Alzheimer's Scale Research Articles

Relationship between Knowledge, Attitude, and Burden among Alzheimer's Family Care Givers in Jeddah, Saudi Arabia

Background: According to Alzheimer's disease association. The prevalence of Alzheimer's patients will increase to reach 68% worldwide by 2050. More specifically according to Saudi Alzheimer's Association, the number of Alzheimer's patients was reported to be 130 thousand in Saudi Arabia. Therefore, this study looked at assessing the knowledge, attitudes, and level of burden among family care givers having Alzheimer patients. Methodology: A descriptive cross sectional correlational survey design was used to include 150 family care givers from Geriatric Society Association located in Almontazahat District, Jeddah, K.S.A. Three validated tools were used to assess the knowledge, attitudes and burden related to Alzheimer's disease namely: Alzheimer's disease Knowledge Scale, The Dementia Attitudes Scale, and Burden Scale for Family Caregivers. Findings: The majority (88.6 %) of the respondents were female, their mean age was (29.2 ± 12.5), and 55.6% had Bachelor level of education. Nearly three Quarter (72.5 %) of the respondents have moderate level (16-24 out of 30) of total knowledge of Alzheimer's scale. Surprisingly, 78.5% of the respondents had a negative attitude, and 81.9% felt burden towards their Alzheimer's patients. Unexpectedly, a negative correlation was reported between participant's knowledge and their attitude at p ≥ 0.5 while, a positive correlation was conveyed between respondents' knowledge and family burden scale at p ≥ 0.5. Conclusion and implications: It's concluded that, the level of knowledge among study participants was moderate while their attitude was negative and felt burden toward having Alzheimer's patients. Therefore, it's recommended to conduct psychosocial interventions to improve family caregiver attitudes and reduce their burden toward their beloved Alzheimer' patients. Comprehensive management of the Alzheimer patients includes building a partnership between health professionals and family caregivers, referral to Alzheimer's Associations, and psychosocial interventions where indicated.

Psychometric Properties of the Family Stigma in Alzheimer's Disease Scale in Greek Professional Caregivers.

The present study was undertaken in order to evaluate the validity and reliability of the Family Stigma in Alzheimer's Disease Scale (FS-ADS) in the Greek population. The Greek version of the FS-ADS as well as the Maslach Burnout Inventory (MBI) was administered to 171 healthcare professional caring for people with dementia. Exploratory factor analysis was performed to examine the factor structure of the FS-ADS. Test-retest reliability was measured by administration of the FS-ADS in 20 individuals. Principal component analysis revealed 5, 8 and 3 factors (subscales) for each dimension of the original questionnaire, respectively, similar to other previously reported results in the literature. The overall Cronbach's α was .899, yielding a high internal consistency. Test-retest reliability was very high (r = 0.903, p < .001). Statistically significant relationships were found between most of the FS-ADS dimensions and Maslach subscales. The findings favor the use of FS-ADS in nurses and professional caregivers in general, for measuring stigma in dementia in Greece.

Quality of life in early-stage Alzheimer's disease: the moderator role of family variables and coping strategies from the patients' perspective.

This study assessed the effects of sociodemographic and psychological variables on quality of life (QOL), as well as the moderator role of family variables and coping strategies in the relationship between psychological morbidity and QOL, based on patients' perspective. This study used a cross-sectional design. A total of 158 patients with early Alzheimer's disease completed the Mini-Mental State Examination, the Montreal Cognitive Assessment, the Hospital Anxiety and Depression Scale, the Ways of Coping Questionnaire, the Spiritual and Religious Attitudes in Dealing with Illness, the Family Adaptability and Cohesion Evaluation Scales, the Family Satisfaction Scale, the Family Communication Scale, the Barthel Index, and the Quality of Life in Alzheimer's Disease Scale. Being a man, having a higher education, and engaging in more exercise activity were associated with better QOL. Lower levels of cognitive impairment, psychological morbidity, and spirituality predicted better QOL. Also, lower levels of functionality, family communication, family satisfaction, and family functioning contributed to worse QOL. Gender, psychological morbidity, and functionality contributed significantly to QOL. Family satisfaction, family communication, and coping strategies moderated the relationship between psychological morbidity and QOL. Intervention in early-stage Alzheimer's disease should focus on patients' coping strategies and family context, particularly family satisfaction and communication, to foster QOL.

