Quality Of Life In Alzheimer's Disease Research Articles

P57 Mapping Quality of Life - Alzheimer's Disease (QOL-AD) Scores to EQ-5D-5L Utilities in the Ambar Trial Population

Health state utilities are required to model the cost/benefit of novel treatments in accordance with Health Technology Assessment guidelines. The AMBAR phase 2b/3 trial (NCT01561053) evaluated the efficacy and safety of plasma exchange with albumin replacement in mild-to-moderate Alzheimer’s disease (AD) patients. Health-related quality of life was measured through the disease-specific Quality of Life - Alzheimer’s disease (QoL-AD) questionnaire. EQ-5D-5L utilities were estimated from AMBAR QoL-AD data using a validated mapping algorithm developed by Rombach et al.

Associations between low‐value care treatments and patient‐centered outcomes of people with dementia: A cross‐sectional analysis

AbstractBackgroundRapidly increasing healthcare expenditures are a global healthcare challenge. Parts of these costs are caused by an overtreatment of patients or low‐value care (LvC), which is defined as care unlikely to provide a benefit to the patient or likely to provide harm. However, there is currently a lack of evidence about the prevalence of LvC and its association with patient‐reported outcomes in people living with dementia (PwD).MethodThe analysis was based on the baseline data of the DelpHi‐trial, including 516 community‐dwelling PwD. LvC were identified by a systematic review of dementia‐specific evidence‐based guidelines, "do not do" recommendations of initiatives, like “Choosing Wiseley”, and lists of inappropriate medication for the elderly. The association of LvC treatments with health‐related quality of life (HRQol), assessed by using the SF‐12 and the Quality of life in Alzheimer´s diseases, and hospitalization were analyzed using multiple regression models.ResultThe study revealed that 159 PwD (31 %) received at least one LvC treatment. They had, on average, less cognitive impairment and less functional impairment than those without LvC. PwD who received LvC had a lower quality of life (b=‐0.08; CI95% ‐0.14 – ‐0.02) and were more likely to be hospitalized (OR=2.11; CI95% 1.30 – 3.41). The lower HRQol was attributed to the measured sedatives and hypnotics (B=‐0.21; CI95% ‐0.34 – ‐0.08). The higher odds for hospitalization could be caused by antidepressants (OR=2.86; CI95% 1.10 – 7.46) and antihypertensive drugs (OR=4.09; CI95% 1.20 – 13.92).ConclusionLvC could reduce patients' HRQoL and increase the risk of hospitalization. More research is needed to evaluate if innovative approaches, like digital health applications, are useful to identify and reduce LvC within primary care and if this could improve PwD HRQoL and reduce hospitalizations.

Study protocol: SOcial LImitations Turn Up DEmentia (SOLITUDE)—Impact of COVID‐19 social isolation on patients’ cognition and mental health and on carers’ wellbeing

BackgroundSocial isolation and loneliness are both known to exert detrimental effects on mental health and cognitive functioning, as well as on medial temporal lobe volume in older adults. Reduced social interactions have also been found to increase the risk of cognitive decline and dementia in older people. Since restrictions to social contacts have been imposed to tackle the current Coronavirus Disease 2019 (COVID‐19) pandemic, this study aims to investigate the long‐term impact of the resulting social isolation on people with mild dementia and their carers.MethodThis study has been implemented using a multi‐centre longitudinal observational design to monitor mental health (9‐item Patient Health Questionnaire and Neuropsychiatric Inventory Questionnaire), cognitive performance (telephone Mini‐Mental State Examination and Telephone Assessment of Cognitive Function) and quality of life (Quality of Life in Alzheimer's Disease) of patients with mild dementia due to neurodegenerative aetiologies, as well as carers’ burden (12‐item Zarit Burden Interview). Additionally, a structured interview is included to assess the potential impact of social isolation on everyday functioning of patients and carers. Participants are assessed telephonically at three time‐points: baseline and two follow‐ups after 3 and 6 months.ResultSix centres across the UK have confirmed capacity and capability to recruit up to eighty participants. Between September and December 2020, twenty‐nine participants have been recruited across different sites and completed the baseline assessment. Moreover, nine participants have already completed the 3‐month follow‐up.ConclusionThis study (predicted completion date: July 2021) is expected to provide valuable insights into the potential long‐term consequences of lockdown measures on people with dementia and their carers. Moreover, it will enable the identification of potential risk/protective factors for decline in mental health and cognition due to extensive changes in patients’ social environment. Findings from the SOLITUDE study may inform preventative and management strategies for decline in mental function targeting people with dementia, who may be the most affected by social isolation and loneliness.

