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Sabatini S, Martyr A, Hunt A, Gamble LD, Matthews FE, Thom JM, Jones RW, Allan L, Knapp M, Quinn C, Victor C, Pentecost C, Rusted JM, Morris RG, Clare L. Health conditions in spousal caregivers of people with dementia and their relationships with stress, caregiving experiences, and social networks: longitudinal findings from the IDEAL programme. BMC Geriatr 2024; 24:171. [PMID: 38373905 PMCID: PMC10875834 DOI: 10.1186/s12877-024-04707-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 01/13/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Longitudinal evidence documenting health conditions in spousal caregivers of people with dementia and whether these influence caregivers' outcomes is scarce. This study explores type and number of health conditions over two years in caregivers of people with dementia and subgroups based on age, sex, education, hours of care, informant-rated functional ability, neuropsychiatric symptoms, cognition of the person with dementia, and length of diagnosis in the person with dementia. It also explores whether over time the number of health conditions is associated with caregivers' stress, positive experiences of caregiving, and social networks METHODS: Longitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised spousal caregivers (n = 977) of people with dementia. Self-reported health conditions using the Charlson Comorbidity Index, stress, positive experiences of caregiving, and social network were assessed over two years. Mixed effect models were used RESULTS: On average participants had 1.5 health conditions at baseline; increasing to 2.1 conditions over two years. More health conditions were reported by caregivers who were older, had no formal education, provided 10 + hours of care per day, and/or cared for a person with more neuropsychiatric symptoms at baseline. More baseline health conditions were associated with greater stress at baseline but not with stress over time. Over two years, when caregivers' health conditions increased, their stress increased whereas their social network diminished DISCUSSION: Findings highlight that most caregivers have their own health problems which require management to avoid increased stress and shrinking of social networks.
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Affiliation(s)
- Serena Sabatini
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Anthony Martyr
- University of Exeter Medical School, University of Exeter, Exeter, UK.
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK.
| | - Anna Hunt
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona E Matthews
- Institute for Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Jeanette M Thom
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Louise Allan
- University of Exeter Medical School, University of Exeter, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Martin Knapp
- London School of Economics and Political Science, London, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Christina Victor
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University London, London, UK
| | - Claire Pentecost
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Linda Clare
- University of Exeter Medical School, University of Exeter, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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Sabatini S, Martyr A, Hunt A, Gamble LD, Matthews FE, Thom JM, Jones RW, Allan L, Knapp M, Victor C, Pentecost C, Rusted JM, Morris RG, Clare L. Comorbid health conditions and their impact on social isolation, loneliness, quality of life, and well-being in people with dementia: longitudinal findings from the IDEAL programme. BMC Geriatr 2024; 24:23. [PMID: 38182985 PMCID: PMC10768096 DOI: 10.1186/s12877-023-04601-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/14/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Most people with dementia have multiple health conditions. This study explores (1) number and type of health condition(s) in people with dementia overall and in relation to age, sex, dementia type, and cognition; (2) change in number of health conditions over two years; and (3) whether over time the number of health conditions at baseline is related to social isolation, loneliness, quality of life, and/or well-being. METHODS Longitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised people with dementia (n = 1490) living in the community (at baseline) in Great Britain. Health conditions using the Charlson Comorbidity Index, cognition, social isolation, loneliness, quality of life, and well-being were assessed over two years. Mixed effects modelling was used. RESULTS On average participants had 1.8 health conditions at baseline, excluding dementia; increasing to 2.5 conditions over two years. Those with vascular dementia or mixed (Alzheimer's and vascular) dementia had more health conditions than those with Alzheimer's disease. People aged ≥ 80 had more health conditions than those aged < 65 years. At baseline having more health conditions was associated with increased loneliness, poorer quality of life, and poorer well-being, but was either minimally or not associated with cognition, sex, and social isolation. Number of health conditions had either minimal or no influence on these variables over time. CONCLUSIONS People with dementia in IDEAL generally had multiple health conditions and those with more health conditions were lonelier, had poorer quality of life, and poorer well-being.
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Affiliation(s)
- Serena Sabatini
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Anthony Martyr
- University of Exeter Medical School, University of Exeter, Exeter, UK.
| | - Anna Hunt
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Jeanette M Thom
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Louise Allan
- University of Exeter Medical School, University of Exeter, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Martin Knapp
- London School of Economics and Political Science, London, UK
| | - Christina Victor
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University London, London, UK
| | - Claire Pentecost
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Robin G Morris
- King's College Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Linda Clare
- University of Exeter Medical School, University of Exeter, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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Clare L, Gamble LD, Martyr A, Sabatini S, Nelis SM, Quinn C, Pentecost C, Victor C, Jones RW, Jones IR, Knapp M, Litherland R, Morris RG, Rusted JM, Thom JM, Collins R, Henderson C, Matthews FE. 'Living well' trajectories among family caregivers of people with mild-to-moderate dementia in the IDEAL cohort. J Gerontol B Psychol Sci Soc Sci 2022; 77:1852-1863. [PMID: 35796675 PMCID: PMC9535787 DOI: 10.1093/geronb/gbac090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives Understanding whether and how caregivers’ capability to “live well” changes over time, and the factors associated with change, could help target effective caregiver support. Methods We analyzed 3 time points (12 months apart) of Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort data from coresident spouse caregivers of community-dwelling individuals who had mild-to-moderate dementia at baseline, using latent growth and growth mixture models. Capability to “live well” was derived from measures of quality of life, well-being, and satisfaction with life. Results Data from 995 spouse caregivers at Time 1, 780 at Time 2, and 601 at Time 3 were included. The mean “living well” score decreased slightly over time. We identified 3 classes of caregivers: one with higher baseline scores declining slightly over time (Stable; 66.8%), one with low baseline scores remaining stable (Lower Stable; 26.0%), and one with higher baseline scores showing marked decline (Declining; 7.2%). Scores on baseline measures differentiated the Lower Stable, but not the Declining, from the Stable class. Longitudinally, the Declining class was associated with care recipient cognitive decline and increasing hours providing care, as well as caregiver stress and depression. Findings were similar when caregivers with other kin relationships were included. Discussion The findings indicate the importance of prompt identification of, and support for, caregivers at risk of the declining capability to “live well” and may assist in identifying those caregivers who could benefit most from targeted support.
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Affiliation(s)
- Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK.,NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, UK
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
| | - Serena Sabatini
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
| | - Sharon M Nelis
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, UK.,Wolfson Centre for Applied Health Research, Bradford, UK
| | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
| | - Christina Victor
- College of Health, Medicine and Life Sciences, Brunel University London, UK
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Ian R Jones
- Wales Institute for Social and Economic Research, Data and Methods, Cardiff University, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, UK
| | | | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - Jeanette M Thom
- School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Rachel Collins
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
| | - Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, UK
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Jones RW, Perez FG. First Report of Southern Blight, Caused by Athelia rolfsii (syn. Sclerotium rolfsii) on Hellebores in North America. Plant Dis 2022; 106:1073. [PMID: 34689583 DOI: 10.1094/pdis-09-21-2004-pdn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- R W Jones
- USDA-ARS, GIFVL, Beltsville, MD 20705
| | - F G Perez
- USDA-ARS, GIFVL, Beltsville, MD 20705
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van Horik JO, Collins R, Martyr A, Henderson C, Jones RW, Knapp M, Quinn C, Thom JM, Victor C, Clare L. Limited receipt of support services among people with mild-to-moderate dementia: Findings from the IDEAL cohort. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5688. [PMID: 35128725 PMCID: PMC9306706 DOI: 10.1002/gps.5688] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/26/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Global initiatives that promote public health responses to dementia have resulted in numerous countries developing new national policies. Current policy guidelines in England, for example, recommend that people diagnosed with mild-to-moderate dementia receive information and psychosocial interventions to improve their ability to 'live well'. However, it remains unclear to what extent these recommendations are being achieved. METHODS Self-reported information from 1537 people living with dementia and informant-reported information from 1277 carers of people living with dementia was used to quantify receipt of community-based dementia support services, including health and social care services provided by statutory or voluntary-sector organisations, in Britain from 2014 to 2016. Demographic factors associated with differences in receipt of support services were also investigated to identify particularly vulnerable groups of people living with dementia. RESULTS Both self- and informant reports suggested that approximately 50% of people living with dementia received support services for dementia. Receipt of support services was lower among people living with dementia who are older, female, and have fewer educational qualifications. Receipt of support services also differed according to diagnosis and carer status, but was unrelated to marital status. CONCLUSIONS Limited receipt of dementia support services among people living with dementia in Britain provides a baseline to assess the efficacy of current policy guidelines regarding provision of information and support. Targeted efforts to facilitate receipt of support services among the particularly vulnerable groups identified in the current study could improve the efficacy of dementia support services both in Britain and internationally, and should inform policy development.
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Affiliation(s)
- Jayden O. van Horik
- REACH: The Centre for Research in Ageing and Cognitive HealthUniversity of ExeterExeterUK,Clinical Trials UnitUniversity of Exeter Medical SchoolExeterUK
| | - Rachel Collins
- REACH: The Centre for Research in Ageing and Cognitive HealthUniversity of ExeterExeterUK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive HealthUniversity of ExeterExeterUK
| | - Catherine Henderson
- Care Policy and Evaluation CentreLondon School of Economics and Political ScienceLondonUK
| | - Roy W. Jones
- RICE: The Research Institute for the Care of Older PeopleRoyal United HospitalsBathUK
| | - Martin Knapp
- Care Policy and Evaluation CentreLondon School of Economics and Political ScienceLondonUK
| | - Catherine Quinn
- The Centre for Applied Dementia StudiesUniversity of BradfordBradfordUK,Wolfson Centre for Applied Health ResearchBradfordUK
| | - Jeanette M. Thom
- School of Medical SciencesUniversity of New South WalesSydneyAustralia
| | - Christina Victor
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University LondonUxbridgeUK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive HealthUniversity of ExeterExeterUK,NIHR Applied Research Collaboration South‐West PeninsulaDevonUK
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Clare L, Gamble LD, Martyr A, Sabatini S, Nelis SM, Quinn C, Pentecost C, Victor C, Jones RW, Jones IR, Knapp M, Litherland R, Morris RG, Rusted JM, Thom JM, Collins R, Henderson C, Matthews FE. Longitudinal trajectories of quality of life among people with mild-to-moderate dementia: a latent growth model approach with IDEAL cohort study data. J Gerontol B Psychol Sci Soc Sci 2022; 77:1037-1050. [PMID: 35134935 PMCID: PMC9159063 DOI: 10.1093/geronb/gbac022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives We aimed to examine change over time in self-rated quality of life (QoL) in people with mild-to-moderate dementia and identify subgroups with distinct QoL trajectories. Methods We used data from people with mild-to-moderate dementia followed up at 12 and 24 months in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort study (baseline n = 1,537). A latent growth model approach examined mean change over time in QoL, assessed with the QoL-AD scale, and investigated associations of baseline demographic, cognitive, and psychological covariates with the intercept and slope of QoL. We employed growth mixture modeling to identify multiple growth trajectories. Results Overall mean QoL scores were stable and no associations with change over time were observed. Four classes of QoL trajectories were identified: 2 with higher baseline QoL scores, labeled Stable (74.9%) and Declining (7.6%), and 2 with lower baseline QoL scores, labeled Stable Lower (13.7%) and Improving (3.8%). The Declining class had higher baseline levels of depression and loneliness, and lower levels of self-esteem and optimism, than the Stable class. The Stable Lower class was characterized by disadvantage related to social structure, poor physical health, functional disability, and low psychological well-being. The Improving class was similar to the Stable Lower class but had lower cognitive test scores. Discussion Understanding individual trajectories can contribute to personalized care planning. Efforts to prevent decline in perceived QoL should primarily target psychological well-being. Efforts to improve QoL for those with poorer QoL should additionally address functional impairment, isolation, and disadvantage related to social structure.
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Affiliation(s)
- Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, UK
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
| | - Serena Sabatini
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
| | - Sharon M Nelis
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
| | - Christina Victor
- College of Health, Medicine and Life Sciences, Brunel University London, UK
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Ian R Jones
- Wales Institute for Social and Economic Research, Data and Methods, Cardiff University, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, UK
| | | | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | | | - Jeanette M Thom
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Rachel Collins
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
| | - Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, UK
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Henderson C, Knapp M, Martyr A, Gamble LD, Nelis SM, Quinn C, Pentecost C, Collins R, Wu YT, Jones IR, Victor CR, Pickett JA, Jones RW, Matthews FE, Morris RG, Rusted J, Thom JM, Clare L. The Use and Costs of Paid and Unpaid Care for People with Dementia: Longitudinal Findings from the IDEAL Cohort. J Alzheimers Dis 2021; 86:135-153. [PMID: 35001888 DOI: 10.3233/jad-215117] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The drivers of costs of care for people with dementia are not well understood and little is known on the costs of care for those with rarer dementias. OBJECTIVE To characterize use and costs of paid and unpaid care over time in a cohort of people with dementia living in Britain. To explore the relationship between cohort members' demographic and clinical characteristics and service costs. METHODS We calculated costs of health and social services, unpaid care, and out-of-pocket expenditure for people with mild-to-moderate dementia participating in three waves of the IDEAL cohort (2014- 2018). Latent growth curve modelling investigated associations between participants' baseline sociodemographic and diagnostic characteristics and mean weekly service costs. RESULTS Data were available on use of paid and unpaid care by 1,537 community-dwelling participants with dementia at Wave 1, 1,199 at Wave 2, and 910 at Wave 3. In models of paid service costs, being female was associated with lower baseline costs and living alone was associated with higher baseline costs. Dementia subtype and caregiver status were associated with variations in baseline costs and the rate of change in costs, which was additionally influenced by age. CONCLUSION Lewy body and Parkinson's disease dementias were associated with higher service costs at the outset, and Lewy body and frontotemporal dementias with more steeply increasing costs overall, than Alzheimer's disease. Planners of dementia services should consider the needs of people with these relatively rare dementia subtypes as they may require more resources than people with more prevalent subtypes.