Exploration of the relationship between stigma and burnout among Greek nurses in dementia care

To investigate possible correlations between stigma and burnout of nurses and non-graduate professional caregivers of elderly with dementia in nursing homes. Research on dementia stigma in health care professionals as well as its relationship with their well-being is seriously lacking. This cross-sectional study involved a convenience sample of 171 nurses and other professional caregivers in 16 Greek elderly care units who responded to Maslah Burnout Inventory (ΜΒΙ) as well as the Family Stigma in Alzheimer's Disease Scale (FS-ADS). In order to find adjusted associations between independent variables and the stigma and burnout of professional caregivers, multiple linear regression analysis was used. Cognitive, emotional and behavioural attributions of the three dimensions of stigma were found to be independent predictive factors of burnout's dimensions which indicate that stigma nurses deposit on patients, contributes towards their burnout. Educational preparation of geriatric nurses should provide them with the option of seeing dementia as a normal stage of life since reducing stigma can contribute towards preventing and managing professional burnout. In order to reduce burnout, nurse managers should design lifelong learning programs on the basis of changing the stigmatizing negative cognitive and emotional attitudes of professionals towards dementia.

Comparison of Integrated Outpatient Palliative Care With Standard Care in Patients With Parkinson Disease and Related Disorders

Parkinson disease and related disorders (PDRD) have consequences for quality of life (QoL) and are the 14th leading cause of death in the United States. Despite growing interest in palliative care (PC) for persons with PDRD, few studies are available supporting its effectiveness. To determine if outpatient PC is associated with improvements in patient-centered outcomes compared with standard care among patients with PDRD and their caregivers. This randomized clinical trial enrolled participants at 3 academic tertiary care centers between November 1, 2015, and September 30, 2017, and followed them up for 1 year. A total of 584 persons with PDRD were referred to the study. Of those, 351 persons were excluded by phone and 23 were excluded during in-person screenings. Patients were eligible to participate if they had PDRD and moderate to high PC needs. Patients were excluded if they had urgent PC needs, another diagnosis meriting PC, were already receiving PC, or were unable or unwilling to follow the study protocol. Enrolled participants were assigned to receive standard care plus outpatient integrated PC or standard care alone. Data were analyzed between November 1, 2018, and December 9, 2019. Outpatient integrated PC administered by a neurologist, social worker, chaplain, and nurse using PC checklists, with guidance and selective involvement from a palliative medicine specialist. Standard care was provided by a neurologist and a primary care practitioner. The primary outcomes were the differences in patient quality of life (QoL; measured by the Quality of Life in Alzheimer Disease scale) and caregiver burden (measured by the Zarit Burden Interview) between the PC intervention and standard care groups at 6 months. A total of 210 patients with PDRD (135 men [64.3%]; mean [SD] age, 70.1 [8.2] years) and 175 caregivers (128 women [73.1%]; mean [SD] age, 66.1 [11.1] years) were enrolled in the study; 193 participants (91.9%) were white and non-Hispanic. Compared with participants receiving standard care alone at 6 months, participants receiving the PC intervention had better QoL (mean [SD], 0.66 [5.5] improvement vs 0.84 [4.2] worsening; treatment effect estimate, 1.87; 95% CI, 0.47-3.27; P = .009). No significant difference was observed in caregiver burden (mean [SD], 2.3 [5.0] improvement vs 1.2 [5.6] improvement in the standard care group; treatment effect estimate, -1.62; 95% CI, -3.32 to 0.09; P = .06). Other significant differences favoring the PC intervention included nonmotor symptom burden, motor symptom severity, completion of advance directives, caregiver anxiety, and caregiver burden at 12 months. No outcomes favored standard care alone. Secondary analyses suggested that benefits were greater for persons with higher PC needs. Outpatient PC is associated with benefits among patients with PDRD compared with standard care alone. This study supports efforts to integrate PC into PDRD care. The lack of diversity and implementation of PC at experienced centers suggests a need for implementation research in other populations and care settings. ClinicalTrials.gov Identifier: NCT02533921.

