Neuropsychiatric symptoms and Quality of Life in patients with very mild and mild Alzheimer's disease

School of Medicine, Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio Campus, Finland
International Journal of Geriatric Psychiatry (Impact Factor: 2.87). 05/2011; 26(5):473 - 482. DOI: 10.1002/gps.2550


Neuropsychiatric symptoms (NPS) are common manifestations of Alzheimer' s disease (AD).Objective
To examine the prevalence and significance of NPS in very mild and mild AD patients with emphasis on their influence on the well-being of the patients and their caregivers.Methods
The participants were 240 patient-caregiver dyads who participated in a prospective, controlled rehabilitation study (ALSOVA). Three Quality of Life (QoL) instruments were used; generic 15D, disease-specific QoL-AD and Visual Analog Scale (VAS). The disease-specific QoL-AD was both self-rated and caregiver rated. Other scales used were Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), ADCS-ADL, Neuropsychiatric Inventory (NPI) and Beck Depression Inventory (BDI).ResultsNPS were present in 76.5% of patients with very mild AD (CDR 0.5) and in 84.9% of patients with mild to moderate AD (CDR 1). The most frequent symptoms were apathy, depression, irritability, and agitation. The strongest predictor of self-reported QoL-AD scores was depressive symptoms whereas functional decline and presence of NPS predicted poor caregiver ratings of patients' QoL. However, caregiver depression also influenced significantly their ratings.ConclusionNPS are common even in the early stages of AD. NPS were significantly associated with caregiver assessment of the patient's QoL but not with patients' self-assessed QoL. Depression decreases QoL, but may remain unrecognized in AD patients, emphasizing the need for careful and structured assessment of NPS before deciding on the appropriate treatment. Copyright © 2010 John Wiley & Sons, Ltd.