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Affiliation(s)
- Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Claire Pentecost
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rachel Collins
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Yu-Tzu Wu
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ian R Jones
- Wales Institute for Social and Economic Research and Data, Cardiff University, Cardiff, UK
| | - Christina R Victor
- College of Health, Medicine and Life Sciences, Brunel University London, London, UK
| | | | - Roy W Jones
- The Research Institute for the Care of Older People (RICE), Bath, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Robin G Morris
- King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - Jeanette M Thom
- School of Health Sciences, University of New South Wales, Kensington, Australia
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK.,National Institute of Health Research (NIHR) Applied Research Collaboration South-West Peninsula (PenARC), Exeter, UK
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Frederiksen KS, Nielsen TR, Winblad B, Schmidt R, Kramberger MG, Jones RW, Hort J, Grimmer T, Georges J, Frölich L, Engelborghs S, Dubois B, Waldemar G. European Academy of Neurology/European Alzheimer's Disease Consortium position statement on diagnostic disclosure, biomarker counseling, and management of patients with mild cognitive impairment. Eur J Neurol 2021; 28:2147-2155. [PMID: 33368924 PMCID: PMC8246881 DOI: 10.1111/ene.14668] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE Careful counseling through the diagnostic process and adequate postdiagnostic support in patients with mild cognitive impairment (MCI) is important. Previous studies have indicated heterogeneity in practice and the need for guidance for clinicians. METHODS A joint European Academy of Neurology/European Alzheimer's Disease Consortium panel of dementia specialists was appointed. Through online meetings and emails, positions were developed regarding disclosing a syndrome diagnosis of MCI, pre- and postbiomarker sampling counseling, and postdiagnostic support. RESULTS Prior to diagnostic evaluation, motives and wishes of the patient should be sought. Diagnostic disclosure should be carried out by a dementia specialist taking the ethical principles of "the right to know" versus "the wish not to know" into account. Disclosure should be accompanied by written information and a follow-up plan. It should be made clear that MCI is not dementia. Prebiomarker counseling should always be carried out if biomarker sampling is considered and postbiomarker counseling if sampling is carried out. A dementia specialist knowledgeable about biomarkers should inform about pros and cons, including alternatives, to enable an autonomous and informed decision. Postbiomarker counseling will depend in part on the results of biomarkers. Follow-up should be considered for all patients with MCI and include brain-healthy advice and possibly treatment for specific underlying causes. Advice on advance directives may be relevant. CONCLUSIONS Guidance to clinicians on various aspects of the diagnostic process in patients with MCI is presented here as position statements. Further studies are needed to enable more evidence-based and standardized recommendations in the future.
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Affiliation(s)
| | - T. Rune Nielsen
- Department of NeurologyDanish Dementia Research CentreRigshospitaletCopenhagenDenmark
| | - Bengt Winblad
- Division of NeurogeriatricsDepartment of Neurobiology, Care Sciences and SocietyCenter for Alzheimer ResearchKarolinska InstituteSolnaSweden
- Theme AgingKarolinska University HospitalStockholmSweden
| | | | - Milica G. Kramberger
- Department of NeurologyCenter for Cognitive ImpairmentsUniversity Medical CentreLjubljanaSlovenia
| | - Roy W. Jones
- RICE (The Research Institute for the Care of Older People)Royal United HospitalBath and University of BristolBristolUK
| | - Jakub Hort
- Department of NeurologyCognitive CenterSecond Faculty of Medicine and Motol University HospitalCharles UniversityPragueCzech Republic
| | - Timo Grimmer
- Department of Psychiatry and PsychotherapySchool of MedicineRechts der Isar HospitalTechnical University of MunichMunichGermany
| | | | - Lutz Frölich
- Department of Geriatric PsychiatryUniversity of HeidelbergMannheimGermany
| | - Sebastiaan Engelborghs
- Department of Neurology and Center for NeurosciencesUZ Brussel and Free University of Brussels (VUBBrusselsBelgium
- Reference Center for Biological Markers of Dementia (BIODEM)Institute Born‐BungeUniversity of AntwerpAntwerpBelgium
| | - Bruno Dubois
- Department of NeurologyDementia Research CenterSalpêtrière HospitalSorbonne UniversityParisFrance
| | - Gunhild Waldemar
- Department of NeurologyDanish Dementia Research CentreRigshospitaletCopenhagenDenmark
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Lang FM, Mo Y, Sabbagh M, Solomon P, Boada M, Jones RW, Frisoni GB, Grimmer T, Dubois B, Harnett M, Friedhoff SR, Coslett S, Cummings JL. Intepirdine as adjunctive therapy to donepezil for mild-to-moderate Alzheimer's disease: A randomized, placebo-controlled, phase 3 clinical trial (MINDSET). Alzheimers Dement (N Y) 2021; 7:e12136. [PMID: 34095437 PMCID: PMC8165732 DOI: 10.1002/trc2.12136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/13/2022]
Abstract
INTRODUCTION A previous phase 2b study supported the use of the 5-HT6 receptor antagonist intepirdine as adjunctive therapy to donepezil for Alzheimer's disease (AD) dementia. A phase 3 study, MINDSET, was performed to test this hypothesis. METHODS MINDSET was a global, double-blind, randomized, placebo-controlled trial in 1315 mild-to-moderate AD dementia patients on stable donepezil. Patients received 35 mg/day intepirdine or placebo for 24 weeks. The co-primary endpoints were change from baseline to week 24 on the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) and Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL). RESULTS There were no statistically significant differences between intepirdine and placebo groups (adjusted mean [95% confidence interval]) on the co-primary endpoints ADAS-Cog (-0.36 [-0.95, 0.22], P = 0.2249) and ADCS-ADL (-0.09 [-0.90, 0.72], P = 0.8260). Intepirdine demonstrated a favorable safety profile similar to placebo. DISCUSSION Intepirdine as adjunctive therapy to donepezil did not produce statistical improvement over placebo on cognition or activities of daily living in mild-to-moderate AD dementia patients.
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Affiliation(s)
- Frederick M. Lang
- Axovant SciencesNew YorkNew YorkUSA
- Roivant SciencesNew YorkNew YorkUSA
- Columbia University Vagelos College of Physicians & SurgeonsNew YorkNew YorkUSA
| | - Yi Mo
- Axovant SciencesNew YorkNew YorkUSA
| | - Marwan Sabbagh
- Cleveland Clinic Lou Ruvo Center for Brain HealthLas VegasNevadaUSA
| | - Paul Solomon
- Boston Center for Memory and Boston University Alzheimer's Disease CenterBostonMassachusettsUSA
| | - Merce Boada
- Research Center and Memory Clinic, Fundaciό ACE, Institut Català de Neurociències AplicadesUniversitat Internacional de CatalunyaBarcelonaSpain
- Instituto de Salud Carlos IIINetworking Research Center on Neurodegenerative Diseases (CIBERNED)MadridSpain
| | - Roy W. Jones
- RICE (The Research Institute for the Care of Older People)BathUK
| | - Giovanni B. Frisoni
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Memory Clinic and LANVIE ‐ Laboratory of Neuroimaging of AgingUniversity Hospitals and University of GenevaGenevaSwitzerland
| | - Timo Grimmer
- School of Medicine, Klinikum rechts der IsarTechnical University of MunichMunichGermany
| | - Bruno Dubois
- Department of Neurology and Institute for Alzheimer's Disease (IM2A), Salpêtrière HospitalAP‐HP, Sorbonne UniversitéParisFrance
| | | | | | | | - Jeffrey L. Cummings
- Chambers‐Grundy Center for Transformative NeuroscienceDepartment of Brain Health, School of Integrated Health SciencesUniversity of Nevada Las Vegas (UNLV)Las VegasNevadaUSA
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10
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Dunne RA, Aarsland D, O’Brien JT, Ballard C, Banerjee S, Fox NC, Isaacs JD, Underwood BR, Perry RJ, Chan D, Dening T, Thomas AJ, Schryer J, Jones AM, Evans AR, Alessi C, Coulthard EJ, Pickett J, Elton P, Jones RW, Mitchell S, Hooper N, Kalafatis C, Rasmussen JGC, Martin H, Schott JM, Burns A. Mild cognitive impairment: the Manchester consensus. Age Ageing 2021; 50:72-80. [PMID: 33197937 PMCID: PMC7793599 DOI: 10.1093/ageing/afaa228] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Indexed: 11/14/2022] Open
Abstract
Given considerable variation in diagnostic and therapeutic practice, there is a need for national guidance on the use of neuroimaging, fluid biomarkers, cognitive testing, follow-up and diagnostic terminology in mild cognitive impairment (MCI). MCI is a heterogenous clinical syndrome reflecting a change in cognitive function and deficits on neuropsychological testing but relatively intact activities of daily living. MCI is a risk state for further cognitive and functional decline with 5-15% of people developing dementia per year. However, ~50% remain stable at 5 years and in a minority, symptoms resolve over time. There is considerable debate about whether MCI is a useful clinical diagnosis, or whether the use of the term prevents proper inquiry (by history, examination and investigations) into underlying causes of cognitive symptoms, which can include prodromal neurodegenerative disease, other physical or psychiatric illness, or combinations thereof. Cognitive testing, neuroimaging and fluid biomarkers can improve the sensitivity and specificity of aetiological diagnosis, with growing evidence that these may also help guide prognosis. Diagnostic criteria allow for a diagnosis of Alzheimer's disease to be made where MCI is accompanied by appropriate biomarker changes, but in practice, such biomarkers are not available in routine clinical practice in the UK. This would change if disease-modifying therapies became available and required a definitive diagnosis but would present major challenges to the National Health Service and similar health systems. Significantly increased investment would be required in training, infrastructure and provision of fluid biomarkers and neuroimaging. Statistical techniques combining markers may provide greater sensitivity and specificity than any single disease marker but their practical usefulness will depend on large-scale studies to ensure ecological validity and that multiple measures, e.g. both cognitive tests and biomarkers, are widely available for clinical use. To perform such large studies, we must increase research participation amongst those with MCI.
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Affiliation(s)
| | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - John T O’Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SP, UK
| | | | | | - Nick C Fox
- University College London, London WC1E 6BT, UK
| | - Jeremy D Isaacs
- St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Benjamin R Underwood
- Gnodde Goldman Sachs Translational Neuroscience Unit, Cambridgeshire and Peterborough Foundation Trust, Cambridge, UK
| | | | - Dennis Chan
- Institute of Cognitive Neuroscience, UCL, London, UK
| | - Tom Dening
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Alan J Thomas
- Newcastle University, Gateshead Health NHS Foundation Trust, Newcastle, UK
| | | | | | | | | | | | | | - Peter Elton
- Greater Manchester and Eastern Cheshire Strategic Clinical Network, Manchester M1 3BN UK
| | - Roy W Jones
- The Research Institute for the Care of Older People, Royal United Hospital, Combe Park, Bath BA1 3NG, UK
| | | | - Nigel Hooper
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Chris Kalafatis
- Clinical Trials/S&L Care Home Intervention Team, South London and Maudsley NHS Foundation Trust, Department of Old Age Psychiatry, IOPPN, London SE5 8AF, UK
| | | | - Helen Martin
- Greater Manchester Dementia Research Centre, Palliative Care Lead, Dementia United, Greater Manchester Health and Social Care Partnership, Manchester M! 2BN, UK
| | - Jonathan M Schott
- Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Alistair Burns
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
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11
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Clare L, Kudlicka A, Oyebode JR, Jones RW, Bayer A, Leroi I, Kopelman M, James IA, Culverwell A, Pool J, Brand A, Henderson C, Hoare Z, Knapp M, Morgan-Trimmer S, Burns A, Corbett A, Whitaker R, Woods B. Goal-oriented cognitive rehabilitation for early-stage Alzheimer's and related dementias: the GREAT RCT. Health Technol Assess 2020; 23:1-242. [PMID: 30879470 DOI: 10.3310/hta23100] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cognitive rehabilitation (CR) is an individualised, person-centred intervention for people with mild to moderate dementia that addresses the impact of cognitive impairment on everyday functioning. OBJECTIVES To determine whether or not CR is a clinically effective and cost-effective intervention for people with mild to moderate Alzheimer's disease or vascular or mixed dementia, and their carers. DESIGN This multicentre randomised controlled trial compared CR with treatment as usual (TAU). Following a baseline assessment and goal-setting to identify areas of everyday functioning that could be improved or better managed, participants were randomised (1 : 1) via secure web access to an independent randomisation centre to receive either TAU or CR and followed up at 3 and 9 months post randomisation. SETTING Community. PARTICIPANTS Participants had an International Classification of Diseases, Tenth Edition, diagnosis of Alzheimer's disease or vascular or mixed dementia, had mild to moderate cognitive impairment (Mini Mental State Examination score of ≥ 18 points), were stable on medication if prescribed, and had a family carer who was willing to contribute. The exclusion criteria were people with a history of brain injury or other neurological disorder and an inability to speak English. To achieve adequate power, we needed 350 people to complete the trial, with 175 people in each trial arm. INTERVENTION Cognitive rehabilitation consisted of 10 therapy sessions over 3 months, followed by four maintenance sessions over 6 months, delivered in participants' homes. The therapists were nine occupational therapists and one nurse. OUTCOME MEASURES The primary outcome was self-reported goal attainment at 3 months. Goal attainment was also assessed at 9 months. Carers provided independent ratings of goal attainment at both time points. The secondary outcomes were participant quality of life, mood, self-efficacy and cognition, and carer stress, health status and quality of life. The assessments at 3 and 9 months were conducted by researchers who were blind to the participants' group allocation. RESULTS A total of 475 participants were randomised (CR arm, n = 239; TAU arm, n = 236), 427 participants (90%) completed the trial and 426 participants were analysed (CR arm, n = 208, TAU arm, n = 218). At 3 months, there were statistically significant large positive effects for participant-rated goal attainment [mean change in the CR arm: 2.57; mean change in the TAU arm: 0.86; Cohen'sd = 0.97, 95% confidence interval (CI) 0.75 to 1.19], corroborated by carer ratings (Cohen'sd = 1.11, 95% CI 0.89 to 1.34). These effects were maintained at 9 months for both the participant ratings (Cohen's d = 0.94, 95% CI 0.71 to 1.17) and the carer ratings (Cohen's d = 0.96, 95% CI 0.73 to 1.20). There were no significant differences in the secondary outcomes. In the cost-utility analyses, there was no evidence of cost-effectiveness in terms of gains in the quality-adjusted life-years (QALYs) of the person with dementia (measured using the DEMentia Quality Of Life questionnaire utility score) or the QALYs of the carer (measured using the EuroQol-5 Dimensions, three-level version) from either cost perspective. In the cost-effectiveness analyses, by reference to the primary outcome of participant-rated goal attainment, CR was cost-effective from both the health and social care perspective and the societal perspective at willingness-to-pay values of £2500 and above for improvement in the goal attainment measure. There was no evidence on the cost-effectiveness of the self-efficacy measure (the Generalized Self-Efficacy Scale) from either cost perspective. LIMITATIONS Possible limitations arose from the non-feasibility of using observational outcome measures, the lack of a general measure of functional ability and the exclusion of people without a carer or with rarer forms of dementia. CONCLUSIONS Cognitive rehabilitation is clinically effective in enabling people with early-stage dementia to improve their everyday functioning in relation to individual goals targeted in the therapy sessions. FUTURE WORK Next steps will focus on the implementation of CR into NHS and social care services and on extending the approach to people with rarer forms of dementia. TRIAL REGISTRATION Current Controlled Trials ISRCTN21027481. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Aleksandra Kudlicka
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Jan R Oyebode
- School of Dementia Studies, University of Bradford, Bradford, UK
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Antony Bayer
- Division of Population Medicine, University Hospital Llandough, Cardiff University, Cardiff, UK
| | - Iracema Leroi
- Department of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Michael Kopelman
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, St Thomas' Hospital, King's College London, London, UK
| | - Ian A James
- Centre of the Health of the Elderly, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alison Culverwell
- Kent and Medway NHS and Social Care Partnership Trust, St Martin's Hospital, Canterbury, UK
| | | | - Andrew Brand
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Catherine Henderson
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | | | - Alistair Burns
- Department of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Anne Corbett
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | | | - Bob Woods
- Dementia Services Development Centre, Bangor University, Bangor, UK
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12
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Zamora-Ledesma S, Hernández-Camacho N, Sánchez-Moreno M, Ruiz-Piña H, Villagrán-Herrera ME, Marín-Sánchez C, Carrillo-Angeles IG, Jones RW, Camacho-Macías B. Seropositivity for Trypanosoma cruzi and Leishmania mexicana in dogs from a metropolitan region of Central Mexico. Vet Parasitol Reg Stud Reports 2020; 22:100459. [PMID: 33308745 DOI: 10.1016/j.vprsr.2020.100459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/05/2020] [Accepted: 08/26/2020] [Indexed: 12/01/2022]
Abstract
Trypanosoma cruzi and Leishmania mexicana are parasites of humans and other mammals, causing American Trypanosomiasis and Cutaneous Leishmaniasis, respectively. Domestic dogs are considered key hosts for these parasites in the domicile and peridomicile cycles of transmission, due to their abundance and contact with human population. In Mexico, there are few studies that involve the study of infection with these parasites in dogs, and have only been carried out mainly in the endemic areas for these diseases. In the state of Querétaro (Mexico), infections with both parasites have been reported for dogs only from rural areas, with no records for the metropolitan zone. We analyzed the seropositivity to T. cruzi and L. mexicana in dogs from localities within of the metropolitan zone of Querétaro City in order to determine if these animals are exposed to these parasites and thus, could be an important part of the transmission cycle of these trypanosomatids in a densely populated urban region within the state of Querétaro, Mexico. Serum samples were collected from 303 dogs housed in the Animal Control centers of the municipalities of Querétaro and El Marques, analyzed by indirect ELISA and Western Blot using as an antigen the Iron Superoxide Dismutase (FeSODe) of the parasites. From the total serum samples, we detected 10.2% of seropositivity for T. cruzi and 2.9% for L. mexicana. Our results represent the first evidence of infection with T. cruzi in domestic dogs from the Metropolitan Zone of Querétaro, and the first record for L. mexicana in Central Mexico. Ongoing investigations seek to confirm the circulation of these parasites in the area to evaluate the risk associated to the human population.
