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Darab MG, Engel L, Henzler D, Lauerer M, Nagel E, Brown V, Mihalopoulos C. Model-Based Economic Evaluations of Interventions for Dementia: An Updated Systematic Review and Quality Assessment. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:503-525. [PMID: 38554246 PMCID: PMC11178626 DOI: 10.1007/s40258-024-00878-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND There has been an increase in model-based economic evaluations of interventions for dementia. The most recent systematic review of economic evaluations for dementia highlighted weaknesses in studies, including lack of justification for model assumptions and data inputs. OBJECTIVE This study aimed to update the last published systematic review of model-based economic evaluations of interventions for dementia, including Alzheimer's disease, with a focus on any methodological improvements and quality assessment of the studies. METHODS Systematic searches in eight databases, including PubMed, Cochrane, Embase, CINAHL, PsycINFO, EconLit, international HTA database, and the Tufts Cost-Effectiveness Analysis Registry were undertaken from February 2018 until August 2022. The quality of the included studies was assessed using the Philips checklist and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist. The findings were summarized through narrative analysis. RESULTS This review included 23 studies, comprising cost-utility analyses (87%), cost-benefit analyses (9%) and cost-effectiveness analyses (4%). The studies covered various interventions, including pharmacological (n = 10, 43%), non-pharmacological (n = 4, 17%), prevention (n = 4, 17%), diagnostic (n = 4, 17%) and integrated (n = 1, 4%) [diagnostics-pharmacologic] strategies. Markov transition models were commonly employed (65%), followed by decision trees (13%) and discrete-event simulation (9%). Several interventions from all categories were reported as being cost effective. The quality of reporting was suboptimal for the Methods and Results sections in almost all studies, although the majority of studies adequately addressed the decision problem, scope, and model-type selection in their economic evaluations. Regarding the quality of methodology, only a minority of studies addressed competing theories or clearly explained the rationale for model structure. Furthermore, few studies systematically identified key parameters or assessed data quality, and uncertainty was mostly addressed partially. CONCLUSIONS This review informs future research and resource allocation by providing insights into model-based economic evaluations for dementia interventions and highlighting areas for improvement.
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Affiliation(s)
- Mohsen Ghaffari Darab
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia.
- Institute for Management in Medicine and Health Sciences, University of Bayreuth, Bayreuth, Germany.
| | - Lidia Engel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Dennis Henzler
- Institute for Management in Medicine and Health Sciences, University of Bayreuth, Bayreuth, Germany
| | - Michael Lauerer
- Institute for Management in Medicine and Health Sciences, University of Bayreuth, Bayreuth, Germany
| | - Eckhard Nagel
- Institute for Management in Medicine and Health Sciences, University of Bayreuth, Bayreuth, Germany
| | - Vicki Brown
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Lin R, Luo YT, Yan YJ, Huang CS, Chen LL, Chen MF, Lin MJ, Li H. Effects of an art-based intervention in older adults with mild cognitive impairment: a randomised controlled trial. Age Ageing 2022; 51:6649131. [PMID: 35871420 DOI: 10.1093/ageing/afac144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Art-based interventions may delay cognitive decline and improve health-related outcomes in older adults with mild cognitive impairment (MCI). OBJECTIVE To examine the effects of the Creative Expressive Arts-based Storytelling (CrEAS) program compared to active and waitlist controls on neurocognitive and other health-related outcomes in older people with MCI. DESIGN Three-arm parallel-group, randomised controlled design. PARTICIPANTS One-hundred and thirty-five adults with MCI (mean age: 70.93 ± 6.91 years). METHODS Participants were randomly assigned to intervention (CrEAS, n = 45), active control (n = 45) or waitlist control (n = 45) groups. Interventions were applied once per week for 24 weeks. The primary outcome was global cognitive function; secondary outcomes were specific cognition domains (memory, executive function, language and attention) and other health-related outcomes (anxiety, depression and quality of life [QoL]). All variables were measured at baseline (T0), 24-week follow-up (T1) and 48-week follow-up (T2). RESULTS Participants in the CrEAS group showed significantly higher global cognitive function (adjusted mean difference [MD] = -0.905, 95% confidence interval [CI] -1.748 to -0.062; P = 0.038) and QoL (adjusted MD = -4.150, 95% CI -6.447 to -1.853; P = 0.001) and lower depression symptoms (adjusted MD = 2.902, 95% CI 0.699-5.104; P = 0.011) post-intervention at the 24-week follow-up compared with the active control group. At 48-week follow-up, only the Auditory Verbal Learning Test Immediate recall score was significantly improved compared with the active control group (adjusted MD = -2.941, 95% CI -5.262 to -0.620; P = 0.014). CONCLUSIONS Older adults with MCI who participated in the CrEAS program improved their neuropsychological outcomes and QoL and reduced their rate of cognitive deterioration.
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Affiliation(s)
- Rong Lin
- Research Center for Nursing Theory and Practice, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Yu-Ting Luo
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Yuan-Jiao Yan
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Chen-Shan Huang
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Li-Li Chen
- Research Center for Nursing Theory and Practice, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Ming-Feng Chen
- Neurology Department, Fujian Provincial Hospital, Fuzhou, China
| | - Mo-Jun Lin
- The School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Hong Li
- Research Center for Nursing Theory and Practice, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,The School of Nursing, Fujian Medical University, Fuzhou, China
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Alexander CM, Martyr A, Gamble LD, Savage SA, Quinn C, Morris RG, Collins R, Clare L. Does awareness of condition help people with mild-to-moderate dementia to live well? Findings from the IDEAL programme. BMC Geriatr 2021; 21:511. [PMID: 34563135 PMCID: PMC8467163 DOI: 10.1186/s12877-021-02468-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/06/2021] [Indexed: 01/07/2023] Open
Abstract
Background People living with dementia vary in awareness of their abilities. We explored awareness of the condition and diagnosis in people with mild-to-moderate dementia, and how this relates to quality of life, well-being, life satisfaction, and caregiver stress. Methods This study was a cross-sectional exploratory analysis of data from the IDEAL cohort, which recruited people with dementia living at home and available caregivers from 29 research sites in Great Britain. Our study included 917 people with mild-to-moderate dementia and 755 carers. Low and high awareness groups were derived from self-reported responses to a dementia representation measure. Logistic regression was used to explore predictors of awareness of condition and diagnosis using demographic, cognitive, functional and psychological measures, and the relationship with quality of life, well-being and life satisfaction (‘living well’), and caregiver stress. Results There were 83 people with low awareness of their condition. The remaining 834 people showed some awareness and 103 of these had high awareness of their condition and diagnosis. Psychosocial factors were stronger predictors of awareness than cognitive and functional ability. Those with higher awareness reported lower mood, and lower scores on indices of living well as well as lower optimism, self-efficacy and self-esteem. Low awareness was more likely in those aged 80y and above, and living in more socially deprived areas. No relationship was seen between caregiver stress and awareness. Conclusions Awareness of the condition and diagnosis varies in people with mild-to-moderate dementia and is relevant to the capability to live well. Awareness should be considered in person-centered clinical care. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02468-4.
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Affiliation(s)
- Catherine M Alexander
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sharon A Savage
- School of Psychology, The University of Newcastle, Australia, Newcastle, Australia
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Robin G Morris
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Rachel Collins
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK.,National Institute for Health Research Applied Research Collaboration South-West Peninsula, Exeter, UK
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4
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Stypa V, Haussermann P, Fleiner T, Neumann S. Validity and Reliability of the German Quality of Life-Alzheimer's Disease (QoL-AD) Self-Report Scale. J Alzheimers Dis 2020; 77:581-590. [PMID: 32675413 DOI: 10.3233/jad-200400] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Quality of Life-Alzheimer's Disease (QoL-AD) scale is a widely used measure of quality of life (QoL) in dementia. Although the instrument has been validated in several languages, the psychometric properties of the German self-report version have not yet been analyzed. OBJECTIVE This study examines the internal consistency, test-retest reliability, and construct validity of the German QoL-AD self-report scale. METHODS The sample included 30 patients suffering from mild to moderate Alzheimer's disease or vascular dementia (19 females; mean age 77.3 years; mean Mini-Mental State Examination (MMSE) score 19.7 points). To determine test-retest reliability, the QoL-AD self-report scale was re-administered four to seven days apart. For construct validity analysis, the Dementia Quality of Life instrument (DQoL), Geriatric Depression Scale (GDS), MMSE, and an adapted short form of the Neuropsychiatric Inventory (NPI) were used. RESULTS The German QoL-AD self-report scale shows an internal consistency of α= 0.79 and a test-retest reliability of r = 0.75 (p < 0.01). Regarding construct validity, there was a significant positive correlation between the total scores of the QoL-AD and DQoL (r = 0.47, p < 0.05). The analysis revealed no significant correlations with the GDS or the adapted NPI. No association could be observed between the QoL-AD and the MMSE (r = 0.01), confirming divergent validity. CONCLUSION The results indicate that the German QoL-AD self-report scale is a suitable instrument for assessing QoL in patients suffering from mild to moderate dementia, thus supporting its use in clinical practice and research.
