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Gómez-Ulloa D, Runken MC, Rodriguez WI, Hernández B, Chivite M, Davis EA, Nisbet P. Understanding treatment goals and their application in clinical trial design for patients with Alzheimer disease and caregivers. Drugs Context 2024; 13:2023-11-6. [PMID: 38699065 PMCID: PMC11065135 DOI: 10.7573/dic.2023-11-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/03/2024] [Indexed: 05/05/2024] Open
Abstract
Background As research continues towards improved treatments for Alzheimer disease (AD), there is growing interest in the views and needs from patients and caregivers on AD treatments. Methods In this study, we surveyed patients with AD and caregivers to determine the treatment goals that are most important to them. Patients with AD and caregivers were independently recruited in Europe and North America to complete a web-based survey. Eligible participants were ≥18 years old and diagnosed with mild cognitive impairment or mild-to-moderate AD (patient-reported group) or persons involved in the care of patients with AD (caregiver-reported group). A total of 322 patients and 614 caregivers completed the survey. Results The demographic characteristics of patients in the patient-reported and the caregiver-reported groups were similar. Disease severity of patients was greater in the caregiver-reported group compared with the patient-reported group (72.1% versus 46.9% moderate AD). The most important goal of AD treatment in both groups was maintenance of quality of life (QoL) (patient-reported group 31.1% and caregiver-reported group 38.8%; p=0.01). This was consistent across disease stages or symptom severity except for patients with mild cognitive impairment in the caregiver-reported group where slowing the progression of memory loss was the most important treatment goal. Conclusions Patient QoL was consistently the most relevant treatment goal for patients with AD and caregivers. In AD clinical trials, patient-relevant outcomes, for example, QoL, should be given high priority to reflect the needs and demands of patients with AD and their caregivers.A preliminary report of this work was presented at the 14th Clinical Trials on Alzheimer's Disease meeting (November 9-12, 2021).
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Affiliation(s)
- David Gómez-Ulloa
- Health Economics and Outcomes Research, Grifols, Sant Cugat Del Vallès, Spain
| | - M Chris Runken
- Health Economics and Outcomes Research, Grifols, Research Triangle Park, NC, USA
| | | | | | | | - E Anne Davis
- Health Economics and Outcomes Research, Grifols, Research Triangle Park, NC, USA
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Nishimura M, Harrison Dening K, Sampson EL, Vidal EIDO, Nakanishi M, Davies N, Abreu W, Kaasalainen S, Eisenmann Y, Dempsey L, Moore KJ, Bolt SR, Meijers JMM, Dekker NL, Miyashita M, Nakayama T, van der Steen JT. A palliative care goals model for people with dementia and their family: Consensus achieved in an international Delphi study. Palliat Med 2024; 38:457-470. [PMID: 38634232 PMCID: PMC11025301 DOI: 10.1177/02692163241234579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Advance care planning in dementia includes supporting the person and their family to consider important goals of care. International research reports the importance of psycho-social-spiritual aspects towards end of life. AIM To develop a multidimensional international palliative care goals model in dementia for use in practice. DESIGN International Delphi study integrating consensus and evidence from a meta-qualitative study. The Delphi panel rated statements about the model on a 5-point agreement scale. The criteria for consensus were pre-specified. SETTING/PARTICIPANTS Seventeen researchers from eight countries developed an initial model, and 169 candidate panellists were invited to the international online Delphi study. RESULTS Panellists (107; response 63.3%) resided in 33 countries. The model comprised four main care goals: (1) Comfort ensured; (2) Control over function maintained; (3) Identity protected and personhood respected and (4) Coping with grief and loss-person and caregiver supported. The model reflects how needs and care goals change over time with the progression of dementia, concluding with bereavement support. The first version of the model achieved a consensus after which it was slightly refined based on feedback. We did not achieve a consensus on adding a goal of life prolongation, and on use of the model by people with dementia and family themselves. CONCLUSION A new palliative care goals model for people with dementia and their families includes relationship aspects for use by professionals and achieved a consensus among a panel with diverse cultural background. The position of life prolongation in relation to palliative care goals needs further research.
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Affiliation(s)
- Mayumi Nishimura
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | | | - Elizabeth L Sampson
- Royal London Hospital and Centre for Psychiatry and Mental health, East London NHS Foundation Trust, London, UK
- Wolfson Institute of Population Health, Queen Mary University London, London, UK
| | | | - Miharu Nakanishi
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nathan Davies
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Wilson Abreu
- Center for Health Technology and Ser- vices Research, University of Porto (ESEP/CINTESIS), Porto, Portugal
| | | | - Yvonne Eisenmann
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Laura Dempsey
- Department of Nursing and Healthcare, Technological University of the Shannon: Midlands Midwest, Athlone, Ireland
| | - Kirsten J Moore
- National Ageing Research Institute, Parkville, VIC, Australia
- Medicine-Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Sascha R Bolt
- Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, North Brabant, The Netherlands
| | - Judith MM Meijers
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Limburg, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
- Zuyderland Care, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Natashe Lemos Dekker
- Institute of Cultural Anthropology and Development Sociology, Leiden University, Leiden, South Holland, The Netherlands
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, South Holland, The Netherlands
- Department of Primary and Community Care, Radboud University, Nijmegen, The Netherlands
- Cicely Saunders Institute, King’s College London, UK
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Jönsson L, Ivkovic M, Atri A, Handels R, Gustavsson A, Hahn-Pedersen JH, León T, Lilja M, Gundgaard J, Raket LL. Progression analysis versus traditional methods to quantify slowing of disease progression in Alzheimer's disease. Alzheimers Res Ther 2024; 16:48. [PMID: 38424559 PMCID: PMC10903002 DOI: 10.1186/s13195-024-01413-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The clinical meaningfulness of the effects of recently approved disease-modifying treatments (DMT) in Alzheimer's disease is under debate. Available evidence is limited to short-term effects on clinical rating scales which may be difficult to interpret and have limited intrinsic meaning to patients. The main value of DMTs accrues over the long term as they are expected to cause a delay or slowing of disease progression. While awaiting such evidence, the translation of short-term effects to time delays or slowing of progression could offer a powerful and readily interpretable representation of clinical outcomes. METHODS We simulated disease progression trajectories representing two arms, active and placebo, of a hypothetical clinical trial of a DMT. The placebo arm was simulated based on estimated mean trajectories of clinical dementia rating scale-sum of boxes (CDR-SB) recordings from amyloid-positive subjects with mild cognitive impairment (MCI) from Alzheimer's Disease Neuroimaging Initiative (ADNI). The active arm was simulated to show an average slowing of disease progression versus placebo of 20% at each visit. The treatment effects in the simulated trials were estimated with a progression model for repeated measures (PMRM) and a mixed model for repeated measures (MMRM) for comparison. For PMRM, the treatment effect is expressed in units of time (e.g., days) and for MMRM in units of the outcome (e.g., CDR-SB points). PMRM results were implemented in a health economics Markov model extrapolating disease progression and death over 15 years. RESULTS The PMRM model estimated a 19% delay in disease progression at 18 months and 20% (~ 7 months delay) at 36 months, while the MMRM model estimated a 25% reduction in CDR-SB (~ 0.5 points) at 36 months. The PMRM model had slightly greater power compared to MMRM. The health economic model based on the estimated time delay suggested an increase in life expectancy (10 months) without extending time in severe stages of disease. CONCLUSION PMRM methods can be used to estimate treatment effects in terms of slowing of progression which translates to time metrics that can be readily interpreted and appreciated as meaningful outcomes for patients, care partners, and health care practitioners.
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Affiliation(s)
- Linus Jönsson
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, 171 64, Sweden.
| | | | - Alireza Atri
- Banner Sun Health Research Institute and Banner Alzheimer's Institute, Banner Health, Sun City and Phoenix, AZ, USA
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ron Handels
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, 171 64, Sweden
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre+, Maastricht, MD, 6200, The Netherlands
| | - Anders Gustavsson
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, 171 64, Sweden
- Quantify Research, Hantverkargatan 8, Stockholm, 112 21, Sweden
| | | | | | - Mathias Lilja
- Quantify Research, Hantverkargatan 8, Stockholm, 112 21, Sweden
| | | | - Lars Lau Raket
- Novo Nordisk A/S, Søborg, Denmark
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
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Tariot PN, Boada M, Lanctôt KL, Hahn-Pedersen J, Dabbous F, Udayachalerm S, Raket LL, Halchenko Y, Michalak W, Weidner W, Cummings J. Relationships of change in Clinical Dementia Rating (CDR) on patient outcomes and probability of progression: observational analysis. Alzheimers Res Ther 2024; 16:36. [PMID: 38355706 PMCID: PMC10868090 DOI: 10.1186/s13195-024-01399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/26/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Understanding the relationship among changes in Clinical Dementia Rating (CDR), patient outcomes, and probability of progression is crucial for evaluating the long-term benefits of disease-modifying treatments. We examined associations among changes in Alzheimer's disease (AD) stages and outcomes that are important to patients and their care partners including activities of daily living (ADLs), geriatric depression, neuropsychiatric features, cognitive impairment, and the probabilities of being transitioned to a long-term care facility (i.e., institutionalization). We also estimated the total time spent at each stage and annual transition probabilities in AD. METHODS The study included participants with unimpaired cognition, mild cognitive impairment (MCI) due to AD, and mild, moderate, and severe AD dementia in the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS) database. The associations among change in AD stages and change in relevant outcomes were estimated using linear mixed models with random intercepts. The probability of transitioning to long-term care facilities was modeled using generalized estimating equations. The total length of time spent at AD stages and annual transition probabilities were estimated with multistate Markov models. RESULTS The estimated average time spent in each stage was 3.2 years in MCI due to AD and 2.2, 2.0, and 2.8 years for mild, moderate, and severe AD dementia, respectively. The annual probabilities of progressing from MCI to mild, moderate, and severe AD dementia were 20, 4, and 0.7%, respectively. The incremental change to the next stage of participants with unimpaired cognition, MCI, and mild, moderate, and severe AD dementia (to death) was 3.2, 20, 26.6, 31, and 25.3%, respectively. Changes in ADLs, neuropsychiatric features, and cognitive measures were greatest among participants who transitioned from MCI and mild AD dementia to more advanced stages. Participants with MCI and mild and moderate AD dementia had increasing odds of being transitioned to long-term care facilities over time during the follow-up period. CONCLUSIONS The findings demonstrated that participants with early stages AD (MCI or mild dementia) were associated with the largest changes in clinical scale scores. Early detection, diagnosis, and intervention by disease-modifying therapies are required for delaying AD progression. Additionally, estimates of transition probabilities can inform future studies and health economic modeling.
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Affiliation(s)
| | - Mercè Boada
- Ace Alzheimer Center Barcelona - Universitat Internacional de Catalunya, 08028, Barcelona, Spain
- Networking Research Center On Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | | | | | | | | | - Lars Lau Raket
- Novo Nordisk A/S, 2860, Søborg, Denmark
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | | | - Wendy Weidner
- Alzheimer's Disease International, London, SE1 4PU, UK
| | - Jeffrey Cummings
- Chambers-Grundy Center for Transformative Neuroscience, UNLV, Las Vegas, NV, 89154, USA
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Wang W, Xia X, Zhang H. Childhood Emotional Neglect and Cognitive Function Among Middle-Aged and Older Adults: Mediating Role of Social Engagement. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:828-847. [PMID: 37727995 DOI: 10.1177/08862605231198245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Studies have demonstrated that childhood maltreatment and adverse experiences lead to impaired cognitive function. However, relatively few studies have examined the independent effect of childhood emotional neglect on cognitive function in middle-aged and older adults, and the role of social engagement in this relationship. Using a sample from the China Health and Retirement Longitudinal Study, the current study examined the mediating role of social engagement in the association between childhood emotional neglect and cognitive function among middle-aged and older adults. Participants were 32,540 middle-aged and older adults (Mage = 63.45, SD = 8.83). Data were analyzed using a fixed effects model for panel data and bootstrap resampling method. Results showed that participants who experienced emotional neglect had poorer cognitive function (β = -.068, p < .001). Social engagement mediated 7.55% of the association between emotional neglect and cognitive function (β = -.004, 95% CI [-0.006, -0.002], p < .05). The results indicated that interventions are required to improve awareness of emotional neglect and facilitate healthy parenting practices. Further research on how to motivate adults who experienced emotional neglect to engage in social activities is necessary.