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Affiliation(s)
- S Zamora-Ledesma
- Academic Group in Ecology and Faunal Diversity, Department of Natural Sciences, Autonomous University of Querétaro, Mexico
| | - N Hernández-Camacho
- Academic Group in Ecology and Faunal Diversity, Department of Natural Sciences, Autonomous University of Querétaro, Mexico.
| | - M Sánchez-Moreno
- Molecular Parasitology Laboratory, Faculty of Sciences, Universidad de Granada, Spain
| | - H Ruiz-Piña
- Academic Group for Ecological and Geographical Surveillance of Zoonosis in the Yucatan Peninsula, Autonomous University of Yucatán, Mexico
| | - M E Villagrán-Herrera
- Department of Biomedical Research, School of Medicine, Autonomous University of Querétaro, Mexico
| | - C Marín-Sánchez
- Molecular Parasitology Laboratory, Faculty of Sciences, Universidad de Granada, Spain
| | - I G Carrillo-Angeles
- Academic Group in Ecology and Faunal Diversity, Department of Natural Sciences, Autonomous University of Querétaro, Mexico
| | - R W Jones
- Academic Group in Ecology and Faunal Diversity, Department of Natural Sciences, Autonomous University of Querétaro, Mexico
| | - B Camacho-Macías
- Academic Group in Ecology and Faunal Diversity, Department of Natural Sciences, Autonomous University of Querétaro, Mexico
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13
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Jones RW, Conant M, Tanious A, Armstrong P, Moudgill N, Back M, Illig K, Brooks J. Single Center Outcomes of Carotid Artery Stenting in Veterans with Prior Head and Neck Cancer. Ann Vasc Surg 2020; 70:230-236. [PMID: 32795652 DOI: 10.1016/j.avsg.2020.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients meeting criteria for intervention of carotid stenosis with a history of prior cervical radiation or neck dissection are considered "high risk" for carotid endarterectomy. This is a well-established indication for carotid artery stenting (CAS). The long-term outcomes of CAS in this population are less frequently published in the literature but are poor. The purpose of this study was to review long-term results of CAS in veteran patients with a prior history of treatment for head and/or neck cancer. METHODS This is a retrospective review of a veteran patient population from 1998 to 2016. All patients at our institution with a prior history of treatment for head and/or neck cancer who underwent CAS were included in the analysis. During this time period, 44 patients met inclusion criteria and were treated with 57 carotid stenting interventions. The Kaplan-Meier analysis was used to determine survival and primary patency. The secondary aims were to analyze early outcomes and to identify predictive risk factors for mortality and reintervention. RESULTS The mean follow-up was 42.9 ± 36.6 months. The cumulative survival at 1, 5, and 10 years was 91%, 67%, and 48%, respectively. The primary patency at 1, 5, and 10 years was 95%, 86%, and 86%, respectively. The reintervention rate was 11% (n = 6) with an assisted primary patency rate of 100%. No neurologic events occurred within 30 days. There were 3 strokes in late follow-up and no stroke-related deaths. Eighteen patients (41%) died during the follow-up period, 15 of whom died during the first 5 years of follow-up. Ten (66%) of those patients died of recurrent or active index cancer. On univariate analysis, tumor, node, metastasis stage IV was significantly associated with death (P = 0.02). Multivariate models were not statistically significant for predicting mortality or reintervention CONCLUSIONS: On the basis of the results in this series, CAS can be performed in these patients with low long-term rates of neurologic events and need for reintervention. However, the survival of patients with head and neck cancer undergoing CAS in this cohort is poor, which is consistent with other published series of patients undergoing CAS for head/neck cancer with at least 5-year follow-up. In this specific patient population, a more critical analysis of the patient's overall prognosis, especially as related to cancer, should be undertaken before offering CAS.
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Affiliation(s)
- Roy W Jones
- Division of Vascular Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Mark Conant
- Division of Vascular Surgery, University of South Florida Morsani College of Medicine, Tampa, FL.
| | - Adam Tanious
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - Paul Armstrong
- Division of Vascular Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Neil Moudgill
- Division of Vascular Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Martin Back
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
| | - Karl Illig
- Department of Surgery, Regional Medical Center, Orangeburg, SC
| | - James Brooks
- Division of Vascular Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
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14
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Lamont RA, Nelis SM, Quinn C, Martyr A, Rippon I, Kopelman MD, Hindle JV, Jones RW, Litherland R, Clare L. Psychological predictors of 'living well' with dementia: findings from the IDEAL study. Aging Ment Health 2020; 24:956-964. [PMID: 30836765 DOI: 10.1080/13607863.2019.1566811] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objectives: Increasingly, research has explored how psychological resources enable adaptation to illness. However, it is unclear whether psychological resources protect against the potential negative effects on living well with a progressive and life-limiting condition such as dementia. This paper examines the association between psychological resources and the ability to 'live well' with dementia.Method: Data from 1547 people with mild-to-moderate dementia in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort were used. Multivariate linear regression was employed to examine the association between self-reported measures of psychological resources (self-efficacy, optimism and self-esteem) and indices of capability to 'live well' (quality of life, well-being and life satisfaction).Results: All three measures of psychological resources had positive and independent associations with indices of living well and the effect sizes were similar. Effect sizes reduced when accounting for shared variance between psychological resources, showing some overlap in these constructs.Conclusion: Self-efficacy, optimism and self-esteem were each associated with capability to 'live well'. Overlap between these three resources is evident and when combined they may provide greater resilience when dealing with the challenges of living with dementia. Interventions for people with dementia could seek to improve levels of these potentially-modifiable psychological resources.
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Affiliation(s)
- Ruth A Lamont
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Catherine Quinn
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Isla Rippon
- Department of Clinical Sciences, Brunel University, London, UK
| | - Michael D Kopelman
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - John V Hindle
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Roy W Jones
- Research Institute for the Care of Older People, Bath, UK
| | | | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
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15
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Wu YT, Nelis SM, Quinn C, Martyr A, Jones IR, Victor CR, Knapp M, Henderson C, Hindle JV, Jones RW, Kopelman MD, Morris RG, Pickett JA, Rusted JM, Thom JM, Litherland R, Matthews FE, Clare L. Factors associated with self- and informant ratings of quality of life, well-being and life satisfaction in people with mild-to-moderate dementia: results from the Improving the experience of Dementia and Enhancing Active Life programme. Age Ageing 2020; 49:446-452. [PMID: 32037460 DOI: 10.1093/ageing/afz177] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/13/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND a large number of studies have explored factors related to self- and informant ratings of quality of life in people with dementia, but many studies have had relatively small sample sizes and mainly focused on health conditions and dementia symptoms. The aim of this study is to compare self- and informant-rated quality of life, life satisfaction and well-being, and investigate the relationships of the two different rating methods with various social, psychological and health factors, using a large cohort study of community-dwelling people with dementia and carers in Great Britain. METHODS this study included 1,283 dyads of people with mild-to-moderate dementia and their primary carers in the Improving the experience of Dementia and Enhancing Active Life study. Multivariate modelling was used to investigate associations of self- and informant-rated quality of life, life satisfaction and well-being with factors in five domains: psychological characteristics and health; social location; capitals, assets and resources; physical fitness and health; and managing everyday life with dementia. RESULTS people with dementia rated their quality of life, life satisfaction and well-being more highly than did the informants. Despite these differences, the two approaches had similar relationships with social, psychological and physical health factors in the five domains. CONCLUSION although self- and informant ratings differ, they display similar results when focusing on factors associated with quality of life, life satisfaction and well-being. Either self- or informant ratings may offer a reasonable source of information about people with dementia in terms of understanding associated factors.
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Affiliation(s)
- Yu-Tzu Wu
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
| | - Catherine Quinn
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
- Centre of Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
| | - Ian R Jones
- Wales Institute for Social and Economic Research, Data and Methods, Cardiff University, Cardiff, UK
| | - Christina R Victor
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Catherine Henderson
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - John V Hindle
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Michael D Kopelman
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | | | - Jeanette M Thom
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | | | - Fiona E Matthews
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
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16
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Henderson C, Knapp M, Nelis SM, Quinn C, Martyr A, Wu YT, Jones IR, Victor CR, Pickett JA, Hindle JV, Jones RW, Kopelman MD, Matthews FE, Morris RG, Rusted JM, Thom JM, Clare L. Use and costs of services and unpaid care for people with mild-to-moderate dementia: Baseline results from the IDEAL cohort study. Alzheimers Dement (N Y) 2019; 5:685-696. [PMID: 31720369 PMCID: PMC6838500 DOI: 10.1016/j.trci.2019.09.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction We examined 3-month service use and costs of care for people with mild-to-moderate dementia in Great Britain. Methods We analyzed Improving the experience of Dementia and Enhancing Active Life cohort study baseline data on paid care, out-of-pocket expenditure, and unpaid care from participants with dementia (N = 1547) and their carers (N = 1283). In regression analyses, we estimated per-group mean costs of diagnostic and sociodemographic subgroups. Results Use of services apart from primary and outpatient hospital care was low. Unpaid care accounted for three-quarters of total costs (mean, £4008 [standard error, £130] per participant). Most participants (87%) received unpaid care equating to 36 hours weekly. Estimated costs for people with Parkinson's dementia were £8609, £4359 for participants with mixed dementia, and £3484 for those with Alzheimer's disease. Total costs were lower for participants with dementia living alone than living with others (£2484 vs. £4360); costs were lower for female than for male participants (£3607 vs. £4272). Discussion Costs varied by dementia subtype, carer status, and living arrangement. Policy makers should recognize the high costs of unpaid care for people with dementia, who do not always get the support that they need or would like to receive.
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Affiliation(s)
- Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Catherine Quinn
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Yu-Tzu Wu
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Ian R Jones
- Wales Institute for Social and Economic Research, Data and Methods, Cardiff University, Cardiff, UK
| | - Christina R Victor
- College of Health and Life Sciences, Brunel University London, London, UK
| | | | - John V Hindle
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK.,College of Health and Life Sciences, Brunel University London, London, UK
| | - Roy W Jones
- The Research Institute for the Care of Older People (RICE), Bath, UK
| | - Michael D Kopelman
- King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Fiona E Matthews
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Robin G Morris
- King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - Jeanette M Thom
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
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Clare L, Kudlicka A, Oyebode JR, Jones RW, Bayer A, Leroi I, Kopelman M, James IA, Culverwell A, Pool J, Brand A, Henderson C, Hoare Z, Knapp M, Woods B. Individual goal-oriented cognitive rehabilitation to improve everyday functioning for people with early-stage dementia: A multicentre randomised controlled trial (the GREAT trial). Int J Geriatr Psychiatry 2019; 34:709-721. [PMID: 30724405 PMCID: PMC6593854 DOI: 10.1002/gps.5076] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/28/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine whether individual goal-oriented cognitive rehabilitation (CR) improves everyday functioning for people with mild-to-moderate dementia. DESIGN AND METHODS Parallel group multicentre single-blind randomised controlled trial (RCT) comparing CR added to usual treatment (CR) with usual treatment alone (TAU) for people with an ICD-10 diagnosis of Alzheimer, vascular or mixed dementia, and mild-to-moderate cognitive impairment (Mini-Mental State Examination [MMSE] score ≥ 18), and with a family member willing to contribute. Participants allocated to CR received 10 weekly sessions over 3 months and four maintenance sessions over 6 months. Participants were followed up 3 and 9 months post randomisation by blinded researchers. The primary outcome was self-reported goal attainment at 3 months. Secondary outcomes at 3 and 9 months included informant-reported goal attainment, quality of life, mood, self-efficacy, and cognition and study partner stress and quality of life. RESULTS We randomised (1:1) 475 people with dementia; 445 (CR = 281) were included in the intention to treat analysis at 3 months and 426 (CR = 208) at 9 months. At 3 months, there were statistically significant large positive effects for participant-rated goal attainment (d = 0.97; 95% CI, 0.75-1.19), corroborated by informant ratings (d = 1.11; 95% CI, 0.89-1.34). These effects were maintained at 9 months for both participant (d = 0.94; 95% CI, 0.71-1.17) and informant (d = 0.96; 95% CI, 0.73-1.2) ratings. The observed gains related to goals directly targeted in the therapy. There were no significant differences in secondary outcomes. CONCLUSIONS CR enables people with early-stage dementia to improve their everyday functioning in relation to individual goals targeted in the therapy.