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Affiliation(s)
- Vanessa Stypa
- Department of Geriatric Psychiatry and Psychotherapy, LVR-Hospital Cologne, Cologne, Germany
| | - Peter Haussermann
- Department of Geriatric Psychiatry and Psychotherapy, LVR-Hospital Cologne, Cologne, Germany
| | - Tim Fleiner
- Department of Geriatric Psychiatry and Psychotherapy, LVR-Hospital Cologne, Cologne, Germany.,Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany
| | - Sandra Neumann
- Inclusive Education of Children with Communication Needs, University Erfurt, Erfurt, Germany
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Schüssler S, Zuschnegg J, Paletta L, Fellner M, Lodron G, Steiner J, Pansy-Resch S, Lammer L, Prodromou D, Brunsch S, Holter M, Carnevale L, Russegger S. Effects of a Humanoid Socially Assistive Robot Versus Tablet Training on Psychosocial and Physical Outcomes of Persons With Dementia: Protocol for a Mixed Methods Study. JMIR Res Protoc 2020; 9:e14927. [PMID: 32022697 PMCID: PMC7055795 DOI: 10.2196/14927] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/12/2019] [Accepted: 09/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background New technologies, like socially assistive robots (SARs), may have the potential to support caregivers at home. Still, the evidence for people with dementia in home care is unclear because a lot of studies are performed in a laboratory or institutional setting, and mainly use robots in prototype stages. Objective This study aims to explore the effects of the refined, commercially-available, humanoid SAR Pepper combined with a tablet PC–based dementia training program (Coach Pepper) versus an exclusively tablet PC–based dementia training program on psychosocial and physical outcomes of people with dementia living at home, including caregivers and dementia trainers. We hypothesize that Coach Pepper has a more positive effect on the primary outcome motivation (stable or decreased apathy) of people with dementia. Methods A mixed methods study will be performed, including a randomized controlled, parallel, 2-arm study with a complementary qualitative part. This sample includes 40 PWD living at home and 40 relatives, each complemented with five professional caregivers and dementia trainers. The intervention group will receive Coach Pepper (a SAR connected with a tablet PC–based dementia training program), and the control group will receive exclusively tablet PC–based training without the SAR. The duration of the intervention will be three weeks per household. Data will be collected at baseline and during and after the intervention by standardized questionnaires, sensor data of the robot, and tablet PC, as well as semistructured interviews, focus groups, and observation. Results To date, no results are available for this study protocol. The study intervention started in May 2019 and will end in Spring 2020. Conclusions The intervention of this study can be seen as a nonpharmacological intervention, including cognitive and physical training by a robot. This study will help to further refine SAR for the specific needs of people with dementia living at home. International Registered Report Identifier (IRRID) DERR1-10.2196/14927
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Affiliation(s)
- Sandra Schüssler
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Julia Zuschnegg
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Lucas Paletta
- Institut Digital, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
| | - Maria Fellner
- Institut Digital, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
| | - Gerald Lodron
- Institut Digital, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
| | - Josef Steiner
- Sozialverein Deutschlandsberg, Deutschlandsberg, Austria
| | | | - Lara Lammer
- Humanizing Technologies GmbH, Vienna, Austria
| | | | | | - Magdalena Holter
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | | | - Silvia Russegger
- Institut Digital, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
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6
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Cleland J, Hutchinson C, Khadka J, Milte R, Ratcliffe J. A Review of the Development and Application of Generic Preference-Based Instruments with the Older Population. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:781-801. [PMID: 31512086 DOI: 10.1007/s40258-019-00512-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Older people (aged 65 years and over) are the fastest growing age cohort in the majority of developed countries, and the proportion of individuals defined as the oldest old (aged 80 years and over) living with physical frailty and cognitive impairment is rising. These population changes put increasing pressure on health and aged care services, thus it is important to assess the cost effectiveness of interventions targeted for older people across health and aged care sectors to identify interventions with the strongest capacity to enhance older peoples' quality of life and provide value for money. Cost-utility analysis (CUA) is a form of economic evaluation that typically uses preference-based instruments to measure and value health-related quality of life for the calculation of quality-adjusted life-years (QALYS) to enable comparisons of the cost effectiveness of different interventions. A variety of generic preference-based instruments have been used to measure older people's quality of life, including the Adult Social Care Outcomes Toolkit (ASCOT); Health Utility Index Mark 2 (HUI2); Health Utility Index Mark 3 (HUI3); Short-Form-6 Dimensions (SF-6D); Assessment of Quality of Life-6 dimensions (AQoL-6D); Assessment of Quality of Life-8 dimensions (AQoL-8D); Quality of Wellbeing Scale-Self-Administered (QWB-SA); 15 Dimensions (15D); EuroQol-5 dimensions (EQ-5D); and an older person specific preference-based instrument-the Investigating Choice Experiments Capability Measure for older people (ICECAP-O). This article reviews the development and application of these instruments within the older population and discusses the issues surrounding their use with this population. Areas for further research relating to the development and application of generic preference-based instruments with populations of older people are also highlighted.
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Affiliation(s)
- Jenny Cleland
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - Claire Hutchinson
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - Jyoti Khadka
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
- Healthy Ageing Research Consortium, Registry of Older South Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia.
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Gerstenecker A, Martin RC, Triebel KL, Marson DC. Anosognosia of financial ability in mild cognitive impairment. Int J Geriatr Psychiatry 2019; 34:1200-1207. [PMID: 30968462 DOI: 10.1002/gps.5118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 04/08/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Although financial ability has been well-studied in mild cognitive impairment (MCI) and Alzheimer's disease (AD) using performance-based financial capacity assessment instruments, research is limited investigating everyday financial problems and declines in persons with AD and MCI and the insight of people with MCI to recognize that financial capacity declines are occurring. To address this gap in the research, we investigated everyday financial activities and skills in a sample of older adults representing the dementia spectrum. METHODS Participants were 186 older adults in three diagnostic classifications: cognitively healthy, MCI likely due to AD, and mild AD dementia. Everyday financial ability was assessed using the Current Financial Activities Report (CFAR). The CFAR is a standardized report-based measure which elicits participant and study partner ratings about a participant's everyday financial abilities. RESULTS Results showed that both CFAR self- and study partner-report distinguished diagnostic groups on key financial capacity variables in a pattern consistent with level of clinical pathology. Study partner-report indicated higher levels of financial skill difficulties in study participants than did the self-report of the same study participants. Study partner-ratings were more highly correlated with participant scores on a performance-based measure of financial capacity than were participant self-ratings. Results also showed that loss of awareness of financial decline is emerging at the MCI stage of AD. CONCLUSIONS People with MCI represent a group of older adults at particular risk for financial missteps and-similar to people with AD-are in need of supervision of their financial skills and activities.