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Affiliation(s)
- Weiwei Wang
- Center for Studies of Sociological Theory and Method, Renmin University of China, Beijing, China
- Department of Social Work and Social Policy, Renmin University of China, Beijing, China
| | - Xinger Xia
- Center for Studies of Sociological Theory and Method, Renmin University of China, Beijing, China
| | - Huiping Zhang
- Center for Studies of Sociological Theory and Method, Renmin University of China, Beijing, China
- Department of Social Work and Social Policy, Renmin University of China, Beijing, China
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Lanctôt KL, Boada M, Tariot PN, Dabbous F, Hahn‐Pedersen J, Udayachalerm S, Raket LL, Saiontz‐Martinez C, Michalak W, Weidner W, Cummings J. Association between clinical dementia rating and clinical outcomes in Alzheimer's disease. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12522. [PMID: 38239329 PMCID: PMC10794857 DOI: 10.1002/dad2.12522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/16/2023] [Accepted: 12/05/2023] [Indexed: 01/22/2024]
Abstract
INTRODUCTION We examined associations between the Clinical Dementia Rating Scale (CDR) and function (Functional Assessment Scale [FAS]), neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire [NPI-Q]), and cognitive impairment in Alzheimer's disease (AD). METHODS We used data from the National Alzheimer's Coordinating Center Uniform Data Set and defined cognitively unimpaired and AD stages using CDR-global. RESULTS Functional and neuropsychiatric symptoms occur as early as the mild cognitive impairment (MCI) phase. The adjusted lest square mean FAS (95% confidence interval [CI]) was lowest in cognitively unimpaired (3.88 [3.66, 4.11] to 5.01 [4.76, 5.26]) and higher with more advanced AD (MCI: 8.17 [6.92, 9.43] to 20.87 [19.53, 22.20]; mild: 18.54 [17.57, 19.50] to 28.13 [27.14, 29.12]; moderate: 26.01 [25.31, 26.70] to 29.42 [28.73, 30.10]). FAS and NPI-Q scores increased steeply with MCI (NPI-Q: 5.55 [4.89, 6.20] to 7.11 [6.43, 7.78]) and mild AD dementia (NPI-Q: 6.66 [5.72, 7.60] to 8.32 [7.32, 9.33]). DISCUSSION CDR-global staged AD by capturing differences in relevant outcomes along AD progression. Highlights There were strong associations among CDR and the various outcomes relevant to healthcare providers, patients, and their care givers, such as activities of daily living.Overall, activities of daily living, neuropsychiatric symptoms, and cognitive function outcomes deteriorated over time and can be observed in early stages of AD (MCI or mild dementia).Our findings directly inform the current understanding of AD progression and can aid in care planning and benefit assessments of early AD interventions to delay the progression of AD to more advanced stages.
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Affiliation(s)
- Krista L. Lanctôt
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Mercè Boada
- Ace Alzheimer Center Barcelona – Universitat Internacional de CatalunyaBarcelonaSpain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED)Instituto de Salud Carlos IIIMadridSpain
| | | | | | | | | | | | | | | | | | - Jeffrey Cummings
- Department of Brain Health, Chambers‐Grundy Center for Transformative NeuroscienceUNLVLas VegasNevadaUSA
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Aye S, Bouteloup V, Tate A, Wimo A, Handels R, Jean D, Winblad B, Jönsson L. Health-related quality of life in subjective cognitive decline and mild cognitive impairment: a longitudinal cohort analysis. Alzheimers Res Ther 2023; 15:200. [PMID: 37968734 PMCID: PMC10648708 DOI: 10.1186/s13195-023-01344-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/25/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Health-related quality of life (HR-QoL) is an important outcome for patients and crucial for demonstrating the value of new treatments. Health utility estimates in subjective cognitive decline (SCD) and mild cognitive impairment (MCI) are limited, especially in biomarker-confirmed populations. Besides, little is known about the longitudinal HR-QoL trajectory. This study aims to provide health utility estimates for SCD and MCI and investigate the QoL trajectory along the disease continuum. METHODS Longitudinal data from 919 SCD and 1336 MCI patients from the MEMENTO cohort were included. SCD was defined as clinical dementia rating (CDR) = 0, and MCI as CDR = 0.5. HR-QoL was measured using the EQ-5D-3L patient-reported instrument. Linear mixed-effect models (LMM) were used to assess the longitudinal change in HR-QoL and identify predictors of these changes. RESULTS Baseline health utilities were 0.84 ± 0.16 and 0.81 ± 0.18, and visual analogue scale (VAS) were 75.8 ± 14.82 and 70.26 ± 15.77 in SCD and MCI. In amyloid-confirmed cases, health utilities were 0.85 ± 0.14 and 0.86 ± 0.12 in amyloid-negative and amyloid-positive SCD, and 0.83 ± 0.17 and 0.84 ± 0.16 in amyloid-negative and amyloid-positive MCI. LMM revealed an annual decline in health utility of - 0.015 (SE = 0.006) and - 0.09 (SE = 0.04) in moderate and severe dementia (P < 0.05). There was a negative association between clinical stage and VAS where individuals with MCI, mild, moderate, and severe dementia were on average 1.695 (SE = 0.274), 4.401 (SE = 0.676), 4.999 (SE = 0.8), and 15.386 (SE = 3.142) VAS points lower than individuals with SCD (P < 0.001). Older age, female sex, higher body mass index, diabetes, cardiovascular history, depression, and functional impairment were associated with poor HR-QoL. Amyloid positivity was associated with an annual decline of - 0.011 (SE = 0.004, P < 0.05) health utility over time. CONCLUSIONS Health utility estimates from this study can be used in economic evaluations of interventions targeting SCD and MCI. Health utility declines over time in moderate and severe dementia, and VAS declines with advancing clinical stages. Amyloid-positive patients show a faster decline in health utility indicating the importance of considering biomarker status in HR-QoL assessments. Future research is needed to confirm the longitudinal relationship between amyloid status and HR-QoL and to examine the level at which depression and IADL contribute to HR-QoL decline in AD.
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Affiliation(s)
- Sandar Aye
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, BioClinicum J9:20, Akademiska Stråket, Solna, 171 64, Sweden.
| | - Vincent Bouteloup
- Centre Inserm U1219, Institut de Santé Publiqued'Epidémiologie Et de Développement (ISPED), Bordeaux School of Public Health, Université de Bordeaux, 146 Rue Léo Saignat, Bordeaux, Cedex, 33076, France
- CHU de Bordeaux, Pôle de Santé Publique, Bordeaux, 33000, France
| | - Ashley Tate
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, BioClinicum J9:20, Akademiska Stråket, Solna, 171 64, Sweden
| | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, BioClinicum J9:20, Akademiska Stråket, Solna, 171 64, Sweden
| | - Ron Handels
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, BioClinicum J9:20, Akademiska Stråket, Solna, 171 64, Sweden
- Deperatment of Psychiatry and Neuropsychology, Maastricht University, Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht, the Netherlands
| | - Delphine Jean
- Centre Inserm U1219, Institut de Santé Publiqued'Epidémiologie Et de Développement (ISPED), Bordeaux School of Public Health, Université de Bordeaux, 146 Rue Léo Saignat, Bordeaux, Cedex, 33076, France
- CHU de Bordeaux, Pôle de Santé Publique, Bordeaux, 33000, France
| | - Bengt Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, BioClinicum J9:20, Akademiska Stråket, Solna, 171 64, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Linus Jönsson
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, BioClinicum J9:20, Akademiska Stråket, Solna, 171 64, Sweden
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Torregrossa F, Buscemi F, Gulino V, Campisi BM, Teresi G, Grasso G. Health-Related Quality of Life and Role of Surgical Treatment in Idiopathic Normal Pressure Hydrocephalus: A Systematic Review. World Neurosurg 2023; 179:197-203.e1. [PMID: 37657591 DOI: 10.1016/j.wneu.2023.08.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Although shunting has been shown to ameliorate symptoms in idiopathic normal pressure hydrocephalus (iNPH), its impact on health-related quality of life (HRQoL) has yet to be fully elucidated. Patient and caregiver subjective life satisfaction and HRQoL represent crucial indicators for assessing the well-being of individuals facing chronic illnesses, including iNPH. This study aimed to systematically analyze the existing data about HRQoL in iNPH-treated patients to evaluate the role of surgical treatment in such a scenario. METHODS Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the literature in the PubMed/Medline, Web of Science, and Scopus databases was searched. Fourteen studies met our inclusion criteria. The Joanna Briggs Institute critical appraisal tool was used to assess the risk of bias. RESULTS Overall, HRQoL improved significantly within 1 year after shunt placement although patients with iNPH reported worse HRQoL values compared with healthy-matched individuals. Up to 5 years after shunting, a sustained heterogeneity exists on published data showing improved scores across all domains for at least 21 months after shunting. Further, although surgical treatment can improve HRQoL, long-term follow-up showed that it remained lower than that of healthy controls. These data suggest a significant decrease of HRQoL in patients with iNPH over time after shunting, probably due to aging, comorbidities, and disease progression. CONCLUSIONS Despite that iNPH has been recognized as a potentially reversible neurological disorder, the available data about the impact of shunting on the HRQoL are unsatisfactory. To improve the well-informed clinical decision-making, it is essential to reach additional high-quality evidence regarding the effect of shunting on HRQoL. New prospective studies, using validated instruments specifically tailored for assessing HRQoL in patients with iNPH, and improved reporting standards are needed. Current evidence suggests that although shunting can provide initial benefits, affected patients may experience long-term impairment in HRQoL.
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Affiliation(s)
- Fabio Torregrossa
- Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Felice Buscemi
- Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Vincenzo Gulino
- Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Benedetta Maria Campisi
- Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Gaia Teresi
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Giovanni Grasso
- Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy.
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Tao L, Wang X, Gao S, Nie Z, Chen L, Liang W, Ding Y, Yang R. Longitudinal relationships between grip strength, subjective memory complaints and cognitive function among middle-aged and older adults in China. Aging Clin Exp Res 2023; 35:2101-2108. [PMID: 37603266 DOI: 10.1007/s40520-023-02507-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Subjective memory complaints are considered an early sign of cognitive decline. Recent evidence shows that grip strength is an important predictor of cognitive function. However, few studies have compared whether one condition is uniquely associated with cognitive function when another condition is controlled for. AIMS To explore the longitudinal associations of cognitive function with subjective memory complaints and grip strength in middle-aged and older adults, with a particular focus on whether one condition is uniquely associated with cognitive function when another condition is considered. METHODS A total of 3,877 middle-aged and older adults (aged 45-92 years) from the China Health and Retirement Longitudinal Study reported on their demographic and health status and completed measures of grip strength and subjective memory complaints, as well as a series of cognitive tests, every two years between 2011 and 2015. Generalized estimating equation models were used to assess the relationships between grip strength, subjective memory complaints, and cognitive function. RESULTS Grip strength was longitudinally associated with cognitive function (β = 0.021, 95% confidence interval [CI]: 0.011, 0.030, P < 0.001) independent of subjective memory complaints. In contrast, changes in the subjective memory complaints were not related to cognitive function over time (β = 0.107, 95% CI: - 0.025, 0.238, P = 0.112). Only at baseline subjective memory complaints were associated with poorer cognitive function (β = - 1.142, 95% CI: - 1.309, - 0.975, P < 0.001). CONCLUSIONS Grip strength might be a more important clinical correlate of cognitive function decline over time than subjective memory complaints. DISCUSSION Regular assessment and close monitoring of grip strength might help identify individuals who might be at high risk for cognitive impairment.
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Affiliation(s)
- Lu Tao
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Xiaoxiao Wang
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Shiying Gao
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Zuoting Nie
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Long Chen
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Wei Liang
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China.
| | - Yaping Ding
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China.
| | - Rumei Yang
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China.