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Affiliation(s)
- Linda Clare
- Centre for Research in Ageing and Cognitive HealthUniversity of ExeterExeterUK
| | - Aleksandra Kudlicka
- Centre for Research in Ageing and Cognitive HealthUniversity of ExeterExeterUK
| | - Jan R. Oyebode
- School of Dementia StudiesUniversity of BradfordBradfordUK
| | | | - Antony Bayer
- Division of Population Medicine, Cardiff UniversityUniversity Llandough HospitalPenarthUK
| | - Iracema Leroi
- Department of Neuroscience and Experimental Psychology, Jean McFarlane BuildingUniversity of ManchesterManchesterUK
| | - Michael Kopelman
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, St Thomas' HospitalKing's College LondonLondonUK
| | - Ian A. James
- Centre of the Health of the ElderlyNorthumberland Tyne and Wear NHS Foundation TrustNewcastle upon TyneUK
| | - Alison Culverwell
- Kent and Medway NHS Partnership TrustSt Martin's HospitalCanterburyUK
| | | | - Andrew Brand
- North Wales Organisation for Randomised Trials in HealthBangor UniversityBangorUK
| | - Catherine Henderson
- Personal Social Services Research UnitLondon School of Economics and Political ScienceLondonUK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in HealthBangor UniversityBangorUK
| | - Martin Knapp
- Personal Social Services Research UnitLondon School of Economics and Political ScienceLondonUK
| | - Bob Woods
- Dementia Services Development CentreBangor UniversityBangorUK
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18
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Nelis SM, Wu YT, Matthews FE, Martyr A, Quinn C, Rippon I, Rusted J, Thom JM, Kopelman MD, Hindle JV, Jones RW, Clare L. The impact of co-morbidity on the quality of life of people with dementia: findings from the IDEAL study. Age Ageing 2019; 48:361-367. [PMID: 30403771 PMCID: PMC6503940 DOI: 10.1093/ageing/afy155] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/12/2018] [Indexed: 12/26/2022] Open
Abstract
Background The aim was to investigate the co-morbidity profile of people with dementia and examine the associations between severity of co-morbidity, health-related quality of life (HRQoL) and quality of life (QoL). Methods The improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort consisted of 1,547 people diagnosed with dementia who provided information on the number and type of co-morbid conditions. Participants also provided ratings of their health-related and dementia-specific QoL. Results The majority of the sample were living with more than one chronic condition. Hypertension was commonly reported and frequently combined with connective tissue disease, diabetes and depression. The number of co-morbid conditions was associated with low QoL scores, and those with severe co-morbidity (≥5 conditions) showed the greatest impact on their well-being. Conclusions Co-morbidity is an important risk factor for poor QoL and health status in people with dementia. Greater recognition of the nature and impact of co-morbidity is needed to inform support and interventions for people with dementia and a multidisciplinary approach to care provision is recommended.
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Affiliation(s)
- Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke’s Campus, Exeter, UK
| | - Yu-Tzu Wu
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke’s Campus, Exeter, UK
- King’s College London, Social Epidemiology Research Group, Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Fiona E Matthews
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke’s Campus, Exeter, UK
| | - Catherine Quinn
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke’s Campus, Exeter, UK
| | - Isla Rippon
- College of Health and Life Sciences, Brunel University London, London, UK
| | | | - Jeanette M Thom
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Michael D Kopelman
- King’s College London, Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, UK
| | - John V Hindle
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke’s Campus, Exeter, UK
| | - Roy W Jones
- RICE (The Research Institute for the Care of Older People), Bath, UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke’s Campus, Exeter, UK
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
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19
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Belger M, Haro JM, Reed C, Happich M, Argimon JM, Bruno G, Dodel R, Jones RW, Vellas B, Wimo A. Determinants of time to institutionalisation and related healthcare and societal costs in a community-based cohort of patients with Alzheimer's disease dementia. Eur J Health Econ 2019; 20:343-355. [PMID: 30178148 PMCID: PMC6438944 DOI: 10.1007/s10198-018-1001-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 08/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To examine the costs of caring for community-dwelling patients with Alzheimer's disease (AD) dementia in relation to the time to institutionalisation. METHODS GERAS was a prospective, non-interventional cohort study in community-dwelling patients with AD dementia and their caregivers in three European countries. Using identified factors associated with time to institutionalisation, models were developed to estimate the time to institutionalisation for all patients. Estimates of monthly total societal costs, patient healthcare costs and total patient costs (healthcare and social care together) prior to institutionalisation were developed as a function of the time to institutionalisation. RESULTS Of the 1495 patients assessed at baseline, 307 (20.5%) were institutionalised over 36 months. Disease severity at baseline [based on Mini-Mental State Examination (MMSE) scores] was associated with risk of being institutionalised during follow up (p < 0.001). Having a non-spousal informal caregiver was associated with a faster time to institutionalisation (944 fewer days versus having a spousal caregiver), as was each one-point worsening in baseline score of MMSE, instrumental activities of daily living and behavioural disturbance (67, 50 and 30 fewer days, respectively). Total societal costs, total patient costs and, to a lesser extent, patient healthcare-only costs were associated with time to institutionalisation. In the 5 years pre-institutionalisation, monthly total societal costs increased by more than £1000 (€1166 equivalent for 2010) from £1900 to £3160 and monthly total patient costs almost doubled from £770 to £1529. CONCLUSIONS Total societal costs and total patient costs rise steeply as community-dwelling patients with AD dementia approach institutionalisation.
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Affiliation(s)
- Mark Belger
- Lilly Research Centre, Eli Lilly and Company Limited, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey, GU20 6PH, UK.
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Catherine Reed
- Lilly Research Centre, Eli Lilly and Company Limited, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey, GU20 6PH, UK
| | - Michael Happich
- Lilly Research Centre, Eli Lilly and Company Limited, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey, GU20 6PH, UK
| | - Josep Maria Argimon
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
| | - Giuseppe Bruno
- Clinica della Memoria, Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Richard Dodel
- Geriatrie-Zentrum Haus Berge, Essen University Hospital, Essen, Germany
| | - Roy W Jones
- RICE (The Research Institute for the Care of Older People), Royal United Hospital, Bath, UK
| | - Bruno Vellas
- Gérontopôle, Toulouse University Hospital, INSERM 1027, Toulouse, France
| | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
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Abstract
Problem-based learning arose out of educational initiatives in the 1960s and is often one of the most contentious issues within medical education. McMaster University in Canada was the first to implement problem-based learning on a large scale within medicine and this was soon followed by universities in Europe and Australia. In modern times, few western medical schools do not include at least some aspect of problem-based learning within their instructional itinerary, and many build their entire curriculum and instructional procedures around problem-based learning. This article provides an overview of problem-based learning within medical education, pertinent background, describes the characteristics of problem-based learning, its advantages and disadvantages, problem-based learning scenarios and facilitation.
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Affiliation(s)
- R W Jones
- Australian and New Zealand College of Anaesthetists, Melbourne, Victoria, Australia
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21
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Abstract
The continuing medical education (CME) needs of anaesthetists within Australia, New Zealand, Hong Kong, Malaysia and Singapore have been largely unknown. The aim of this study was to undertake a comprehensive survey of the attitude to CME, learning preferences, attitudes and abilities relating to self-paced material, literature and information searching, preferred content and preferred approach to CME of anaesthetists within these countries. A survey tool was developed and refined for ease of use by pilot-testing. The survey was mailed to 3,156 anaesthetists throughout Australia, New Zealand, Hong Kong, Malaysia and Singapore. Three options for data return were offered; postal reply, facsimile and a data entry web-page. There were 1800 responses, which represented a response rate of 57%. The demographics of the respondents were similar to the overall demographics of Fellows of the Australian and New Zealand College of Anaesthetists. A large majority of respondents (92%) stated that their involvement in CME improved patient care. However, almost half the respondents reported that they have difficulty either in participating in current CME activities (31 %) or implementing new knowledge into their workplace (14%). Anaesthetists within this region appear to be motivated by the need to make better decisions based on independent standards of practice. While Australia is a world leader in flexible education, it is still emerging as a discipline. Flexible education may be used to facilitate anaesthetists’ participation in CME activities and in implementation of new knowledge in their workplace.
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Affiliation(s)
- A P Tucker
- Department of Anaesthesia and Perioperative Medicine, Monash Medical Centre, Melbourne, Victoria, Australia
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22
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Silarova B, Nelis SM, Ashworth RM, Ballard C, Bieńkiewicz M, Henderson C, Hillman A, Hindle JV, Hughes JC, Lamont RA, Litherland R, Jones IR, Jones RW, Knapp M, Kotting P, Martyr A, Matthews FE, Morris RG, Quinn C, Regan J, Rusted JM, van den Heuvel EA, Victor CR, Wu YT, Clare L. Protocol for the IDEAL-2 longitudinal study: following the experiences of people with dementia and their primary carers to understand what contributes to living well with dementia and enhances active life. BMC Public Health 2018; 18:1214. [PMID: 30376832 PMCID: PMC6208177 DOI: 10.1186/s12889-018-6129-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/18/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND There is a major need for longitudinal research examining the experiences of people with dementia and their primary carers, as relatively little is known about how the factors associated with capability to 'live well' vary over time. The main aim of the IDEAL-2 study is to investigate how and why, over time, people with dementia and their primary carers might vary in their capability to live well with dementia, whilst exploring both their use of health and care services and their unmet needs. METHODS IDEAL-2 will build on the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort of 1547 people (who, at recruitment between July 2014 and July 2016, had mild-to-moderate dementia), and their 1283 primary carers in Great Britain. The existing cohort will be enriched with additional participants with mild-to-moderate dementia (and their primary carers where available and willing) from the following groups: people with rarer forms of dementia, and/or those who are ≥90 years or < 65 years of age at time of recruitment. We will assess the primary outcome, capability to live well with dementia, and the factors influencing it using questionnaires at yearly intervals for 3 years. Additionally, we will seek to link the cohort data with administrative data to obtain information about health service use. Some participants will be invited for in-depth face-to-face interviews. The cohort study will be supplemented by linked research focusing on: the co-production of new measures of living well; including the perspectives of people with advanced dementia living in residential care settings; including people with dementia from black, Asian, and minority ethnic groups; and understanding the experience of people living with undiagnosed dementia. DISCUSSION IDEAL-2 will provide evidence about the key indicators of, and factors associated with, living well over the course of dementia and how these differ for particular subgroups. It will tell us which combinations of services and support are most beneficial and cost-effective. Moreover, the IDEAL-2 study will gather evidence from under-researched groups of people with dementia, who are likely to have their own distinct perceptions of living well.
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Affiliation(s)
- Barbora Silarova
- Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Sharon M. Nelis
- Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Rosalie M. Ashworth
- Alzheimer’s Society Centre of Excellence, Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Clive Ballard
- College of Medicine and Health, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Marta Bieńkiewicz
- Alzheimer’s Society Centre of Excellence, Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Catherine Henderson
- London School of Economics and Political Science, Houghton Street, London, WC2A 2AE UK
| | | | - John V. Hindle
- Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Julian C. Hughes
- RICE (The Research Institute for the Care of Older People), Royal United Hospital, Bath, BA1 3NG UK
- University of Bristol, Department of Population and Health Sciences, Bristol Medical School, Bristol, BS8 2BN UK
| | - Ruth A. Lamont
- Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | | | - Ian R. Jones
- WISERD, Cardiff University, 38 Park Place, Cardiff, CF10 3BB UK
| | - Roy W. Jones
- RICE (The Research Institute for the Care of Older People), Royal United Hospital, Bath, BA1 3NG UK
| | - Martin Knapp
- London School of Economics and Political Science, Houghton Street, London, WC2A 2AE UK
| | - Piers Kotting
- College of Medicine and Health, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Fiona E. Matthews
- Newcastle University, Institute for Health and Society, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL UK
| | - Robin G. Morris
- King’s College London, Henry Wellcome Building, Institute of Psychiatry, Psychology, and Neuroscience, De Crespigny Park, London, SE5 8AF UK
| | - Catherine Quinn
- Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Jemma Regan
- Alzheimer’s Society Centre of Excellence, Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Jennifer M. Rusted
- University of Sussex, School of Psychology, Pevensey 1 2B21, Falmer, Brighton, BN1 9QH UK
| | - Eleanor Ann van den Heuvel
- Brunel University London, College of Health and Life Sciences, Department of Clinical Sciences, Kingston Lane, Uxbridge, UB8 3PH UK
| | - Christina R. Victor
- Brunel University London, College of Health and Life Sciences, Department of Clinical Sciences, Kingston Lane, Uxbridge, UB8 3PH UK
| | - Yu-Tzu Wu
- Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Linda Clare
- Alzheimer’s Society Centre of Excellence, Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
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23
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Silarova B, Nelis SM, Ashworth RM, Ballard C, Bieńkiewicz M, Henderson C, Hillman A, Hindle JV, Hughes JC, Lamont RA, Litherland R, Jones IR, Jones RW, Knapp M, Kotting P, Martyr A, Matthews FE, Morris RG, Quinn C, Regan J, Rusted JM, van den Heuvel EA, Victor CR, Wu YT, Clare L. Protocol for the IDEAL-2 longitudinal study: following the experiences of people with dementia and their primary carers to understand what contributes to living well with dementia and enhances active life. BMC Public Health 2018. [PMID: 30376832 DOI: 10.1186/s12889‐018‐6129‐7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a major need for longitudinal research examining the experiences of people with dementia and their primary carers, as relatively little is known about how the factors associated with capability to 'live well' vary over time. The main aim of the IDEAL-2 study is to investigate how and why, over time, people with dementia and their primary carers might vary in their capability to live well with dementia, whilst exploring both their use of health and care services and their unmet needs. METHODS IDEAL-2 will build on the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort of 1547 people (who, at recruitment between July 2014 and July 2016, had mild-to-moderate dementia), and their 1283 primary carers in Great Britain. The existing cohort will be enriched with additional participants with mild-to-moderate dementia (and their primary carers where available and willing) from the following groups: people with rarer forms of dementia, and/or those who are ≥90 years or < 65 years of age at time of recruitment. We will assess the primary outcome, capability to live well with dementia, and the factors influencing it using questionnaires at yearly intervals for 3 years. Additionally, we will seek to link the cohort data with administrative data to obtain information about health service use. Some participants will be invited for in-depth face-to-face interviews. The cohort study will be supplemented by linked research focusing on: the co-production of new measures of living well; including the perspectives of people with advanced dementia living in residential care settings; including people with dementia from black, Asian, and minority ethnic groups; and understanding the experience of people living with undiagnosed dementia. DISCUSSION IDEAL-2 will provide evidence about the key indicators of, and factors associated with, living well over the course of dementia and how these differ for particular subgroups. It will tell us which combinations of services and support are most beneficial and cost-effective. Moreover, the IDEAL-2 study will gather evidence from under-researched groups of people with dementia, who are likely to have their own distinct perceptions of living well.