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Affiliation(s)
- Adam Gerstenecker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL.,Alzheimer's Disease Center, University of Alabama at Birmingham, Birmingham, AL
| | - Roy C Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL.,Alzheimer's Disease Center, University of Alabama at Birmingham, Birmingham, AL
| | - Kristen L Triebel
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL.,Alzheimer's Disease Center, University of Alabama at Birmingham, Birmingham, AL
| | - Daniel C Marson
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL.,Alzheimer's Disease Center, University of Alabama at Birmingham, Birmingham, AL
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Picard G, Bier JC, Capron I, De Deyn PP, Deryck O, Engelborghs S, Hanseeuw B, Lemper JC, Mormont E, Petrovic M, Salmon E, Segers K, Sieben A, Thiery E, Ventura M, Versijpt J, Ivanoiu A. Dementia, End of Life, and Euthanasia: A Survey Among Dementia Specialists Organized by the Belgian Dementia Council. J Alzheimers Dis 2019; 69:989-1001. [DOI: 10.3233/jad-181277] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Gaëtane Picard
- Department of Neurology, Clinique Saint-Pierre, Ottignies, Belgium
| | - Jean-Christophe Bier
- Department of Neurology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Capron
- Department of Neurology, Cliniques de l’Europe – St Michel, Brussels, Belgium
| | - Peter Paul De Deyn
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Belgium
- Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Olivier Deryck
- Department of Neurology, Memory Clinic General Hospital Sint-Jan Brugge-Oostende Brugge, Belgium
| | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Belgium
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Center for Neurosciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Bernard Hanseeuw
- Department of Neurology, Cliniques Universitaires St Luc, Université catholique de Louvain, Brussels, Belgium
- Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium
| | | | - Eric Mormont
- Department of Neurology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
- Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium
| | - Mirko Petrovic
- Department of Internal Medicine, Section of Geriatrics, Ghent University, Gent, Belgium
| | - Eric Salmon
- GIGA Cyclotron Research Centre Imaging, University of Liége, Liége, Belgium
- Department of Neurology, Memory Clinic, Centre Hospitalier Universitaire (CHU) Liége, Liége, Belgium
| | - Kurt Segers
- Department of Neurology, Brugmann University Hospital, Brussels, Belgium
| | - Anne Sieben
- Department of Neurology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Evert Thiery
- Department of Neurology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | | | - Jan Versijpt
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Center for Neurosciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Adrian Ivanoiu
- Department of Neurology, Cliniques Universitaires St Luc, Université catholique de Louvain, Brussels, Belgium
- Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium
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Item distribution, internal consistency, and structural validity of the German version of the DEMQOL and DEMQOL-proxy. BMC Geriatr 2018; 18:247. [PMID: 30340468 PMCID: PMC6194625 DOI: 10.1186/s12877-018-0930-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/26/2018] [Indexed: 11/25/2022] Open
Abstract
Background Accurate assessment of health-related quality of life as an endpoint in intervention studies is a major challenge in dementia research. The DEMQOL (29 items) and the proxy version (32 items), which is partly based on the DEMQOL, are internationally used instruments. To date, there is no information on the structural validity, item distribution, or internal consistency for the German language version of these questionnaires. Methods This psychometric study is based on a secondary data analysis of a sample of 201 outpatients with a mild form of Alzheimer’s disease (AD) and their informal caregivers. The informal caregivers who were interviewed were involved in the care of the person with AD several times per week. The analysis for the evaluation of the structural validity was performed using Mokken scale analysis. The internal consistency was calculated using the ρ of the Molenaar Sijtsma statistic and Cronbach’s α. Results For both versions, four subscales were identified: [A] “positive emotions”, [B] “negative emotions”, [C] “physical and cognitive functioning”, and [D] “daily activities and social relationships”. For both instruments, the internal consistency of all subscales was considered “good” (ρ = 0.71–0.88, α = 0.72–0.87). Conclusions The results are a first indication of good construct validity of the instruments used for the German setting. We recommend further investigations of the test-retest reliability and the inter-rater reliability of the proxy instrument. Electronic supplementary material The online version of this article (10.1186/s12877-018-0930-0) contains supplementary material, which is available to authorized users.
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Discrepancies Between Alzheimer’s Disease Patients’ and Caregivers’ Ratings About Patients’ Quality of Life. Alzheimer Dis Assoc Disord 2018; 32:240-246. [DOI: 10.1097/wad.0000000000000232] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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11
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Easton T, Milte R, Crotty M, Ratcliffe J. An empirical comparison of the measurement properties of the EQ-5D-5L, DEMQOL-U and DEMQOL-Proxy-U for older people in residential care. Qual Life Res 2018; 27:1283-1294. [PMID: 29305782 PMCID: PMC5891554 DOI: 10.1007/s11136-017-1777-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to empirically compare the measurement properties of self-reported and proxy-reported (in cases of severe cognitive impairment) generic (EQ-5D-5L) and condition-specific (DEMQOL-U and DEMQOL-Proxy-U) preference-based HRQoL instruments in residential care, where the population is characterised by older people with high rates of cognitive impairment, dementia and disability. METHODS Participants were recruited from seventeen residential care facilities across four Australian states. One hundred and forty-three participants self-completed the EQ-5D-5L and the DEMQOL-U while three hundred and eight-seven proxy completed (due to the presence of severe dementia) the EQ-5D-5L and DEMQOL-Proxy-U. The convergent validity of the outcome measures and known group validity relative to a series of clinical outcome measures were assessed. RESULTS Results satisfy convergent validity among the outcome measures. EQ-5D-5L and DEMQOL-U utilities were found to be significantly correlated with each other (p < 0.01) as were EQ-5D-5L and DEMQOL-Proxy-U utilities (p < 0.01). Both self-reported and proxy-reported EQ-5D-5L utilities demonstrated strong known group validity in relation to clinically recognised thresholds of cognition and physical functioning, while in contrast neither DEMQOL-U nor DEMQOL-Proxy-U demonstrated this association. CONCLUSIONS The findings suggest that the EQ-5D-5L, DEMQOL-U and DEMQOL-Proxy-U capture distinct aspects of HRQoL for this population. The measurement and valuation of HRQoL form an essential component of economic evaluation in residential care. However, high levels of cognitive impairment may preclude self-completion for a majority. Further research is needed to determine cognition thresholds beyond which an individual is unable to reliably self-report their own health-related quality of life.
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Affiliation(s)
- Tiffany Easton
- Flinders Health Economics Group, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Sydney, NSW, Australia
| | - Rachel Milte
- Institute for Choice, Business School, University of South Australia, Adelaide, SA, Australia
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Sydney, NSW, Australia
| | - Maria Crotty
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Sydney, NSW, Australia
- Rehabilitation, Aged and Extended Care, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Julie Ratcliffe
- Institute for Choice, Business School, University of South Australia, Adelaide, SA, Australia.
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Sydney, NSW, Australia.
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Easton T, Milte R, Crotty M, Ratcliffe J. Where's the evidence? a systematic review of economic analyses of residential aged care infrastructure. BMC Health Serv Res 2017; 17:226. [PMID: 28327120 PMCID: PMC5361718 DOI: 10.1186/s12913-017-2165-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/15/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Residential care infrastructure, in terms of the characteristics of the organisation (such as proprietary status, size, and location) and the physical environment, have been found to directly influence resident outcomes. This review aimed to summarise the existing literature of economic evaluations of residential care infrastructure. METHODS A systematic review of English language articles using AgeLine, CINAHL, Econlit, Informit (databases in Health; Business and Law; Social Sciences), Medline, ProQuest, Scopus, and Web of Science with retrieval up to 14 December 2015. The search strategy combined terms relating to nursing homes, economics, and older people. Full economic evaluations, partial economic evaluations, and randomised trials reporting more limited economic information, such as estimates of resource use or costs of interventions were included. Data was extracted using predefined data fields and synthesized in a narrative summary to address the stated review objective. RESULTS Fourteen studies containing an economic component were identified. None of the identified studies attempted to systematically link costs and outcomes in the form of a cost-benefit, cost-effectiveness, or cost-utility analysis. There was a wide variation in approaches taken for valuing the outcomes associated with differential residential care infrastructures: 8 studies utilized various clinical outcomes as proxies for the quality of care provided, and 2 focused on resident outcomes including agitation, quality of life, and the quality of care interactions. Only 2 studies included residents living with dementia. CONCLUSIONS Robust economic evidence is needed to inform aged care facility design. Future research should focus on identifying appropriate and meaningful outcome measures that can be used at a service planning level, as well as the broader health benefits and cost-saving potential of different organisational and environmental characteristics in residential care. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) registration number CRD42015015977 .
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Affiliation(s)
- Tiffany Easton
- Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, SA Australia
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, Canberra, Australia
- Rehabilitation, Aged and Extended Care, School of Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001 Australia
| | - Rachel Milte
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, Canberra, Australia
- Rehabilitation, Aged and Extended Care, School of Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001 Australia
- Institute for Choice, Business School, University of South Australia, Adelaide, SA Australia
| | - Maria Crotty
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, Canberra, Australia
- Rehabilitation, Aged and Extended Care, School of Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001 Australia
| | - Julie Ratcliffe
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, Canberra, Australia
- Institute for Choice, Business School, University of South Australia, Adelaide, SA Australia
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Avondino E, Antoine P. Heterogeneity of Cognitive Anosognosia and its Variation with the Severity of Dementia in Patients with Alzheimer's Disease. J Alzheimers Dis 2016; 50:89-99. [PMID: 26638866 DOI: 10.3233/jad-150496] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Currently, the lack of awareness of deficits, i.e., anosognosia, is a major obstacle in the healthcare circuit that delays the diagnosis of Alzheimer's disease (AD). However, a clear framework is lacking in the literature related to this phenomenon in terms of its definition, mechanisms, and objects. The aim of this study is to assess the different levels of cognitive anosognosia using a prediction-performance procedure and to identify the potential correlates of these levels. A sample of patients with probable AD was divided into three groups according to the severity of dementia (mild (MiD), moderate (MoD), and moderately severe (MSD) dementia), ranked according to the results of the Mini-Mental State Examination. We observed the following three scores: the real score, the prediction score, and the anosognosia score. These scores were calculated based on the prediction-performance task MISAwareness from the Dementia Rating Scale for cognitive processes (i.e., Attention, Initiation, Conceptualization, Construction, and Memory). We obtained a strong plateau effect between the MiD and MoD groups for anosognosia scores for actual performance or prediction for both the level of overall functioning and for specific processes. The sole exception was the result for memory processes. Moreover, the profiles of the patients' responses on the Memory subscale were substantially different and, indeed, opposite from those for the other processes. The main results confirm the multidimensionality of anosognosia and its variability with the stage of dementia and specifically implicate memory processes that indicate a cleavage between memory and other cognitive functions.