Quality of life, mood and cognitive performance in older adults with cognitive impairment during the first wave of COVID 19 in Argentina

BackgroundIn Argentina, government has established lock down on 19 March in order to decrease SARS‐COV 2 infection. These restrictions have remained effective for long time, with increase of anxiety depression and insomnia as shown in several studies. Older population was particularly at risk due to greater limitations to go out. Our objective was to evaluate the impact of confinement in quality of life, mood and cognitive performance of older adults with cognitive impairment.MethodLongitudinal descriptive‐observational study. Patients with cognitive impairment (CDR 0.5‐1) attending to virtual cognitive stimulation sessions have participated. Participants have completed by themselves Quality of Life in Alzheimer's Disease scale (QOL AD), Beck Depression Inventory (BDI‐II), Test your Memory (TYM) and an attention and executive battery created by our institution. Same assessments were done at the beginning of the lock down and 7 months later. SPSS program was used and means, standard deviations and paired‐samples t test were calculated.Result51 adults (43 women, mean age: 68.53 SD: 8.06, mean education: 14.33 SD: 2.63) were included. An increase in BDI ‐II score (p = 0.049) and worse performance in one of the executive attention tests (p = 0.012) were found. No significant differences in total score of QOL‐AD (p = 0.090), TYM (p = 0.067), verbal fluency (p = 0.323) or memory tests (p = 0.098) were found. Reviewing sub items, differences in changes in sleep habits (p = 0.021), decrease in the energy level (p = 0.004), worse subjective record of memory capacity (p = 0.028) and decrease in ability to do housework (p = 0.007) were found. In those who lived alone a higher score in BDI ‐ II (p = 0.030) and TYM (p = 0.22) were found.ConclusionThis is the first longitudinal study that measures the impact of lockdown on quality of life and cognitive performance in older adults with cognitive impairment in Argentina. Lockdown and isolation have shown worsening of mood and some quality of life variables and decrease in attention. Finally, our results show an increase in depressive symptoms in those patients who lived alone.

Quality of life, mood, and cognitive performance in older adults with cognitive impairment during the first wave of COVID 19 in Argentina.

Background and ObjectivesIn Argentina, government has established lockdown on 19 March 2020 to decrease SARS‐COV‐2 infection. The study aim was to understand how mandatory quarantine imposed due to COVID‐19 pandemic has affected quality of life, mood, and cognitive performance of older adults with cognitive impairment.DesignLongitudinal descriptive–observational study.ParticipantsPatients with cognitive impairment attending to online cognitive training sessions.MeasurementsParticipants have completed by themselves Quality of Life in Alzheimer's Disease scale (QOL‐AD), Beck Depression Inventory (BDI‐II), Test your Memory (TYM), and an attention and executive task created by our institution. Same assessments were done at the beginning of the lockdown and 7 months later.ResultsFifty‐one adults were included. An increase in BDI‐II score (p = 0.049) and worse performance in one of the executive attention tests (p = 0.012) have been found. No significant differences in QOL‐AD, TYM, verbal fluency, or memory tests total scores have been observed. Reviewing scales subitems, differences in changes in sleep habits (p = 0.021), energy level decrease (p = 0.004), worse subjective record of memory capacity (p = 0.028), and decrease in ability to do housework (p = 0.007) have been shown. In those who lived alone, BDI and TYM higher scores in BDI‐II (p = 0.030) (p = 0.022) have been found.ConclusionMandatory quarantine imposed due to COVID‐19 pandemic was associated with worsening of mood, some quality‐of‐life variables, and decrease in attention in older adults with cognitive impairment in Argentina.

