Quality Of Life In Alzheimer's Disease Research Articles

The impact of different researchers to capture quality of life measures in a dementia randomised controlled trial

BackgroundCapturing changes in health and wellbeing within randomised controlled trials (RCTs) can be complex. The precision and accuracy of outcome scales to measure change is crucial, and therefore, consideration needs to be given to potential measurement errors when collecting these outcomes.Many RCTs use multiple researchers to collect data, which has the potential to introduce variation in measurements. This study aimed to identify if there was a measurable effect of using different researchers to collect repeated assessments of quality of life (QoL) at different time points.MethodsA previously conducted study assessing the impact of reminiscence therapy on participants with dementia and carer (PwD-carer) dyads, ‘REMCARE’ (Reminiscence groups for people with dementia and their family caregivers), provided the platform for this exploratory secondary analysis. Data was categorised into two broad groups: those where the same researcher attended all assessments and those where different researchers undertook the assessments. ANCOVA (analysis of covariance) models used in the original REMCARE analysis with the addition of the ‘researcher-continuity’ variable were run on two QoL measures, the QoL-AD (Quality of Life in Alzheimer’s Disease) and QCPR (Quality of the Caregiving Relationship).ResultsThree hundred thirty PwD-carer dyads were included in the analysis. For the PwD, a statistically significant effect was found on the researcher continuity variable for the QoL-AD and QCPR outcome measures at follow-up 1 but not at follow-up 2 signifying an impact of researcher attendance at the first follow-up but not follow-up 2. For the carer data, analyses revealed no statistically significant effects at follow-up 1; however, the QoL-AD measure at follow-up 2 was found to be statistically significant.ConclusionsThese exploratory results indicate the possible impact of researcher continuity on QoL outcomes in dementia studies. Further research is required to explore this further and establish causality. If demonstrated, this would have implications for the planning of future empirical studies in dementia, in order to reduce this potential source of bias.

The Effects of Essential Oil and Massage on Patients’ Affected by Alzheimer’s Disease. An Observational Study

Background: Alzheimer's Disease (AD) is the most widespread form of dementia. The present study analyses the effects of aromatherapy using Melissa Officinalis essential oil, applied by massage to the hands and forearms of patients suffering from Alzheimer's disease. and to evaluate the effect on their perceived overall quality of life. Methods: A prospective observational study was conducted in two nursing homes in Italy in 2018. Data were collected through individual qualitative structured interviews based on the Quality of Life in Alzheimer’s Disease (QoL-AD) questionnaire and the Mini Mental State Examination (MMSE). The authors referred to STROBE guidelines for quality reporting of observational studies. Results: Treatment with Melissa Officinalis showed positive effects on all patients after the 12th week of treatment. The results were most evident in patients in class 3 MMSE. However, class 4 MMSE patients also benefited from the treatment. Conclusions: The aromatherapy treatment delivered in this observational study, using Melissa Officinalis essential oil applied to hands and forearms, showed an improvement in the quality of life of the patients living in two different nursing homes. Due to the small sample size in this study, it is suggested that more research be done on the effects and effectiveness of aromatherapy with Melissa Officinalis essential oil for Alzheimer's disease patients.

Quality of Life Ratings and Proxy Bias in Primary Progressive Aphasia: Two Sides to the Story?

A valid measure of quality of life is important for clinical goal setting and for evaluating interventions. In the amnestic dementias, proxy-raters (e.g. friends, families, clinicians) typically rate quality of life lower than the self-ratings given by the person with dementia - a proxy bias. This study investigated whether the same proxy bias occurs in Primary Progressive Aphasia (PPA), a language-led dementia.Quality of life was measured in 18 individuals with PPA using self-ratings, and proxy-ratings by their main communication partner, using the Quality of Life in Alzheimer's Disease Scale.There was no strong evidence for proxy bias at a group level, with no consistent pattern across dyads, where proxy- and self-ratings did not show good levels of agreement. We suggest that self-ratings and proxy-ratings of quality of life in PPA are not interchangeable. Higher-powered investigation of the patterns observed here is warranted in future studies.