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Kelleher M, Tolea MI, Galvin JE. Anosognosia increases caregiver burden in mild cognitive impairment. Int J Geriatr Psychiatry 2016; 31:799-808. [PMID: 26643996 PMCID: PMC8483618 DOI: 10.1002/gps.4394] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/30/2015] [Accepted: 11/03/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Our aim is to determine the clinical correlates of impaired insight in patients with mild cognitive impairment (MCI) by examining its impact on cognition, functional status, neuropsychiatric symptoms, and caregiver burden. METHODS The study involved 75 patients with MCI and their caregivers. Patients and caregivers underwent a comprehensive evaluation including the Clinical Dementia Rating, memory tests, and the Functional Assessment Questionnaire. Behavioral symptoms were assessed by the Neuropsychiatric Inventory, caregiver burden by the Zarit Burden Inventory, and insight by comparing self-report on the AD8 dementia screening tool to informant collateral. Patients were asked about their perceptions of their memory, and answers were compared with informants' responses. Patient mood was assessed with the Hospital Anxiety Depression Scale. RESULTS There was a significant difference in AD8 scores among patients who retained versus lacked insight. Zarit Burden Inventory scores showed a significant rise as patient insight declined; the burden appeared greater on spouse versus non-spouse caregivers. Patients with poor insight had significantly worse ratings in Clinical Dementia Rating domains of personal care and judgment, while patients who retained insight had significantly higher depression and anxiety. Insight impairment was associated with worse caregiver mood. CONCLUSIONS Decreased patient awareness for cognitive problems was significantly associated with higher caregiver burden, independent of neuropsychiatric symptoms, functional abilities, and cognition. Personal care, judgment, and problem-solving skills could contribute to caregiver burden. Increased awareness seemed a source of patient depression and anxiety. The research highlights the need to focus on the needs of MCI caregivers and to incorporate psychosocial assessments of caregiver-patient dyads into office visits.
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Affiliation(s)
- Mary Kelleher
- Center for Cognitive Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Magdalena I. Tolea
- Center for Cognitive Neurology, NYU Langone Medical Center, New York, NY, USA,Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - James E. Galvin
- Center for Cognitive Neurology, NYU Langone Medical Center, New York, NY, USA,Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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Conde-Sala JL, Turró-Garriga O, Portellano-Ortiz C, Viñas-Diez V, Gascón-Bayarri J, Reñé-Ramírez R. Self-Perceived Quality of Life Among Patients with Alzheimer’s Disease: Two Longitudinal Models of Analysis. J Alzheimers Dis 2016; 52:999-1012. [DOI: 10.3233/jad-160040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Josep L. Conde-Sala
- Faculty of Psychology, University of Barcelona, Spain
- Aging, Disability and Health Research Group, Biomedical Research Institute of Girona (IdIBGi), Catalonia, Spain
| | - Oriol Turró-Garriga
- Aging, Disability and Health Research Group, Biomedical Research Institute of Girona (IdIBGi), Catalonia, Spain
| | | | - Vanesa Viñas-Diez
- Department of Neurology, Dementia Unit, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Jordi Gascón-Bayarri
- Department of Neurology, Dementia Unit, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Ramón Reñé-Ramírez
- Department of Neurology, Dementia Unit, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
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Baptista MAT, Santos RL, Kimura N, Lacerda IB, Johannenssen A, Barca ML, Engedal K, Dourado MCN. Quality of life in young onset dementia: an updated systematic review. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2016; 38:6-13. [DOI: 10.1590/2237-6089-2015-0049] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/28/2015] [Indexed: 11/22/2022]
Abstract
Introduction Young onset dementia (YOD) develops before 65 years of age and has specific age-related adverse consequences for quality of life (QoL). We systematically examined factors related to the QoL of people with YOD and their caregivers. Method This systematic review used the PRISMA methodology. The literature search was undertaken on July 5, 2015, using Cochrane, PubMed, SciELO, PsycINFO, Scopus and Thomson Reuters Web of Science electronic databases. The search keywords included early onset and young onset combined with, dementia, Alzheimer, vascular dementia, mixed dementia, frontotemporal dementia, quality of life, well-being and unmet needs. Nine studies were included. We revised objectives, study design, sample, instruments and results related to QoL. Results People with YOD rated their own QoL significantly higher than their caregivers. Greater awareness of disease among people with YOD is associated with better QoL in caregivers. A relationship was found between unmet needs and daytime activities, lack of companionship and difficulties with memory. Issues associated with unmet needs were prolonged time to diagnosis, available health services and lack of caregiver's own future perspective. Conclusion Consideration should be given to conducting investigations with more homogeneous samples and use of a clear concept of QoL. The present study highlights the need for future research in a wider range of countries, using instruments specifically for YOD. It would be interesting if studies could trace parallels with late onset dementia groups.
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Self-awareness in Mild Cognitive Impairment: Quantitative evidence from systematic review and meta-analysis. Neurosci Biobehav Rev 2016; 61:90-107. [DOI: 10.1016/j.neubiorev.2015.10.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 10/11/2015] [Accepted: 10/12/2015] [Indexed: 12/20/2022]
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Conde-Sala JL, Turró-Garriga O, Piñán-Hernández S, Portellano-Ortiz C, Viñas-Diez V, Gascón-Bayarri J, Reñé-Ramírez R. Effects of anosognosia and neuropsychiatric symptoms on the quality of life of patients with Alzheimer's disease: a 24-month follow-up study. Int J Geriatr Psychiatry 2016; 31:109-19. [PMID: 25963296 DOI: 10.1002/gps.4298] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/15/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Neuropsychiatric symptoms and anosognosia are known to influence the perceived quality of life of patients (QoL-p) with Alzheimer's disease (AD). This study analysed their impact on patient and caregiver ratings of QoL-p and how these ratings changed in relation to the severity of dementia. METHODS A baseline sample of 221 patients and caregivers was followed up over 24 months. Instruments: Neuropsychiatric Inventory (NPI), Anosognosia Questionnaire-Dementia (AQ-D), Quality of life-Alzheimer's Disease (QoL-AD) and the Global Deterioration Scale (GDS). Longitudinal data were analysed using generalized linear models. RESULTS In the multivariate analysis, greater anosognosia was always associated with higher ratings of QoL-p among patients, especially at 24 months (p < 0.001), and with more negative ratings among caregivers, especially at baseline (p < 0.001). A higher total NPI score was associated with a more negative rating of QoL-p among caregivers (p < 0.001), and it also had a smaller negative effect on patients' self-ratings (p = 0.001). The neuropsychiatric symptoms (NPI) associated with a more negative view of QoL-p were depression, for patients' self-ratings, and apathy and agitation for caregiver ratings. The discrepancy between patient and caregiver ratings increased in line with the severity of dementia. CONCLUSION Neuropsychiatric symptoms had a similarly negative effect on the QoL-p ratings of both patients and caregivers, whereas the effect of anosognosia differed according to the rater (positive for patients, negative for caregivers).
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Affiliation(s)
| | - Oriol Turró-Garriga
- Research Unit, Santa Caterina Hospital, Institut d'Assistència Sanitària, Salt, Spain
| | | | | | - Vanesa Viñas-Diez
- Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Jordi Gascón-Bayarri
- Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Ramón Reñé-Ramírez
- Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
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Dourado MC, Sousa MFD, Santos RL, Simões JP, Nogueira ML, Belfort TT, Torres B, Dias R, Laks J. Quality of life in mild dementia: patterns of change in self and caregiver ratings over time. ACTA ACUST UNITED AC 2016; 38:294-300. [PMID: 26785107 PMCID: PMC7111349 DOI: 10.1590/1516-4446-2014-1642] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/23/2015] [Indexed: 11/22/2022]
Abstract
Objectives: To determine changes over time in self and caregiver ratings of quality of life (QoL) in people with dementia (PwD) and to identify factors associated with changes in QoL ratings. Methods: In this longitudinal study, 69 people with mild Alzheimer’s disease and their caregivers were assessed at baseline and after 1 year. We examined the association of QoL ratings with the following variables at the two time points: awareness of disease, cognitive status, mood, functionality, neuropsychiatric symptoms, and caregiver burden. Multivariate regression analyses were conducted to examine the contribution of co-factors. Results: At baseline, PwD self-ratings of QoL were associated with caregiver ratings of PwD QoL (p = 0.001). Caregiver ratings were associated with PwD mood (p = 0.001) and self-rated QoL (p = 0.001). After 1 year, caregiver ratings of PwD QoL changed significantly (p = 0.049, d = -0.27), whereas PwD self-ratings did not (p = 0.89, d = 0.09). PwD awareness of disease changed significantly (p = 0.001) at 1 year, having declined in 25.4% and improved in 12.3% of participants. PwD QoL self-ratings were associated with caregiver ratings (p = 0.001). Caregiver ratings of PwD QoL after 1 year were associated with PwD mood (p = 0.029), self-reported QoL (p = 0.001), and awareness of disease (p = 0.033). Conclusions: The association between self and caregiver ratings of PwD QoL was maintained over 1 year. The primary factors accounting for the change in caregiver ratings were PwD mood and awareness of disease. QoL and cognitive impairment seem to be relatively independent in mild dementia.