Effects of a digital reminiscing intervention on people with dementia and their care-givers and relatives

AbstractDementia is a source of growing concern globally, and often impacts on social and communicative functioning. INdependent LIving Support Functions for the Elderly (IN LIFE) was a project carried out within the European Commission Research and Innovation programme Horizon 2020 that resulted in the development of two digital communication aids for reminiscence intervention for elderly people with dementia and their communication partners. The purpose of this intervention study was to investigate the effects on quality of life for people with dementia when using these aids. People with dementia (N = 118) and their formal care-givers (N = 187) and relatives (N = 9) were given the communication aids for a period of 4–12 weeks. To assess a range of outcomes, questionnaires developed within the project were used along with the EQ-5D (European Quality of Life – 5 Dimensions) and QoL-AD (Quality of Life in Alzheimer's Disease) questionnaires. Quality of life improved among people with dementia when measured using EQ-5D (p < 0.05). There was also a correlation between the impact on the participants’ health and wellbeing, the carers’ rating of the usefulness of the digital communication aids and the care-givers’ satisfaction with using technology (p < 0.05). These results indicate that digital communication aids may be useful in social interaction where one partner has dementia.

French cross-cultural adaptation and validation of the Quality of Life-Alzheimer's Disease scale in Nursing Homes (QOL-AD NH)

BackgroundNo specific scale to measure Quality of Life in Alzheimer's Disease in Nursing Homes (QoL-AD NH) exists in French. We aimed to translate and culturally adapt the QoL-AD NH participant scale into a French version and evaluate its psychometric properties with residents in French nursing homes (EHPAD).MethodsFirst, the QoL-AD NH was cross-culturally adapted into French according to guidelines. Secondly, a convenience group of residents with mild to moderate dementia answered the Folstein’s test and the QoL-AD NH. They also answered the Dementia Quality of Life and the Geriatric Depression Scale to test convergent and divergent validity. Known-group validity was tested with a comparison group of residents without dementia. Exploratory Structural Equation Modeling (ESEM) was used after Exploratory Factor Analysis (EFA) to identify factors and measure invariance across age and mental state groups. Reliability (internal consistency, McDonald’s omega and test–retest) were also measured.ResultsFollowing successful adaptation of the QoL-AD NH, 174 residents (mean age 86.6) from 7 nursing homes with mild to moderate dementia participated in the validation study. We retained a 3-factor model of the scale after ESEM identifying: “Intra & interpersonal environment-related QoL”, “Self-functioning-related QoL” and “Perceived current health-related QoL” that were invariant across age and mental state groups. The QoL-AD NH had acceptable convergent (ρ range 0.24–0.53) and divergent validity (ρ range − 0.43 to − 0.57) and good known-group validity with 33 residents without dementia (t(205) = 2.70, p = .007). For reliability, the results revealed very good and adequate internal consistency (α = 0.86 for total scale and ≥ 0.71 for subscales). All total omega values exceeded the threshold 0.70. The hierarchical omega was 0.50, supporting the multidimensionality of the scale. Hierarchical omega subscale values exceeded the minimal level 0.50 except for the third factor, although reliable, would deserve more items. Test–retest was good with ICC (3,1) = 0.76.ConclusionsThe QoL-AD NH French participant version has globally good reliability and validity for evaluating residents' quality of life. However, further studies must rework and confirm the factor structure, test sensitivity to change and responsiveness.

Construct Validity of the Health Utilities Index Mark 2 and Mark 3 to Measure Health-Related Quality of Life of Residents in Long-Term Care Facilities.