Physical fitness in institutionalized older adults with dementia: association with cognition, functional capacity and quality of life

This cross-sectional study investigated the association of physical fitness with cognitive function, functional capacity and quality of life among institutionalized older adults with dementia. One hundred and two older adults aged 78.0 ± 8.4 years, predominantly female (67.6%), with neurocognitive disorder due to Alzheimer’s disease (AD) (49.2%), vascular dementia (14.7%), Parkinson’s disease (2%), dementia with Lewy bodies (2%) or unspecified dementia (32.1%) participated in the present study. Regression analyses were used to examine associations between physical fitness components (Senior Fitness Test) and cognitive function (Mini-Mental State Examination), functional capacity (Katz Index of Independence in Activities of Daily Living) and Quality of Life (QoL)-Alzheimer's Disease scale. Univariate regression indicates that strength, flexibility, agility/dynamic balance and aerobic endurance are relevant for cognitive function, physical capacity and perceived QoL in institutionalized older people with dementia. After multiple regression analyses, adjusted for body mass index (BMI), results showed that aerobic endurance had a significant positive association with Total Katz Index. For both, caregiver perception of QoL-AD and global QoL-AD, BMI remained significantly and positively associated. Agility–dynamic balance presented a significant negative relation with global QoL-AD. Overall, our findings suggest that better physical fitness is important for cognition and autonomous functional capacity and that it has positive repercussions on the QoL in institutionalized older adults with dementia. Consequently, exercise-based therapeutic strategies aiming to improve physical fitness should be implemented.

Mechanisms to Reduce the Burden on Dementia Caregivers

Background: Caregiving for people with dementia is highly demanding. It is unclear which patient factors should be targeted to relieve caregiver burden. We aimed to identify potential mechanisms that could alleviate caregiver burden. Methods: We conducted a causal mediation analysis of the Dementia And Physical Activity (DAPA) randomised controlled trial. DAPA was a pragmatic, investigator masked, randomised controlled trial conducted in 15 regions across England. DAPA recruited a sample of 494 people with mild to moderate dementia (DSM-IV) and their caregivers and compared a moderate to high intensity exercise programme (n=329) versus usual care (n=165). We estimated mediating effects of the intervention on caregiver burden at 12 months through the following mediators measured at six months, participants' social quality of life (Quality of Life in Alzheimer's Disease scale), physical function (Bristol Activities of Daily Living scale), behavioural symptoms (Neuropsychiatric Inventory), and cognitive function (Alzheimer disease assessment scale cognitive subscale). Findings: The exercise programme had no effect on behavioural, cognitive, physical and social mediators. All mediators were significantly associated with less caregiver burden. Physical function had the strongest association with carer burden (0.20, 95%CI = 0.11 to 0.30), followed by behavioural symptoms (0.19, CI = 0.08 to 0.30). Interpretation: Interventions that can improve physical function and reduce behavioural symptoms of people with dementia can reduce caregiver burden. Funding Statement: National Institute of Health Research (NIHR) Health Technology Assessment Programme, NIHR Collaboration for Leadership in Applied Health Research and Care Oxford at Oxford Health NHS Foundation Trust, and the NIHR Oxford Musculoskeletal Biomedical Research Unit. Declaration of Interests: All authors declare no conflicts of interests. Ethics Approval Statement: The national ethics review committees (REC No 11/SW/0232) and research governance departments in each organisation approved the original DAPA trial.

How Should We Capture Health State Utility in Dementia? Comparisons of DEMQOL-Proxy-U and of Self- and Proxy-Completed EQ-5D-5L