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Affiliation(s)
- Marcia C Dourado
- Centro para Doença de Alzheimer e Outros Transtornos Mentais na Velhice, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Maria F de Sousa
- Centro para Doença de Alzheimer e Outros Transtornos Mentais na Velhice, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Raquel L Santos
- Centro para Doença de Alzheimer e Outros Transtornos Mentais na Velhice, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - José P Simões
- Centro de Estudos e Pesquisa do Envelhecimento, Instituto Vital Brazil, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Marcela L Nogueira
- Centro para Doença de Alzheimer e Outros Transtornos Mentais na Velhice, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Tatiana T Belfort
- Centro para Doença de Alzheimer e Outros Transtornos Mentais na Velhice, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Bianca Torres
- Centro para Doença de Alzheimer e Outros Transtornos Mentais na Velhice, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Rachel Dias
- Centro para Doença de Alzheimer e Outros Transtornos Mentais na Velhice, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Jerson Laks
- Centro para Doença de Alzheimer e Outros Transtornos Mentais na Velhice, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Centro de Estudos e Pesquisa do Envelhecimento, Instituto Vital Brazil, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Mak E, Chin R, Ng LT, Yeo D, Hameed S. Clinical associations of anosognosia in mild cognitive impairment and Alzheimer's disease. Int J Geriatr Psychiatry 2015; 30:1207-14. [PMID: 25754519 DOI: 10.1002/gps.4275] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/27/2015] [Accepted: 01/29/2015] [Indexed: 12/15/2022]
Abstract
AIMS AND OBJECTIVE While loss of insight of cognitive deficits is a common phenomenon in patients with Alzheimer's disease (AD), there is a lack of consensus regarding the presence of impaired insight among patients with mild cognitive impairment (MCI). We aim to investigate the clinical, cognitive, and behavioral associations of anosognosia in AD and MCI subjects. METHODS A consecutive series of 87 subjects (30 healthy older patients, 21 MCI, and 36 AD) each accompanied by a caregiver, underwent clinical assessment including the evaluation of insight using the Anosognosia Questionnaire for Dementia (AQD). We also separately assessed Intellectual Function (AQD-IF) and Behavior domains of the AQD scale. Regression models were subsequently used to investigate associations of AQD scores with cognitive and other neuropsychiatric symptoms, including depression and apathy. RESULTS Both AD and MCI groups demonstrated significant anosognosia compared with the healthy control group. In the AD group, 55.6% had "Mild Anosognosia," and 27.8% had "Severe Anosognosia." In the MCI group, 42.9% showed "Mild Anosognosia," and 9.5% had "Severe Anosognosia." Greater levels of AQD-Total and AQD-IF were associated with lower Mini-mental state examination and higher apathy scores in the AD group. In the MCI group, caregiver burden was significantly associated with AQD-Total (p = 0.016) and AQD-IF (p = 0.039). CONCLUSION The results indicated that anosognosia is common in both AD and MCI patients and associated with cognitive dysfunction and apathy in AD. The findings of this study warrant further research to delineate the mechanisms of anosognosia as it poses a challenge to treatment outcomes.
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Affiliation(s)
- E Mak
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - R Chin
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - L T Ng
- Department of Neurology, Singapore General Hospital, Singapore, Singapore
| | - D Yeo
- Department of Neurology, Singapore General Hospital, Singapore, Singapore
| | - S Hameed
- Department of Neurology, Singapore General Hospital, Singapore, Singapore
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Dichter MN, Schwab CGG, Meyer G, Bartholomeyczik S, Halek M. Linguistic validation and reliability properties are weak investigated of most dementia-specific quality of life measurements-a systematic review. J Clin Epidemiol 2015; 70:233-45. [PMID: 26319270 DOI: 10.1016/j.jclinepi.2015.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 07/20/2015] [Accepted: 08/11/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE For people with dementia, the concept of quality of life (Qol) reflects the disease's impact on the whole person. Thus, Qol is an increasingly used outcome measure in dementia research. This systematic review was performed to identify available dementia-specific Qol measurements and to assess the quality of linguistic validations and reliability studies of these measurements (PROSPERO 2013: CRD42014008725). STUDY DESIGN AND SETTING The MEDLINE, CINAHL, EMBASE, PsycINFO, and Cochrane Methodology Register databases were systematically searched without any date restrictions. Forward and backward citation tracking were performed on the basis of selected articles. RESULTS A total of 70 articles addressing 19 dementia-specific Qol measurements were identified; nine measurements were adapted to nonorigin countries. The quality of the linguistic validations varied from insufficient to good. Internal consistency was the most frequently tested reliability property. Most of the reliability studies lacked internal validity. CONCLUSION Qol measurements for dementia are insufficiently linguistic validated and not well tested for reliability. None of the identified measurements can be recommended without further research. The application of international guidelines and quality criteria is strongly recommended for the performance of linguistic validations and reliability studies of dementia-specific Qol measurements.
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Affiliation(s)
- Martin Nikolaus Dichter
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Straße 12, 58453 Witten, Germany; School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453 Witten, Germany.
| | - Christian G G Schwab
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Straße 12, 58453 Witten, Germany; School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453 Witten, Germany
| | - Gabriele Meyer
- School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453 Witten, Germany; Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112 Halle (Saale), Germany
| | - Sabine Bartholomeyczik
- School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453 Witten, Germany
| | - Margareta Halek
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Straße 12, 58453 Witten, Germany; School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453 Witten, Germany
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Gomez-Gallego M, Gomez-Garcia J, Ato-Lozano E. Addressing the bias problem in the assessment of the quality of life of patients with dementia: determinants of the accuracy and precision of the proxy ratings. J Nutr Health Aging 2015; 19:365-72. [PMID: 25732223 DOI: 10.1007/s12603-014-0564-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We aimed to examine the discrepancy between patients and caregivers' ratings of quality of life in terms of accuracy and precision, and identify factors associated with it, in order to facilitate the use of this scale as dementia progresses. DESIGN Cross-sectional analytic study. SETTING Day care centres. PARTICIPANTS Community-living patients with Alzheimer's disease in early or moderate stage and their principal caregivers. MEASUREMENTS PARTICIPANTS rated patients' quality of life using DEMQOL. The discrepancy was assessed using the individual difference score and the residuals for each domain of DEMQOL. The scores on Mini-Mental State Examination, Geriatric Depression Scale, Neuropsychiatric Inventory, Clinical Insight Rating Scale, Cumulative Illness Rating Scale, Health Utilities Index Mark 3 and Zarit Burden Interview were considered as possible predictors of the discrepancy. RESULTS A total of 276 subjects participated in the study (138 patients with Alzheimer's disease and their caregivers). Discrepancy measured by individual difference score was lower than that measured by the residuals. Burden and mood-related symptoms explained the positive differences and residuals, while pain, self-perceived depression and cognition determined the negative ones. CONCLUSIONS Differences exist between patients and caregivers' perceptions about subjective states. The evaluations of each informant seem to be influenced by their own emotional state and the inner experience of the effects of the disease. Caregivers' ratings on DEMQOL could be useful to monitor the efficacy of any treatment whenever burden is low and patients have no great physical or emotional suffering.