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10
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Crowell V, Reyes A, Zhou SQ, Vassilaki M, Gsteiger S, Gustavsson A. Disease severity and mortality in Alzheimer's disease: an analysis using the U.S. National Alzheimer's Coordinating Center Uniform Data Set. BMC Neurol 2023; 23:302. [PMID: 37580727 PMCID: PMC10424331 DOI: 10.1186/s12883-023-03353-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Evidence on the relative risk of death across all stages of Alzheimer's disease (AD) is lacking but greatly needed for the evaluation of new interventions. We used data from the Uniform Data Set (UDS) of the National Alzheimer's Coordinating Center (NACC) to assess the expected survival of a person progressing to a particular stage of AD and the relative risk of death for a person in a particular stage of AD compared with cognitively normal (CN) people. METHODS This was a retrospective observational cohort study of mortality and its determinants in participants with incident mild cognitive impairment (MCI) due to AD or AD dementia compared with CN participants. Overall survival and hazard ratios of all-cause mortality in participants ≥ 50 years of age with clinically assessed or diagnosed MCI due to AD, or mild, moderate, or severe AD dementia, confirmed by Clinical Dementia Rating scores, versus CN participants were estimated, using NACC UDS data. Participants were followed until death, censoring, or until information to determine disease stage was missing. RESULTS Aged between 50 and 104 years, 12,414 participants met the eligibility criteria for the study. Participants progressing to MCI due to AD or AD dementia survived a median of 3-12 years, with higher mortality observed in more severe stages. Risk of death increased with the severity of AD dementia, with the increase significantly higher at younger ages. Participants with MCI due to AD and CN participants had a similar risk of death after controlling for confounding factors. CONCLUSIONS Relative all-cause mortality risk increases with AD severity, more so at younger ages. Mortality does not seem to be higher for those remaining in MCI due to AD. Findings might imply potential benefit of lower mortality if preventing or delaying the progression of AD is successful, and importantly, this potential benefit might be greater in relatively younger people. Future research should replicate our study in other samples more representative of the general US population as well as other populations around the world.
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Affiliation(s)
| | | | | | - Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Anders Gustavsson
- Quantify Research, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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11
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Ellison TS, Cappa SF, Garrett D, Georges J, Iwatsubo T, Kramer JH, Lehmann M, Lyketsos C, Maier AB, Merrilees J, Morris JC, Naismith SL, Nobili F, Pahor M, Pond D, Robinson L, Soysal P, Vandenbulcke M, Weber CJ, Visser PJ, Weiner M, Frisoni GB. Outcome measures for Alzheimer's disease: A global inter-societal Delphi consensus. Alzheimers Dement 2023; 19:2707-2729. [PMID: 36749854 PMCID: PMC11010236 DOI: 10.1002/alz.12945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/20/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION We aim to provide guidance on outcomes and measures for use in patients with Alzheimer's clinical syndrome. METHODS A consensus group of 20 voting members nominated by 10 professional societies, and a non-voting chair, used a Delphi approach and modified GRADE criteria. RESULTS Consensus was reached on priority outcomes (n = 66), measures (n = 49) and statements (n = 37) across nine domains. A number of outcomes and measurement instruments were ranked for: Cognitive abilities; Functional abilities/dependency; Behavioural and neuropsychiatric symptoms; Patient quality of life (QoL); Caregiver QoL; Healthcare and treatment-related outcomes; Medical investigations; Disease-related life events; and Global outcomes. DISCUSSION This work provides indications on the domains and ideal pertinent measurement instruments that clinicians may wish to use to follow patients with cognitive impairment. More work is needed to develop instruments that are more feasible in the context of the constraints of clinical routine.
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Affiliation(s)
| | - Stefano F. Cappa
- Scuola Universitaria Superiore IUSS Pavia, Pavia, Italy
- Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | | | | | - Takeshi Iwatsubo
- Unit for Early and Exploratory Clinical Development, The University of Tokyo Hospital, Tokyo, Japan
- Department of Neuropathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Joel H. Kramer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | | | - Constantine Lyketsos
- Richman Family Precision Medicine Center of Excellence in Alzheimer’s Disease, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University and Medicine, Baltimore, USA
| | - Andrea B. Maier
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Centre for Healthy Longevity, National University Health System, Singapore, Singapore
| | - Jennifer Merrilees
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - John C. Morris
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Sharon L. Naismith
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Flavio Nobili
- UO Clinica Neurologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Child and Mother Health, University of Genoa, Genova, Italy
| | - Marco Pahor
- Department of Aging and Geriatric Research, Institute on Aging, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Dimity Pond
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
- European Society of Geriatric Medicine, Dementia Special Interest Group
| | - Mathieu Vandenbulcke
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Geriatric Psychiatry, University Psychiatric Centre KU Leuven, Leuven, Belgium
| | | | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
- Alzheimer Center, Department of Neurology, Neuroscience Campus Amsterdam, Amsterdam University Medical Center, VU Medical Center, Amsterdam, Netherlands
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institute, Stockholm, Sweden
| | - Michael Weiner
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Giovanni B. Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Memory Clinic, Department of Readaptation and Geriatrics, Geneva University and University Hospitals, Geneva, Switzerland
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12
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Ottenhoff L, Vijverberg EGB, Visser LNC, Verijp M, Prins ND, Van der Flier WM, Sikkes SAM. Experiences of and recommendations on clinical trial design in Alzheimer's disease from the participant's point of view: a mixed-methods study in two clinical trial centers in the Netherlands. Alzheimers Res Ther 2023; 15:72. [PMID: 37016435 PMCID: PMC10071606 DOI: 10.1186/s13195-023-01190-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 02/13/2023] [Indexed: 04/06/2023]
Abstract
INTRODUCTION In the context of the development of pharmaceutical interventions, expectations and experiences of participants are essential. Their insights may be particularly helpful to address the challenges of recruiting and retaining participants for Alzheimer's disease (AD) clinical trials. We examined clinical trial participants' experiences to optimize trial design in Alzheimer's disease (AD). METHOD In this mixed-methods study, we included adults who participated in sponsor-initiated AD trials at Brain Research Center, a clinical trial organization in the Netherlands. Participants (N = 71, age 69 ± 6.5, 54%F, 19 cognitively normal (CN), 19 mild cognitive impairment (MCI), and 33 AD dementia) first completed an online survey. Diagnostic group differences were investigated using chi-square tests or one-way ANOVAs. Next, a subsample (N = 12; 8 = CN, 4 = MCI) participated in focus groups to gain in-depth insight into their opinions on optimizing trial design from a participants' point of view. Audio recordings from focus group interviews were transcribed verbatim and analyzed by thematic content analysis by two independent researchers. RESULTS Most reported motives for enrolment included "to benefit future generations" (89%), followed by "for science" (66%) and "better monitoring" (42%). Frequent suggestions for increasing willingness to participate included a smaller chance to receive placebo (n = 38, 54%), shorter travel times (n = 27, 38%), and sharing individual results of different assessments (n = 57, 80%), as well as receiving trial results (n = 52, 73). Highest visual analogue burden scores (0-100) were found for the lumbar puncture (M = 47.2, SD = 38.2) and cognitive assessments (M = 27.2, SD = 25.7). Results did not differ between diagnostic groups, nor between patient and caregiver participants (all p-values>.05). Two additional themes emerged from the focus groups: "trial design," such as follow-up visit(s) after participating, and "trial center," including the relevance of a professional and empathic staff. CONCLUSION Relevant factors include expectation management and careful planning of high-burden assessments, provision of individual feedback, and prioritizing professionalism and empathy throughout conduct of the trial. Our findings provide insight into participants' priorities to increase willingness to participate and can be used to optimize trial success.
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Affiliation(s)
- Lois Ottenhoff
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
- Brain Research Center Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands
| | - Everard G B Vijverberg
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands
| | - Leonie N C Visser
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands, Amsterdam, The Netherlands
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Solna, Sweden
| | - Merike Verijp
- Brain Research Center Amsterdam, Amsterdam, The Netherlands
| | - Niels D Prins
- Brain Research Center Amsterdam, Amsterdam, The Netherlands
| | - Wiesje M Van der Flier
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands
- Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Sietske A M Sikkes
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands.
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU University, Amsterdam, The Netherlands.
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13
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Wessels AM, Dennehy EB, Dowsett SA, Dickson SP, Hendrix SB. Meaningful Clinical Changes in Alzheimer Disease Measured With the iADRS and Illustrated Using the Donanemab TRAILBLAZER-ALZ Study Findings. Neurol Clin Pract 2023; 13:e200127. [PMID: 36891463 PMCID: PMC9987204 DOI: 10.1212/cpj.0000000000200127] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/09/2022] [Indexed: 02/18/2023]
Abstract
Purpose of Review To provide relevant background of the Integrated Alzheimer's Disease Rating Scale (iADRS), with examples, to assist the reader with the interpretation of iADRS findings from the TRAILBLAZER-ALZ study. Recent Findings The iADRS is an integrated measure of global Alzheimer disease (AD) severity for use in the clinical trial environment. It provides a single score that captures commonalities across cognitive and functional ability domains, reflecting disease-related impairment, while minimizing noise not related to disease progression that may exist within each domain. In AD, disease-modifying therapies (DMTs) are expected to slow the rate of clinical decline, changing the trajectory of disease progression. The overall percent slowing of disease progression with treatment is a more informative outcome of effect than absolute point differences between treatment and placebo groups at any given time point because the latter is influenced by treatment period and disease severity. The TRAILBLAZER-ALZ trial was a phase 2 study designed to evaluate the safety and efficacy of donanemab in participants with early symptomatic AD; the primary outcome measure was the change from baseline to 76 weeks on the iADRS. In the TRAILBLAZER-ALZ study, donanemab slowed disease progression by 32% at 18 months (p = 0.04 vs placebo), demonstrating clinical efficacy. At the patient level, one can assess whether the DMT effect is clinically meaningful by estimating the threshold of change consistent with clinically meaningful worsening; based on the TRAILBLAZER-ALZ findings, treatment with donanemab would delay reaching this threshold by approximately 6 months. Summary The iADRS is capable of accurately describing clinical changes associated with disease progression and detecting treatment effects and is an effective assessment tool for use in clinical trials of individuals with early symptomatic AD.
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Affiliation(s)
- Alette M Wessels
- Eli Lilly and Company (AMW, EBD, SAD), Indianapolis, IN; Department of Psychological Sciences (EBD), Purdue University, West Lafayette, IN; and Pentara Corporation (SPD, SBH), Millcreek, UT
| | - Ellen B Dennehy
- Eli Lilly and Company (AMW, EBD, SAD), Indianapolis, IN; Department of Psychological Sciences (EBD), Purdue University, West Lafayette, IN; and Pentara Corporation (SPD, SBH), Millcreek, UT
| | - Sherie A Dowsett
- Eli Lilly and Company (AMW, EBD, SAD), Indianapolis, IN; Department of Psychological Sciences (EBD), Purdue University, West Lafayette, IN; and Pentara Corporation (SPD, SBH), Millcreek, UT
| | - Samuel P Dickson
- Eli Lilly and Company (AMW, EBD, SAD), Indianapolis, IN; Department of Psychological Sciences (EBD), Purdue University, West Lafayette, IN; and Pentara Corporation (SPD, SBH), Millcreek, UT
| | - Suzanne B Hendrix
- Eli Lilly and Company (AMW, EBD, SAD), Indianapolis, IN; Department of Psychological Sciences (EBD), Purdue University, West Lafayette, IN; and Pentara Corporation (SPD, SBH), Millcreek, UT
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Advanced Overview of Biomarkers and Techniques for Early Diagnosis of Alzheimer's Disease. Cell Mol Neurobiol 2023:10.1007/s10571-023-01330-y. [PMID: 36847930 DOI: 10.1007/s10571-023-01330-y] [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: 12/05/2022] [Accepted: 02/15/2023] [Indexed: 03/01/2023]
Abstract
The development of early non-invasive diagnosis methods and identification of novel biomarkers are necessary for managing Alzheimer's disease (AD) and facilitating effective prognosis and treatment. AD has multi-factorial nature and involves complex molecular mechanism, which causes neuronal degeneration. The primary challenges in early AD detection include patient heterogeneity and lack of precise diagnosis at the preclinical stage. Several cerebrospinal fluid (CSF) and blood biomarkers have been proposed to show excellent diagnosis ability by identifying tau pathology and cerebral amyloid beta (Aβ) for AD. Intense research endeavors are being made to develop ultrasensitive detection techniques and find potent biomarkers for early AD diagnosis. To mitigate AD worldwide, understanding various CSF biomarkers, blood biomarkers, and techniques that can be used for early diagnosis is imperative. This review attempts to provide information regarding AD pathophysiology, genetic and non-genetic factors associated with AD, several potential blood and CSF biomarkers, like neurofilament light, neurogranin, Aβ, and tau, along with biomarkers under development for AD detection. Besides, numerous techniques, such as neuroimaging, spectroscopic techniques, biosensors, and neuroproteomics, which are being explored to aid early AD detection, have been discussed. The insights thus gained would help in finding potential biomarkers and suitable techniques for the accurate diagnosis of early AD before cognitive dysfunction.