BackgroundDementia-specific and proxy-completed preference-based measures have been proposed for use in intervention studies involving people living in residential care, in instances where generic, self-reported preference-based measures have been deemed inappropriate. ObjectiveThis study was conducted to investigate the construct validity, criterion validity, and responsiveness of DEMQOL-Proxy-U and of self- and proxy-completed EQ-5D-5L. MethodsThe analysis used a 3-wave, individual-level data set of 1004 people living with dementia in residential care that included self-completed EQ-5D-5L and formal-carer and informal-carer proxy-completed EQ-5D-5L and DEMQOL-Proxy-U utility values, in addition to other nonutility cognitive measures (Functional Assessment Staging [FAST], Clinical Dementia Rating [CDR], Cohen-Mansfield Agitation Inventory [CMAI]) and health-related quality of life (HRQOL) measures (nursing home version of the Quality of Life with Alzheimer's disease scale [QOL-AD-NH], Quality of Life in Late-Stage Dementia [QUALID] scale). Construct validity, criterion validity, and responsiveness were assessed using correlation, Bland-Altman plots, and panel data regression models. ResultsSelf-completed EQ-5D-5L failed to reflect clinically important differences and changes in FAST, CDR, and CMAI but did capture the resident's own view of HRQOL (QOL-AD-NH). As dementia severity increased, collection of EQ-5D-5L-proxy and DEMQOL-Proxy-U data was more feasible than collection of self-completed EQ-5D-5L. These formal-carer and informal-carer proxy measures also better reflected changes in FAST, CDR, and CMAI but did not capture the resident's own view of HRQOL (QOL-AD-NH), despite adequately capturing the proxy's own view of the resident's HRQOL (QUALID). This indicates discrepancies between a proxy's view and resident's view of the impact that tangible declines in health, cognition, or functional abilities have on HRQOL. The EQ-5D-5L-proxy and DEMQOL-Proxy-U were generally poor substitutes. Regardless of which proxy completed it, the EQ-5D-5L-proxy was typically more responsive than the DEMQOL-Proxy-U to changes in CDR, FAST, and CMAI, indicating that use of the DEMQOL-Proxy-U is not always justified. ConclusionDisparities in the measurement properties of different utility measures mean that choices about how to measure utility in trials could affect economic evaluation outcomes and hence how resources are allocated for dementia care.

Factor structure of the Japanese version of the Quality of Life in Alzheimer's Disease Scale (QOL-AD).

The Quality of Life in Alzheimer's Disease Scale (QOL-AD) developed by Logsdon et al. in1999 is believed to be useful for evaluating responses from both patients and their caregivers. We previously confirmed both the reliability and the validity of the Japanese version of the QOL-AD. However, the factor structure of this scale should be confirmed because the QOL-AD covers multiple facets of dementia patients' lives. Thus, we performed a factor analysis of the Japanese QOL-AD. Then, we examined the correlations between each of the identified QOL factor scores and the results of other scales. The Japanese version of the QOL-AD was given to 132 AD patients and 132 caregivers. Four other tests were also performed at the same time: the Mini-Mental State Examination, the Neuropsychiatric Inventory (NPI), the Hyogo Activities of Daily Living Scale (HADL), and the Short Memory Questionnaire. A factor analysis using Varimax rotation was used to examine the dimensions underlying the QOL-AD. In addition, we examined the Pearson correlations between each of the identified QOL factor scores and the results of the other four tests. Factor analyses of both versions of the Japanese QOL-AD (both the patients' and the caregivers' responses) revealed three factors that were named 'psychological wellbeing', 'human relationships', and 'physical and social environment'. The 'psychological wellbeing' factor was significantly correlated with the Mood factor of the NPI. The 'human relationships' factor was significantly correlated with the Psychosis factor of the NPI. The 'physical and social environment' factor was significantly correlated with the HADL. Both the patients' and the caregivers' responses to the Japanese version of the QOL-AD were composed of three factors: 'psychological wellbeing', 'human relationships', and 'physical and social environment'. The present results support the multi-domain concept of QOL proposed by Lawton.

Self-Efficacy Mediates the Association Between Physical Function and Perceived Quality of Life in Individuals with Mild Cognitive Impairment.

Research has shown that individuals with mild cognitive impairment (MCI) value quality of life (QoL) above and beyond cognitive function or other potential outcomes in MCI. There is evidence supporting the negative impact of poor physical function on QoL ratings. The study explored whether a modified measure of self-efficacy for managing MCI and education mediated and/or moderated the relationship between physical function and QoL in persons with MCI. Baseline data from 200 participants with MCI were obtained from a larger study assessing the effectiveness of a behavioral intervention. Physical function was assessed by the Short Physical Performance Battery. QoL was assessed with the Quality of Life in Alzheimer's Disease scale. Memory-related self-efficacy was assessed using a modified 9-item version of the Chronic Disease Self-Efficacy Scales. Mediation and moderation analyses tested the hypotheses that self-efficacy and education alter the association between physical function and QoL in individuals with MCI. All analyses were adjusted for age, cognitive severity, and sex. Self-efficacy for managing MCI was a significant mediator of the association between physical function and perceived QoL. Individuals with better physical function reported higher self-efficacy which was associated with higher QoL ratings. Greater self-efficacy for managing MCI mediated the negative association between physical function and quality of life in this exploratory study. Interventions aimed at enhancing memory self-efficacy in MCI may improve perceived QoL, even in the presence of poor physical function. Future research is needed to investigate this further.