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Affiliation(s)
- Barbora Silarova
- Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - Sharon M Nelis
- Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Rosalie M Ashworth
- Alzheimer's Society Centre of Excellence, Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Clive Ballard
- College of Medicine and Health, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Marta Bieńkiewicz
- Alzheimer's Society Centre of Excellence, Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Catherine Henderson
- London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | | | - John V Hindle
- Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Julian C Hughes
- RICE (The Research Institute for the Care of Older People), Royal United Hospital, Bath, BA1 3NG, UK.,University of Bristol, Department of Population and Health Sciences, Bristol Medical School, Bristol, BS8 2BN, UK
| | - Ruth A Lamont
- Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | | | - Ian R Jones
- WISERD, Cardiff University, 38 Park Place, Cardiff, CF10 3BB, UK
| | - Roy W Jones
- RICE (The Research Institute for the Care of Older People), Royal United Hospital, Bath, BA1 3NG, UK
| | - Martin Knapp
- London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Piers Kotting
- College of Medicine and Health, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Fiona E Matthews
- Newcastle University, Institute for Health and Society, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Robin G Morris
- King's College London, Henry Wellcome Building, Institute of Psychiatry, Psychology, and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Catherine Quinn
- Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Jemma Regan
- Alzheimer's Society Centre of Excellence, Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Jennifer M Rusted
- University of Sussex, School of Psychology, Pevensey 1 2B21, Falmer, Brighton, BN1 9QH, UK
| | - Eleanor Ann van den Heuvel
- Brunel University London, College of Health and Life Sciences, Department of Clinical Sciences, Kingston Lane, Uxbridge, UB8 3PH, UK
| | - Christina R Victor
- Brunel University London, College of Health and Life Sciences, Department of Clinical Sciences, Kingston Lane, Uxbridge, UB8 3PH, UK
| | - Yu-Tzu Wu
- Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Linda Clare
- Alzheimer's Society Centre of Excellence, Centre for Research in Ageing and Cognitive Health (REACH), College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
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Ismail S, Christopher G, Dodd E, Wildschut T, Sedikides C, Ingram TA, Jones RW, Noonan KA, Tingley D, Cheston R. Psychological and Mnemonic Benefits of Nostalgia for People with Dementia. J Alzheimers Dis 2018; 65:1327-1344. [PMID: 30149444 DOI: 10.3233/jad-180075] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Emily Dodd
- University of the West of England, Bristol, UK
| | | | | | - Tom A. Ingram
- Avon and Wiltshire Mental Health (NHS) Mental Health Partnership (NHS) Trust, UK
| | - Roy W. Jones
- RICE (The Research Institute for the Care of Older People), Bath, UK
| | - Krist A. Noonan
- Avon and Wiltshire Mental Health (NHS) Mental Health Partnership (NHS) Trust, UK
| | - Danielle Tingley
- RICE (The Research Institute for the Care of Older People), Bath, UK
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25
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Clare L, Wu YT, Jones IR, Victor CR, Nelis SM, Martyr A, Quinn C, Litherland R, Pickett J, Hindle JV, Jones RW, John Knapp MR, Kopelman M, Morris RG, Rusted JM, Thom JM, Lamont RA, Henderson C, Rippon I, Hillman A, Matthews F. O4‐08‐04: A COMPREHENSIVE MODEL OF FACTORS ASSOCIATED WITH SUBJECTIVE PERCEPTIONS OF LIVING WELL WITH DEMENTIA: FINDINGS FROM THE IDEAL STUDY. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Yu-Tzu Wu
- University of ExeterExeterUnited Kingdom
| | | | | | | | | | | | | | | | | | - Roy W. Jones
- Research Institute for the Care of Older PeopleBathUnited Kingdom
| | | | | | - Robin G. Morris
- King's College LondonInstitute of PsychiatryLondonUnited Kingdom
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Lenox-Smith A, Reed C, Lebrec J, Belger M, Jones RW. Potential cost savings to be made by slowing cognitive decline in mild Alzheimer's disease dementia using a model derived from the UK GERAS observational study. BMC Geriatr 2018; 18:57. [PMID: 29471784 PMCID: PMC5824582 DOI: 10.1186/s12877-018-0748-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 02/15/2018] [Indexed: 11/16/2022] Open
Abstract
Background Given the high costs associated with the care of those with Alzheimer’s disease (AD) dementia, we examined the likely impact of a reduction in the rate of cognitive decline upon cost outcomes associated with this disease. Methods Using the group of patients with mild AD dementia from the GERAS study, generalised linear modelling (GLM) was used to explore the relationship between change in cognition as measured using the Mini-Mental State Examination (MMSE) and UK overall costs (health care and social care costs, and total societal costs) associated with AD dementia. Results A total of 200 patients with mild AD dementia were identified. Least squares mean (LSM) ± standard error (SE) reduction in MMSE score was 3.6 ± 0.4 points over 18 months. Using GLM it was possible to calculate that this worsening in cognition was associated with an 8.7% increase in total societal costs, equating to an increase of approximately £2200 per patient over an 18-month period. If the rate of decline in cognition was reduced by 30% or 50%, the associated savings in total societal costs over 18 months would be approximately £670 and £1100, respectively, of which only £110 and £180, respectively, could be attributed to a saving of health care costs. Conclusion This study demonstrates that there are potential savings to be made in the care of patients with AD dementia through reducing the rate of cognitive decline. A reduction in wider societal costs is likely to be the main contributor to these potential savings, and need to be further evaluated when intervention costs and cost offsets can be measured.
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Affiliation(s)
- Alan Lenox-Smith
- Eli Lilly and Company, Priestly Road, Basingstoke, RG24 9NL, UK.
| | | | | | - Mark Belger
- Eli Lilly and Company, Erl Wood, Windlesham, UK
| | - Roy W Jones
- RICE (The Research Institute for the Care of Older People), Royal United Hospital, Bath, UK
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Aisen PS, Cummings J, Jack CR, Morris JC, Sperling R, Frölich L, Jones RW, Dowsett SA, Matthews BR, Raskin J, Scheltens P, Dubois B. On the path to 2025: understanding the Alzheimer's disease continuum. Alzheimers Res Ther 2017; 9:60. [PMID: 28793924 PMCID: PMC5549378 DOI: 10.1186/s13195-017-0283-5] [Citation(s) in RCA: 258] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/04/2017] [Indexed: 12/02/2022]
Abstract
Basic research advances in recent years have furthered our understanding of the natural history of Alzheimer's disease (AD). It is now recognized that pathophysiological changes begin many years prior to clinical manifestations of disease and the spectrum of AD spans from clinically asymptomatic to severely impaired. Defining AD purely by its clinical presentation is thus artificial and efforts have been made to recognize the disease based on both clinical and biomarker findings. Advances with biomarkers have also prompted a shift in how the disease is considered as a clinico-pathophysiological entity, with an increasing appreciation that AD should not only be viewed with discrete and defined clinical stages, but as a multifaceted process moving along a seamless continuum. Acknowledging this concept is critical to understanding the development process for disease-modifying therapies, and for initiating effective diagnostic and disease management options. In this article, we discuss the concept of a disease continuum from pathophysiological, biomarker, and clinical perspectives, and highlight the importance of considering AD as a continuum rather than discrete stages. While the pathophysiology of AD has still not been elucidated completely, there is ample evidence to support researchers and clinicians embracing the view of a disease continuum in their study, diagnosis, and management of the disease.
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Affiliation(s)
- Paul S. Aisen
- University of Southern California, San Diego, CA USA
| | - Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV USA
| | | | - John C. Morris
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO USA
| | - Reisa Sperling
- Center for Alzheimer’s Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Roy W. Jones
- The Research Institute for the Care of Older People (RICE), Royal United Hospital, Bath, UK
| | | | | | | | - Philip Scheltens
- Department of Neurology & Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Bruno Dubois
- Institute for Memory and Alzheimer’s Disease (IM2A) and ICM, Salpêtrière University Hospital, Paris University (UPMC), Paris, France
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Reed CC, Lebrec J, Jones RW, Bruno G, Dell'Agnello G, Monkul ES, Andrews JS. [P2–307]: INTERMEDIATE CHANGES IN COGNITION PREDICT LONG TERM OUTCOMES IN MILD ALZHEIMER's DISEASE DEMENTIA. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Roy W. Jones
- Research Institute for the Care of Older PeopleBathUnited Kingdom
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Reed C, Happich M, Argimon JM, Haro JM, Wimo A, Bruno G, Dodel R, Jones RW, Vellas B, Belger M. What Drives Country Differences in Cost of Alzheimer’s Disease? An Explanation from Resource Use in the GERAS Study. J Alzheimers Dis 2017; 57:797-812. [DOI: 10.3233/jad-160449] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Catherine Reed
- Eli Lilly and Company Limited, Lilly Research Centre, Windlesham, UK
| | | | | | - Josep Maria Haro
- Parc Santari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Anders Wimo
- KI Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Centre for Research and Development, Uppsala University/Region of Gavleborg, Gävle, Sweden
| | - Giuseppe Bruno
- Clinica della Memoria, Department of Neurology & Psychiatry, University of Rome “Sapienza”, Rome, Italy
| | - Richard Dodel
- Department of Neurology, Philipps-University, Marburg, Germany
| | - Roy W. Jones
- RICE (The Research Institute for the Care of Older People), >The RICE Centre, Royal United Hospital, Bath, UK
| | - Bruno Vellas
- Gerontopole, Alzheimer’s Disease Research and Clinical Care, INSERM 1027, Toulouse University Hospital, Toulouse, France
| | - Mark Belger
- Eli Lilly and Company Limited, Lilly Research Centre, Windlesham, UK
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Jones RW, Lebrec J, Kahle-Wrobleski K, Dell'Agnello G, Bruno G, Vellas B, Argimon JM, Dodel R, Haro JM, Wimo A, Reed C. Disease Progression in Mild Dementia due to Alzheimer Disease in an 18-Month Observational Study (GERAS): The Impact on Costs and Caregiver Outcomes. Dement Geriatr Cogn Dis Extra 2017; 7:87-100. [PMID: 28611822 PMCID: PMC5465649 DOI: 10.1159/000461577] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 12/13/2016] [Indexed: 01/16/2023] Open
Abstract
Background/Aims We assessed whether cognitive and functional decline in community-dwelling patients with mild Alzheimer disease (AD) dementia were associated with increased societal costs and caregiver burden and time outcomes. Methods Cognitive decline was defined as a ≥3-point reduction in the Mini-Mental State Examination and functional decline as a decrease in the ability to perform one or more basic items of the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL) or ≥20% of instrumental ADL items. Total societal costs were estimated from resource use and caregiver hours using 2010 costs. Caregiver burden was assessed using the Zarit Burden Interview (ZBI); caregiver supervision and total hours were collected. Results Of 566 patients with mild AD enrolled in the GERAS study, 494 were suitable for the current analysis. Mean monthly total societal costs were greater for patients showing functional (+61%) or cognitive decline (+27%) compared with those without decline. In relation to a typical mean monthly cost of approximately EUR 1,400 at baseline, this translated into increases over 18 months to EUR 2,254 and 1,778 for patients with functional and cognitive decline, respectively. The number of patients requiring supervision doubled among patients showing functional or cognitive decline compared with those not showing decline, while caregiver total time increased by 70 and 33%, respectively and ZBI total score by 5.3 and 3.4 points, respectively. Conclusion Cognitive and, more notably, functional decline were associated with increases in costs and caregiver outcomes in patients with mild AD dementia.
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Affiliation(s)
- Roy W Jones
- aRICE (The Research Institute for the Care of Older People), Royal United Hospital, Bath, UK
| | | | | | | | - Giuseppe Bruno
- eDepartment of Neurology and Psychiatry, Clinica della Memoria, University of Rome "Sapienza", Rome, Italy
| | - Bruno Vellas
- fGerontopole, Toulouse University Hospital, INSERM 1027, Toulouse, France
| | - Josep M Argimon
- gDivisió d'Avaluació, Catalan Health Service, Barcelona, Spain
| | - Richard Dodel
- hDepartment of Neurology, Philipps University, Marburg, Germany
| | - Josep Maria Haro
- iParc Santari Saint Joan de Déu, CIBERSAM, University of Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Anders Wimo
- jDivision of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Catherine Reed
- kEli Lilly and Company Limited, Lilly Research Centre, Windlesham, UK
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Reed C, Barrett A, Lebrec J, Dodel R, Jones RW, Vellas B, Wimo A, Argimon JM, Bruno G, Haro JM. How useful is the EQ-5D in assessing the impact of caring for people with Alzheimer's disease? Health Qual Life Outcomes 2017; 15:16. [PMID: 28109287 PMCID: PMC5251250 DOI: 10.1186/s12955-017-0591-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 01/14/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The impact on informal caregivers of caring for people with Alzheimer's disease (AD) dementia can be substantial, but it remains unclear which measures(s) best assess such impact. Our objective was to use data from the GERAS study to assess the ability of the EuroQol 5-dimension questionnaire (EQ-5D) to measure the impact on caregivers of caring for people with AD dementia and to examine correlations between EQ-5D and caregiver burden. METHODS GERAS was a prospective, non-interventional cohort study in community-dwelling patients with AD dementia and their informal caregivers. The EQ-5D and Zarit Burden Interview (ZBI) were used to measure health-related quality of life and caregiver burden, respectively. Resource-use data collected included caregiver time spent with the patient on activities of daily living (ADL). Spearman correlations were computed between EQ-5D scores, ZBI scores, and time spent on instrumental ADL (T-IADL) at baseline, 18 months, and for 18-month change scores. T-IADL and ZBI change scores were summarized by EQ-5D domain change category (better/stable/worse). RESULTS At baseline, 1495 caregivers had mean EQ-5D index scores of 0.86, 0.85, and 0.82, and ZBI total scores of 24.6, 29.4, and 34.1 for patients with mild, moderate, and moderately severe/severe AD dementia, respectively. Change in T-IADL showed a stronger correlation with change in ZBI (0.12; P < 0.001) than with change in EQ-5D index score (0.02; P = 0.546) although both correlations were very weak. Worsening within EQ-5D domains was associated with increases in ZBI scores, although 68%-90% of caregivers remained stable within each EQ-5D domain. There was no clear pattern for change in T-IADL by change in EQ-5D domain. CONCLUSIONS EQ-5D may not be the optimum measure of the impact of caring for people with AD dementia due to its focus on physical health. Alternative measures need further investigation.