The purpose is to evaluate the construct validity of two generic health measures, the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) in residents of long-term care (LTC) facilities, using a convergent/divergent validity approach, with the Functional Independence Measure (FIM), Quality of Life-Alzheimer's Disease (QOL-AD) and Resident Assessment Instrument (RAI) 2.0 as comparators. Health status of 130 residents with dementia residing in one of seven LTC facilities was evaluated by their Healthcare Aides who were their primary care assistants. A priori hypotheses on the magnitude and direction of the correlations were formulated by two clinician/researchers and a researcher familiar with the measures and this population. Predicted and observed correlations were compared. Mean overall HUI2 (0.48, SD 0.16) and HUI3 scores (0.31, SD 0.27) were indicative of severe disability. Of the 208 a priori hypotheses, 39.9% (n = 83) matched the observed correlations, 29.8% were underestimated and 19.7% were overestimated by one category. Findings support the use of the HUI2 and HUI3 in measuring health-related quality of life in dementia-related research to complement disease-specific measures.

Ginkgo Biloba Extract Is Comparable With Donepezil in Improving Functional Recovery in Alzheimer's Disease: Results From a Multilevel Characterized Study Based on Clinical Features and Resting-State Functional Magnetic Resonance Imaging.

Background: Ginkgo biloba extract (GBE) and donepezil have been reported to be effective in patients with Alzheimer’s disease (AD). Nonetheless, how these drugs impact spontaneous brain activities and how they consequently improve functional recovery are currently unclear.Objectives: This study was to explore the efficacy of GBE vs. donepezil and their add-on efficacy on functional recovery and the adaption of spontaneous brain activities following pharmacologic treatment in patients with AD.Methods: Patients with AD were enrolled and assigned to the GBE group (n = 50), the donepezil group (n = 50), or the combined group (n = 50). Neuropsychological assessments, including minimum mental state examination (MMSE), Alzheimer’s disease assessment scale-cognition (ADAS-Cog), instrumental activity of daily living (IADL), geriatric depression scale (GDS), neuropsychiatric inventory (NPI), and quality of life in Alzheimer’s disease (QOL-AD), were conducted at baseline, 1 month, 3 months, and 6 months. Resting-state functional magnetic resonance imaging (rs-fMRI) was collected to compare the amplitude of low-frequency fluctuation (ALFF), percent amplitude of fluctuation (PerAF), regional homogeneity (ReHo), and degree centrality (DC) at baseline and 6 months.Results: No major significant differences were detected in all comparisons between groups across all follow-up time points. For intragroup comparison, MMSE and ADAS-Cog scores differed significantly across all follow-ups in three groups. The combined group showed significant improvement of GDS scores between baseline and 6 months (p = 0.007). The GBE group (p = 0.044) and donepezil group (p = 0.012) demonstrated significant improvement of NPI scores between baseline and 6 months. Significant correlations were observed between IADL and ALFF in the right gyrus rectus (p = 0.03) and in the left superior cerebellum gyrus (p = 0.01), between GDS and ALFF in the right middle temporal gyrus (p = 0.01), between NPI and PerAF in the left fusiform gyrus (p = 0.03), and between MMSE and ReHo in right superior frontal gyrus (p = 0.04).Conclusion: GBE was comparable with donepezil in the improvement of functional recovery in patients with AD while the combined application of GBE and donepezil seems unnecessary. GBE-mediated improvement of functional recovery was characterized by decreased ALFF values in the right gyrus rectus and decreased PerAF values in the left fusiform gyrus. These featured variations of imaging metrics in specific brain regions may serve as biomarkers in the monitoring of the therapeutic efficacy of GBE.

Study of the effects of mindfulness training on quality of life of patients with Alzheimer's disease and their caregivers (Dyad Mindfulness Project).