Sleep Disturbance in Mild Cognitive Impairment and Association With Cognitive Functioning. A Case-Control Study.

Objectives: The aims of the current study are to (1) report the frequency of specific sleep disturbance symptoms in Mild Cognitive Impairment (MCI) and cognitive healthy older persons; (2) examine whether overall poor sleep and specific sleep disturbance symptoms are more common in persons with MCI compared to cognitive healthy older controls and; (3) examine the association between sleep disturbances and performance in general and specific cognitive domains in persons with MCI and separately in cognitive healthy older persons.Methods: Data were collected at the Fondazione Ospedale San Camillo Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Venice, Italy as part of the European VPH-DARE@IT project. We included 69 persons with MCI (mean age 75.7; SD = 7.7) and 72 sex-matched cognitively healthy controls (mean age 71.8; SD = 7.0). Participants underwent extensive neuropsychological assessment and evaluation of subjective sleep performance with the Sleep Continuity in Alzheimer’s Disease Scale(SCADS).Results: A fifth of MCI patients (21.7%, n = 15) had poor sleep compared to 15.3% (n = 11) of cognitively healthy controls. MCI patients had a 3.2 higher odds of having poor sleep compared to cognitively healthy controls after adjustment for age, education, sex, and general cognitive functioning (Odds Ratio (OR) = 3.2; 95% Confidence Interval (CI) = 1.1–9.2). Persons who reported waking up twice or more during the night had higher odds of being MCI compared to those who never wake or wake only once (OR = 2.6; 95% CI = 1.1–6.1). In MCI patients, poor sleep was associated with better general cognitive functioning and short-term working memory, whereas in cognitive healthy older persons poor sleep was associated with impairment in episodic memory performance and executive functioning.Discussion: Our results confirm previous studies showing that sleep disturbances are common in MCI, and this may be due to an ongoing neurodegenerative process rather than a symptom of cognitive impairment. Future research with objective sleep measurements are needed in MCI as well as interventions to improve sleep with the aim of preventing cognitive decline.

The effect of reminiscence therapy on cognitive functions, depression, and quality of life in Alzheimer patients: Randomized controlled trial.

Alzheimer is a disease leading to various neuropsychiatric behavioral disorders, and the most common symptom observed during the prognosis of Alzheimer's disease is dysmnesia. The aim of the present study is to investigate the effect of reminiscence therapy on cognitive functions, depression, and quality of life in Alzheimer's patients. The present study was a randomized controlled single blind study with two groups, which was designed in the experimental pretest-posttest pattern in the city of Konya, Turkey. It was decided to include a total of 60 elderly individuals. Information form that evaluated socio-demographic characteristics and disease history of individuals in intervention and control groups and was developed by the researcher. Standardized Mini-Mental State Examination (SMMSE), Cornell Scale for Depression in Dementia, and the Quality of Life in Alzheimer's Disease (QOL-AD) Scale were used to collect the data. Reminiscence therapy was applied once a week and lasted for 8weeks. Every session took 60minutes. Groups consisted of six people. Mini-Mental Test, depression, and quality of life mean scores of the elderly in intervention group before reminiscence therapy program increased after the administration, and the difference was statistically significant (P<0.05). In the intergroup comparison, a significant difference was found between elderly individuals' posttest Mini-Mental Test, depression, and quality of life mean scores (P<0.05). Our results suggest that regular reminiscence therapy should be considered for inclusion as routine care for the improvement of cognitive functions, depressive symptoms, and quality of life in elderly people with Alzheimer.

Discrepancies Between Alzheimer's Disease Patients' and Caregivers' Ratings About Patients' Quality of Life: A 1-year Observation Study in Brazil.

We investigated the factors associated with discrepancies between patients' and caregivers' ratings about patients' general quality of life (QoL) and about the domains of Quality of Life in Alzheimer's disease (QoL-AD) Scale at baseline and 12 months. This was a longitudinal study that comprised 114 outpatients with AD and their caregivers. Patients were assessed with the QoL-AD, Mini-mental State Examination, Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia, Cornell Scale for Depression, Functional Activities Questionnaire, and Neuropsychiatric Inventory, and Clinical Dementia Rating Scale. Caregivers answered the QoL-AD, Zarit Burden Interview and Sociodemographic Questionnaire. Linear regression analyses indicated that the factors associated with discrepancies of patients' and caregivers' ratings of patients' QoL-AD were impaired awareness and caregiver burden at baseline and impaired awareness at 12 months. Moreover, the factor associated with discrepancies in the domain memory was impaired awareness and in the domain ability to do chores, impaired awareness and functional deficit. The discrepancies between patients and caregivers were related to awareness and caregiver burden at baseline and to awareness at 12 months. These results raise questions regarding the subjective nature of QoL and the validity of patients' evaluation of their own QoL.

