these findings, the present protocol aims to provide a proof of concept phase II of the potential of roflumilast to aid patients diagnosed with (a)MCI or mild Alzheimer's disease (AD) dementia.

METHODS

The study will be conducted according to a double-blind, randomized placebo-controlled, between-subjects design. Participants with (a)MCI and mild AD dementia will be recruited through the Memory Clinic at the Maastricht University Medical Centre + (MUMC +) in Maastricht, the Netherlands, alongside outreach through regional hospitals, and social media. The study will have three arms: placebo, 50 μg roflumilast, and 100 μg roflumilast, with a treatment duration of 24 weeks. The primary outcome measure will focus on the assessment of episodic memory, as evaluated through participants' performance on the 15-word Verbal Learning Task (VLT). Our secondary objectives are multifaceted, including an exploration of various cognitive domains. In addition, insights into the well-being and daily functioning of participants will be investigated through interviews with both the participants and their (informal) caregivers, we are interested in the well-being and daily functioning of the participants.

DISCUSSION

The outcomes of the present study aim to elucidate the significance of the PDE4 inhibition mechanism as a prospective therapeutic target for enhancing cognitive function in individuals with (a)MCI and mild AD dementia. Identifying positive effects within these patient cohorts could extend the relevance of this treatment to encompass a broader spectrum of neurological disorders.

TRIAL REGISTRATION

The Medical Ethics Committee of MUMC + granted ethics approval for the 4th version of the protocol on September 10th, 2020. The trial was registered at the European Drug Regulatory Affairs Clinical Trials (EudraCT) registered on the 19th of December 2019 ( https://www.clinicaltrialsregister.eu/ctr-search/trial/2019-004959-36/NL ) and ClinicalTrial.gov (NCT04658654, https://clinicaltrials.gov/study/NCT04658654?intr=roflumilast&cond=mci&rank=1 ) on the 8th of December 2020. The Central Committee on Research Involving Human Subjects (CCMO) granted approval on the 30th of September 2020.

The effect of short daytime napping on cognitive function, sleep quality, and quality of life in mild cognitive impairment patients

Mild cognitive impairment (MCI) is a neurological disorder that can increase the risk of Alzheimer's disease (AD) by three to five times more than those with normal cognition. To better understand the effects of daytime napping on MCI patients, a study was conducted to measure the effects of short naps on cognitive function, sleep quality, and quality of life. In total, 38 participants were asked to take 20-minute naps between 1:00p.m. and 3:00p.m. three times a week for eight weeks. The cognitive function of the participants was measured using the Thai version of the Montreal Cognitive Assessment (Thai-MoCA), their sleep quality was measured using the Thai version of the Pittsburgh Sleep Quality Index (Thai-PSQI), and their quality of life was measured using the Thai version of the Quality of Life (Thai-QoL) questionnaire. After the 8-week period, the participants' scores for the Thai-MoCA and the Thai-QoL questionnaire showed a significant improvement (p < 0.001 for both), while the Thai-PSQI decreased significantly (p = 0.012). This suggests that taking short daytime naps can help to improve the cognitive function, sleep quality, and quality of life of MCI patients.

Validation of the Japanese version of the quality of life-Alzheimer's disease for nursing homes

OBJECTIVES

This study aims to validate the Japanese version of Quality of Life-Alzheimer's Disease for Nursing Homes (QOL-AD NH). This is the modified version of QOL-AD, initially developed for residents living with dementia in long-term care settings.

METHODS

Psychometric assessment was conducted in a sample of 101 residents and their professional care staff to obtain self-ratings and proxy-ratings of QOL, respectively. Residents' behavior was observed using Dementia Care Mapping (DCM) method, and their mood/engagement (ME) value was evaluated as a proxy measure of QOL.

RESULTS

Self-ratings were higher than proxy-ratings (t = 10.22, p<.001), with moderate correlation (r=.51, p<.001) and strong internal consistency (α=.87 for both). The exact agreement between the two groups was 38.23%. Convergent validity was confirmed with ME value and positive engagements of DCM. Exploratory factor analysis was performed for further validity testing. Three factors - self and life overall, social environment, and physical and psychological health, accounted for 85.9% of the total variance with Cronbach's α of .87, .73, .90, respectively.

CONCLUSION

Using a validated Japanese version of the QOL-AD NH may help assess the QOL of older residents living in long-term care settings to improve the continuum of care for dementia.