The training of mindfulness enhances the emotive and cognitive equilibrium and well-being in older adults. So some authors hypothesize it is an appropriate approach to cultivating these benefits and a good quality of life in Alzheimer's patients (AD-P) at early stage and in their caregivers (Cg) (Dyad). Our main hypothesis is that AD-P and Cg who completed the program of Mindfulness-Based Interventions (MBIs) training would experience improvements in well-being and mood and cognitive performance (AD-P: attention and memory). The perspective randomized controlled will enroll the Dyad of 80 Alzheimer's patients (age ≥ 60) and 80 caregivers (age > 18) who will be randomly assigned to 6 months MBI training in groups and to control group study. All outcome will be analyzed before intervention (baseline), after follow-up 1 (at the end of treatment), after 6months (follow-up 2) and after 1year (follow-up 3) from the end of treatment. AD-P-expected outcomes: (a) improvement of the quality of life (QoL-AD); (b) decrease of depression (BDI); (c) improvement of spiritual well-being (Facit SWB Index); (d) improvement of attention and good cognitive performance Rey Memory Test (MFIT); (e) decrease of neuropsychiatric symptoms. (NPI)-Cg-expected outcomes: (a) improvement of the quality of life (SF36); (b) decrease of the care burden (CBI); (c) decrease of depression (BDI); (d) improvement of self-awareness (FFMQ); (e) increase in spiritual-well-being (Facit SWB). This study could provide a clues on multidisciplinary interventions as secondary prevention of Alzheimer's dementia and on stress reduction in family caregivers.

A tablet-based intervention for activating nursing home residents with dementia: results from a cluster-randomized controlled trial.

To investigate global and momentary effects of a tablet-based non-pharmacological intervention for nursing home residents living with dementia. Cluster-randomized controlled trial. Ten nursing homes in Germany were randomly allocated to the tablet-based intervention (TBI, 5 units) or conventional activity sessions (CAS, 5 units). N = 162 residents with dementia. Participants received regular TBI (n = 80) with stimulating activities developed to engage people with dementia or CAS (n = 82) for 8 weeks. Apathy Evaluation Scale (AES-I, primary outcome), Quality of Life in Alzheimer's Disease scale, QUALIDEM scale, Neuropsychiatric Inventory, Geriatric Depression Scale, and psychotropic medication (secondary outcomes). Momentary quality of life was assessed before and after each activity session. Participants and staff were blinded until the collection of baseline data was completed. Data were analyzed with linear mixed-effects models. Levels of apathy decreased slightly in both groups (mean decrease in AES-I of .61 points, 95% CI -3.54, 2.33 for TBI and .36 points, 95% CI -3.27, 2.55 for CAS). Group difference in change of apathy was not statistically significant (β = .25; 95% CI 3.89, 4.38, p = .91). This corresponds to a standardized effect size (Cohen's d) of .02. A reduction of psychotropic medication was found for TBI compared to CAS. Further analyses revealed a post-intervention improvement in QUALIDEM scores across both groups and short-term improvements of momentary quality of life in the CAS group. Our findings suggest that interventions involving tailored activities have a beneficial impact on global and momentary quality of life in nursing home residents with dementia. Although we found no clear advantage of TBI compared to CAS, tablet computers can support delivery of non-pharmacological interventions in nursing homes and facilitate regular assessments of fluctuating momentary states.

Assessing people with dementia participating in cognitive stimulation activities-A qualitative pilot video analysis exploring the importance of facilitating the participation.

BackgroundThis pilot video analysis was part of a feasibility control study, which aimed to gain information about the size and variability of the changes in outcome measures to plan a substantive effect study. It compared a cognitive stimulation programme named Lifelong Learning with other existing dementia services.ObjectiveThe pilot video analysis explored how facilitation is performed, when assessing people with dementia with standardized measures, to ensure their participation in research.DesignA test battery of five measures (Mini‐Mental State Examination (MMSE), Quality of Life in Alzheimer's Disease Scale (QoL‐AD), General Self‐Efficacy Scale, Rosenberg Self‐Esteem Scale and Hawthorn Friendship Scale) was used. Each assessment was video‐recorded. The findings from a microanalysis of 10 videos are presented in this article.SettingThe study involved 55 active participants with mild‐to‐moderate dementia in six municipalities in Northern Denmark.ResultsThe identified themes related to supportive facilitation: Positive facilitator strategies; Creating a safe and comfortable environment; and to dilemmas in facilitation: Balancing multiple dilemmas and Balancing the MMSE test.DiscussionResults are discussed in relation to using standardized measures.ConclusionThe quality of facilitation when using standardized measures is of great importance as it may influence the participant, the assessment and the answers given. The facilitation role needs to be thoroughly planned and executed with ethical consideration to improve the participation of vulnerable groups in research and ensure a person‐centred approach.Patient or public contributionThe identified measures were chosen based upon previous qualitative results and user‐involvement workshops with people with dementia.