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15
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Hauber B, Paulsen R, Krasa HB, Vradenburg G, Comer M, Callahan LF, Winfield J, Potashman M, Hartry A, Lee D, Wilson H, Hoffman DL, Wieberg D, Kremer IN, Taylor GA, Taylor JM, Lappin D, Martin AD, Frangiosa T, Biggar V, Slota C, Romano C, DiBenedetti DB. Assessing What Matters to People Affected by Alzheimer's Disease: A Quantitative Analysis. Neurol Ther 2023; 12:505-527. [PMID: 36763306 PMCID: PMC10043143 DOI: 10.1007/s40120-023-00445-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION In this phase of the ongoing What Matters Most study series, designed to evaluate concepts that are meaningful to people affected by Alzheimer's disease (AD), we quantified the importance of symptoms, impacts, and outcomes of AD to people at risk for or with AD and care partners of people with AD. METHODS We administered a web-based survey to individuals at risk for or with AD (Group 1: unimpaired cognition with evidence of AD pathology; Group 2: AD risk factors and subjective cognitive complaints/mild cognitive impairment; Group 3: mild AD) and to care partners of individuals with moderate AD (Group 4) or severe AD (Group 5). Respondents rated the importance of 42 symptoms, impacts, and outcomes on a scale ranging from 1 ("not at all important") to 5 ("extremely important"). RESULTS Among the 274 respondents (70.4% female; 63.1% white), over half of patient respondents rated all 42 items as "very important" or "extremely important," while care partners rated fewer items as "very important" or "extremely important." Among the three patient groups, the minimum (maximum) mean importance rating for any item was 3.4 (4.6), indicating that all items were at least moderately to very important. Among care partners of people with moderate or severe AD, the minimum (maximum) mean importance rating was 2.1 (4.4), indicating that most items were rated as at least moderately important. Overall, taking medications correctly, not feeling down or depressed, and staying safe had the highest importance ratings among both patients and care partners, regardless of AD phase. CONCLUSION Concepts of importance to individuals affected by AD go beyond the common understanding of "cognition" or "function" alone, reflecting a desire to maintain independence, overall physical and mental health, emotional well-being, and safety. Preservation of these attributes may be key to understanding whether interventions deliver clinically meaningful outcomes.
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Affiliation(s)
- Brett Hauber
- RTI Health Solutions, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Russ Paulsen
- UsAgainstAlzheimer's, Washington, DC, 20043, USA
| | - Holly B Krasa
- Blue Persimmon Group LLC, Washington, DC, 20016, USA
| | | | - Meryl Comer
- UsAgainstAlzheimer's, Washington, DC, 20043, USA
| | | | - John Winfield
- University of North Carolina, Chapel Hill, NC, 27599, USA
| | | | | | - Daniel Lee
- Otsuka Pharmaceutical Development and Commercialization Inc., Princeton, NJ, 08540, USA
| | - Hilary Wilson
- Boehringer Ingelheim, Burlington, ON, L7L 5H4, Canada
| | | | | | - Ian N Kremer
- LEAD Coalition (Leaders Engaged on Alzheimer's Disease), Washington, DC, 20043, USA
| | | | | | - Debra Lappin
- Faegre Drinker Consulting, Washington, DC, 20001, USA
| | | | | | | | - Christina Slota
- RTI Health Solutions, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Carla Romano
- RTI Health Solutions, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Dana B DiBenedetti
- RTI Health Solutions, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC, 27709-2194, USA.
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Bachman SL, Blankenship JM, Busa M, Serviente C, Lyden K, Clay I. Capturing Measures That Matter: The Potential Value of Digital Measures of Physical Behavior for Alzheimer's Disease Drug Development. J Alzheimers Dis 2023; 95:379-389. [PMID: 37545234 PMCID: PMC10578291 DOI: 10.3233/jad-230152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/08/2023]
Abstract
Alzheimer's disease (AD) is a devastating neurodegenerative disease and the primary cause of dementia worldwide. Despite the magnitude of AD's impact on patients, caregivers, and society, nearly all AD clinical trials fail. A potential contributor to this high rate of failure is that established clinical outcome assessments fail to capture subtle clinical changes, entail high burden for patients and their caregivers, and ineffectively address the aspects of health deemed important by patients and their caregivers. AD progression is associated with widespread changes in physical behavior that have impacts on the ability to function independently, which is a meaningful aspect of health for patients with AD and important for diagnosis. However, established assessments of functional independence remain underutilized in AD clinical trials and are limited by subjective biases and ceiling effects. Digital measures of real-world physical behavior assessed passively, continuously, and remotely using digital health technologies have the potential to address some of these limitations and to capture aspects of functional independence in patients with AD. In particular, measures of real-world gait, physical activity, and life-space mobility captured with wearable sensors may offer value. Additional research is needed to understand the validity, feasibility, and acceptability of these measures in AD clinical research.
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Affiliation(s)
| | | | - Michael Busa
- Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Corinna Serviente
- Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA
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Ferrell PB, Fillit H, Neumann PJ, Wall JK, Murray JF. Toward comprehensive value assessment for Alzheimer's disease innovations. Alzheimers Dement 2022; 19:1558-1567. [PMID: 36427013 DOI: 10.1002/alz.12874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Assessing medical technologies for Alzheimer's disease (AD) creates challenges for current methods of value assessment. New value assessment approaches for AD are also needed. METHODS We adapted concepts from health economics to help guide decision makers to more informed decisions about AD therapies and diagnostics. RESULTS We propose a value framework based on five categories: perspective, value elements, analysis, reporting, and decision making. AD value assessments should include the perspective of the patient-caregiver dyad. We propose a broader array of value elements than currently used. Analytics and decision methods can synthesize evidence for all elements of value. Decisions should use a "deliberative appraisal" approach informed by the composite evidence and be transparently reported. DISCUSSION Using the proposed framework, the value of forthcoming innovations for AD may be more thoroughly assessed for and by all stakeholders. It can guide decision makers to carefully consider all relevant elements of value contributing to more holistic and transparent decision making. RESEARCH HIGHLIGHTS Alzheimer's disease challenges common methods of evaluating medical technology. Using current methods, new AD innovations might not be appropriately valued. Poor value assessments will adversely affect patient access to AD innovations. A full AD value framework expands perspective, elements, analysis, decision-making, reporting.
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Affiliation(s)
| | - Howard Fillit
- Alzheimer's Drug Discovery Foundation and Icahn School of Medicine at Mount Sinai New York New York USA
| | - Peter J. Neumann
- Center for the Evaluation of Value and Risk in Health Tufts Medical Center Boston Massachusetts USA
| | - J. K. Wall
- Eli Lilly and Company Lilly Corporate Center Indianapolis Indiana USA
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Lin L, Cao B, Chen W, Li J, Zhang Y, Guo VY. Association of Adverse Childhood Experiences and Social Isolation With Later-Life Cognitive Function Among Adults in China. JAMA Netw Open 2022; 5:e2241714. [PMID: 36367722 PMCID: PMC9652754 DOI: 10.1001/jamanetworkopen.2022.41714] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
IMPORTANCE Studies investigating the association of threat-related and deprivation-related adverse childhood experiences (ACEs) with later-life cognitive decline are lacking. OBJECTIVES To evaluate the independent association of threat-related and deprivation-related ACEs with cognitive decline over time among middle-aged and older Chinese adults and to examine the modifying role of social isolation in such associations. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study used cognitive data from the China Health and Retirement Longitudinal Study (CHARLS) baseline survey that was administered between June 1, 2011, and March 31, 2012, and the CHARLS follow-up survey administered between July 1 and September 30, 2015. The life history survey with information of ACEs was additionally administered between June 1 and December 31, 2014. Statistical analysis was performed from March 1 to July 31, 2022. The study population consisted of middle-aged and older adults (age range, 45-97 years) with complete data on ACEs and 2 cognitive assessments and without cognitive impairment at baseline. EXPOSURES Five threat-related ACEs (ie, physical abuse, household substance abuse, domestic violence, unsafe neighborhood, and bullying) and 5 deprivation-related ACEs (ie, emotional neglect, household mental illness, incarcerated household member, parental separation or divorce, and parental death) before 17 years of age were queried by questionnaires. The cumulative scores of the 2 ACE dimensions were calculated and grouped into 3 categories as 0, 1, and 2 or more in main analyses. MAIN OUTCOMES AND MEASURES Cognitive function was measured by episodic memory and executive function. Global cognition was further calculated as the total score of these 2 dimensions. The raw scores of each cognitive test were standardized to z scores using baseline means and SDs. Linear mixed-effects models were constructed to examine the association between 2 dimensions of ACEs and the rate of annual cognitive decline. The modifying role of baseline social isolation in such associations was assessed with 3-way interaction tests. RESULTS Of the 6466 participants included in main analyses, 3301 (51.1%) were men and the mean (SD) age was 57.2 (8.3) years. Compared with no exposures, experience of 1 deprivation-related ACE was associated with faster cognitive decline in global cognition (β = -0.012 [95% CI, -0.022 to -0.002] SD/y) and executive function (β = -0.010 [95% CI, -0.020 to -0.00002] SD/y), whereas individuals with at least 2 childhood deprivations had faster cognitive declines in all cognitive tests (β = -0.035 [95% CI, -0.050 to -0.019] SD/y for global cognition; β = -0.047 [95% CI, -0.068 to -0.025] SD/y for episodic memory; β = -0.019 [95% CI, -0.034 to -0.004] SD/y for executive function). However, such an association was not observed for threat-related ACEs. In addition, baseline social isolation was a significant modifier in the associations between deprivation-related ACEs and cognitive declines in global cognition (β = -0.033 [95% CI, -0.061 to -0.005] SD/y; P = .02 for 3-way interaction) and executive function (β = -0.032 [95% CI, -0.059 to -0.005] SD/y; P = .02 for 3-way interaction). CONCLUSIONS AND RELEVANCE Deprivation-related ACEs, but not threat-related ACEs, were associated with faster decline in later-life cognitive function, whereas social isolation could modify such detrimental impact. These findings highlight the potential benefits of promoting social integration in maintaining later-life cognitive function among individuals who have experienced childhood deprivation.
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Affiliation(s)
- Li Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Bing Cao
- Department of Neurosurgery, Wu Tsai Neuroscience Institute, Stanford University School of Medicine, Stanford, California
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jinghua Li
- Department of Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuying Zhang
- Department of Child Healthcare, Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Villarejo-Galende A, García-Arcelay E, Piñol-Ripoll G, del Olmo-Rodríguez A, Viñuela F, Boada M, Franco-Macías E, Ibañez de la Peña A, Riverol M, Puig-Pijoan A, Abizanda-Soler P, Arroyo R, Baquero-Toledo M, Feria-Vilar I, Balasa M, Berbel Á, Rodríguez-Rodríguez E, Vieira-Campos A, García-Ribas G, Rodrigo-Herrero S, Terrancle Á, Prefasi D, Lleó A, Maurino J. Quality of Life and the Experience of Living with Early-Stage Alzheimer’s Disease. J Alzheimers Dis 2022; 90:719-726. [DOI: 10.3233/jad-220696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: There is a need to better understand the experience of patients living with Alzheimer's disease (AD) in the early stages. Objective: The aim of the study was to evaluate the perception of quality of life in patients with early-stage AD. Methods: A multicenter, non-interventional study was conducted including patients of 50–90 years of age with prodromal or mild AD, a Mini-Mental State Examination (MMSE) score ≥22, and a Clinical Dementia Rating-Global score (CDR-GS) of 0.5.–1.0. The Quality of Life in Alzheimer ’s Disease (QoL-AD) questionnaire was used to assess health-related quality of life. A battery of self-report instruments was used to evaluate different psychological and behavioral domains. Associations between the QoL-AD and other outcome measures were analyzed using Spearman’s rank correlations. Results: A total of 149 patients were included. Mean age (SD) was 72.3 (7.0) years and mean disease duration was 1.4 (1.8) years. Mean MMSE score was 24.6 (2.1). The mean QoL-AD score was 37.9 (4.5). Eighty-three percent (n = 124) of patients had moderate-to-severe hopelessness, 22.1% (n = 33) had depressive symptoms, and 36.9% (n = 55) felt stigmatized. The quality of life showed a significant positive correlation with self-efficacy and negative correlations with depression, emotional and practical consequences, stigma, and hopelessness. Conclusion: Stigma, depressive symptoms, and hopelessness are frequent scenarios in AD negatively impacting quality of life, even in a population with short disease duration and minimal cognitive impairment.