Factor structure of the Japanese version of the Quality of Life in Alzheimer's Disease Scale (QOL-AD)

BACKGROUND

The Quality of Life in Alzheimer's Disease Scale (QOL-AD) developed by Logsdon et al. in1999 is believed to be useful for evaluating responses from both patients and their caregivers. We previously confirmed both the reliability and the validity of the Japanese version of the QOL-AD. However, the factor structure of this scale should be confirmed because the QOL-AD covers multiple facets of dementia patients' lives. Thus, we performed a factor analysis of the Japanese QOL-AD. Then, we examined the correlations between each of the identified QOL factor scores and the results of other scales.

METHODS

The Japanese version of the QOL-AD was given to 132 AD patients and 132 caregivers. Four other tests were also performed at the same time: the Mini-Mental State Examination, the Neuropsychiatric Inventory (NPI), the Hyogo Activities of Daily Living Scale (HADL), and the Short Memory Questionnaire. A factor analysis using Varimax rotation was used to examine the dimensions underlying the QOL-AD. In addition, we examined the Pearson correlations between each of the identified QOL factor scores and the results of the other four tests.

RESULTS

Factor analyses of both versions of the Japanese QOL-AD (both the patients' and the caregivers' responses) revealed three factors that were named 'psychological wellbeing', 'human relationships', and 'physical and social environment'. The 'psychological wellbeing' factor was significantly correlated with the Mood factor of the NPI. The 'human relationships' factor was significantly correlated with the Psychosis factor of the NPI. The 'physical and social environment' factor was significantly correlated with the HADL.

CONCLUSIONS

Both the patients' and the caregivers' responses to the Japanese version of the QOL-AD were composed of three factors: 'psychological wellbeing', 'human relationships', and 'physical and social environment'. The present results support the multi-domain concept of QOL proposed by Lawton.

Psychometric Validation of the Czech Version of the Quality of Life - Alzheimer's Disease Scale in Patients with Early-Stage Dementia

BACKGROUND/AIMS

The aim of this study was to perform a psychometric validation of the Czech version of the Quality of Life - Alzheimer's Disease scale (QoL-AD) for patients with early-stage dementia.

METHODS

The sample included 212 patient-proxy pairs. For convergent validity, the Czech version of the Bristol Activities of Daily Living Scale (BADLS-CZ), the Short Physical Performance Battery (SPPB), and the Geriatric Depression Scale (GDS) were used.

RESULTS

The reliability of the QoL-AD for patients and caregivers was good (Cronbach's α = 0.85, ICC = 0.25-0.54). A positive correlation existed between the QoL-AD and the SPPB, and negative correlations existed between the QoL-AD and the BADLS-CZ as well as between the QoL-AD and the GDS. Factor analysis resulted in a three-factor solution (physical and mental health, family life, and social security).

CONCLUSION

The Czech version of the QoL-AD has good psychometric properties in compliance with international recommendations.

Reliability, validity and clinical correlates of the Quality of Life in Alzheimer's disease (QoL-AD) scale in medical inpatients

Background

There is a lack of standardisation in quality of life (QoL) measurements to be used in older multimorbid patients. An ideal QoL measurement should be reliable, valid, subjective, multidimensional, feasible and generic. We hypothesised that the QoL-AD (Quality of Life in Alzheimer’s Disease) scale could have these properties. Our aim was to determine the psychometric properties and clinical correlations of QoL-AD in a population of elderly, multimorbid medical inpatients.

Methods

QoL-AD was performed in 200 medical inpatients, and available caregivers. Reliability was determined using cronbach’s alpha and corrected item-total correlations. The agreement between patient and proxy ratings were examined using intra-class correlations (ICC). Correlations between QoL-AD and demographic data, comorbidity, cognitive tests, ADL (activities of daily living) and depression were examined. To characterise the underlying constructs of QoL-AD, an exploratory factor analysis was performed.

Results

In total, 199 patients fulfilled the QoL-AD rating, with 139 proxy ratings. Cronbach’s alpha (95 % CI) was 0.74 (0.68–0.79) for patients and 0.86 (0.83–0.90) for proxies. Patient-proxy ICC (95 % CI) was 0.31 (0.16–0.46). Lower QoL was correlated to depression, cognitive impairment, ADL impairment and solitary living, but not with comorbidity. The factor analysis gave a three-factor solution, with factors representing phsyical, social and psychological well-being.

Conclusion

The QoL-AD scale showed some promising properties but more research is needed before it can be recommended in this setting. If replicated, the finding that cognitive impairment, depression and ADL impairment were more associated with lower QoL than somatic comorbidity could have clinical implications for further studies aiming to improve QoL in this population.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-016-0493-8) contains supplementary material, which is available to authorized users.