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Affiliation(s)
- M Gomez-Gallego
- Maria Gomez-Gallego, Campus de Los Jerónimos, 30107 Murcia, Telephone: (+34) 968 27 88 00,
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Richarz U, Gaudig M, Rettig K, Schauble B. Galantamine treatment in outpatients with mild Alzheimer's disease. Acta Neurol Scand 2014; 129:382-92. [PMID: 24461047 DOI: 10.1111/ane.12195] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess long-term effectiveness of galantamine in community-dwelling persons with mild Alzheimer's disease. METHODS Prospective open-label trial including patients with mild AD (NINCDS-ADRDA criteria) treated with galantamine for up to 36 months. Outcome parameters included ADAS-cog/11, Bayer-ADL scale (self- and caregivers' ratings), 10-item NPI and CGI-change, safety and tolerability measures. Data are presented based on ITT analyses (LOCF). RESULTS Seventy-five patients (55% women; mean ADAS-cog 22.3; mean age 70.2 years) were treated with galantamine for approximately 36 months. About 60% (n=45) received a total daily dose of 24 mg galantamine at final visit. After 3, 6, and 12 months of treatment, mean improvements in ADAS-cog ranged between 2.2 and 3.0 points (all P<0.05). After 24-month treatment, ADAS-cog returned to baseline value and at 3-year follow-up, patient deteriorated on average by 2.9 points. There was significant improvement on the NPI scale between baseline and 3- to 12-month follow-up (all P<0.05) and at 3-year endpoint, a slight deterioration was noted. Activities of daily living (B-ADL) decreased significantly after 24 months in self-ratings and after 12 months in caregivers' ratings. Fifty-four patients reported at least one AE, most of them occurring during the first 2 years of treatment. Among the most frequently (>10%) reported AEs irrespective of causal relationship to study medication were nausea (17.3%), dizziness (12%), and vomiting (10.7%). CONCLUSION Galantamine was generally safe and well tolerated during the 3-year observation period. Cognition, behavior, and activities of daily living improved during 12 months treatment. At 3-year follow-up, worsening in all outcomes was measured; however, cognition remained improved compared with an untreated population.
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Affiliation(s)
- U. Richarz
- Global Medical Affairs; GMAL Established Products; Janssen Global Services LCC; Titusville NJ USA
| | - M. Gaudig
- Health Economics & Reimbursement; Janssen; Neuss Germany
| | | | - B. Schauble
- EMEA Medical Affairs; Janssen; Neuss Germany
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Gitlin LN, Hodgson N, Piersol CV, Hess E, Hauck WW. Correlates of quality of life for individuals with dementia living at home: the role of home environment, caregiver, and patient-related characteristics. Am J Geriatr Psychiatry 2014; 22:587-97. [PMID: 23890928 PMCID: PMC4091677 DOI: 10.1016/j.jagp.2012.11.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 11/05/2012] [Accepted: 11/07/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine prevalence of modifiable risk factors and their contribution to patient quality of life (QoL) as rated by dementia patients and family caregivers. DESIGN Cross-sectional. SETTING Home environment. PARTICIPANTS 88 patients and their caregivers. MEASUREMENTS Modifiable characteristics of home environments, patients, and caregivers were observed or obtained through interview. Demographics and ratings of patients' QoL were obtained from patients and caregivers. RESULTS Patients had mean Mini-mental Status Examination (MMSE) score = 17.7 ± 4.6, (range: 10-28) on an average 7.7 ± 2.4 neuropsychiatric behaviors, 6.0 ± 3.1 health conditions and moderate functional challenges; 70.7% (N = 58) had fall risk; 60.5% (N = 52) had sleep problems at least once weekly; and 42.5% (N = 37) had pain. An average of 8.1 ± 5.2 home hazards and 5.4 ± 4.1 adaptations were observed; 51.7% had unmet device/navigation needs. Patients' and caregivers' QoL ratings were unrelated to MMSE; and patients' self-rated QoL was higher than rated by caregivers. Number of health conditions and unmet device/navigation needs were inversely associated with patient self-rated QoL, and number of health conditions, frequency of behaviors, and level of negative communications were inversely associated with caregiver's assessment of patient QoL. Positive endorsement of caregiving was positively associated with caregiver's appraisal of patient QoL. Other factors were unrelated. CONCLUSIONS Most patients lived at home with high fall risk, unmanaged behavioral symptoms, pain, sleep disturbances, environmental challenges, and multiple hazards. Except for health, factors associated with lower QoL differed for patients and caregivers. Results suggest need to improve QoL by addressing modifiable risk factors and tailoring interventions to patient and caregiver perspectives.
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Affiliation(s)
- Laura N Gitlin
- Johns Hopkins University School of Nursing, Baltimore, MD.
| | - Nancy Hodgson
- Johns Hopkins University School of Nursing, Baltimore, MD
| | | | - Edward Hess
- Johns Hopkins University School of Medicine, Baltimore, MD
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Stewart-Archer LA, Afghani A, Toye CM, Gomez FA. Dialogue on Ideal End-of-Life Care for Those With Dementia. Am J Hosp Palliat Care 2014; 32:620-30. [PMID: 24782574 DOI: 10.1177/1049909114532342] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To identify both meanings and perceptions of delivery of end-of-life (EoL) care for the person experiencing dementia. DESIGN/METHODS As part of a larger cross-sectional mixed methods study examining quality of life in dementia, perspectives of EoL care were sought from 136 seniors using open-ended questions administered at interview. RESULTS Seniors living in various settings identified obligatory requisites of care as time when the finality of death needed to be accepted, comfort was prioritized, family presence was valued, appearance remained important, and solitude or time "to be with God" was stressed. Skilled nursing care, honesty, and engaged family were also necessary. IMPLICATIONS Understanding EoL preferences of those with dementia is critical for advocacy and service delivery.
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Affiliation(s)
- Lois A Stewart-Archer
- Winnipeg Health Region, Winnipeg, Manitoba, Canada Helen Glass Centre for Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Afrooz Afghani
- School of Arts & Sciences, Brandman University, Irvine, CA, USA
| | - Christine M Toye
- Older Persons' Health Care, School of Nursing & Midwifery, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Frank A Gomez
- College of Health Sciences, Trident University International, Cypress, CA, USA
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Severity of dementia, anosognosia, and depression in relation to the quality of life of patients with Alzheimer disease: discrepancies between patients and caregivers. Am J Geriatr Psychiatry 2014; 22:138-47. [PMID: 23567444 DOI: 10.1016/j.jagp.2012.07.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 05/30/2012] [Accepted: 07/12/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the factors associated with discrepancies between patient and caregiver reports of the quality of life of patients (QoLp) with Alzheimer disease. METHODS Cross-sectional analytic study of 141 patients and their caregivers. The instruments used were the Quality of Life in AD, the Global Deterioration Scale (GDS), the Geriatric Depression Scale, and the Anosognosia Questionnaire-Dementia. Differences were analyzed according to GDS stage. A linear regression analysis was conducted using the difference between the absolute QoLp scores of patients and caregivers. A cluster analysis involving patient variables was then performed. RESULTS The discrepancy between patient and caregiver QoLp ratings increased in line with GDS stages (χ(2) (2) = 8.7, p = 0.013). In the regression model (F [7,133] = 16.6, p <0.001; R(2) = 0.477), discrepancies in QoLp reports were associated with greater anosognosia, less depression, and a better cognitive status in patients and with female gender among caregivers. The cluster analysis showed that patients with the lowest ratings of QoLp had a better cognitive status, more depression, and less anosognosia. Conversely, the highest ratings were given by patients with a poorer cognitive status, less depression, and greater anosognosia. CONCLUSIONS The factors associated with greater discrepancies between patient and caregiver ratings of QoLp were severity of dementia, anosognosia, depression, and cognitive status in patients and female gender in caregivers. In patients with advanced dementia, greater anosognosia leads to more positive ratings in QoLp and complementary observations are required.
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Joosten-Weyn Banningh LWA, Roelofs SCF, Vernooij-Dassen MJFJ, Prins JB, Olde Rikkert MGM, Kessels RPC. Long-term effects of group therapy for patients with mild cognitive impairment and their significant others: a 6- to 8-month follow-up study. DEMENTIA 2013; 12:81-91. [PMID: 24336664 DOI: 10.1177/1471301211420332] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present study examines the long-term effects of a 10-session cognitive behavioural group therapy for patients with mild cognitive impairment (MCI) and their significant others 6 to 8 months after completion of the intervention. Forty-seven MCI patients and 47 significant others participated in the follow-up assessment. Results of the RAND-36, Illness Cognition Questionnaire, IQCODE, GDS-15 and Sense of Competence Questionnaire at follow-up were compared with the post-intervention assessment. Our findings showed that the increased level of acceptance in the MCI patients was maintained at follow-up, with an increased insight into their cognitive decline compared with post-intervention assessment (p < 0.001). In both the patients and the significant others, helplessness and wellbeing were worse at follow up (p < 0.05), but sense of competence increased in the significant others (p < 0.05). These results indicate a need for extension of the support after completion of the program, for example by providing regular booster sessions.