Self-reported quality of life in people with dementia attending a day-care programme in Norway: A 24-month quasi-experimental study.

The objectives of the study were (a) to compare self-reported Quality of Life (QoL) in a 24-month follow-up of people with dementia attending day care designed for people with dementia (day-care group, DC) with people with dementia who did not attend day care (control group, CG) and (b) to explore factors associated with QoL. A quasi-experimental design with a 24-month follow-up period was used. The DC group included 181 participants recruited from 53day-care services. The CG included 76 participants recruited from 19 municipalities with no available day care designed for people with dementia. The sample covered the four health regions of Norway and inclusion period lasted from December 2013 to July 2015. The Quality of Life in Alzheimer's Disease (QoL-AD) scale was used as the outcome measure. The differences in QoL between groups and the associations between participant characteristics and QoL, such as depressive symptoms and functional dependency, were examined using a linear mixed model. In the multiple model, the overall trend in QoL did not differ significantly between the DC and CG. However, the DC group exhibited significantly higher self-reported QoL than the CG at all time points (p<0.001 at T0, p=0.018 at T12, and p=0.006 at T24). Participants with shallow or no awareness who attended day care had significantly higher scores on QoL-AD than persons with full awareness (p=0.017). More depressive symptoms (p<0.001) and higher functional dependency (p<0.001) were associated with lower self-reported QoL. The study revealed higher scores of self-reported QoL among people attending day care compared with those who did not attend, showing that day care might have positive impact on the lives of people with dementia.

Effect of horticultural therapy on apathy in nursing home residents with dementia: a pilot randomized controlled trial

Objectives: This study aimed to examine (1) the feasibility of the study procedures (i.e. recruitment, retention, attendance, and assessment completion rates), and (2) the effects of horticultural therapy (HT) on apathy, cognitive ability, quality of life, and functional capacity. Methods: This was a parallel-group, match-paired, randomized controlled trial. Thirty-two participants were allocated to either the experimental or the control group. Data were collected at baseline (T0), immediately postintervention (T1), and 3 months postintervention (T2). The Apathy Evaluation Scale-informant version (AES-I); Mini-Mental State Examination (MMSE); Quality of Life in Alzheimer’s disease (QoL-AD) scale; Barthel index (BI) were used to measure apathy, cognitive ability, quality of life, and functional capacity, respectively. Results: The recruitment, retention, attendance and assessment completion rates were 22.7%, 87.5%, 100% and 100%, respectively. The between-group differences in AES-I (p = 0.007) and MMSE (p = 0.034) scores were statistically significant at T1. In the experimental group, the AES-I (p = 0.001), MMSE (p = 0.010), and QoL-AD (p = 0.017) scores were significantly different over time. In the post hoc pair-wise analysis, the AES-I scores of the experimental group observed at T1 were significantly lower than that at T0 (p = 0.032). In the control group, the MMSE scores (p = 0.001) were significantly different over time. Conclusion: HT is feasible for residents with dementia and apathy. The HT program effectively reduced apathy and promoted cognitive function, but its effects on quality of life and functional capacity were not observed.

Health-related physical indicators and self-rated quality of life in older adults with neurocognitive disorder.

