Kristiina Hongisto1,2,3, Ilona Hallikainen1, Tuomas Selander4, Soili Törmälehto5, Saku Väätäinen5, Janne Martikainen5, Tarja Välimäki6, Sirpa Hartikainen7,8, Jaana Suhonen9, Anne M Koivisto1,3. 1. Institute of Clinical Medicine, Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland. 2. Institute of Public Health and Clinical Nutrition, Department of Geriatrics, University of Eastern Finland, Kuopio, Finland. 3. NeuroCentre, Neurology, Kuopio University Hospital, Kuopio, Finland. 4. Science Service Center, Kuopio University Hospital, Kuopio, Finland. 5. Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland. 6. Department of Nursing Science, University of Eastern Finland, Kuopio, Finland. 7. Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland. 8. Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland. 9. Department of Neurology, Al-Ahli Hospital, Doha, Qatar.
Abstract
OBJECTIVE: To examine the association between neuropsychiatric symptoms (NPS) with self- and caregiver-rated Quality of Life (QoL) for patients with Alzheimer's disease (AD) during a 5-year follow-up. METHODS: The ALSOVA 5-year follow-up study included, at baseline, 236 patients with either very mild (Clinical Dementia Rating Scale (CDR) 0.5), or mild (CDR 1) AD, together with their caregivers from three Finnish hospital districts. QoL was evaluated using patient self-reported, and caregiver-rated, QoL in AD (QoL-AD) scores. NPS were assessed using the Neuropsychiatric Inventory (NPI), and AD severity was evaluated using the CDR, with cognition tested by the mini-mental state examination. The performance of daily activities was assessed using the Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory. RESULTS: Over the 5-year follow-up period, patient self-reported QoL-AD scores did not change significantly (p = 0.245), despite increases in their NPS. However, caregiver-rated patient QoL-AD scores declined significantly (p ≤ 0.001), as total NPI scores increased during follow-up. No NPS at baseline, and only apathy at follow-up, correlated significantly (p = 0.007) with patient self-rated QoL-AD scores. Caregiver-rated patient QoL-AD scores correlated significantly with most NPS, especially (p ≤ 0.001) apathy, agitation, anxiety, irritability, depression, and delusions at baseline, and delusions, hallucinations, apathy, appetite disturbances, and anxiety during follow-up. CONCLUSIONS: Patient rated QoL-AD scores are an unreliable tool with which to evaluate the success of therapy for NPS. Instead, caregiver-rated scores for patients correlated well with NPI scores, and health care professionals in the clinic should preferentially use these.
OBJECTIVE: To examine the association between neuropsychiatric symptoms (NPS) with self- and caregiver-rated Quality of Life (QoL) for patients with Alzheimer's disease (AD) during a 5-year follow-up. METHODS: The ALSOVA 5-year follow-up study included, at baseline, 236 patients with either very mild (Clinical Dementia Rating Scale (CDR) 0.5), or mild (CDR 1) AD, together with their caregivers from three Finnish hospital districts. QoL was evaluated using patient self-reported, and caregiver-rated, QoL in AD (QoL-AD) scores. NPS were assessed using the Neuropsychiatric Inventory (NPI), and AD severity was evaluated using the CDR, with cognition tested by the mini-mental state examination. The performance of daily activities was assessed using the Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory. RESULTS: Over the 5-year follow-up period, patient self-reported QoL-AD scores did not change significantly (p = 0.245), despite increases in their NPS. However, caregiver-rated patient QoL-AD scores declined significantly (p ≤ 0.001), as total NPI scores increased during follow-up. No NPS at baseline, and only apathy at follow-up, correlated significantly (p = 0.007) with patient self-rated QoL-AD scores. Caregiver-rated patient QoL-AD scores correlated significantly with most NPS, especially (p ≤ 0.001) apathy, agitation, anxiety, irritability, depression, and delusions at baseline, and delusions, hallucinations, apathy, appetite disturbances, and anxiety during follow-up. CONCLUSIONS:Patient rated QoL-AD scores are an unreliable tool with which to evaluate the success of therapy for NPS. Instead, caregiver-rated scores for patients correlated well with NPI scores, and health care professionals in the clinic should preferentially use these.
Authors: Franziska Maier; Annika Spottke; Jan-Philipp Bach; Claudia Bartels; Katharina Buerger; Richard Dodel; Andreas Fellgiebel; Klaus Fliessbach; Lutz Frölich; Lucrezia Hausner; Martin Hellmich; Stefan Klöppel; Arne Klostermann; Johannes Kornhuber; Christoph Laske; Oliver Peters; Josef Priller; Tanja Richter-Schmidinger; Anja Schneider; Kija Shah-Hosseini; Stefan Teipel; Christine A F von Arnim; Jens Wiltfang; Frank Jessen Journal: JAMA Netw Open Date: 2020-05-01