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Geschke K, Fellgiebel A, Laux N, Schermuly I, Scheurich A. Quality of life in dementia: impact of cognition and insight on applicability of the SF-36. Am J Geriatr Psychiatry 2013; 21:646-54. [PMID: 23567410 DOI: 10.1016/j.jagp.2012.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 09/29/2011] [Accepted: 10/20/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Comparability of measures of quality of life in dementia and in other diagnostic groups, such as mild cognitive impairment, normal aging, or other diseases, is highly desirable. However, the impact of cognitive deficits and impaired insight on applicability and validity of generic instruments is sparsely studied. PARTICIPANTS AND MEASUREMENTS Sixty patients with dementia [38 women; age: mean (SD) = 78.7 (6.4) years; Mini-Mental State Examination (MMSE): mean (SD) = 20.2 (6.0)] recruited as part of the start-modem study, a multicenter care research study in Germany, completed the generic instrument SF-36 and the specific instrument Quality of Life-Alzheimer's Disease (QOL-AD). RESULTS QOL-AD self-rating scores [mean (SD) = 32.8 (5.9)] and SF-36 subscales indicated moderate to good quality of life in the total group. Reliability and validity of five subdomains of the SF-36 were poor in subgroups of patients with impaired insight or with MMSE scores less than 17 (Cronbach's α <0.7, no significant correlation to the QOL-AD). In contrast, for patients with both adequate insight and MMSE score greater than 16 (n = 33; 55%) Cronbach's α of the subdomains of the SF-36 ranged between 0.920 and 0.676. Seven of the eight subdomains correlated significantly with the QOL-AD self-rating and composite score in this group of patients (0.355 ≤ r ≤ 0.709). CONCLUSIONS Despite the impact of insight and cognition on self-rated quality of life, we found reliable and valid data for a broad spectrum of patients with dementia. According to the present data, the SF-36 is suitable for dementia patients with both insight into their deficits and an MMSE score greater than 16.
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Affiliation(s)
- Katharina Geschke
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Quality of life in dementia: the role of non-cognitive factors in the ratings of people with dementia and family caregivers. Int Psychogeriatr 2013; 25:1097-105. [PMID: 23561627 DOI: 10.1017/s1041610213000410] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The validity of self-reported quality-of-life (QoL) assessments of people with dementia (PWD) is a critical issue. We designed this study to determine the non-cognitive factors that are associated with self-reported QoL and PWD QoL as rated by family caregivers. METHODS Using a cross-sectional study, we assessed QoL of 41 people with mild Alzheimer's disease (AD). The individuals with AD and their family caregivers completed the Quality of Life in Alzheimer's Disease Scale (QoL-AD), the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), the Mini-Mental State Examination (MMSE), the Clinical Dementia Rating (CDR) scale, the Cornell Scale for Depression in Dementia (CSDD), the Pfeffer Functional Activities Questionnaire (FAQ), and the Zarit Burden Interview (ZBI). Univariate and multivariate regression analyses were conducted to examine the contribution of the various cofactors. RESULTS We observed a significant difference (t = 3.292, p < 0.01, d = 0.727) in the QoL measures of PWD after comparing self-reported assessments with the assessments of family caregivers. Linear regression analysis demonstrated that awareness of disease was related to PWD QoL-AD scores. Both the education levels of family caregivers and the depressive symptoms in PWD were related to the family caregivers' ratings of PWD QoL. CONCLUSIONS The difference between self-reported QoL and family caregivers' ratings of QoL in people with mild dementia indicated that cognitive impairment was not the primary factor that accounted for the differences in the QoL assessments. Our findings suggested that non-cognitive factors, such as awareness of disease and depressive symptoms, played an important role in the differences between the self-reported AD QoL ratings and the caregivers' AD QoL ratings. A major implication is that discrete measures such as cognition or level of function are likely to miss important factors that influence QoL.
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Satler C, Tomaz C. Cognitive anosognosia and behavioral changes in probable Alzheimer's disease patients. Dement Neuropsychol 2013; 7:197-205. [PMID: 29213840 PMCID: PMC5619518 DOI: 10.1590/s1980-57642013dn70200010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Anosognosia, impairment insight and unawareness of deficits are used as
equivalent terms in this study.
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Affiliation(s)
- Corina Satler
- PhD, Adjunct Professor, Faculty of Ceilandia, UnB, Brasilia DF, Brazil
| | - Carlos Tomaz
- PhD, Full Professor, Laboratory of Neurosciences and Behavior, Institute of Biology, UnB, Brasília DF, Brazil
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31
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[Quality of life in mild cognitive impairment, patients with different stages of Alzheimer disease and healthy control subjects]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2012; 26:72-7. [PMID: 22836551 DOI: 10.1007/s40211-012-0016-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 01/09/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aim of the current study is to evaluate quality of life in patients with different stages of dementia, MCI patients and healthy control subjects. METHODS The study comprises a number of 92 elderly patients (23 healthy control subjects, 24 subjects diagnosed with mild cognitive impairment, 28 patients with early AD and 17 patients with moderate AD). Quality of life was measured with the SF36. RESULTS We found significant differences between the diagnostic groups in the scales: perception of general health, vitality, limits in role performance due to emotional problems and mental health Generally, healthy control subjects and patients diagnosed with moderate AD showed better quality of life scores than patients with MCI and early stages of dementia. Additionally, we found a significant negative correlation between depression and all scales of the SF36. CONCLUSIONS Our results confirm that mood seems to be the strongest predictor of quality of life in elderly persons and patients in different stages of cognitive decline.
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Kruger TM, Abner EL, Mendiondo M, Schmitt FA, Smith CD, Jicha GA. Differential reports of pain and depression differentiate mild cognitive impairment from cognitively intact elderly participants. J Geriatr Psychiatry Neurol 2012; 25:107-12. [PMID: 22689703 PMCID: PMC3660012 DOI: 10.1177/0891988712445097] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Positive associations between pain and depression in the general population have been well characterized; however, the interplay between pain, depression, and early cognitive decline, characterized as mild cognitive impairment (MCI), is poorly understood. METHODS The current study examined the association of self-reported pain complaints (measured by the 36-item Short Form Health Survey) and self-reported depressive symptoms (measured by the 30-item Geriatric Depression Scale) in cognitively intact participants (n = 492) and participants with a clinical diagnosis of MCI (n = 83). RESULTS Depressive symptoms and subjective reports of pain were significantly associated in the entire sample (r = .29; P < .0001). Multiple logistic regression modeling (adjusted for age, education, and APOE4 status as covariates) demonstrated that while depressive symptoms were positively associated with the diagnosis of MCI (P < .001), subjective pain reports were negatively associated with MCI (P < .002). CONCLUSION While the negative association of subjective pain complaints with MCI might arguably be explained by the development of anosognosia, self-reports of depressive symptoms were actually increased in these participants, suggesting preserved insight into cognitive decline-associated symptoms. It is possible that preferential involvement of limbic circuitry in MCI could explain these findings. Future studies are needed to elucidate the reasons for the dissociation of pain and depressive symptoms in MCI described in the present article.
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Affiliation(s)
- T. M. Kruger
- Graduate Center for Gerontology, University of Kentucky, Lexington, KY, USA
| | - E. L. Abner
- Sanders Brown-Center on Aging, Lexington, KY, USA,University of Kentucky Alzheimer’s Disease Center, Lexington, KY, USA
| | - M. Mendiondo
- Sanders Brown-Center on Aging, Lexington, KY, USA,University of Kentucky Alzheimer’s Disease Center, Lexington, KY, USA
| | - F. A. Schmitt
- Graduate Center for Gerontology, University of Kentucky, Lexington, KY, USA,Sanders Brown-Center on Aging, Lexington, KY, USA,University of Kentucky Alzheimer’s Disease Center, Lexington, KY, USA,Psychiatry, Psychology, Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA,Neurology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - C. D. Smith
- Sanders Brown-Center on Aging, Lexington, KY, USA,University of Kentucky Alzheimer’s Disease Center, Lexington, KY, USA,Neurology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - G. A. Jicha
- Sanders Brown-Center on Aging, Lexington, KY, USA,University of Kentucky Alzheimer’s Disease Center, Lexington, KY, USA,Neurology, University of Kentucky College of Medicine, Lexington, KY, USA
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33
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Validation of the Spanish version of the QoL-AD scale in Alzheimer disease patients, their carers, and health professionals. NEUROLOGÍA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.nrleng.2011.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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34
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Gómez-Gallego M, Gómez-Amor J, Gómez-García J. Validación de la versión española de la escala QoL-AD en pacientes con enfermedad de Alzheimer, cuidadores y profesionales sanitarios. Neurologia 2012; 27:4-10. [DOI: 10.1016/j.nrl.2011.03.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 01/27/2011] [Accepted: 03/06/2011] [Indexed: 11/17/2022] Open
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Patient self-report for evaluating mild cognitive impairment and prodromal Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2011; 3:35. [PMID: 22152342 PMCID: PMC3308024 DOI: 10.1186/alzrt97] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient-reported outcome (PRO) measures are used to evaluate disease and treatments in many therapeutic areas, capturing relevant aspects of the disorder not obtainable through clinician or informant report, including those for which patients may have a greater level of awareness than those around them. Using PRO measures in mild cognitive impairment (MCI) and prodromal Alzheimer's disease (AD) presents challenges given the presence of cognitive impairment and loss of insight. This overview presents issues relevant to the value of patient report with emphasis on the role of insight. Complex activities of daily living functioning and executive functioning emerge as areas of particular promise for obtaining patient self-report. The full promise of patient self-report has yet to be realized in MCI and prodromal AD, however, in part because of lack of PRO measures developed specifically for mild disease, limited use of best practices in new measure development, and limited attention to psychometric evaluation. Resolving different diagnostic definitions and improving clinical understanding of MCI and prodromal AD will also be critical to the development and use of PRO measures.