This study aimed to identify the association between health-related physical indicators-sarcopenia-related factors, physical fitness, independence in activities of daily living (ADL) and habitual physical activity-and self-rated quality of life (QoL) in people with neurocognitive disorder (NCD). This cross-sectional study included 115 participants (78.22 ± 7.48years; 74.8% female) clinically diagnosed with NCD. Self-rated QoL was evaluated using The Quality of Life-Alzheimer's Disease (QoL-AD). Dual energy X-ray Absorptiometry, handgrip strength, Short Physical Performance Battery, and the 6-m Walk test were used to assess sarcopenia-related factors. Senior Fitness Test and One Leg Balance test, Barthel Index, Baecke Modified Habitual Physical Activity Questionnaire were used to determine physical fitness, independence in ADL and physical activity, respectively. Regressions analyses were performed to examine associations between these variables and QoL-AD. Data from univariable linear regression analysis revealed that self-rated QoL was associated with sarcopenia-related factors (lower body function, handgrip strength, gait speed, and appendicular skeletal muscle mass index-ASMI), physical fitness (upper-and-lower-body strength, agility/dynamic balance, cardiorespiratory fitness and body mass index), habitual physical activity and independence in ADL. Results from multivariable regression analysis showed that ASMI (B = 1.846, 95% CI 0.165-3.527, p = 0.032) and lower body function (B = 0.756, 95% CI 0.269-1.242, p = 0.003) were positively associated with self-rated QoL. These variables explained 20.1% of the variability seen in self-rated QoL, controlling for age, sex, marital status and education. Sarcopenia-related factors, namely lower body function and ASMI, should be acknowledged in future research studies as critical health-related indicators associated with QoL in people with NCD. ClinicalTrials.gov-identifier number NCT04095962.

The impact of auditory hallucinations on "living well" with dementia: Findings from the IDEAL programme.

To determine whether auditory hallucinations in community-dwelling people with dementia (PwD) living in the community impacted on quality of life (QoL), subjective wellbeing and life satisfaction. Cross-sectional cohort study. 1251 community-dwelling PwD and caregivers were included in this study. Neuropsychiatric Inventory Questionnaire completed by caregiver interview. Mean differences between the absence and presence of auditory hallucinations were compared to scores on three validated measures of living well: QoL in Alzheimer's disease scale (QoL-AD), World Health Organization-Five Well-being Index and Satisfaction with Life Scale. Analysis of covariance determined the confounding contributions of cognition via Mini-Mental State Examination, depression via Geriatric Depression Scale-10, caregiver stress via Relative Stress Scale and whether antipsychotic drugs were prescribed. Auditory hallucinations were associated with lower scores for QoL (p<0.001, η2 =0.01), wellbeing (p<0.001, η2 =0.02) and life satisfaction (p<0.001, η2 =0.01). After controlling for background measures, which were potential confounds, the relationship between auditory hallucinations and QoL (p=0.04, pη2 =0.01) and wellbeing (p<0.000, pη2 =0.02) remained significant but there was no significant association with life satisfaction. Auditory hallucinations are associated with lower QoL and wellbeing in PwD living in the community. This has implications for targeted therapies in PwD with psychotic symptoms.

Contributors and Moderators of Quality of Life in Caregivers of Alzheimer´s Disease Patients

ABSTRACT Aim and objective: This study aimed to identify the variables that contributed to Quality of Life (QoL) of Alzheimer’s Disease (AD) caregivers, taking into consideration the caregiving context, stressors, role strains, and resources. Methods: The sample included 102 caregivers of AD patients who answered the following instruments: Depression, Anxiety and Stress Scale-21; Satisfaction with Social Support Scale; Revised Memory and Behavioral Problems Checklist; Family Communication and Satisfaction Scales; Spiritual and Religious Attitudes in Dealing with Illness; and Quality of Life in Alzheimer’s Disease – Caregiver Version. Results: Caregivers who were employed, chose the caregiving role, and received help in caring showed better QoL. Also, being younger, less caregiving daily hours, caring for patients with less memory and behavior problems, lower distress, and family satisfaction predicted better QoL. Finally, spirituality was a moderator between family communication and QoL but not between family satisfaction and QoL. Conclusion: Caregiving-context variables (age, professional status, choosing to care, receiving help in the caregiving role and duration of daily care); role strains (family dissatisfaction); stressors (caregivers’ distress and patients’ memory and behavioral problems); and resources (spirituality) had an impact on caregivers’ QoL emphasizing the adequacy of the Stress Process Model. Intervention should also focus on spirituality given its moderating role.

Quality of life in early-onset Alzheimer's disease due to a PSEN1-E280A mutation.