QUALITY OF LIFE IN ADULTS LIVING WITH COGNITIVE IMPAIRMENT: DEVELOPMENT OF A UNIVERSAL MEASURE

Abstract Quality of life is one of the most important and holistic measures of perceived overall well-being across the lifespan. For older adults living with cognitive impairment, quality of life has been conceptualized as consisting of an array of intertwined domains, such as relationship quality, physical health and ability, and opportunities for roles and activities. A subset of measures have been developed to gauge quality of life in older adults living with cognitive impairment, yet no “gold standard” in measurement has emerged. Quality of Life – Alzheimer’s Disease (QOL-AD) is one of the most commonly used and long-standing measures, yet it was developed in 2002 and has yet to be updated to reflect the evolution of our understanding of quality of life in adults living with cognitive impairment. Drawing from the literature on adults living with intellectual and developmental disabilities (IDD), the researchers identified several domains and items to update and expand the applicability of the QOL-AD measure. The proposed revised measure, Quality of Life – Alzheimer’s Disease/Intellectual and Developmental Disabilities (QOL-AD/IDD), is intended for adults living with cognitive impairment regardless of age or cause of impairment (e.g., dementia, IDD). The QOL-AD/IDD retains the format of the original measure, most notably the useful prompts that accompany each item and the supplemental proxy measure for caregivers. In this presentation, the researchers will discuss the development of the QOL-AD/IDD and ongoing (e.g., Delphi review) and planned steps to evaluate the reliability and validity of this promising measure.

DIURNAL CORTISOL SECRETION AND SELF-REPORTED AND CAREGIVER-REPORTED QUALITY OF LIFE IN PEOPLE LIVING WITH DEMENTIA

Abstract Introduction People living with dementia (PLwD) report lower quality of life (QoL), compared to healthy older adults. The poorer QoL is not fully accounted for by the severity of dementia. Dementia is associated with prominent neuroendocrine changes, however, there is a lack of research examining whether biological factors are related to QoL in PLwD. This study examined relationships between cortisol, symptom severity, and QoL in PLwD. Methods A total of 143 participants aged 55-94 years (65.7% women) in the Healthy Patterns Study (NCT03682185) provided three saliva samples at wake-up (AM1), 30 minutes (AM2) after waking, and bedtime (PM) on two consecutive days. We derived cortisol awakening response (CAR), wake to bedtime cortisol slope, and diurnal mean cortisol secretion. Sociodemographic and severity of dementia were assessed by interviews and questionnaires. Self-reported and caregiver-reported QoL was measured using the Quality of Life in Alzheimer’s Disease (QoL-AD). Results Poorer QoL was associated with more severe dementia rating. Flattened cortisol slope was significantly correlated with overall poorer self-reported QoL (β=0.43, p=0.017), but not caregiver-reported QoL (p=0.12), after controlling for severity of dementia and demographic variables. We did not find a significant relationship between CAR and diurnal mean cortisol with QoL. Conclusions This study provides novel evidence linking neuroendocrine mechanisms to QoL in PLwD. The findings indicate that dysregulation of the hypothalamic-pituitary-adrenal axis is linked to poorer QoL, independently of the severity of dementia. Biopsychosocial approaches to QoL for PLwD may lead to a greater understanding of the underlying mechanisms.