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36
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Al-Aloucy MJ, Cotteret R, Thomas P, Volteau M, Benmaou I, Dalla Barba G. Unawareness of memory impairment and behavioral abnormalities in patients with Alzheimer's disease: relation to professional health care burden. J Nutr Health Aging 2011; 15:356-60. [PMID: 21528161 DOI: 10.1007/s12603-011-0045-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The present study investigates the impact of unawareness of deficit (anosognosia) in patients with Alzheimer's disease upon professional health care burden. DESIGN Cross-sectional study with a consecutive clinical sample from an Alzheimer day-care hospital in France. SUBJECTS 65 patients with probable AD, aged from 75 to 94 years old, consecutively admitted at the Alzheimer Day Hospital to complete a program of cognitive stimulation and psychosocial rehabilitation. MEASUREMENTS Each patient was submitted to a standardized evaluation including clinical investigation, cerebral imagery, and neuropsychological assessment. Anosognosia of memory deficit and anosognosia of behavioral disturbances were measured as the "discrepancy scores" between patients' self-reports and family member ratings of patient memory performance and behavioral disturbances. Professional health care burden was assessed with the Professional Health Care Dementia Burden Index (PCDBI; maximal score: 12), designed for this study. Multiple linear regressions were used to examine the correlations between the PCDBI and the severity of anosognosia. RESULTS The findings showed a significant positive correlation between the PCDBI and both anosognosia of memory impairment and behavioral abnormalities (both p at least less than 0.05). However, there was no significant correlation between the severity of the burden and the severity of cognitive decline or functional impairment (both p at least>0.05). CONCLUSION Anosognosia in Alzheimer disease patients has a negative impact upon the professional caregivers' burden over and above the cognitive deficit and the functional impairments.
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Affiliation(s)
- M J Al-Aloucy
- Alzheimer Day Centre, Paul Doumer, GHU Nord, Assistance Publique-Hôpitaux de Paris, Liancourt, France.
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Berwig M, Leicht H, Hartwig K, Gertz HJ. Self-Rated Quality of Life in Mild Cognitive Impairment and Alzheimer’s Disease. GEROPSYCH-THE JOURNAL OF GERONTOPSYCHOLOGY AND GERIATRIC PSYCHIATRY 2011. [DOI: 10.1024/1662-9647/a000029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Cognitively impaired or demented patients may have difficulty performing the complex and multidimensional appraisal required by self-ratings (SR) of quality of life (QoL). Even healthy subjects often refer to their current mood state for QoL self-assessment. Therefore, it is hypothesized that patients rely on current mood state as a reference point for QoL SR, and that the degree of reliance increases with the level of cognitive impairment. Methods: Two consecutive samples of 14 patients with mild cognitive impairment (MCI) and 16 patients with Alzheimer’s disease (AD) were examined using the self-rated Dementia-Quality of Life (DEMQoL), a multidimensional mood state questionnaire (MDBF-A, Mehrdimensionaler Befindlichkeitsfragebogen), and the Mini-Mental State Examination (MMSE; MCI: mean = 25.1, SD = 2.1; AD: mean = 20.3, SD = 2.7). Results: As expected, correlations between current mood state and QoL SR (DEMQoL) were highly significant in AD patients but not in MCI patients. The degree of association for all significant correlations was also significantly higher in AD than in MCI patients. Conclusions: The results indicate that SR of QoL are more affectively distorted in AD than MCI. Mood state questionnaires may be an alternative to QoL questionnaires for AD patients, in particular if mood state ratings can be averaged across several points of assessment thus enhancing their validity.
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Affiliation(s)
- M. Berwig
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Leipzig, Germany
| | - H. Leicht
- Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Germany
| | - K. Hartwig
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Leipzig, Germany
| | - H. J. Gertz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Leipzig, Germany
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Anosognosia in mild cognitive impairment and mild Alzheimer's disease: frequency and neuropsychological correlates. Am J Geriatr Psychiatry 2010; 18:1133-40. [PMID: 20808100 DOI: 10.1097/jgp.0b013e3181dd1c50] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate severity of anosognosia and to identify its neuropsychological correlates in preclinical and clinical Alzheimer's Disease (AD). METHODS The Clinical Insight Rating Scale, the Anosognosia Questionnaire for Dementia (AQ-D), and the Mental Deterioration Battery were used to assess anosognosia and cognitive performances in mild AD (N = 38), amnesic mild cognitive impairment (a-MCI; N = 35), and multiple domain MCI (md-MCI; N = 38). RESULTS Patients with mild AD were more anosognosic than both MCI groups, which, however, did not differ from one other. A categorical diagnosis of anosognosia was made in 42% of patients with mild AD, 3% of md-MCI, but in no subjects with a-MCI. Reduced verbal episodic memory raw score was associated with decreased awareness of cognitive difficulties (AQ-D total and intellectual functioning scores) only in MCI. In mild AD, anosognosia was linked only to increased age and reduced basic activities of daily living performances. CONCLUSIONS The diagnosis of anosognosia is frequent in patients with mild AD but not in those with MCI. In the latter case, the authors cannot speak of true anosognosia but only of decreased awareness of illness. Furthermore, reduced awareness of cognitive difficulties is linked with verbal memory performances in patients with MCI but not in those with AD, suggesting for the latter the involvement of factors other than neuropsychological. Thus, neuropsychiatric dimensions commonly present in patients with AD should be investigated along with anosognosia.
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39
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Novelli MMPC, Caramelli P. The influence of neuropsychiatric and functional changes on quality of life in Alzheimer's disease. Dement Neuropsychol 2010; 4:47-53. [PMID: 29213660 PMCID: PMC5619530 DOI: 10.1590/s1980-57642010dn40100008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To investigate the influence of neuropsychiatric manifestations and functional
performance on quality of life (QOL) of AD patients and their caregivers/family
members.
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Affiliation(s)
- Marcia M P C Novelli
- Occupational Therapy Course, Department of Health Sciences, Federal University of São Paulo, Santos SP, Brazil.,Behavioral and Cognitive Neurology Unit, Department of Neurology, University of São Paulo School of Medicine, São Paulo SP, Brazil
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Unit, Department of Neurology, University of São Paulo School of Medicine, São Paulo SP, Brazil.,Behavioral and Cognitive Neurology Unit, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte MG, Brazil
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40
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Ayalon L, Covinsky KE. Spouse-rated vs self-rated health as predictors of mortality. ACTA ACUST UNITED AC 2010; 169:2156-61. [PMID: 20008702 DOI: 10.1001/archinternmed.2009.386] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The Health and Retirement Study is a national sample of Americans older than 50 years and their spouses. The present study evaluated cross-sectional and longitudinal data from January 2000 through December 2006. The objective of the study was to evaluate the roles of spouse-rated vs self-rated health as predictors of all-cause mortality among adults older than 50 years. METHODS A total of 673 dyads of married couples were randomly selected to participate in a Health and Retirement Study module examining spouse-rated health. For each couple, one member was asked to rate his or her overall health status, and his or her spouse was asked to report the partner's overall health status. Mortality data were available through 2006. RESULTS Our findings demonstrate that spouse-rated health (area under the curve, 0.75) is as strong a predictor of mortality as self-rated health (area under the curve, 0.73) (chi(2)(1) = 0.36, P = .54). Combining spouse-rated and self-rated health predicts mortality better than using self-rated health alone (area under the curve, 0.77) (chi(2)(1) = 6.72, P = .009). CONCLUSIONS Spouse ratings of health are at least as strongly predictive of mortality as self-rated health. This suggests that, when self-rated health is elicited as a prognostic indicator, spouse ratings can be used when self-ratings are unavailable. Both measures together may be more informative than either measure alone.
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41
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CTAD international research conference: Clinical trials in Alzheimer’s disease. J Nutr Health Aging 2009. [DOI: 10.1007/s12603-009-0058-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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