Donepezil for dementia due to Alzheimer's disease.

Background Alzheimer's disease is the most common cause of dementia in older people. One of the aims of therapy is to inhibit the breakdown of a chemical neurotransmitter, acetylcholine, by blocking the relevant enzyme. This can be done by a group of chemicals known as cholinesterase inhibitors. Objectives The objective of this review is to assess whether donepezil improves the well-being of patients with dementia due to Alzheimer's disease. Search methods The Cochrane Dementia and Cognitive Improvement Group's Specialized Register was searched using the terms 'donepezil', 'E2020' and 'Aricept' on 5 April 2006. This Register contains up-to-date records of all major health care databases and many ongoing trial databases. Members of the Donepezil Study Group and Eisai Inc were contacted. Selection criteria All unconfounded, double-blind, randomized controlled trials in which treatment with donepezil was compared with placebo for patients with mild, moderate or severe dementia due to Alzheimer's disease. Data collection and analysis Data were extracted by one reviewer (JSB), pooled where appropriate and possible, and the pooled treatment effects, or the risks and benefits of treatment estimated. Main results 24 trials are included, involving 5796 participants, of which 15 reported results in sufficient detail for the meta-analyses. Most trials were of 6 months or less duration in selected patients. Patients in 20 trials had mild to moderate disease, in two trials moderate to severe, and in two severe disease. Available outcome data cover domains including cognitive function, activities of daily living, behaviour, global clinical state, adverse events and health care resource costs. For cognition there is a statistically significant improvement for both 5 and 10 mg/day of donepezil at 24 weeks compared with placebo on the ADAS-Cog scale (-2.01 points MD, 95%CI -2.69 to -1.34, P < 0.00001); -2.80 points, MD 95% CI -3.74 to -2.10, P < 0.00001) and for 10 mg/day donepezil compared with placebo at 24 weeks (5.55 SIB points, 95% CI 3.60 to 7.49, p<0.00001) and 52 weeks (1.84 MMSE points, 95% CI, 0.53 to 3.15, P =0.006). The results show some improvement in global clinical state (assessed by a clinician) in people treated with 5 and 10 mg/day of donepezil compared with placebo at 24 weeks for the number of patients showing improvement (OR 2.38, 95% CI 1.78 to 3.19, P = < 0.00001, OR 1.82, 95% CI 1.42 to 2.35, P < 0.00001). Benefits of treatment were also seen on measures of activities of daily living and behaviour, but not on the quality of life score. There were significantly more withdrawals before the end of treatment from the 10 mg/day (289/1125 24% 10 mg/day vs 219/1079 20% placebo, OR 1.35, 95% CI 1.11 to 1.65, P = 0.003) but not the 5 mg/day, (100/561 18% 5 mg/day vs 109/568 19% placebo, OR 0.91, 95% CI 0.68 to 1.24, P = 0.56) donepezil group compared with placebo which may have resulted in some overestimation of beneficial changes at 10 mg/day. Benefits on the 10 mg/day dose were marginally larger than on the 5 mg/day dose. The results were similar for all severities of disease. Two studies presented results for health resource use, and the associated costs. There were no significant differences between treatment and placebo for any item, the cost of any item, and for the total costs, and total costs including the informal carer costs. Many adverse events were recorded, with more incidents of nausea, vomiting, diarrhoea, muscle cramps, dizziness, fatigue and anorexia (significant risk associated with treatment) in the 10 mg/day group, compared with placebo. There were more incidents of anorexia, diarrhoea, and muscle cramps in the 5 mg/day group compared with placebo, but not of dizziness, fatigue, nausea or vomiting. Very few patients left a trial as a direct result of the intervention. Authors' conclusions People with mild, moderate or severe dementia due to Alzheimer's disease treated for periods of 12, 24 or 52 weeks with donepezil experienced benefits in cognitive function, activities of daily living and behaviour. Study clinicians rated global clinical state more positively in treated patients, and measured less decline in measures of global disease severity. There is some evidence that use of donepezil is neither more nor less expensive compared with placebo when assessing total health care resource costs. Benefits on the 10 mg/day dose were marginally larger than on the 5 mg/day dose. Taking into consideration the better tolerability of the 5 mg/day donepezil compared with the 10 mg/day dose, together with the lower cost, the lower dose may be the better option. The debate on whether donepezil is effective continues despite the evidence of efficacy from the clinical studies because the treatment effects are small and are not always apparent in practice.