Cultural adaptation and validation of the social functioning in dementia scale (SF‐DEM) in Taiwanese patients with dementia

AbstractBackgroundThe social functioning in dementia scale (SF‐DEM) is a 20‐item interviewer‐administered questionnaire, with patient‐ and carer‐rated versions. It was the first test designed to measure social function in people with dementia. It has not been validated in people with dementia in a Taiwanese population. We aimed to culturally adapt then validate the SF‐DEM in Taiwan and explore correlates of social functioning.MethodWe culturally adapted the SF‐DEM for Taiwan (T‐SF‐DEM) according to guidelines and tested it with people with clinically diagnosed dementia and their caregivers in Northern Taiwan We used descriptive and correlation analysis to explore how scores relate to the Clinical Dementia Rating (CDR), Addenbrooke’s cognitive examination III (ACE‐III) and Quality of Life in Alzheimer’s Disease (QoL‐AD).ResultWe recruited 12 people aged 45 to 100 with dementia (5 Alzheimer’s disease, 4 Vascular dementia, 1 Parkinson’s disease dementia, and 2 mixed. All patients and 11/12 (92%) of carers completed the SF‐Dem. Nine participants (75%) scored 0.5 on CDR and three (25%) scored 1. The mean ACE‐III score was 64.4 (standard deviation (SD) 11.9). The mean scores of patients and their carers for the sub‐domains of “spending time with other people (max 21 points)” were 3.3 (3.1) and 4.9 (3.4), for “communicating with other people (max 18)” were 5.7 (4.0) and 5.4 (3.8), for “sensitivity to other people (max 12)” were 10.9 (1.8) and 8.7 (2.6). The correlation between carer‐ and patient‐ratings was low (r = 0.33). There was a moderate correlation of the carer‐rated SF‐DEM with ACE (r = 0.66) and carer‐rated quality of life (r = 0.44). Seventy‐five percent of patients stated that they did not want to change their social life, while 100% of the carers stated they would like the patients’ social life to change.ConclusionThe T‐SF‐DEM is an acceptable test for measuring social function in Taiwanese populations in memory clinic settings. Patients scored low on social contact as they were isolated due to the pandemic. We will test SF‐DEM in more patients and report the results.

Groepstherapie met assistentie van een pony. Het effect op de kwaliteit van leven van ouderen met dementie

As people worldwide generally live longer, the number of people with dementia is also increasing, a condition for which there is no cure yet. Therefore, there is a growing focus on enhancing the quality of life of people with dementia, as well as a growing need for (new) psychosocial interventions that enhance quality of life. An example of this is Animal assisted therapy (AAT), a goal oriented, planned and structured therapeutic intervention directed and/or delivered by professionals. Equine assisted therapy (EAT) is a specific form of AAT which uses horses or other equines. In our research, the effect of EAT as group therapy was compared to the effect of group therapy without the assistance of animals. Over a period of six weeks, weekly group therapy sessions were conducted by a professional, who is psychologist and equine assisted therapist. In both groups, quality of life was measured before and after the therapy program with the Qualidem and the Quality of Life in Alzheimer's Disease questionnaires. Compared to the group that only participated in group therapy sessions, participation in the EAT program with assistance of a pony led to better results.

Association of Psychotropic Education with Quality of Life: A Before-After Study in Residential Aged Care Facilities.