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Affiliation(s)
- Catherine Reed
- Eli Lilly and Company Limited, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey GU20 6PH UK
| | - Annabel Barrett
- Eli Lilly and Company Limited, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey GU20 6PH UK
| | | | | | - Roy W. Jones
- RICE (The Research Institute for the Care of Older People), Royal United Hospital, Bath, UK
| | | | | | | | | | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
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Lenox-Smith A, Reed C, Lebrec J, Belger M, Jones RW. Resource utilisation, costs and clinical outcomes in non-institutionalised patients with Alzheimer's disease: 18-month UK results from the GERAS observational study. BMC Geriatr 2016; 16:195. [PMID: 27887645 PMCID: PMC5124297 DOI: 10.1186/s12877-016-0371-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 11/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD), the commonest cause of dementia, represents a significant cost to UK society. This analysis describes resource utilisation, costs and clinical outcomes in non-institutionalised patients with AD in the UK. METHODS The GERAS prospective observational study assessed societal costs associated with AD for patients and caregivers over 18 months, stratified according to baseline disease severity (mild, moderate, or moderately severe/severe [MS/S]). All patients enrolled had an informal caregiver willing to participate in the study. Healthcare resource utilisation was measured using the Resource Utilization in Dementia instrument, and 18-month costs estimated by applying unit costs of services and products (2010 values). Total societal costs were calculated using an opportunity cost approach. RESULTS Overall, 526 patients (200 mild, 180 moderate and 146 MS/S at baseline) were recruited from 24 UK centres. Mini-Mental State Examination (MMSE) scores deteriorated most markedly in the MS/S patient group, with declines of 3.6 points in the mild group, 3.5 points in the moderate group and 4.7 points in the MS/S group; between-group differences did not reach statistical significance. Patients with MS/S AD dementia at baseline were more likely to be institutionalised (Kaplan-Meier probability 28% versus 9% in patients with mild AD dementia; p < 0.001 for difference across all severities) and had a greater probability of death (Kaplan-Meier probability 15% versus 5%; p = 0.013) at 18 months. Greater disease severity at baseline was also associated with concomitant increases in caregiver time and mean total societal costs. Total societal costs of £43,560 over 18 months were estimated for the MS/S group, versus £25,865 for the mild group and £30,905 for the moderate group (p < 0.001). Of these costs, over 50% were related to informal caregiver costs at each AD dementia severity level. CONCLUSIONS This study demonstrated a mean deterioration in MMSE score over 18 months in patients with AD. It also showed that AD is a costly disease, with costs increasing with disease severity, even when managed in the community: informal caregiver costs represented the main contributor to societal costs.
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Affiliation(s)
| | | | | | - Mark Belger
- Eli Lilly and Company, Erl Wood, Windlesham, UK
| | - Roy W Jones
- RICE (The Research Institute for the Care of Older People), Royal United Hospital, Bath, UK
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Abstract
The global impact of Alzheimer's disease (AD) continues to increase, and focused efforts are needed to address this immense public health challenge. National leaders have set a goal to prevent or effectively treat AD by 2025. In this paper, we discuss the path to 2025, and what is feasible in this time frame given the realities and challenges of AD drug development, with a focus on disease-modifying therapies (DMTs). Under the current conditions, only drugs currently in late Phase 1 or later will have a chance of being approved by 2025. If pipeline attrition rates remain high, only a few compounds at best will meet this time frame. There is an opportunity to reduce the time and risk of AD drug development through an improvement in trial design; better trial infrastructure; disease registries of well-characterized participant cohorts to help with more rapid enrollment of appropriate study populations; validated biomarkers to better detect disease, determine risk and monitor disease progression as well as predict disease response; more sensitive clinical assessment tools; and faster regulatory review. To implement change requires efforts to build awareness, educate and foster engagement; increase funding for both basic and clinical research; reduce fragmented environments and systems; increase learning from successes and failures; promote data standardization and increase wider data sharing; understand AD at the basic biology level; and rapidly translate new knowledge into clinical development. Improved mechanistic understanding of disease onset and progression is central to more efficient AD drug development and will lead to improved therapeutic approaches and targets. The opportunity for more than a few new therapies by 2025 is small. Accelerating research and clinical development efforts and bringing DMTs to market sooner would have a significant impact on the future societal burden of AD. As these steps are put in place and plans come to fruition, e.g., approval of a DMT, it can be predicted that momentum will build, the process will be self-sustaining, and the path to 2025, and beyond, becomes clearer.
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Affiliation(s)
- Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV USA
| | - Paul S. Aisen
- University of Southern California, San Diego, CA USA
| | - Bruno DuBois
- Institute for Memory and Alzheimer’s Disease (IM2A) and ICM, Salpêtrière University Hospital, Paris University, Paris, France
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Roy W. Jones
- The Research Institute for the Care of Older People (RICE), Royal United Hospital, Bath, UK
| | - John C. Morris
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO USA
| | | | | | - Philip Scheltens
- Department of Neurology & Alzheimer Center, VU University Medical Center, Amsterdam, Netherlands
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Belger M, Haro JM, Reed C, Happich M, Kahle-Wrobleski K, Argimon JM, Bruno G, Dodel R, Jones RW, Vellas B, Wimo A. How to deal with missing longitudinal data in cost of illness analysis in Alzheimer's disease-suggestions from the GERAS observational study. BMC Med Res Methodol 2016; 16:83. [PMID: 27430559 PMCID: PMC4950752 DOI: 10.1186/s12874-016-0188-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 07/08/2016] [Indexed: 11/10/2022] Open
Abstract
Background Missing data are a common problem in prospective studies with a long follow-up, and the volume, pattern and reasons for missing data may be relevant when estimating the cost of illness. We aimed to evaluate the effects of different methods for dealing with missing longitudinal cost data and for costing caregiver time on total societal costs in Alzheimer’s disease (AD). Methods GERAS is an 18-month observational study of costs associated with AD. Total societal costs included patient health and social care costs, and caregiver health and informal care costs. Missing data were classified as missing completely at random (MCAR), missing at random (MAR) or missing not at random (MNAR). Simulation datasets were generated from baseline data with 10–40 % missing total cost data for each missing data mechanism. Datasets were also simulated to reflect the missing cost data pattern at 18 months using MAR and MNAR assumptions. Naïve and multiple imputation (MI) methods were applied to each dataset and results compared with complete GERAS 18-month cost data. Opportunity and replacement cost approaches were used for caregiver time, which was costed with and without supervision included and with time for working caregivers only being costed. Results Total costs were available for 99.4 % of 1497 patients at baseline. For MCAR datasets, naïve methods performed as well as MI methods. For MAR, MI methods performed better than naïve methods. All imputation approaches were poor for MNAR data. For all approaches, percentage bias increased with missing data volume. For datasets reflecting 18-month patterns, a combination of imputation methods provided more accurate cost estimates (e.g. bias: −1 % vs −6 % for single MI method), although different approaches to costing caregiver time had a greater impact on estimated costs (29–43 % increase over base case estimate). Conclusions Methods used to impute missing cost data in AD will impact on accuracy of cost estimates although varying approaches to costing informal caregiver time has the greatest impact on total costs. Tailoring imputation methods to the reason for missing data will further our understanding of the best analytical approach for studies involving cost outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12874-016-0188-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mark Belger
- Lilly Research Centre, Eli Lilly and Company Limited, Erl Wood Manor, Sunninghill Road, Windlesham Surrey, GU20 6PH, UK.
| | - Josep Maria Haro
- Parc Santari Sant Joan de Deu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Catherine Reed
- Lilly Research Centre, Eli Lilly and Company Limited, Erl Wood Manor, Sunninghill Road, Windlesham Surrey, GU20 6PH, UK
| | - Michael Happich
- Lilly Research Centre, Eli Lilly and Company Limited, Erl Wood Manor, Sunninghill Road, Windlesham Surrey, GU20 6PH, UK
| | | | | | - Giuseppe Bruno
- Clinica della Memoria, Department of Neurology and Psychiatry, University of Rome "Sapienza", Rome, Italy
| | - Richard Dodel
- Department of Neurology, Philipps-University, Marburg, Germany
| | - Roy W Jones
- RICE (The Research Institute for the Care of Older People), Royal United Hospital, Bath, UK
| | - Bruno Vellas
- Gerontopole, Toulouse University Hospital, INSERM 1027, Toulouse, France
| | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology, Care Science and Society, Karolinska Institute, Stockholm, Sweden
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Chouliaras L, Kenis G, Visser PJ, Scheltens P, Tsolaki M, Jones RW, Kehoe PG, Graff C, Girtler NG, Wallin ÅK, Rikkert MO, Spiru L, Elias-Sonnenschein LS, Ramakers IHGB, Pishva E, Os JV, Steinbusch HWM, Verhey FRJ, van den Hove DLA, Rutten BPF. DNMT3A moderates cognitive decline in subjects with mild cognitive impairment: replicated evidence from two mild cognitive impairment cohorts. Epigenomics 2015; 7:533-7. [DOI: 10.2217/epi.15.22] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Epigenetic dysregulation has been associated with cognitive decline and Alzheimer's disease. The present study investigated associations between common SNPs in genes regulating DNA methylation and age-related changes in cognitive decline in two independent prospective cohorts of patients suffering from mild cognitive impairment. An association between the rs1187120 SNP in DNMT3A and annual decline in cognitive functioning was discovered and replicated, suggesting that DNMT3A moderates cognitive decline in subjects with mild cognitive impairment.
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Affiliation(s)
- Leonidas Chouliaras
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Gunter Kenis
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Pieter Jelle Visser
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Neurology, Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Magda Tsolaki
- Aristotle University of Thessaloniki, Memory & Dementia Center, 3rd Department of Neurology, G Papanicolaou General Hospital, Thessaloniki, Greece
| | - Roy W Jones
- The Research Institute for the Care of Older People (RICE), Bath, UK
| | - Patrick G Kehoe
- School of Clinical Sciences, Dementia Research Group, University of Bristol Frenchay Hospital, Bristol, UK
| | - Caroline Graff
- Department of Neurobiology, Care Sciences & Society, Karolinska Institutet, Huddinge, Sweden
| | - Nicola G Girtler
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, Italy
| | - Åsa K Wallin
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Marcel Olde Rikkert
- Radboud Alzheimer Center, Department of Geriatrics, Donders Institute for Cognitive Neurosciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Luiza Spiru
- “Carol Davila” University of Medicine & Pharmacy, Bucharest, Romania
| | - Lyzel S Elias-Sonnenschein
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Inez HGB Ramakers
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ehsan Pishva
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Harry WM Steinbusch
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Frans RJ Verhey
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Daniel LA van den Hove
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bart PF Rutten
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry & Psychology, Faculty of Health, Medicine & Life Sciences, School for Mental Health & Neuroscience (MHeNS), European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Universiteitssingel 50, 6229 ER, PO Box 616 6200 MD, Maastricht, The Netherlands
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Dodel R, Belger M, Reed C, Wimo A, Jones RW, Happich M, Argimon JM, Bruno G, Vellas B, Haro JM. Determinants of societal costs in Alzheimer's disease: GERAS study baseline results. Alzheimers Dement 2015; 11:933-45. [PMID: 25846298 DOI: 10.1016/j.jalz.2015.02.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 12/19/2014] [Accepted: 02/09/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Richard Dodel
- Department of Neurology, Philipps-University, Marburg, Germany
| | - Mark Belger
- Eli Lilly and Company Limited, Lilly Research Centre, Windlesham, Surrey, UK
| | - Catherine Reed
- Eli Lilly and Company Limited, Lilly Research Centre, Windlesham, Surrey, UK.
| | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Roy W Jones
- RICE - The Research Institute for the Care of Older People, The RICE Centre, Royal United Hospital, Bath, UK
| | - Michael Happich
- Eli Lilly and Company Limited, Lilly Research Centre, Windlesham, Surrey, UK
| | | | - Giuseppe Bruno
- Clinica della Memoria, Department of Neurological Sciences, University of Rome "Sapienza", Rome, Italy
| | - Bruno Vellas
- Gerontopole, Alzheimer's Disease Research and Clinical Center, INSERM 1027, Toulouse University Hospital, Toulouse, France
| | - Josep Maria Haro
- Parc Santari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
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Trigg R, Jones RW, Knapp M, King D, Lacey LA. The relationship between changes in quality of life outcomes and progression of Alzheimer's disease: results from the dependence in AD in England 2 longitudinal study. Int J Geriatr Psychiatry 2015; 30:400-8. [PMID: 24920081 DOI: 10.1002/gps.4150] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 04/28/2014] [Accepted: 05/08/2014] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The relationship between conventional indicators of Alzheimer's disease (AD) progression and quality of life (QoL) outcomes is unclear. Dependence on others has been recommended as a unifying construct in defining AD severity. This study examined the relationship between indicators of disease severity (including dependence) and changes in QoL and utility over 18 months. METHODS A multi-centre, cohort study was conducted across 18 UK sites. One hundred and forty-five patients with possible/probable AD and their caregivers completed assessments of disease severity (Dependence Scale, Mini-mental state examination, Neuropsychiatric Inventory, Disability Assessment for Dementia), dementia-specific QoL (DEMQOL, DEMQOL-Proxy) and generic health-related utility (EQ-5D) at both time points. RESULTS There was evidence of individual change in QoL over 18 months, with over 50% of patients reporting either maintenance or improvement of life quality. The EQ-5D proxy suggested a mean decline in QoL, whereas the DEMQOL-Proxy indicated overall improvement. In the subsample of people who self-reported QoL and utility, no mean change was evident. Changes in dependence did not explain changes on any QoL or utility outcome. There was a weak association between the EQ-5D proxy and changes in cognition, whereas changes on the DEMQOL-Proxy were partly explained by changes in behavioural disturbance. CONCLUSIONS The natural progression of AD over 18 months does not lead to inevitable decline in QoL or utility. There are no clear or consistent direct relationships between changes in disease severity and QoL outcomes. The impact of increasing dependence and worsening disease severity is likely buffered by a combination of psychological, social and environmental factors.