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Affiliation(s)
- Alberto Villarejo-Galende
- Department of Neurology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Gerard Piñol-Ripoll
- Cognitive Disorders Unit, Hospital Universitari Santa Maria de Lleida, Institut de Recerca Biomédica de Lleida (IRBLLeida), Lleida, Spain
| | | | - Félix Viñuela
- Instituto Neurológico Andaluz, Hospital Victoria Eugenia, Unidad Deterioro Cognitivo, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Mercè Boada
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Emilio Franco-Macías
- Dementia Unit, Department of Neurology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | | | - Mario Riverol
- Department of Neurology, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Albert Puig-Pijoan
- Cognitive Impairment and Movement Disorders Unit, Department of Neurology, Hospital del Mar, Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Pedro Abizanda-Soler
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Rafael Arroyo
- Department of Neurology, Hospital Universitario Quirónsalud, Madrid, Spain
| | - Miquel Baquero-Toledo
- Grup d’Investigació en Malaltia d’Alzheimer, Department of Neurology, Hospital Universitari i Politècnic La Fe, Institut d’Investigació Sanitaria La Fe, Valencia, Spain
| | - Inmaculada Feria-Vilar
- Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Mircea Balasa
- Alzheimer’s Disease and other Cognitive Disorders Unit, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ángel Berbel
- Department of Neurology, Hospital Central de la Cruz Roja, Madrid, Spain
| | - Eloy Rodríguez-Rodríguez
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
- Department of Neurology, Hospital Universitario de Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Universidad de Cantabria, Santander, Spain
| | - Alba Vieira-Campos
- Department of Neurology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Guillermo García-Ribas
- Department of Neurology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain
| | - Silvia Rodrigo-Herrero
- Department of Neurology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain
| | | | | | - Alberto Lleó
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
- Department of Neurology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain
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Hackett K, Giovannetti T. Capturing Cognitive Aging in Vivo: Application of a Neuropsychological Framework for Emerging Digital Tools. JMIR Aging 2022; 5:e38130. [PMID: 36069747 PMCID: PMC9494215 DOI: 10.2196/38130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/19/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022] Open
Abstract
As the global burden of dementia continues to plague our healthcare systems, efficient, objective, and sensitive tools to detect neurodegenerative disease and capture meaningful changes in everyday cognition are increasingly needed. Emerging digital tools present a promising option to address many drawbacks of current approaches, with contexts of use that include early detection, risk stratification, prognosis, and outcome measurement. However, conceptual models to guide hypotheses and interpretation of results from digital tools are lacking and are needed to sort and organize the large amount of continuous data from a variety of sensors. In this viewpoint, we propose a neuropsychological framework for use alongside a key emerging approach—digital phenotyping. The Variability in Everyday Behavior (VIBE) model is rooted in established trends from the neuropsychology, neurology, rehabilitation psychology, cognitive neuroscience, and computer science literature and links patterns of intraindividual variability, cognitive abilities, and everyday functioning across clinical stages from healthy to dementia. Based on the VIBE model, we present testable hypotheses to guide the design and interpretation of digital phenotyping studies that capture everyday cognition in vivo. We conclude with methodological considerations and future directions regarding the application of the digital phenotyping approach to improve the efficiency, accessibility, accuracy, and ecological validity of cognitive assessment in older adults.
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Affiliation(s)
- Katherine Hackett
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States
| | - Tania Giovannetti
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States
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21
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Smith SK, Wolverson EL, Mountain GA. What is intended by the term “participation” and what does it mean to people living with dementia? A conceptual overview and directions for future research. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:952722. [PMID: 36189033 PMCID: PMC9397697 DOI: 10.3389/fresc.2022.952722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022]
Abstract
Policy continues to emphasise the importance of wellbeing in dementia. However, there is a vital need for psychosocial interventions that can promote positive outcomes to enhance “living well with dementia”. Our developing understanding of what people living with dementia report as being important to them, has resulted in new interpretations of what constitutes wellbeing including constructs such as “growth”, “purpose” and “participation”. These exciting and important constructs are not currently captured by outcome measures within dementia research. This limits our understanding of the value of psychosocial interventions. This paper explores the concept of participation and how continued participation in social life can make a difference to the rights of people living with dementia as citizens. We will firstly consider why participation is important for how we might measure outcomes in dementia research and care. Secondly, we will explore how we might measure participation. Finally, we will consider the value of participation as a psychosocial outcome in future research.
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Affiliation(s)
- Sarah Kate Smith
- Health, Wellbeing & Lifesciences, Sheffield Hallam University, Sheffield, United Kingdom
- Correspondence: Sarah Kate Smith
| | - Emma Louise Wolverson
- Health Sciences, University of Hull, Hull, United Kingdom
- Clinical Psychology for Older People, Humber Teaching NHS Foundation, Hull, United Kingdom
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22
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Howell M, Amir N, Guha C, Manera K, Tong A. The critical role of mixed methods research in developing valid and reliable patient-reported outcome measures. Methods 2022; 205:213-219. [PMID: 35878750 DOI: 10.1016/j.ymeth.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022] Open
Abstract
Randomised controlled clinical trials provide the gold standard for evidence underpinning clinical guidelines and patient centred care. However, this is only true when they are robustly designed, conducted and reported and then only if they include outcomes that are important to patients and clinicians. Important outcomes include those that measure impact on patient experience, quality of life, overall well-being, and physical, social, cognitive and emotional functioning, all of which require patient reported outcome measures (PROMs). Patient centred care must be underpinned by objective evidence of the effect of interventions on outcomes that are important to patients. Evidence for patient reported outcomes must be supported by valid and reliable PROMs. Importantly the PROM must reflect patient experience of the impact of the intervention on the outcome and enable quantitative evaluation of that impact. The purpose of this paper is to highlight the critical role of mixed methods research in developing PROMs that are valid (measure what they purport to measure), acceptable to those reporting the outcome and able to reliably detect meaningful differences between individuals with different conditions or severity and with time. This can only be achieved through a structured mixed methods program combining qualitative and quantitative research techniques.
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Affiliation(s)
- Martin Howell
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia; Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Noa Amir
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia; Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Chandana Guha
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia; Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Karine Manera
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia; Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia; Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
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Latest Trends in Outcome Measures in Dementia and Mild Cognitive Impairment Trials. Brain Sci 2022; 12:brainsci12070922. [PMID: 35884729 PMCID: PMC9313078 DOI: 10.3390/brainsci12070922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/20/2022] Open
Abstract
Disease modification trials in dementia and mild cognitive impairment (MCI) have not met with success. One potential criticism of these trials is the lack of sensitive outcome measures. A large number of outcome measures have been employed in dementia and MCI trials. This review aims to describe and analyze the utility of cognitive/clinical outcome measures in Alzheimer’s disease (AD) and MCI trials. Methods: A PubMed search was conducted using relevant MeSH terms and exploded keywords. The search was confined to English language publications of human studies from the last five years which describe the latest trends in the use of outcome measures. Results: Despite broad use, the outcome measures employed are heterogeneous, with little data on correlations between scales. Another problem is that most studies are over-reliant on clinician/researcher assessment and cognitive outcomes, and there is a definite lack of stakeholder input. Finetuning of the paradigm is also required for people with early-stage disease, mild to moderate disease, and advanced dementia, as the outcome measures in these subgroups have varying relevance. Disease modification/prevention is an appropriate goal in early disease, whereas palliation and freedom from discomfort are paramount in later stages. The outcome measures selected must be suitable for and sensitive to these particular care goals. Although there is a shift to enrich MCI cohorts using a biomarker-based approach, the clinical relevance of such outcome measures remains uncertain. Conclusions: Outcome measures in dementia/MCI trials remain inhomogeneous and diverse, despite extensive use. Outcome measures fall within several paradigms, including cognitive, functional, quality-of-life, biomarker-based, and patient-reported outcome measures. The success of future disease-modifying trials is reliant to a large extent on the selection of outcome measures which combine all outcomes of clinical relevance as well as clinical meaning. Outcome measures should be tied to the type and stage of dementia and to the specific interventions employed.
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Liang N, Chen Y, Yang S, Liang C, Gao L, Wang S, Wang Y, Zhang Z, Shi N. Chinese Herbal Medicine for Mild Cognitive Impairment: A Systematic Review of Randomized Controlled Trials. Front Neurol 2022; 13:903224. [PMID: 35847214 PMCID: PMC9279622 DOI: 10.3389/fneur.2022.903224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/10/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives This study aims to explore the benefits and harms of Chinese Herbal Medicine (CHM) for mild cognitive impairment (MCI). Methods Electronic searching was conducted in two English and four Chinese databases till 2021 December. Randomized clinical trials on CHM compared to no intervention, placebo or other therapies for MCI were included. Results Forty-nine RCTs (48 finished trials and 1 protocol) were identified. The overall methodological quality of included trials was relatively low. This review found that compared to no intervention or placebo, CHM can significantly decrease the number of patients who progressed to dementia (RR 0.36, 95% CI 0.22-0.58) and increase the cognitive function assessed by MMSE (MD 1.96, 95% CI 1.41-2.50) and MoCA (MD 2.44, 95% CI 1.57-3.31). The subgroup analysis of different CHM showed that Ginko leaf tablets can significantly improve the cognitive function compared to no intervention or placebo when assessed by MMSE (MD 2.03, 95% CI 1.18-2.88) and MoCA (MD 3.11, 95% CI 1.90-4.33). Compared to western medicine, CHM can significantly increase the score of MMSE (MD 0.88 95% CI 0.46-1.30) and MoCA (MD 0.87, 95% CI 0.33-1.41), but there was no significant difference on the score of ADL (SMD -0.61, 95% CI -1.49 to 0.27). None of the RCTs reported on the quality of life. Of 22 RCTs that reported adverse events, there was no statistical difference between the CHM and the control group. Conclusions CHM, Ginko leaf extracts in particular, could help to prevent progression into dementia and to improve cognitive function and ability of daily living activities. More qualified RCTs were needed to confirm the conclusion due to the low quality of current trials. Systematic Review Registration Unique Identifier: CRD42020157148.
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Affiliation(s)
- Ning Liang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yaxin Chen
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Sihong Yang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Changhao Liang
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Lidong Gao
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shang Wang
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yanping Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhanjun Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Nannan Shi
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
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Vassilaki M, Petersen RC, Vemuri P. Area Deprivation Index as a Surrogate of Resilience in Aging and Dementia. Front Psychol 2022; 13:930415. [PMID: 35846636 PMCID: PMC9277306 DOI: 10.3389/fpsyg.2022.930415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/07/2022] [Indexed: 11/15/2022] Open
Abstract
Area deprivation index (ADI), a tool used to capture the multidimensional neighborhood socioeconomic disadvantage across populations, is highly relevant to the field of aging and Alzheimer’s disease and Alzheimer’s disease related dementias (AD/ADRD). ADI is specifically relevant in the context of resilience, a broad term used to explain why some older adults have better cognitive outcomes than others. The goal of this mini-review is three-fold: (1) to summarize the current literature on ADI and its link to cognitive impairment outcomes; (2) suggest possible mechanisms through which ADI may have an impact on AD/ADRD outcomes, and (3) discuss important considerations when studying relations between ADI and cognitive as well as brain health. Though difficult to separate both the upstream factors that emerge from high (worse) ADI and all the mechanisms at play, ADI is an attractive proxy of resilience that captures multifactorial contributors to the risk of dementia. In addition, a life-course approach to studying ADI may allow us to capture resilience, which is a process developed over the lifespan. It might be easier to build, preserve or improve resilience in an environment that facilitates instead of hindering physical, social, and cognitively beneficial activities. Neighborhood disadvantage can adversely impact cognitive impairment risk but be at the same time a modifiable risk factor, amenable to policy changes that can affect communities.