Six-month observational follow-up on activities of daily living in people with dementia living in nursing homes after a 6-month group based on either exercise or social activities.

Studies have demonstrated changes in activities of daily living after an exercise intervention in people with dementia (PWD) living in nursing homes (NH). However, some discrepancies are shown during follow-up. Our objective was to measure activities of daily living (ADL) performance during a 6-month observational follow-up after a 6-month exercise or social activity intervention in PWD living in NH. After cluster randomisation, 91 PWD living in NH performed a 6-month structured exercise intervention (n = 44) or a social activity intervention (n = 47). After the intervention, 85 PWD were assessed for post-intervention follow-up. Instrumental and basic activities of daily living (IADL, ADL) were measured at 6-month observational follow-up after the intervention using the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory for Severe Alzheimer's Disease (ADCS-ADL-sev) scale (scores ranging from 0 to 51, higher is better). Compared to participants in the social activity, those who participated to the exercise intervention had a significant decrease of their ADCS-ADL-sev score (between-group adjusted mean difference: 4.6 points, p = 0.001) with IADL having the most decrease (2.8 points, p = 0.004). Unexpectedly, exercisers declined sharply in the performance of ADLs and IADLs, whereas participants in the social intervention group maintained their levels. The potential mechanisms to explain these findings remain still to be elucidated.

Efficacy of cognitive stimulation therapy for older adults with vascular dementia.

ABSTRACT.Background:Cognitive stimulation therapy (CST) is an evidence-based psychosocial intervention for people with mild-to-moderate dementia due to various etiological factors.Objective:The aim of the present study was to assess the efficacy of the CST program, Italian adaptation -CST-IT-, in individuals who have vascular dementia (VaD).Methods:Older adults with mild-to-moderate VaD (N = 35) were assigned to one of two programs: one group (N = 21) attended the 14 sessions of the CST-IT program, while the other, active control group (N = 14) took part in alternative activities. The following domains were examined: cognitive functioning, quality of life, mood, behavior, functional activities of daily living.Results:Compared with the active controls, the CST-IT group showed a greater improvement in general cognitive functioning after the intervention (i.e. score increase on the Mini-Mental State Examination and decrease on the Alzheimer's Disease Assessment Scale – Cognitive subscale). A trend towards improvement was also identified in short-term/working memory – the backward digit span task- and perceived quality of life (Quality of Life – Alzheimer's Disease scale). No significant differences emerged between the two groups for the other domains considered.Conclusion:The present results support the efficacy of CST in people with vascular dementia.

Exercise or Social Intervention for Nursing Home Residents with Dementia: A Pilot Randomized, Controlled Trial.

To compare the effects of exercise with those of a structured nonphysical intervention on ability to perform activities of daily living (ADLs) and physical and cognitive function of persons with dementia (PWDs) living in nursing homes (NH). Cluster-randomized pilot-controlled trial. Seven French NHs. PWDs living in NHs. NHs were randomized to an exercise group (4 NHs, n=47) or structured social activity group (3 NHs, n=50) for a 24-week intervention performed twice per week for 60minutes per session. The main endpoint was ADL performance (Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory for Severe Alzheimer's Disease Scale (ADCS-ADL-sev); range 0-54, higher is better); secondary endpoints were overall cognitive function (Mini-Mental State Examination (MMSE)) and performance-based tests of physical function (Short Physical Performance Battery (SPPB), usual gait speed). Ninety-one participants with at least one postbaseline ADL assessment were included in efficacy analysis. Groups differed at baseline in terms of sex, neuropsychiatric symptoms, and nutritional status. Multilevel analysis adjusted for baseline differences between groups found no significant difference between effects of exercise and social activity (group-by-time interaction), with adjusted mean differences at 6months of 1.9 points for ADCS-ADL-sev and 0.55 points for MMSE favoring social activity and 0.6 points for SPPB and 0.05m/s favoring exercise. Adverse events did not differ between groups, except that the social activity group had more falls than the exercise group. A larger, longer trial is required to determine whether exercise has greater health benefits thannonphysical interventions for institutionalized PWDs.