Improving or maintaining quality of life (QoL) is an important aim for caring for people with dementia living in residential aged care facilities (RACFs). This study aimed to investigate the effect of a specific intervention, the Medication Management Consultancy (MMC), on the QoL of residents of RACFs in Western Australia, and to examine the association between psychotropic medications and QoL. A before-after study was conducted. Staff from four RACFs participated in the MMC, and 56 residents with dementia from these RACFs were included. The MMC consisted of an online interactive staff education training course comprising educational videos, and a case study encompassing non-pharmacological strategies, person-centred care for behavioural and psychological symptoms of dementia (BPSD), and strategies to reduce the use of antipsychotics. Following the training, posters, reference cards, reminder stickers, administration of the Older Age Psychotropic Quiz (OAPQ), and 30-min video conferences with action groups in RACFs were utilised. At baseline (T0), QoL, neuropsychiatric symptoms (NPS) and staff distress, cognition, and activities of daily living were assessed by QoL in Alzheimer's Disease (QoL-AD), Neuropsychiatric Inventory-Questionnaire (NPI-Q), Standardised Mini-Mental State Examination (SMMSE) and Bristol Activity of Daily Living Scale (BADLS), respectively, and repeated at 6 (T1) and 12 months (T2). Medication data were obtained from residents' medication charts. At baseline, of the 56 participants, 33 completed the study. Compared with baseline (31.2, 95% confidence interval [CI] 28.9-33.6), QoL significantly improved at 6 months (33.5, 95% CI 30.9-36.0; p<0.001) but not from baseline to 12 months (31.09, 95% CI 28.5-33.7; p=0.58). The NPI-Q severity (residents) significantly improved from 9 (interquartile range [IQR] 11) at T0 to 6 (IQR 9.5) at T1 (p=0.014) and to 7 (IQR 11) at T2 (p=0.026). The medians of NPI-Q distress (staff) significantly improved from 12 (IQR 13.5) at T0 to 8 (IQR 9) at T1 (p=0.013) and to 6 (IQR 11.5) at T2 (p=0.018). Monthly doses of antipsychotics declined significantly by 51.8% at 6 months (p=0.003) and by 43.5% at 12 months (p=0.003); antidepressant doses declined significantly by 25.4% at 6 months (p=0.013) and by 39.4% at 12 months (p=0.016); benzodiazepines doses remained stable. QoL and use of psychotropics, age, sex, NPI-severity, and BADLS were not correlated. The MMC was associated with improvement in QoL, NPS, staff distress, and reduction in monthly use of antipsychotics and antidepressants among RACF residents. There was no correlation between improved QoL and reduction in use of psychotropic medications, but due to the limitations of our study, this should be confirmed in additional studies.

Life-Space Mobility in Aged Care Residents: Frailty In Residential Sector over Time (FIRST) Study Findings.

Life-space mobility is a measure of the extent and frequency of mobility in older adults reflecting not only physical function, but also cognitive, psychosocial, and environmental factors. This study aimed to (1) develop life-space mobility profiles for nursing home residents; (2) examine independent factors associated with these profiles; and (3) identify health outcomes [ie, mortality, quality of life (QoL) and falls] associated with the life-space mobility profiles at 1year. Prospective cohort study. Twelve nursing homes including 556 residents, mean age 87.73 ± 7.25years, 73.0% female. Life-space mobility was measured using the Nursing Home Life-Space Diameter (NHLSD). Mortality and falls were extracted from residents' records. QoL was measured using the QoL in Alzheimer Disease (QoL-AD) scale. NHLSD scores ranged from 0 to 50 with a mean score of 27.86 ± 10.12. Resident life-space mobility was mainly centered around their room (94.8%, n= 527) and wing (86.4%, n= 485). One-half of the residents left their wing daily (51.0%, n= 284), and over one-quarter (26.4%, n= 147) ventured outside their nursing home at least weekly. Significant associations (P &lt; .05) with high life-space mobility, identified through multivariable analyses, included lower age [odds ratio (OR) 0.70, 95% confidence interval (CI) 0.51, 0.96]; lower frailty levels (OR 0.67, 95% CI 0.50, 0.86); lower sarcopenia risk (OR 0.72, 95% CI 0.65, 0.79); and a better nutritional status (OR 1.16, 95% CI 1.05, 1.29). High life-space mobility was a predictor (P &lt; .05) of lower mortality, lower falls rate, and higher QoL at 1year when compared with moderate or low mobility. Given the independent association between high life-space mobility and lower frailty status, lower sarcopenia risk, and a better nutritional status, physical activity and nutritional interventions may be beneficial in leading to improved life-space use. This requires further investigation. Improved life-space mobility can lead to improved health outcomes, such as lower mortality, lower falls rate, and improved QoL.