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Hoffman P, Clarke N, Jones RW, Noonan KA. Vocabulary relearning in semantic dementia: Positive and negative consequences of increasing variability in the learning experience. Neuropsychologia 2015; 76:240-53. [PMID: 25585251 PMCID: PMC4582807 DOI: 10.1016/j.neuropsychologia.2015.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/23/2014] [Accepted: 01/09/2015] [Indexed: 12/03/2022]
Abstract
Anomia therapy typically aims to improve patients' communication ability through targeted practice in naming a set of particular items. For such interventions to be of maximum benefit, the use of trained (or relearned) vocabulary must generalise from the therapy setting into novel situations. We investigated relearning in three patients with semantic dementia, a condition that has been associated with poor generalisation of relearned vocabulary. We tested two manipulations designed to improve generalisation of relearned words by introducing greater variation into the learning experience. In the first study, we found that trained items were retained more successfully when they were presented in a variety of different sequences during learning. In the second study, we found that training items using a range of different pictured exemplars improved the patients' ability to generalise words to novel instances of the same object. However, in one patient this came at the cost of inappropriate over-generalisations, in which trained words were incorrectly used to name semantically or visually similar objects. We propose that more variable learning experiences benefit patients because they shift responsibility for learning away from the inflexible hippocampal learning system and towards the semantic system. The success of this approach therefore depends critically on the integrity of the semantic representations of the items being trained. Patients with naming impairments in the context of relatively mild comprehension deficits are most likely to benefit from this approach, while avoiding the negative consequences of over-generalisation. SD patients attempted to recover lost vocabulary by naming pictures daily. Learning was more successful when pictures presented in a different order each day. One patient benefitted from naming multipleexemplars of each item. But in the other patient, this resulted in over-generalisation of the trained name.
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Affiliation(s)
- Paul Hoffman
- Neuroscience and Aphasia Research Unit (NARU), University of Manchester, UK; Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE), Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh EH8 9JZ, UK.
| | - Natasha Clarke
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Krist A Noonan
- Research Institute for the Care of Older People (RICE), Bath, UK
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Clare L, Nelis SM, Quinn C, Martyr A, Henderson C, Hindle JV, Jones IR, Jones RW, Knapp M, Kopelman MD, Morris RG, Pickett JA, Rusted JM, Savitch NM, Thom JM, Victor CR. Improving the experience of dementia and enhancing active life--living well with dementia: study protocol for the IDEAL study. Health Qual Life Outcomes 2014. [PMID: 25433373 DOI: 10.1186/s12955‐014‐0164‐6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Enabling people with dementia and carers to 'live well' with the condition is a key United Kingdom policy objective. The aim of this project is to identify what helps people to live well or makes it difficult to live well in the context of having dementia or caring for a person with dementia, and to understand what 'living well' means from the perspective of people with dementia and carers. METHODS/DESIGN Over a two-year period, 1500 people with early-stage dementia throughout Great Britain will be recruited to the study, together with a carer wherever possible. All the participants will be visited at home initially and again 12 months and 24 months later. This will provide information about the way in which well-being, life satisfaction and quality of life are affected by social capitals, assets and resources, the challenges posed by dementia, and the ways in which people adjust to and cope with these challenges. A smaller group will be interviewed in more depth. DISCUSSION The findings will lead to recommendations about what can be done by individuals, communities, health and social care practitioners, care providers and policy-makers to improve the likelihood of living well with dementia.
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Affiliation(s)
- Linda Clare
- Research in Ageing and Cognitive Health, School of Psychology, Bangor University, Bangor, UK.
| | - Sharon M Nelis
- Research in Ageing and Cognitive Health, School of Psychology, Bangor University, Bangor, UK.
| | - Catherine Quinn
- Research in Ageing and Cognitive Health, School of Psychology, Bangor University, Bangor, UK.
| | - Anthony Martyr
- Research in Ageing and Cognitive Health, School of Psychology, Bangor University, Bangor, UK.
| | - Catherine Henderson
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.
| | - John V Hindle
- School of Medical and Health Care Sciences, Bangor University, and Betsi Cadwaladr University Health Board, Bangor, UK.
| | - Ian R Jones
- Wales Institute of Social and Economic Research, Data and Methods, Cardiff University, Cardiff, UK.
| | - Roy W Jones
- Research Institute for the Care of Older People, Bath, UK.
| | - Martin Knapp
- Department of Social Policy, London School of Economics and Political Science, London, UK.
| | - Michael D Kopelman
- Department of Psychological Medicine, King's College London Institute of Psychiatry, London, UK.
| | - Robin G Morris
- Department of Psychology, King's College London Institute of Psychiatry, London, UK.
| | | | | | | | - Jeanette M Thom
- School of Medical Sciences, University of New South Wales, Sydney, Australia.
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Clare L, Nelis SM, Quinn C, Martyr A, Henderson C, Hindle JV, Jones IR, Jones RW, Knapp M, Kopelman MD, Morris RG, Pickett JA, Rusted JM, Savitch NM, Thom JM, Victor CR. Improving the experience of dementia and enhancing active life--living well with dementia: study protocol for the IDEAL study. Health Qual Life Outcomes 2014; 12:164. [PMID: 25433373 PMCID: PMC4260182 DOI: 10.1186/s12955-014-0164-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 10/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Enabling people with dementia and carers to 'live well' with the condition is a key United Kingdom policy objective. The aim of this project is to identify what helps people to live well or makes it difficult to live well in the context of having dementia or caring for a person with dementia, and to understand what 'living well' means from the perspective of people with dementia and carers. METHODS/DESIGN Over a two-year period, 1500 people with early-stage dementia throughout Great Britain will be recruited to the study, together with a carer wherever possible. All the participants will be visited at home initially and again 12 months and 24 months later. This will provide information about the way in which well-being, life satisfaction and quality of life are affected by social capitals, assets and resources, the challenges posed by dementia, and the ways in which people adjust to and cope with these challenges. A smaller group will be interviewed in more depth. DISCUSSION The findings will lead to recommendations about what can be done by individuals, communities, health and social care practitioners, care providers and policy-makers to improve the likelihood of living well with dementia.
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Affiliation(s)
- Linda Clare
- Research in Ageing and Cognitive Health, School of Psychology, Bangor University, Bangor, UK.
| | - Sharon M Nelis
- Research in Ageing and Cognitive Health, School of Psychology, Bangor University, Bangor, UK.
| | - Catherine Quinn
- Research in Ageing and Cognitive Health, School of Psychology, Bangor University, Bangor, UK.
| | - Anthony Martyr
- Research in Ageing and Cognitive Health, School of Psychology, Bangor University, Bangor, UK.
| | - Catherine Henderson
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.
| | - John V Hindle
- School of Medical and Health Care Sciences, Bangor University, and Betsi Cadwaladr University Health Board, Bangor, UK.
| | - Ian R Jones
- Wales Institute of Social and Economic Research, Data and Methods, Cardiff University, Cardiff, UK.
| | - Roy W Jones
- Research Institute for the Care of Older People, Bath, UK.
| | - Martin Knapp
- Department of Social Policy, London School of Economics and Political Science, London, UK.
| | - Michael D Kopelman
- Department of Psychological Medicine, King's College London Institute of Psychiatry, London, UK.
| | - Robin G Morris
- Department of Psychology, King's College London Institute of Psychiatry, London, UK.
| | | | | | | | - Jeanette M Thom
- School of Medical Sciences, University of New South Wales, Sydney, Australia.
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Bocchetta M, Galluzzi S, Kehoe PG, Aguera E, Bernabei R, Bullock R, Ceccaldi M, Dartigues JF, de Mendonça A, Didic M, Eriksdotter M, Félician O, Frölich L, Gertz HJ, Hallikainen M, Hasselbalch SG, Hausner L, Heuser I, Jessen F, Jones RW, Kurz A, Lawlor B, Lleo A, Martinez-Lage P, Mecocci P, Mehrabian S, Monsch A, Nobili F, Nordberg A, Rikkert MO, Orgogozo JM, Pasquier F, Peters O, Salmon E, Sánchez-Castellano C, Santana I, Sarazin M, Traykov L, Tsolaki M, Visser PJ, Wallin ÅK, Wilcock G, Wilkinson D, Wolf H, Yener G, Zekry D, Frisoni GB. The use of biomarkers for the etiologic diagnosis of MCI in Europe: an EADC survey. Alzheimers Dement 2014; 11:195-206.e1. [PMID: 25150733 DOI: 10.1016/j.jalz.2014.06.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 04/27/2014] [Accepted: 06/11/2014] [Indexed: 12/27/2022]
Abstract
We investigated the use of Alzheimer's disease (AD) biomarkers in European Alzheimer's Disease Consortium centers and assessed their perceived usefulness for the etiologic diagnosis of mild cognitive impairment (MCI). We surveyed availability, frequency of use, and confidence in diagnostic usefulness of markers of brain amyloidosis (amyloid positron emission tomography [PET], cerebrospinal fluid [CSF] Aβ42) and neurodegeneration (medial temporal atrophy [MTA] on MR, fluorodeoxyglucose positron emission tomography [FDG-PET], CSF tau). The most frequently used biomarker is visually rated MTA (75% of the 37 responders reported using it "always/frequently") followed by CSF markers (22%), FDG-PET (16%), and amyloid-PET (3%). Only 45% of responders perceive MTA as contributing to diagnostic confidence, where the contribution was rated as "moderate". Seventy-nine percent of responders felt "very/extremely" comfortable delivering a diagnosis of MCI due to AD when both amyloid and neuronal injury biomarkers were abnormal (P < .02 versus any individual biomarker). Responders largely agreed that a combination of amyloidosis and neuronal injury biomarkers was a strongly indicative AD signature.
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Affiliation(s)
- Martina Bocchetta
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS Istituto Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Samantha Galluzzi
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS Istituto Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Patrick Gavin Kehoe
- Dementia Research Group, School of Clinical Sciences, University of Bristol, Frenchay Hospital, Bristol, UK
| | - Eduardo Aguera
- Servicio Neurologia, Hospital Universitario Reina Sofía Córdoba, Spain
| | - Roberto Bernabei
- Department of Gerontological, Geriatric and Psychiatric Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Mathieu Ceccaldi
- Service de Neurologie et Neuropsychologie, CHU Timone and INSERM U1106, Aix-Marseille Univ, Marseille, France
| | | | | | - Mira Didic
- Service de Neurologie et Neuropsychologie, CHU Timone and INSERM U1106, Aix-Marseille Univ, Marseille, France
| | - Maria Eriksdotter
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Olivier Félician
- Service de Neurologie et Neuropsychologie, CHU Timone and INSERM U1106, Aix-Marseille Univ, Marseille, France
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Zentralinstitut für Seelische, Gesundheit Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hermann-Josef Gertz
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | | | | | - Lucrezia Hausner
- Department of Geriatric Psychiatry, Zentralinstitut für Seelische, Gesundheit Mannheim, University of Heidelberg, Mannheim, Germany
| | - Isabell Heuser
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Bonn, Bonn, Germany
| | - Frank Jessen
- Department of Psychiatry, University of Bonn, Bonn, Germany; German Center for Neurodegenerative Disease (DZNE), Bonn, Germany
| | - Roy W Jones
- RICE - The Research Institute for the Care of Older People, Royal United Hospital, Bath, UK
| | - Alexander Kurz
- Technische Universität Psychiatrische Klinik, Munchen, Germany
| | - Brian Lawlor
- Mercer's Institue for Research on Ageing, St James' Hospital, Dublin, Ireland
| | - Alberto Lleo
- Memory Unit, Neurology Service, Hospital Santa Creu i, Sant Pau, Barcelona, Spain
| | | | - Patrizia Mecocci
- Section of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Shima Mehrabian
- Department of Neurology, Univ Hospital Alexandrovska, Sofia, Bulgaria
| | - Andreas Monsch
- Memory Clinic, University Center for Medicine of Aging Basel, Felix Platter Hospital, Basel, Switzerland
| | - Flavio Nobili
- Clinical Neurology, Dept of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
| | - Agneta Nordberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Marcel Olde Rikkert
- Department of Geriatric Medicine, Radboud University Medical Centre, Radboud Alzheimer Centre, Nijmegen, Netherlands
| | | | | | - Oliver Peters
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eric Salmon
- Université de Liège, Cyclotron Research Centre, Liege, Belgium
| | | | - Isabel Santana
- Neurology Department, Coimbra University Hospital, Coimbra, Portugal
| | - Marie Sarazin
- Neurologie de la Mémoire et du Langage, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, Centre Hospitalier Sainte Anne, Paris, France
| | - Latchezar Traykov
- Department of Neurology, Univ Hospital Alexandrovska, Sofia, Bulgaria
| | - Magda Tsolaki
- 3rd Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pieter Jelle Visser
- Alzheimer Centre, Vrije Univ Medical Centre, Amsterdam, Netherlands; Alzheimer centre Maastricht University, Maastricht, Netherlands
| | - Åsa K Wallin
- Clinical Memory Research Unit, Lund University, Memory Clinic Malmö, Sweden
| | - Gordon Wilcock
- University of Oxford, Nuffield Dept of Medicine, John Radcliffe Hospital, Oxford, UK
| | - David Wilkinson
- Memory Assessment and Research Centre MARC, Moorgreen Hospital, Southampton, UK
| | - Henrike Wolf
- German Center for Neurodegenerative Disease (DZNE), Bonn, Germany; Department of Psychiatry Research, Zurich, Switzerland
| | | | - Dina Zekry
- Department of Internal Medicine and Geriatrics, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Giovanni B Frisoni
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS Istituto Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy; Memory Clinic and Laboratoire de Neuroimagerie du Vieillissement (LANVIE), University Hospitals and University of Geneva, Geneva, Switzerland.
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Jones RW, Romeo R, Trigg R, Knapp M, Sato A, King D, Niecko T, Lacey L. Dependence in Alzheimer's disease and service use costs, quality of life, and caregiver burden: the DADE study. Alzheimers Dement 2014; 11:280-90. [PMID: 25074342 DOI: 10.1016/j.jalz.2014.03.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 12/24/2013] [Accepted: 03/06/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND Most models determining how patient and caregiver characteristics and costs change with Alzheimer's disease (AD) progression focus on one aspect, for example, cognition. AD is inadequately defined by a single domain; tracking progression by focusing on a single aspect may mean other important aspects are insufficiently addressed. Dependence has been proposed as a better marker for following disease progression. METHODS This was a cross-sectional observational study (18 UK sites). Two hundred forty-nine community or institutionalized patients, with possible/probable AD, Mini-Mental State Examination (3-26), and a knowledgeable informant participated. RESULTS Significant associations noted between dependence (Dependence Scale [DS]) and clinical measures of severity (cognition, function, and behavior). Bivariate and multivariate models demonstrated significant associations between DS and service use cost, patient quality of life, and caregiver perceived burden. CONCLUSION The construct of dependence may help to translate the combined impact of changes in cognition, function, and behavior into a more readily interpretable form. The DS is useful for assessing patients with AD in clinical trials/research.