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Available from: Hilkka Soininen, Aug 10, 2015
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    • "Similarly to self ratings, carer ratings are strongly influenced by the PwD's ADLs (Gomez-Gallego et al., 2012) and cognition (Snow et al., 2005; Beer et al., 2010; Bosboom et al., 2012), with lower carer ratings associated with greater dependence and lower cognitive scores. Presence of depression (Fuh and Wang, 2006; Hoe et al., 2007; Conde-Sala et al., 2013), neuropsychiatric symptoms (Conde-Sala et al., 2009; Wolak et al., 2009; Nakanishi et al., 2011), and experience of burden (Conde-Sala et al., 2009; Wolak et al., 2009; Black et al., 2012) or depression in the family carer (Logsdon et al., 1999; Logsdon et al., 2002; Snow et al., 2005; Karttunen et al., 2011) also appear to be strongly adversely related to carer-rated QoL. Carer ratings are lower as apathy (Hurt et al., 2008; Leon-Salas et al., 2011; Nakanishi et al., 2011) and dementia severity increases (Nakanishi et al., 2011; Sheehan et al., 2012) and if carers rate their own QoL less positively (Conde-Sala et al., 2009). "
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    ABSTRACT: Quality of life (QoL) is one of the most important outcomes in improving well-being in people with dementia (PwD). The primary aim of the present study was to compare self and carer ratings of QoL in PwD and to identify the most important factors influencing self and carer ratings. We conducted a cross-sectional analytic study of 488 dyads using the Quality of Life in Alzheimer's Disease scale, demographics, data on self-rated health, and clinical characteristics. Higher levels of self-rated health in PwD were associated with higher self-rated QoL after controlling for depression and activities of daily living. When the carer experienced less stress related to caregiving, the PwD reported better QoL. Higher carer-rated QoL was associated with less carer stress, better health for the family carer, and the PwD being of younger age. When carers lived with the PwD, and reported lower levels of depression and better functional ability for their relative, carer-rated QoL was higher. The self-rated health of PwD and carers influences the ratings they make of the QoL of the PwD indicating that it is an important influence on QoL in this population. Copyright © 2014 John Wiley & Sons, Ltd.
    Full-text · Article · May 2014 · International Journal of Geriatric Psychiatry
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    • "Many studies have suggested that depressive symptoms are common in patients with dementia.26,27 Karttuten et al.28 evaluated 240 patients with AD and showed that 32.1% of patients with very mild and 39.6% of patients with mild AD have depressive symptoms. Enache et al.29 reported that 20-30% of patients with AD have depression. "
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    ABSTRACT: Objective Caregivers for patients with Alzheimer's disease (AD) suffer from psychological and financial burdens. However, the results of the relationship between burden and cognitive function, performance of activities of daily living, and depressive symptoms have remained inconsistent. Therefore, the aim of this study was to examine which factors are more significant predictors of heightened burden, cognitive impairment or functional decline, besides neuropsychiatric symptoms. Methods A cross-sectional study was conducted in a sample comprised of 1,164 pairs of patients with AD and caregivers from the Clinical Research of Dementia of South Korea study cohorts. The cognitive function of each sub-domain, functional impairments, depressive symptoms, and caregiver burden were assessed using the dementia version of Seoul Neuropsychological Screening Battery (SNSB-D), Barthel Index for Daily Living Activities (ADL), Seoul-Instrumental Activities of Daily Living (S-IADL), the Clinical Dementia Rating Sum of Box (CDR-SB), the Global Deterioration Scale (GDS), the Korean version of the Neuropsychiatric Inventory (K-NPI), and the 15-item Geriatric Depression Scale. Results We found that higher severity (higher CDR-SB and GDS scores) and more functional impairment (lower ADL and higher S-IADL scores) were significantly associated with higher caregiver burden. In addition, depressive symptoms of patients (higher Geriatric Depression Scale scores) were associated with higher caregiver burden. Conclusion Therefore, interventions to help maintain activities of daily living in patients with AD may alleviate caregiver burden and improve caregiver well-being.
    Full-text · Article · Apr 2014 · Psychiatry investigation
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    • "The third discrepancy concerns the patient's functional status. Although functional deficits had a negative effect on patients themselves, especially during the first year of follow-up when they were more aware of their condition, the greatest effect was on caregivers, in whom the patient's functional impairment produced a negative view of QoL-p throughout the follow-up period [5] [14] [35] [36] [41]. "
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    ABSTRACT: Cross-sectional studies report notable discrepancies between patient and caregiver ratings of the quality of life of patients (QoL-p) with Alzheimer’s disease (AD). This study aimed to identify the factors associated with any changes in QoL-p ratings and any discrepancies between patient and caregiver ratings of QoL-p. Three-year follow-up of a cohort of non-institutionalized patients (n = 119). QoL-p was assessed by the Quality of Life in AD (QoL-AD) scale. We analyzed the influence of functional and cognitive status and behavioral problems in patients, and burden and mental health in caregivers. Repeated measures analysis was applied to the scores of patients and caregivers on the QoL-AD, and to the discrepancies between them. Generally, patients’ own ratings remained stable over time (F 3,116 = 0.9, p = 0.439), whereas caregiver ratings showed a decline (F 3,116 = 9.4, p < 0.001). In the analysis of discrepancies, patients with anosognosia gave higher ratings (F 1,117 = 11.9, p = 0.001), whereas caregiver ratings were lower when the patient showed greater agitation (F 1,117 = 13.0, p < 0.001), apathy (F 1,117 = 15.4, p < 0.001), and disabilities (F 1,117 = 17.1, p < 0.001), and when the caregiver experienced greater burden (F 1,117 = 9.0, p = 0.003) and worse mental health (F 1,117 = 10.1, p = 0.003). Patient ratings of QoL-p remain generally stable over time, whereas those of caregivers show a decline, there being significant discrepancies in relation to specific patient and caregiver factors.
    Full-text · Article · Feb 2014 · Journal of Alzheimer's disease: JAD
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