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Affiliation(s)
- Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Maria Vassilaki,
| | - Ronald C. Petersen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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26
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Wessels AM, Belger M, Johnston JA, Yu Y, Rentz DM, Dowsett SA, Chandler J. Demonstration of Clinical Meaningfulness of the Integrated Alzheimer’s Disease Rating Scale (iADRS): Association Between Change in iADRS Scores and Patient and Caregiver Health Outcomes. J Alzheimers Dis 2022; 88:577-588. [PMID: 35694928 PMCID: PMC9398086 DOI: 10.3233/jad-220303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: The integrated Alzheimer’s Disease Rating Scale (iADRS) is a validated cognitive/functional composite that effectively captures cognitive and functional decline over a broad spectrum of disease. The clinical meaningfulness of change on iADRS can be supported by establishing an association with changes on important health outcome measures. Objective: To evaluate the relationship between change on the iADRS and changes in health outcomes in individuals with mild cognitive impairment (MCI) due to Alzheimer’s disease (AD), or mild or moderate AD dementia using placebo data from four AD clinical trials and data from one AD observational study. Methods: Analysis of covariate (ANCOVA) models were used to estimate the relationship between 18-month change on the iADRS and changes on health outcome measures (related to cost, quality of life, and caregiver burden). The regression coefficients for the iADRS were used to compute impact of natural disease progression and disease-modifying treatment on health outcomes. Additional ANCOVAs were conducted to understand whether cognition and/or function was the underlying explanation of any association between iADRS and health outcome change. Results: Across datasets and disease stages, a worsening on the iADRS was significantly associated with increased societal costs, caregiver burden (time and distress) and worsening in measures of patient quality of life. Conclusion: Decline on the iADRS was associated with worsening in health outcome measures. These findings suggest that the iADRS can be used in clinical trials as a proxy measure of clinically meaningful outcomes of AD progression.
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Affiliation(s)
| | - Mark Belger
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Youying Yu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Dorene M. Rentz
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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27
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Smith M, Brown M, Ritchie L, Papadopoulou C, Tolson D. Living with dementia in supported housing: A systematic review and thematic synthesis of qualitative research. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e589-e604. [PMID: 34708451 DOI: 10.1111/hsc.13618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/19/2021] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
Supported housing has been highlighted as a potential way to facilitate independent living for people with dementia by integrating housing with support or care services. However, the benefits and challenges of living with dementia in supported housing are not fully understood. This systematic review and thematic synthesis sought to understand how living in supported housing influences the lives of people with dementia, from the perspectives of people with dementia, their supporters, health and social care professionals. Seven databases were searched for qualitative research, date range: 1 January 2000-31 July 2021. Eleven published articles were included in the thematic synthesis. One core theme was generated, Maintaining Independence and Autonomy, divided into three subthemes - Support and Care, Social Relationships and the Physical Environment. Factors like person-centred care, social interaction and good environmental design contributed to the maintenance of independence and autonomy. Barriers like low staff ratios, stigma and limited access to the community led to a loss of independence and autonomy - often leading to people with dementia being referred or managed out of the settings. Although the articles acknowledged the importance of maintaining independence and autonomy for people with dementia, it appeared that supported housing settings often lacked the resources and facilities to make this a reality. More high-quality research is needed, particularly from the perspectives of people with dementia and their supporters, to understand if supported housing can delay care home admission, promote independence and autonomy and facilitate social networks and community connections for this population.
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Affiliation(s)
- Michael Smith
- Alzheimer Scotland Centre for Policy and Practice, School of Health and Life Sciences, University of the West of Scotland, Blantyre, Scotland, UK
| | - Margaret Brown
- Alzheimer Scotland Centre for Policy and Practice, School of Health and Life Sciences, University of the West of Scotland, Blantyre, Scotland, UK
| | - Louise Ritchie
- Alzheimer Scotland Centre for Policy and Practice, School of Health and Life Sciences, University of the West of Scotland, Blantyre, Scotland, UK
| | | | - Debbie Tolson
- Alzheimer Scotland Centre for Policy and Practice, School of Health and Life Sciences, University of the West of Scotland, Blantyre, Scotland, UK
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Saunders S, Sheehan S, Muniz-Terrera G, Luz S, Ritchie CW. Impact of clinical symptoms and diagnosis: the electronic Person-Specific Outcome Measure (ePSOM) development programme. J Patient Rep Outcomes 2022; 6:33. [PMID: 35380317 PMCID: PMC8982721 DOI: 10.1186/s41687-022-00433-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 03/03/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Regulatory bodies recommend that outcome measures used in Alzheimer’s disease (AD) clinical trials capture clinically meaningful changes for the trial participant. However, commonly used outcome measures do not reflect the individual’s views on what matters to them individually. The aim of the electronic Person-Specific Outcome Measure (ePSOM) programme is to better understand what outcomes matter to patients in early Alzheimer’s disease. Methods As part of the ePSOM programme, we designed and ran an online study to understand what matters to individuals when developing new treatments for AD. The ePSOM survey ran Aug 2019–Dec 2019 (UK) and collected primarily free text responses which were analysed using Natural Language Processing (NLP) techniques. In this paper, we focus our analyses on individuals who reported having a neurodegenerative disease diagnosis (primarily Mild Cognitive Impairment (MCI) or AD), reporting the most frequent and most important brain health priorities for this group. Due to a small sample size, the Diagnosis group was analysed as a whole. Finally, we compared the Diagnosis group to an age and gender matched control group using chi-squared tests to look for any differences between the Diagnosis and control groups’ priorities. Results The survey was completed by 5808 respondents, of whom 167 (2.9%) (women n = 91, men n = 69, other n = 7) had received one of our pre-defined neurodegenerative disease diagnosis: most commonly MCI n = 52, 1.1% (mean age 69.42, SD = 10.8); or Alzheimer’s disease n = 48, 1.0% (mean age 71.24, SD = 9.79). Several thematic clusters were significantly more important for the target diagnostic group, e.g.: Expressing opinions; and less important, e.g., Cognitive Games. Conclusion We conclude there are a range of outcomes which individuals consider important and what potential new treatments should help maintain or improve, suggesting that outcomes that matter shift along the preclinical, prodromal and overt dementia continuum. This has important implications for the development of outcome measures in long term prevention studies that last several years where participants may pass through different stages of disease. In the final stage of our project, we will design an electronic outcomes app which will employ the methodology tested in the large-scale survey to capture what matters to individuals about their brain health at an individual level. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00433-2.
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Law LLF, Mok VCT, Yau MKS, Fong KNK. Effects of functional task exercise on everyday problem-solving ability and functional status in older adults with mild cognitive impairment-a randomised controlled trial. Age Ageing 2022; 51:6399890. [PMID: 34673918 DOI: 10.1093/ageing/afab210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To investigate the effect of functional task exercise on everyday problem-solving ability and functional status in older adults with mild cognitive impairment compared to single exercise or cognitive training and no treatment control. DESIGN A single-blind, four-arm randomised controlled trial. SETTING Out-patient clinic and community centre. PARTICIPANTS Older adults with mild cognitive impairment aged ≥60 living in community. METHODS Participants (N = 145) were randomised to 8-week functional task exercise (N = 34), cognitive training (N = 38), exercise training (N = 37), or wait-list control (N = 36) group. Outcomes measures: Neurobehavioral Cognitive Status Examination, Category Verbal Fluency Test, Trail Making Test, Problems in Everyday Living Test, Activities of Daily Living Questionnaire, Instrumental Activities of Daily Living Scale; Chair stand test, Berg Balance Scale, and Short Form-12 Health Survey were conducted at baseline, post-intervention and 5-months follow-up. RESULTS Post-intervention results of ANCOVA revealed cognitive training improved everyday problem-solving (P = 0.012) and exercise training improved functional status (P = 0.003) compared to wait-list control. Functional task exercise group demonstrated highest improvement compared to cognitive training, exercise training and wait-list control groups in executive function (P range = 0.003-0.018); everyday problem-solving (P < 0.001); functional status (P range = <.001-0.002); and physical performance (P = 0.008) at post-intervention, with all remained significant at 5-month follow-up, and further significant improvement in mental well-being (P = 0.043). CONCLUSIONS Functional task exercise could be an effective intervention to improve everyday problem-solving ability and functional status in older adults with mild cognitive impairment. The findings support combining cognitive and exercise intervention may give additive and even synergistic effects.
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Affiliation(s)
- Lawla L F Law
- School of Medical and Health Sciences, Tung Wah College, Hong Kong SAR
| | - Vincent C T Mok
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Matthew K S Yau
- School of Medical and Health Sciences, Tung Wah College, Hong Kong SAR
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
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Martins R, Urbich M, Brännvall K, Gianinazzi M, Ching JE, Khoury CP, El-Hayek YH. Modelling the Pan-European Economic Burden of Alzheimer's Disease. JAR LIFE 2022; 11:38-46. [PMID: 36923231 PMCID: PMC10002890 DOI: 10.14283/jarlife.2022.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/02/2022] [Indexed: 11/17/2022]
Abstract
Background Recent advances open the opportunity of altering the course of Alzheimer's disease (AD) through lifestyle-based modifications and novel therapies. Ensuring that society is investing limited budgets in the interventions that have the greatest potential to generate tangible impact will require tools to guide policymakers. Objectives To build on previous studies to develop an economic model that estimates the societal burden of AD and evaluates the potential impact of novel interventions in six large European countries. Design AD progression was modelled using a published Markov structure with a 40-year time horizon to estimate lifetime costs and life years in a cohort aged 65 years and above diagnosed with mild cognitive impairment due to AD (MCI-AD) in 2020. Demographic projections were utilized to estimate the prevalence of MCI-AD up to 2100, total corresponding costs and life years. The model allows a comparison of costs associated with the introduction of a hypothetical new disease-modifying therapy that slows disease progression between MCI-AD and all AD-Dementia stages as well as a 'delayed onset' scenario where disease progression is halted at the MCI-AD stage, potentially occurring, for example, through lifestyle-based modifications. Results The 2022 present value of total lifetime costs for this cohort moving through all disease stages is ~€1.2T. Approximately 80% of the present value of lifetime costs in our model are driven by informal care and non-medical direct costs. Our model suggests that a 25% and 50% reduction in disease progression compared to natural history could translate into a present value of cost savings of €33.7B and €72.7B. Halting MCI-AD progression for 3 years with no therapeutic effect thereafter resulted in a present value cost savings of €84.7B in savings. Conclusions Our data further suggest that early intervention via disease-modifying therapies or lifestyle-based modifications in AD could result in cost savings for society. Additionally, our findings reinforce the importance of accounting for the full value of innovative interventions, management and care paradigms, including their potential impact on direct, indirect and intangible costs impacting patients, their care partners and health and social care systems.
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Affiliation(s)
- R Martins
- Global Market Access Solutions, Health Economics Unit, St-Prex, Switzerland; University of Groningen, University Medical Center Groningen, GZW Global Health department, Groningen, The Netherlands
| | - M Urbich
- Biogen International GmbH, Value and Access, HE and HTA Strategy, Switzerland
| | - K Brännvall
- Biogen International GmbH, Value and Access, Switzerland
| | - M Gianinazzi
- Biogen International GmbH, Value and Access, Switzerland
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Cohen S, Cummings J, Knox S, Potashman M, Harrison J. Clinical Trial Endpoints and Their Clinical Meaningfulness in Early Stages of Alzheimer's Disease. J Prev Alzheimers Dis 2022; 9:507-522. [PMID: 35841252 PMCID: PMC9843702 DOI: 10.14283/jpad.2022.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
As the focus of Alzheimer's disease (AD) therapeutic development shifts to the early stages of the disease, the clinical endpoints used in drug trials, and how these might translate into clinical practice, are of increasing importance. The clinical meaningfulness of trial outcome measures is often unclear, with a lack of conclusive evidence as to how these measures correlate to changes in disease progression and treatment response. Clarifying this would benefit all, including patients, care partners, primary care providers, regulators, and payers, and would enhance our understanding of the relationship between clinical trial endpoints and assessments used in everyday practice. At present, there is a wide range of assessment tools used in clinical trials for AD and substantial variability in measures selected as endpoints across these trials. The aim of this review is to summarize the most commonly used assessment tools for early stages of AD, describe their use in clinical trials and clinical practice, and discuss what might constitute clinically meaningful change in these measures in relation to disease progression and treatment response.