Creation of an Interprofessional Teledementia Clinic for Rural Veterans: Preliminary Data.

The teledementia clinic is a new model of care that expands the reach of specialized geriatric and dementia care using clinical video telehealth (CVT) to rural veterans, who frequently lack access to specialty care. The clinic is a Veterans Affairs (VA) Geriatric Research, Education, and Clinical Center clinical demonstration project. It is located in the Pittsburgh VA Healthcare System tertiary referral hospital and serves veterans in affiliated rural community-based outpatient clinics (CBOCs). Rural CBOC primary care providers refer clinic patients, or referral is according to previous cognitive impairment diagnosis in a VAPHS geriatric clinic. Patients undergo interprofessional dementia assessment by a geriatrician, geropsychologist, geriatric psychiatrist or neurologist, and social worker using CVT technology. Metrics for clinic evaluation included rural patients served and savings in travel time, distance, and costs. Assessments collected depended upon individual presentation and included cognitive tests, geriatric depression scales, functional assessment, and the Zarit Burden Interview. A patient satisfaction survey was created and administered. In the first year, 95 individuals were served in 156 clinic visits and 251 interprofessional provider encounters. Of patients served, 61 lived in rural ZIP codes, 72 were diagnosed with dementia, 19 were diagnosed with mild cognitive impairment, and four were found to have primarily psychiatric diagnoses rather than cognitive impairment. The average Functional Assessment Staging of Alzheimer's Disease Scale score was 4.3 ± 1.3. This clinic model demonstrates that CVT technology is a feasible means of providing interprofessional dementia evaluations and follow-up to rural presidents.

Assessing quality of life in Alzheimer's disease: Implications for clinical trials

IntroductionCharacterization of the quality of life (QOL) in Alzheimer's disease (AD) scale within the context of a clinical trial may inform its applicability in future trials. MethodsUsing data from 1322 patients enrolled in two phase-III studies (EXPEDITION 1 [NCT00905372] and 2 [NCT00904683]) of intravenous solanezumab in outpatients with mild AD dementia, correlations between patient- and caregiver-assessed QOL and between QOL and clinical outcome measures were examined. Longitudinal effects of solanezumab over 80 weeks were explored, controlling for patient and caregiver baseline characteristics. ResultsCaregivers rated patients' QOL worse than did patients themselves. Patients' QOL was correlated, albeit modestly, with clinical/health measures. Patients' QOL changed minimally over 80 weeks, although a treatment effect of solanezumab on QOL was detected. DiscussionFurther investigations are needed to determine the optimal measures with which to quantify and qualify QOL of patients with mild AD.

Perception of change in sexual activity in Alzheimer's disease: views of people with dementia and their spouse-caregivers.

The onset of Alzheimer's disease (AD) affects couples' relationship. We investigated the perception of change and sexual satisfaction in spouse-caregivers and their partners diagnosed with AD. We compared 74 dyads of people with Alzheimer's disease (PwAD)/spouse-caregivers and 21 elderly dyads control. We assessed sexual satisfaction with Questionnaire on Sexual Experience and Satisfaction (QSES), cognition using a Mini-Mental State Examination (MMSE), disease severity using a Clinical Dementia Rating scale (CDR), awareness of disease with Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), functionality with Pfeffer Functional Activities Questionnaire (FAQ), depressive symptoms with Cornell Scale for Depression in Dementia (CSDD), quality of life using a Quality of Life in Alzheimer's Disease Scale (QoL-AD), and burden using a Zarit Burden Interview (ZBI). We found differences between the perception and no perception of change in sexual activity of PwAD (p < 0.001), spouse-caregivers (p < 0.01), and controls (p < 0.05). Moderate to severe sexual dissatisfaction was observed in 36.5% of PwAD, 65% of spouse-caregivers, and 31% of controls. PwAD sexual satisfaction was related to cognitive impairment (p < 0.05). Spouse-caregivers sexual satisfaction was related to gender (p < 0.05) and the presence of sexual activity (p < 0.001). The perception of change with higher sexual dissatisfaction, were significant in PwAD and their spouse-caregivers, in comparison with couples of elderly without dementia.