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Affiliation(s)
- Roy W Jones
- RICE (The Research Institute for the Care of Older People), Royal United Hospital, Bath, UK.
| | - Renee Romeo
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, London, UK
| | - Richard Trigg
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Martin Knapp
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, London, UK; LSE Health and Social Care, London School of Economics and Political Science, London, UK
| | - Azusa Sato
- LSE Health and Social Care, London School of Economics and Political Science, London, UK
| | - Derek King
- LSE Health and Social Care, London School of Economics and Political Science, London, UK
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Haro JM, Kahle-Wrobleski K, Bruno G, Belger M, Dell'Agnello G, Dodel R, Jones RW, Reed CC, Vellas B, Wimo A, Argimon JM. Analysis of burden in caregivers of people with Alzheimer's disease using self-report and supervision hours. J Nutr Health Aging 2014; 18:677-84. [PMID: 25226106 DOI: 10.1007/s12603-014-0500-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study aimed to describe the baseline characteristics of informal carers of community-living Alzheimer's disease (AD) patients by AD severity group and to identify factors associated with two measures of caregiver burden. DESIGN AND SETTING GERAS is a prospective observational study in France, Germany, and the UK, designed to assess costs and resource use associated with AD, for patients and their caregivers, stratified by disease severity. PARTICIPANTS 1497 community-dwelling AD patients and their primary caregivers. MEASUREMENTS Subjective caregiver burden assessed using the Zarit Burden Interview [ZBI] and time spent supervising patients (an objective measure of burden recorded using the Resource Utilization in Dementia instrument) during the month before the baseline visit were recorded. Separate multiple linear regression analyses using ZBI total score and caregiver supervision time as dependent variables were performed to identify patient and caregiver factors independently associated with caregiver burden. RESULTS Increasing AD severity was associated with both subjective caregiver burden (ZBI total score) and overall caregiver time, which includes supervision time (both p<0.001, ANOVA). Better patient functioning (on instrumental activities of daily living) was independently associated with both a lower ZBI total score and less supervision time, whereas higher levels of caregiver distress due to patient behavior were associated with greater caregiver burden. Other factors independently associated with an increased ZBI total score included younger caregiver age, caregiver self-reported depression, caring for a male patient, and longer time since AD diagnosis. Caregivers living with the patient, being a male caregiver, patient living in a rural location, higher patient behavioral problem subdomain scores for apathy and psychosis, more patient emergency room visits, not receiving food delivery and receiving financial support for caregiving were all associated with greater caregiver supervision time. CONCLUSION Our results show that subjective caregiver burden and caregiver time are influenced by different factors, reinforcing the need to consider both aspects of caregiving when trying to minimize the burden of AD. However, interventions that minimize caregiver distress and improve patient functioning may impact on both subjective and objective burden.
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Affiliation(s)
- J M Haro
- Kristin Kahle-Wrobleski, Global Health Outcomes, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA, Tel: +1 317 709 6666 Fax: +1 317 433 6590,
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Damian M, Hausner L, Jekel K, Richter M, Froelich L, Almkvist O, Boada M, Bullock R, De Deyn PP, Frisoni GB, Hampel H, Jones RW, Kehoe P, Lenoir H, Minthon L, Olde Rikkert MGM, Rodriguez G, Scheltens P, Soininen H, Spiru L, Touchon J, Tsolaki M, Vellas B, Verhey FRJ, Winblad B, Wahlund LO, Wilcock G, Visser PJ. Single-domain amnestic mild cognitive impairment identified by cluster analysis predicts Alzheimer's disease in the european prospective DESCRIPA study. Dement Geriatr Cogn Disord 2014; 36:1-19. [PMID: 23651945 DOI: 10.1159/000348354] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To identify prodromal Alzheimer's disease (AD) subjects using a data-driven approach to determine cognitive profiles in mild cognitive impairment (MCI). METHODS A total of 881 MCI subjects were recruited from 20 memory clinics and followed for up to 5 years. Outcome measures included cognitive variables, conversion to AD, and biomarkers (e.g. CSF, and MRI markers). Two hierarchical cluster analyses (HCA) were performed to identify clusters of subjects with distinct cognitive profiles. The first HCA included all subjects with complete cognitive data, whereas the second one selected subjects with very mild MCI (MMSE ≥28). ANOVAs and ANCOVAs were computed to examine whether the clusters differed with regard to conversion to AD, and to AD-specific biomarkers. RESULTS The HCAs identified 4-cluster solutions that best reflected the sample structure. One cluster (aMCIsingle) had a significantly higher conversion rate (19%), compared to subjective cognitive impairment (SCI, p < 0.0001), and non-amnestic MCI (naMCI, p = 0.012). This cluster was the only one showing a significantly different biomarker profile (Aβ42, t-tau, APOE ε4, and medial temporal atrophy), compared to SCI or naMCI. CONCLUSION In subjects with mild MCI, the single-domain amnestic MCI profile was associated with the highest risk of conversion, even if memory impairment did not necessarily cross specific cut-off points. A cognitive profile characterized by isolated memory deficits may be sufficient to warrant applying prevention strategies in MCI, whether or not memory performance lies below specific z-scores. This is supported by our preliminary biomarker analyses. However, further analyses with bigger samples are needed to corroborate these findings.
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Affiliation(s)
- Marinella Damian
- Department of Geriatric Psychiatry, Clinic of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
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Ritchie CW, Bajwa J, Coleman G, Hope K, Jones RW, Lawton M, Marven M, Passmore P. Souvenaid®: a new approach to management of early Alzheimer's disease. J Nutr Health Aging 2014; 18:291-9. [PMID: 24626757 DOI: 10.1007/s12603-013-0411-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Synaptic loss correlates closely with cognitive deficits in Alzheimer's disease and represents a new target for intervention. Souvenaid® is the first medical nutrition product to be designed to support synapse formation and function in early Alzheimer's disease, and has undergone an extensive, 12-year development programme. The relatively large amount of clinical data available for Souvenaid® is unusual for a medical nutrition product. Souvenaid® contains omega-3 polyunsaturated fatty acids (docosahexaenoic acid and eicosapentaenoic acid), uridine (as uridine monophosphate) and choline which are nutritional precursors required for synaptic membrane phospholipid synthesis, together with phospholipids and other cofactors. Souvenaid® has demonstrated cognitive benefits in patients with mild Alzheimer's disease but not in patients with mild-to-moderate Alzheimer's disease. Two randomised, double-blind, controlled trials (duration 12 and 24 weeks) in patients with mild Alzheimer's disease untreated with acetylcholinesterase inhibitors and/or memantine have demonstrated that Souvenaid® is well tolerated and improves episodic memory performance. The daily intake of Souvenaid® has not been associated with any harmful effects or interactions with medications and none are anticipated. The ongoing, 24-month, European Union-funded LipiDiDiet trial in subjects with prodromal Alzheimer's disease is evaluating the potential benefits of Souvenaid® on memory and in slowing progression to Alzheimer's dementia. If Souvenaid® induces synaptogenesis and improved synaptic function, it may provide benefits in other clinical conditions characterised by neurodegeneration. A number of trials are ongoing and planned to evaluate the potential wider benefits of Souvenaid®.
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Affiliation(s)
- C W Ritchie
- C Ritchie, Department of Medicine, Imperial College, London, UK, ;
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Wimo A, Ballard C, Brayne C, Gauthier S, Handels R, Jones RW, Jonsson L, Khachaturian AS, Kramberger M. Health economic evaluation of treatments for Alzheimer's disease: impact of new diagnostic criteria. J Intern Med 2014; 275:304-16. [PMID: 24605810 DOI: 10.1111/joim.12167] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The socio-economic impact of Alzheimer's disease (AD) and other dementias is enormous, and the potential economic challenges ahead are clear given the projected future numbers of individuals with these conditions. Because of the high prevalence and cost of dementia, it is very important to assess any intervention from a cost-effectiveness viewpoint. The diagnostic criteria for preclinical AD suggested by the National Institute on Aging and Alzheimer's Association workgroups in combination with the goal of effective disease-modifying treatment (DMT) are, however, a challenge for clinical practice and for the design of clinical trials. Key issues for future cost-effectiveness studies include the following: (i) the consequences for patients if diagnosis is shifted from AD-dementia to predementia states, (ii) bridging the gap between clinical trial populations and patients treated in clinical practice, (iii) translation of clinical trial end-points into measures that are meaningful to patients and policymakers/payers and (iv) how to measure long-term effects. To improve cost-effectiveness studies, long-term population-based data on disease progression, costs and outcomes in clinical practice are needed not only in dementia but also in predementia states. Reliable surrogate end-points in clinical trials that are sensitive to detect effects even in predementia states are also essential as well as robust and validated modelling methods from predementia states that also take into account comorbidities and age. Finally, the ethical consequences of early diagnosis should be considered.
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Affiliation(s)
- A Wimo
- Department of Neurobiology, Care Sciences and Society, Alzheimer's Disease Research Center, Karolinska Institutet, Stockholm, Sweden; Centre for Research & Development, Uppsala University/County of Gävleborg, Gävle, Sweden
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Wimo A, Reed CC, Dodel R, Belger M, Jones RW, Happich M, Argimon JM, Bruno G, Novick D, Vellas B, Haro JM. The GERAS Study: a prospective observational study of costs and resource use in community dwellers with Alzheimer's disease in three European countries--study design and baseline findings. J Alzheimers Dis 2014; 36:385-99. [PMID: 23629588 DOI: 10.3233/jad-122392] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To address socioeconomic challenges associated with its increasing prevalence, data are needed on country-level resource use and costs associated with Alzheimer's disease (AD). GERAS is an 18-month observational study being conducted in France, Germany, and the U.K. (with an 18-month extension in France and Germany), aimed at determining resource use and total costs associated with AD, stratified by AD severity at baseline. Resource use information and time spent on informal care by non-professional caregivers was obtained using the Resource Utilization in Dementia instrument. Total baseline societal costs were based on four cost components: patient health care costs, patient social care costs, caregiver health care costs, and caregiver informal care costs. Overall, 1,497 community-dwelling patients with AD were analyzed at baseline. Estimated mean monthly total societal costs per patient at baseline differed significantly between groups with mild, moderate, and moderately severe/severe AD (p < 0.001 in each country): euro $1,418, euro 1,737, and euro 2,453 in France; euro 1,312, euro $2,412, and euro 3,722 in Germany; and euro 1,621, euro 1,836, andeuro 2,784 in the U.K., respectively. All cost components except caregiver health care costs increased with AD severity. Informal caregiver costs were the largest cost component accounting for about half to just over 60% of total societal costs, depending on country and AD severity group. In conclusion, GERAS study baseline results showed that country-specific costs increase with AD severity. Informal care costs formed the greatest proportion of total societal costs, increasing with AD severity independent of costing method. Longitudinal data will provide information on cost trends with disease progression.
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Affiliation(s)
- Anders Wimo
- KI Alzheimer's Disease Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Francis PT, Parsons CG, Jones RW. Rationale for combining glutamatergic and cholinergic approaches in the symptomatic treatment of Alzheimer’s disease. Expert Rev Neurother 2014; 12:1351-65. [DOI: 10.1586/ern.12.124] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Reed C, Belger M, Dell'Agnello G, Wimo A, Argimon JM, Bruno G, Dodel R, Haro JM, Jones RW, Vellas B. Caregiver Burden in Alzheimer's Disease: Differential Associations in Adult-Child and Spousal Caregivers in the GERAS Observational Study. Dement Geriatr Cogn Dis Extra 2014; 4:51-64. [PMID: 24711814 PMCID: PMC3977221 DOI: 10.1159/000358234] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND/AIMS To examine factors influencing the caregiver burden in adult-child and spousal caregivers of community-dwelling patients with Alzheimer's disease (AD). METHODS Baseline data from the 18-month, prospective, observational GERAS study of 1,497 patients with AD in France, Germany, and the UK were used. Analyses were performed on two groups of caregivers: spouses (n = 985) and adult children (n = 405). General linear models estimated patient and caregiver factors associated with subjective caregiver burden assessed using the Zarit Burden Interview. RESULTS The caregiver burden increased with AD severity. Adult-child caregivers experienced a higher burden than spousal caregivers despite spending less time caring. Worse patient functional ability and more caregiver distress were independently associated with a greater burden in both adult-child and spousal caregivers. Additional factors were differentially associated with a greater caregiver burden in both groups. In adult-child caregivers these were: living with the patient, patient living in an urban location, and patient with a fall in the past 3 months; in spouses the factors were: caregiver gender (female) and age (younger), and more years of patient education. CONCLUSION The perceived burden differed between adult-child and spousal caregivers, and specific patient and caregiver factors were differentially associated with this burden.
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Affiliation(s)
| | - Mark Belger
- Eli Lilly and Company Limited, Windlesham, UK
| | | | | | - Josep Maria Argimon
- Agencia Qualitat i Avaluació Sanitaries, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Josep Maria Haro
- Parc Santari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Roy W. Jones
- RICE (The Research Institute for the Care of Older People), Bath, UK
| | - Bruno Vellas
- Toulouse University Hospital, INSERM 1027, Toulouse, France
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Vermeiren APA, Bosma H, Visser PJ, Zeegers MP, Graff C, Ewers M, Frisoni GB, Frölich L, Hampel H, Jones RW, Kehoe PG, Lenoir H, Minthon L, Nobili FM, Olde Rikkert M, Rigaud AS, Scheltens P, Soininen H, Spiru L, Tsolaki M, Wahlund LO, Vellas B, Wilcock G, Elias-Sonnenschein LS, Verhey FRJ. The association between APOE ε4 and Alzheimer-type dementia among memory clinic patients is confined to those with a higher education. The DESCRIPA Study. J Alzheimers Dis 2013; 35:241-6. [PMID: 23380990 DOI: 10.3233/jad-122182] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We assessed the interaction between the APOE ε4 allele and education level in the etiology of Alzheimer's disease (AD) among memory clinic patients from the multicenter DESCRIPA study. Subjects (n = 544) were followed for 1 to 5 years. We used Cox's stratified survival modeling, adjusted for age, gender, and center. APOE ε4 predicted the onset of AD-type dementia in middle (HR 3.45 95% CI 1.79-6.65, n = 222) and high (HR 3.67 95% CI 1.36-9.89, n = 139) but not in low educated subjects (HR 0.81, 95% CI 0.38-1.72, n = 183). This suggests that mechanisms in developing Alzheimer-type dementia may differ between educational groups that raises questions related to Alzheimer-type dementia prevention.
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