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Affiliation(s)
- S. Cohen
- Toronto Memory Program, Toronto, ON, Canada
| | - J. Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas (UNLV), NV, USA
| | - S. Knox
- Biogen International GmbH, Baar, Switzerland
| | | | - J. Harrison
- Metis Cognition Ltd, Wiltshire, UK,Alzheimer Center, AU Medical Center, Amsterdam, the Netherlands,Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK
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Bamford C, Wheatley A, Brunskill G, Booi L, Allan L, Banerjee S, Harrison Dening K, Manthorpe J, Robinson L. Key components of post-diagnostic support for people with dementia and their carers: A qualitative study. PLoS One 2021; 16:e0260506. [PMID: 34928972 PMCID: PMC8687564 DOI: 10.1371/journal.pone.0260506] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/10/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There has been a shift in focus of international dementia policies from improving diagnostic rates to enhancing the post-diagnostic support provided to people with dementia and their carers. There is, however, little agreement over what constitutes good post-diagnostic support. This study aimed to identify the components of post-diagnostic dementia support. METHODS We adopted a qualitative design using interviews, focus groups and observation to explore the perspectives of key stakeholders on the content of post-diagnostic dementia support. Purposive sampling was used to identify sites in England and Wales recognised as delivering good practice. Participants included 17 people with dementia, 31 carers, 68 service managers or funders, and 78 frontline staff. Interviews and focus groups were audio recorded and transcribed for analysis. Forty-eight sessions of observation were completed and recorded in fieldnotes. Components were identified through an inductive, thematic approach and cross-checked against national guidelines and existing frameworks; they were subsequently critically reviewed by a range of experts and our mixed stakeholder panel. RESULTS Twenty distinct components of post-diagnostic support were identified, related to five themes: timely identification and management of needs; understanding and managing dementia; emotional and psychological wellbeing; practical support; and integrating support. The first and last of these were cross-cutting themes facilitating the delivery of a unique constellation of components of post-diagnostic support to each individual living with dementia or dyad at a particular time. CONCLUSIONS Our work offers an empirically based framework to inform the development and delivery of holistic, integrated and continuous dementia care from diagnosis to end of life. It highlights the relevance of many components to both people living with dementia and their carers. Since the framework was developed in England and Wales, further research is needed to explore the relevance of our components to other sectors, countries and care systems.
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Affiliation(s)
- Claire Bamford
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Alison Wheatley
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Greta Brunskill
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Laura Booi
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Louise Allan
- South Cloisters, University of Exeter, Exeter, United Kingdom
| | - Sube Banerjee
- Office of Vice Chancellor, University of Plymouth, Plymouth, United Kingdom
| | | | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute at King’s, King’s College London, London, United Kingdom
| | - Louise Robinson
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
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Visser LNC, Minguillon C, Sánchez-Benavides G, Abramowicz M, Altomare D, Fauria K, Frisoni GB, Georges J, Ribaldi F, Scheltens P, van der Schaar J, Zwan M, van der Flier WM, Molinuevo JL. Dementia risk communication. A user manual for Brain Health Services-part 3 of 6. Alzheimers Res Ther 2021; 13:170. [PMID: 34635169 PMCID: PMC8507171 DOI: 10.1186/s13195-021-00840-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/03/2021] [Indexed: 11/17/2022]
Abstract
Growing evidence suggests dementia incidence can be reduced through prevention programs targeting risk factors. To accelerate the implementation of such prevention programs, a new generation of brain health services (BHS) is envisioned, involving risk profiling, risk communication, risk reduction, and cognitive enhancement. The purpose of risk communication is to enable individuals at risk to make informed decisions and take action to protect themselves and is thus a crucial step in tailored prevention strategies of the dementia incidence. However, communicating about dementia risk is complex and challenging.In this paper, we provide an overview of (i) perspectives on communicating dementia risk from an ethical, clinical, and societal viewpoint; (ii) insights gained from memory clinical practice; (iii) available evidence on the impact of disclosing APOE and Alzheimer's disease biomarker test results gathered from clinical trials and observational studies; (iv) the value of established registries in light of BHS; and (v) practical recommendations regarding effective strategies for communicating about dementia risk.In addition, we identify challenges, i.e., the current lack of evidence on what to tell on an individual level-the actual risk-and on how to optimally communicate about dementia risk, especially concerning worried yet cognitively unimpaired individuals. Ideally, dementia risk communication strategies should maximize the desired impact of risk information on individuals' understanding of their health/disease status and risk perception and minimize potential harms. More research is thus warranted on the impact of dementia risk communication, to (1) evaluate the merits of different approaches to risk communication on outcomes in the cognitive, affective and behavioral domains, (2) develop an evidence-based, harmonized dementia risk communication protocol, and (3) develop e-tools to support and promote adherence to this protocol in BHSs.Based on the research reviewed, we recommend that dementia risk communication should be precise; include the use of absolute risks, visual displays, and time frames; based on a process of shared decision-making; and address the inherent uncertainty that comes with any probability.
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Affiliation(s)
- Leonie N C Visser
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.
| | - Carolina Minguillon
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain.
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.
| | - Gonzalo Sánchez-Benavides
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Marc Abramowicz
- Division of Genetic Medicine, Department of Diagnostics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Daniele Altomare
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Memory Clinic, Geneva University Hospitals, Geneva, Switzerland
| | - Karine Fauria
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Giovanni B Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Memory Clinic, Geneva University Hospitals, Geneva, Switzerland
| | | | - Federica Ribaldi
- Division of Genetic Medicine, Department of Diagnostics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), Saint John of God Clinical Research Centre, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jetske van der Schaar
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marissa Zwan
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - José Luis Molinuevo
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
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Mank A, van Maurik IS, Bakker ED, van de Glind EMM, Jönsson L, Kramberger MG, Novak P, Diaz A, Gove D, Scheltens P, van der Flier WM, Visser LNC. Identifying relevant outcomes in the progression of Alzheimer's disease; what do patients and care partners want to know about prognosis? ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12189. [PMID: 34458555 PMCID: PMC8377775 DOI: 10.1002/trc2.12189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/19/2021] [Accepted: 05/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Prognostic studies in the context of Alzheimer's disease (AD) mainly predicted time to dementia. However, it is questionable whether onset of dementia is the most relevant outcome along the AD disease trajectory from the perspective of patients and their care partners. Therefore, we aimed to identify the most relevant outcomes from the viewpoint of patients and care partners. METHODS We used a two-step, mixed-methods approach. As a first step we conducted four focus groups in the Netherlands to elicit a comprehensive list of outcomes considered important by patients (n = 12) and care partners (n = 14) in the prognosis of AD. The focus groups resulted in a list of 59 items, divided into five categories. Next, in an online European survey, we asked participants (n = 232; 99 patients, 133 care partners) to rate the importance of all 59 items (5-point Likert scale). As participants were likely to rate a large number of outcomes as "important" (4) or "very important" (5), we subsequently asked them to select the three items they considered most important. RESULTS The top-10 lists of items most frequently mentioned as "most important" by patients and care partners were merged into one core outcome list, comprising 13 items. Both patients and care partners selected outcomes from the category "cognition" most often, followed by items in the categories "functioning and dependency" and "physical health." No items from the category "behavior and neuropsychiatry" and "social environment" ended up in our core list of relevant outcomes. CONCLUSION We identified a core list of outcomes relevant to patients and care partner, and found that prognostic information related to cognitive decline, dependency, and physical health are considered most relevant by both patients and their care partners.
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Affiliation(s)
- Arenda Mank
- Alzheimer Center AmsterdamDepartment of NeurologyVU University Medical CenterAmsterdam UMCAmsterdamthe Netherlands
| | - Ingrid S. van Maurik
- Alzheimer Center AmsterdamDepartment of NeurologyVU University Medical CenterAmsterdam UMCAmsterdamthe Netherlands
- Department of Epidemiology and Data ScienceAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Els D. Bakker
- Alzheimer Center AmsterdamDepartment of NeurologyVU University Medical CenterAmsterdam UMCAmsterdamthe Netherlands
| | | | | | - Milica G. Kramberger
- Center for Cognitive ImpairmentsUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Petr Novak
- Institute of NeuroimmunologySlovak Academy of SciencesBratislavaSlovakia
| | - Ana Diaz
- Alzheimer Europe (AE)Luxembourg CityLuxembourg
| | - Dianne Gove
- Alzheimer Europe (AE)Luxembourg CityLuxembourg
| | - Philip Scheltens
- Alzheimer Center AmsterdamDepartment of NeurologyVU University Medical CenterAmsterdam UMCAmsterdamthe Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center AmsterdamDepartment of NeurologyVU University Medical CenterAmsterdam UMCAmsterdamthe Netherlands
| | - Leonie N. C. Visser
- Alzheimer Center AmsterdamDepartment of NeurologyVU University Medical CenterAmsterdam UMCAmsterdamthe Netherlands
- Department of Medical PsychologyAmsterdam Public Health Research InstituteAmsterdam UMCAmsterdamthe Netherlands
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Booi L, Wheatley A, Brunskill G, Banerjee S, Manthorpe J, Robinson L, Bamford C. Outcomes valued by people living with dementia and their care partners: protocol for a qualitative systematic review and synthesis. BMJ Open 2021; 11:e050909. [PMID: 34413109 PMCID: PMC8378359 DOI: 10.1136/bmjopen-2021-050909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Growing numbers of interventions are being developed to support people and families living with dementia, but the extent to which they address the areas of most importance to the intended recipients is unclear. This qualitative review will synthesise outcomes identified as important from the perspectives of people living with dementia and their care partners, both for themselves and each other. METHODS AND ANALYSIS The review will employ thematic synthesis methodology. Studies from 1990 or later will be eligible if they include qualitative data on the views of people living with dementia or their care partners on valued outcomes or the lived experience of dementia. Databases to be searched include MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo and Social Sciences Premium Collection, in addition to systematically gathered grey literature. Rayyan QCRI software will be used to manage the screening processes, and NVivo software will be used to manage data extraction and analysis. The review will also critically evaluate the extent to which international recommendations address the areas of importance to people living with dementia and their families. The findings will be of relevance to researchers, policy makers and providers and commissioners of dementia services. The protocol is written in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. ETHICS AND DISSEMINATION As the methodology of this study consists of collecting data from publicly available articles, it does not require ethical approval. We will share the results through conference presentations and an open-access publication in a peer-reviewed journal. Our mixed stakeholder involvement group will advise on dissemination to non-academic audiences. PROSPERO REGISTRATION NUMBER CRD42020219274.
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Affiliation(s)
- Laura Booi
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Alison Wheatley
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Greta Brunskill
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sube Banerjee
- Office of Vice Chancellor, University of Plymouth, Plymouth, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute at King's, King's College London, London, UK
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Angehrn Z, Sostar J, Nordon C, Turner A, Gove D, Karcher H, Keenan A, Mittelstadt B, de Reydet-de Vulpillieres F. Ethical and Social Implications of Using Predictive Modeling for Alzheimer's Disease Prevention: A Systematic Literature Review. J Alzheimers Dis 2021; 76:923-940. [PMID: 32597799 DOI: 10.3233/jad-191159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The therapeutic paradigm in Alzheimer's disease (AD) is shifting from symptoms management toward prevention goals. Secondary prevention requires the identification of individuals without clinical symptoms, yet "at-risk" of developing AD dementia in the future, and thus, the use of predictive modeling. OBJECTIVE The objective of this study was to review the ethical concerns and social implications generated by this new approach. METHODS We conducted a systematic literature review in Medline, Embase, PsycInfo, and Scopus, and complemented it with a gray literature search between March and July 2018. Then we analyzed data qualitatively using a thematic analysis technique. RESULTS We identified thirty-one ethical issues and social concerns corresponding to eight ethical principles: (i) respect for autonomy, (ii) beneficence, (iii) non-maleficence, (iv) equality, justice, and diversity, (v) identity and stigma, (vi) privacy, (vii) accountability, transparency, and professionalism, and (viii) uncertainty avoidance. Much of the literature sees the discovery of disease-modifying treatment as a necessary and sufficient condition to justify AD risk assessment, overlooking future challenges in providing equitable access to it, establishing long-term treatment outcomes and social consequences of this approach, e.g., medicalization. The ethical/social issues associated specifically with predictive models, such as the adequate predictive power and reliability, infrastructural requirements, data privacy, potential for personalized medicine in AD, and limiting access to future AD treatment based on risk stratification, were covered scarcely. CONCLUSION The ethical discussion needs to advance to reflect recent scientific developments and guide clinical practice now and in the future, so that necessary safeguards are implemented for large-scale AD secondary prevention.