The present study aims to explore the association between the quality of life (QoL) score and the clinical and sociodemographic variables in patients with the PSEN1-E280A mutation. We also seek to evaluate the differences between the QoL reported by the patients (P-QoL) and the scores reported by the caregivers (C-QoL). An analysis of 75 patients with the PSEN1-E280A mutation with mild cognitive impairment and dementia was performed. We used the Quality of Life in Alzheimer Disease (QoL-AD) survey to evaluate QoL as an outcome and evaluated its association with sociodemographic, lifestyle, clinical, and past medical history variables. The largest difference in the median of the QoL-AD score was in those who needed help to eat, those with moderate or severe dementia, those classified as frail or pre-frail, those with moderate social risk, and those with depression. Also, C-QoL was lower than the P-QoL, and the QoL-AD of individuals with severe dementia was lower than for milder forms of the disease. Not needing help to eat, not having a stressful situation in the past 3months, and the years of education were positively correlated with QoL-AD in the linear model. As studies in similar populations with AD, factors with more impact on QoL are those related to loss of functionality and independence. These factors are also associated with variables related to the current literature with the burden of the disease for the caregivers.

Perceived and objective availability of green and blue spaces and quality of life in people with dementia: results from the IDEAL programme

PurposeThe aim of this study was to investigate the associations between quality of life and both perceived and objective availability of local green and blue spaces in people with dementia, including potential variation across rural/urban settings and those with/without opportunities to go outdoors.MethodsThis study was based on 1540 community-dwelling people with dementia in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) programme. Quality of life was measured by the Quality of Life in Alzheimer’s Disease (QoL-AD) scale. A list of 12 types of green and blue spaces was used to measure perceived availability while objective availability was estimated using geographic information system data. Regression modelling was employed to investigate the associations of quality of life with perceived and objective availability of green and blue spaces, adjusting for individual factors and deprivation level. Interaction terms with rural/urban areas or opportunities to go outdoors were fitted to test whether the associations differed across these subgroups.ResultsHigher QoL-AD scores were associated with higher perceived availability of local green and blue spaces (0.82; 95% CI 0.06, 1.58) but not objective availability. The positive association between perceived availability and quality of life was stronger for urban (1.50; 95% CI 0.52, 2.48) than rural residents but did not differ between participants with and without opportunities to go outdoors.ConclusionsOnly perceived availability was related to quality of life in people with dementia. Future research may investigate how people with dementia utilise green and blue spaces and improve dementia-friendliness of these spaces.

Group-Based Exercise as a Therapeutic Strategy for the Improvement of Mental Outcomes in Mild to Moderate Alzheimer’s Patients in Low Resource Care Facilities

Background: Exercise is related to enhanced cognitive functioning and brain plasticity. Exercise might represent a potential adjunctive treatment for neuropsychiatric disorders, such as Alzheimer's disease (AD). Furthermore, group exercise may prove especially useful due to its additional benefits. Objectives: This study aimed to determine the effect of low-cost, group-based exercise on mental outcomes in patients with mild to moderate AD. Methods: Participants with mild to moderate AD were randomized to either a non-exercising control (CON) group or a group-exercise (GEX) group (n = 20 each). The GEX participated in eight weeks of three-times-weekly non-consecutive 45-minute sessions consisting of balance, resistance, aerobic, and flexibility exercises to determine their effect on mental outcomes, namely, cognitive function, activities of daily living (ADLs), and quality of life (QOL). Results: The intervention program showed a significant (P ≤ 0.05) increase in Mini-Mental State Examination (MMSE) scores (P = 0.023). While the GEX were found to have no change in their (Alzheimer’s disease cooperative study activities of daily living) ADCS-ADL scores (P = 0.574). The CON demonstrated a significant, but deleterious 13.77% decrease in their ADCS-ADL scores from pre- to mid-test (P = 0.023) and from pre- to post-test (P = 0.038). Quality of Life-Alzheimer’s Disease (QOL-AD) scores were unchanged in both the GEX and CON. Conclusions: Our results indicate that a low-cost, multidimensional group exercise intervention can positively influence cognitive function and improve patients with mild to moderate AD ability to perform ADLs.