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Diaz A, Gove D, Nelson M, Smith M, Tochel C, Bintener C, Ly A, Bexelius C, Gustavsson A, Georges J, Gallacher J, Sudlow C. Conducting public involvement in dementia research: The contribution of the European Working Group of People with Dementia to the ROADMAP project. Health Expect 2021; 24:757-765. [PMID: 33822448 PMCID: PMC8235878 DOI: 10.1111/hex.13246] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/17/2021] [Accepted: 03/10/2021] [Indexed: 11/27/2022] Open
Abstract
Background Dementia outcomes include memory loss, language impairment, reduced quality of life and personality changes. Research suggests that outcomes selected for dementia clinical trials might not be the most important to people affected. Objective One of the goals of the ‘Real world Outcomes across the Alzheimer's Disease spectrum for better care: Multi‐modal data Access Platform’ (ROADMAP) project was to identify important outcomes from the perspective of people with dementia and their caregivers. We review how ROADMAP's Public Involvement shaped the programme, impacted the research process and gave voice to people affected by dementia. Design The European Working Group of People with Dementia (EWGPWD) were invited to participate. In‐person consultations were held with people with dementia and caregivers, with advance information provided on ROADMAP activities. Constructive criticism of survey content, layout and accessibility was sought, as were views and perspectives on terminology and key concepts around disease progression. Results The working group provided significant improvements to survey accessibility and acceptability. They promoted better understanding of concepts around disease progression and how researchers might approach measuring and interpreting findings. They effectively expressed difficult concepts through real‐world examples. Conclusions The role of the EWGPWD in ROADMAP was crucial, and its impact was highly influential. Involvement from the design stage helped shape the ethos of the programme and ultimately its meaningfulness. Public contribution People with dementia and their carers were involved through structured consultations and invited to provide feedback on project materials, methods and insight into terminology and relevant concepts.
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Affiliation(s)
- Ana Diaz
- Alzheimer Europe, Luxembourg City, Luxembourg
| | - Dianne Gove
- Alzheimer Europe, Luxembourg City, Luxembourg
| | - Mia Nelson
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Michael Smith
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Claire Tochel
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Amanda Ly
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | | | | | | | - Cathie Sudlow
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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Traumatic stress as a mediator of quality of life and burden in informal caregivers of amputees due to diabetic foot: a longitudinal study. HEALTH PSYCHOLOGY REPORT 2021. [DOI: 10.5114/hpr.2020.101495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Robinson L, Poole M, McLellan E, Lee R, Amador S, Bhattarai N, Bryant A, Coe D, Corbett A, Exley C, Goodman C, Gotts Z, Harrison-Dening K, Hill S, Howel D, Hrisos S, Hughes J, Kernohan A, Macdonald A, Mason H, Massey C, Neves S, Paes P, Rennie K, Rice S, Robinson T, Sampson E, Tucker S, Tzelis D, Vale L, Bamford C. Supporting good quality, community-based end-of-life care for people living with dementia: the SEED research programme including feasibility RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
In the UK, most people with dementia die in the community and they often receive poorer end-of-life care than people with cancer.
Objective
The overall aim of this programme was to support professionals to deliver good-quality, community-based care towards, and at, the end of life for people living with dementia and their families.
Design
The Supporting Excellence in End-of-life care in Dementia (SEED) programme comprised six interlinked workstreams. Workstream 1 examined existing guidance and outcome measures using systematic reviews, identified good practice through a national e-survey and explored outcomes of end-of-life care valued by people with dementia and family carers (n = 57) using a Q-sort study. Workstream 2 explored good-quality end-of-life care in dementia from the perspectives of a range of stakeholders using qualitative methods (119 interviews, 12 focus groups and 256 observation hours). Using data from workstreams 1 and 2, workstream 3 used co-design methods with key stakeholders to develop the SEED intervention. Worksteam 4 was a pilot study of the SEED intervention with an embedded process evaluation. Using a cluster design, we assessed the feasibility and acceptability of recruitment and retention, outcome measures and our intervention. Four general practices were recruited in North East England: two were allocated to the intervention and two provided usual care. Patient recruitment was via general practitioner dementia registers. Outcome data were collected at baseline, 4, 8 and 12 months. Workstream 5 involved economic modelling studies that assessed the potential value of the SEED intervention using a contingent valuation survey of the general public (n = 1002). These data informed an economic decision model to explore how the SEED intervention might influence care. Results of the model were presented in terms of the costs and consequences (e.g. hospitalisations) and, using the contingent valuation data, a cost–benefit analysis. Workstream 6 examined commissioning of end-of-life care in dementia through a narrative review of policy and practice literature, combined with indepth interviews with a national sample of service commissioners (n = 20).
Setting
The workstream 1 survey and workstream 2 included services throughout England. The workstream 1 Q-sort study and workstream 4 pilot trial took place in North East England. For workstream 4, four general practices were recruited; two received the intervention and two provided usual care.
Results
Currently, dementia care and end-of-life care are commissioned separately, with commissioners receiving little formal guidance and training. Examples of good practice rely on non-recurrent funding and leadership from an interested clinician. Seven key components are required for good end-of-life care in dementia: timely planning discussions, recognising end of life and providing supportive care, co-ordinating care, effective working with primary care, managing hospitalisation, continuing care after death, and valuing staff and ongoing learning. Using co-design methods and the theory of change, the seven components were operationalised as a primary care-based, dementia nurse specialist intervention, with a care resource kit to help the dementia nurse specialist improve the knowledge of family and professional carers. The SEED intervention proved feasible and acceptable to all stakeholders, and being located in the general practice was considered beneficial. None of the outcome measures was suitable as the primary outcome for a future trial. The contingent valuation showed that the SEED intervention was valued, with a wider package of care valued more than selected features in isolation. The SEED intervention is unlikely to reduce costs, but this may be offset by the value placed on the SEED intervention by the general public.
Limitations
The biggest challenge to the successful delivery and completion of this research programme was translating the ‘theoretical’ complex intervention into practice in an ever-changing policy and service landscape at national and local levels. A major limitation for a future trial is the lack of a valid and relevant primary outcome measure to evaluate the effectiveness of a complex intervention that influences outcomes for both individuals and systems.
Conclusions
Although the dementia nurse specialist intervention was acceptable, feasible and integrated well with existing care, it is unlikely to reduce costs of care; however, it was highly valued by all stakeholders (professionals, people with dementia and their families) and has the potential to influence outcomes at both an individual and a systems level.
Future work
There is no plan to progress to a full randomised controlled trial of the SEED intervention in its current form. In view of new National Institute for Health and Care Excellence dementia guidance, which now recommends a care co-ordinator for all people with dementia, the feasibility of providing the SEED intervention throughout the illness trajectory should be explored. Appropriate outcome measures to evaluate the effectiveness of such a complex intervention are needed urgently.
Trial registration
Current Controlled Trials ISRCTN21390601.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research, Vol. 8, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Marie Poole
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma McLellan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Lee
- Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Sarah Amador
- Division of Psychiatry, University College London, London, UK
| | - Nawaraj Bhattarai
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Bryant
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dorothy Coe
- North East and North Cumbria Local Clinical Research Network, Newcastle upon Tyne, UK
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Catherine Exley
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Goodman
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Zoe Gotts
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Sarah Hill
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Susan Hrisos
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Christopher Massey
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Paul Paes
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Katherine Rennie
- Faculty of Medical Sciences, Professional Services, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Rice
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tomos Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Elizabeth Sampson
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | | | - Dimitrios Tzelis
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Bauer A, Wittenberg R, Ly A, Gustavsson A, Bexelius C, Tochel C, Knapp M, Nelson M, Sudlow C. Valuing Alzheimer's disease drugs: a health technology assessment perspective on outcomes. Int J Technol Assess Health Care 2020; 36:1-7. [PMID: 32847642 DOI: 10.1017/s0266462320000574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Due to the nature of Alzheimer's disease (AD), health technology assessment (HTA) agencies might face considerable challenges in choosing appropriate outcomes and outcome measures for drugs that treat the condition. This study sought to understand which outcomes informed previous HTAs, to explore possible reasons for prioritizations, and derive potential implications for future assessments of AD drugs. METHOD We conducted a literature review of studies that analyzed decisions made in HTAs (across disease areas) in three European countries: England, Germany, and The Netherlands. We then conducted case studies of technology assessments conducted for AD drugs in these countries. RESULTS Overall, outcomes measured using clinical scales dominated decisions or recommendations about whether to fund AD drugs, or price negotiations. HTA processes did not always allow the inclusion of outcomes relevant to people with AD, their carers, and families. Processes did not include early discussion and agreement on what would constitute appropriate outcome measures and cut-off points for effects. CONCLUSIONS We conclude that in order to ensure that future AD drugs are valued appropriately and timely, early agreement with various stakeholders about outcomes, outcome measures, and cut-offs is important.
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Affiliation(s)
- Annette Bauer
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, LondonWC2A 2AE, UK
| | - Raphael Wittenberg
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, LondonWC2A 2AE, UK
| | - Amanda Ly
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Nine Edinburgh BioQuarter, 9 Little France Road, EdinburghEH16 4UX, UK
| | - Anders Gustavsson
- Quantify Research, Hantverkargatan 8, 112 21Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Alfred Nobels allé 23, 141 83Stockholm, Sweden
| | - Christin Bexelius
- ROCHE. F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070Basel, Switzerland
| | - Claire Tochel
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Nine Edinburgh BioQuarter, 9 Little France Road, EdinburghEH16 4UX, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, LondonWC2A 2AE, UK
| | - Mia Nelson
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Nine Edinburgh BioQuarter, 9 Little France Road, EdinburghEH16 4UX, UK
| | - Catherine Sudlow
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Nine Edinburgh BioQuarter, 9 Little France Road, EdinburghEH16 4UX, UK
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Clarke C, Woods B, Moniz-Cook E, Mountain G, Øksnebjerg L, Chattat R, Diaz A, Gove D, Vernooij-Dassen M, Wolverson E. Measuring the well-being of people with dementia: a conceptual scoping review. Health Qual Life Outcomes 2020; 18:249. [PMID: 32709238 PMCID: PMC7382062 DOI: 10.1186/s12955-020-01440-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/05/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Enabling people with dementia to 'live well' is a policy and research priority in many countries. However, instruments for measuring outcomes of psychosocial interventions designed to promote well-being in dementia are often derived from a symptom-focused, loss/deficit approach, or from broad quality of life concepts. A pan-European dementia working group called for research on the development of an alternative asset/strengths-based conceptual framework of well-being in dementia. This paper takes forward this recommendation by developing such a framework and using this to map relevant self-report outcome measures. METHODS Three scoping reviews of published studies were conducted iteratively. First, we examined the literature on lived experiences of well-being and quality of life in people with dementia and then the wider dementia literature for application of well-being constructs. The synthesised findings generated conceptual domains of well-being in people with dementia. Corresponding self-report instruments used in dementia research were scoped, categorised within the conceptual framework and their potential value in measuring outcomes for people with dementia was examined. FINDINGS Six conceptual domains for the measurement of well-being and 35 self-report instruments that have been used with people with dementia were identified. Six instruments were developed specifically for people with dementia, five were derived from the gerontological literature and 24 from the well-being literature. Fifteen instruments and one sub-scale have been examined for psychometric properties amongst people with dementia. To date, 20 have been used as outcome measures, with seven measuring change over time. A number of identified instruments utilise traditional retrospective Likert-scaling response formats, limiting their potential for use with some groups of people with dementia. CONCLUSION An assets/strengths-based framework is presented, outlining structural domains for selecting self-report measures of well-being in people with dementia. It provides a foundation for enhancing research into processes and outcomes of psychosocial interventions, including instrument development, more precise matching of intervention aims with outcome measurement, and newer technology-based 'in-the-moment' measurement.
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Affiliation(s)
- Chris Clarke
- Faculty of Health Sciences, University of Hull, Hull, HU6 7RX UK
| | - Bob Woods
- DSDC Wales, Bangor University, Ardudwy, Holyhead Road, Bangor, Gwynedd LL57 2PZ UK
| | - Esme Moniz-Cook
- Faculty of Health Sciences, University of Hull, Hull, HU6 7RX UK
| | - Gail Mountain
- School of Dementia Studies, University of Bradford, Richmond Rd, Bradford, BD7 1DP UK
| | - Laila Øksnebjerg
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Section 6922, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Rabih Chattat
- Department of Psychology Università di Bologna - Via Zamboni, 33 - 40126 Bologna, Italy
| | - Ana Diaz
- Alzheimer Europe, L-1417 14, rue Dicks, Luxembourg
| | - Dianne Gove
- Alzheimer Europe, L-1417 14, rue Dicks, Luxembourg
| | - Myrra Vernooij-Dassen
- Radboud University Medical Centre, Scientific Center for Quality of Healthcare, IQ Healthcare 114, PO Box 9101, 6500HB Nijmegen, The Netherlands
| | - Emma Wolverson
- Faculty of Health Sciences, University of Hull, Hull, HU6 7RX UK
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