지속적인 역할 제공 및 활동 참여가 지역사회 치매환자의 우울수준, 자아존중감, 삶의 질에 미치는 효과

This study aimed to examine the effects of continuous role provision and activity participation on depression, selfesteem, and quality of life in dementia patients residing in local communities. The program aimed to help dementia patients play a role and participate in meaningful activities with others in a group and educate their caregivers so that the patients could carry out such activities continuously at home. Thirty-one local patients with dementia who visited the Dementia Prevention and Management Center in Y city, Gyeonggi-do, from July 2015 to October 2014 were enrolled in the program that was conducted once a week for 12 weeks and included in both pre- and post-assessments. The results of the preand post-assessments showed improvements in depression, self-esteem and quality of life for the patients with dementia, with changes in GDS (Geriatric Depression Scale) scores from 14.61±6.40 to 13.26±5.85, SES (Self-Esteem Scale) scores from 22.74±2.91 to 25.32±5.47 and QOL-AD (Quality of Life in Alzheimer's Disease) scores from 24.42±6.11 to 25.48±6.54 (p&lt;0.01,). It was observed that continuous role provision and activity participation were effective in decreasing depression, and increasing both self-esteem and quality of life in patients with dementia residing in local communities. Therefore, further such studies are needed in the future that would help in improving the mental function of patients with dementia.

Online physical exercise and the neuropsychiatric symptoms in patients with dementia: a cross-sectional study during the COVID-19 pandemic.

The objective of this study was to compare the neuropsychiatric symptoms and QoL of older adults with neurocognitive disorders who participated in an online physical exercise program with sedentary patients during the COVID-19 pandemic. In this cross-sectional study, 25 older patients with neurocognitive disorders (control group=11; online exercise group=14) were evaluated based on Neuropsychiatric Inventory (NPI) and the Quality of Life in Alzheimer's Disease (QoL-AD) scale. There were differences between the two groups in the total NPI (U=36.50, p=0.025) and the nighttime behavior disturbances item (U=38.00, p=0.033), both with large effect sizes (ES=-1.03, 95% confidence interval [CI]:-1.83 to -0.16 and ES=-1.06, 95%CI -1.86 to -0.19, respectively). In terms of QoL-AD, a difference was identified only in the memory subitem (U=20.00, p=0.005), with a large ES (1.59, 95%CI 0.59-2.48). Older adults with neurocognitive disorders who participated in an online physical exercise program, during the COVID-19 pandemic, showed fewer neuropsychiatric total symptoms, fewer nighttime disturbances episodes, and better subjective memory, compared to their physically inactive counterparts. Randomized controlled trials should be performed to better understand the effect of physical exercise in neuropsychiatric symptoms in dementia patients during periods of social isolation.

Awareness of Diagnosis in Persons with Early-Stage Alzheimer's Disease: An Observational Study in Spain.

IntroductionLimited information is available on people’s experiences of living with Alzheimer’s disease (AD) at earlier stages. This study assessed awareness of diagnosis among people with early-stage AD and its impact on different person-centered outcome measures.MethodsWe conducted an observational, cross-sectional study in 21 memory clinics in Spain. Persons aged 50–90 years, diagnosed with prodromal or mild AD (NIA/AA criteria), a Mini Mental State Examination (MMSE) score ≥ 22, and a Clinical Dementia Rating-Global score (CDR-GS) of 0.5 or 1.0 were recruited. The Representations and Adjustment to Dementia Index (RADIX) was used to assess participants’ beliefs about their condition and its consequences.ResultsA total of 149 persons with early-stage AD were studied. Mean (SD) age was 72.3 (7.0) years and 50.3% were female. Mean duration of AD was 1.4 (1.8) years. Mean MMSE score was 24.6 (2.1) and 87.2% had a CDR-GS score of 0.5. Most participants (n = 84, 57.5%) used a descriptive term related to specific AD symptoms (e.g., memory difficulties) when asked what they called their condition. Participants aware of their diagnosis using the term AD (n = 66, 45.2%) were younger, had more depressive symptoms, and poorer life satisfaction and quality of life compared to those without awareness of their specific diagnosis. Practical and emotional consequences RADIX scores showed a significant negative correlation with Quality of Life in Alzheimer’s Disease score (rho = − 0.389 and − 0.413, respectively; p < 0.0001). Years of education was the only predictor of awareness of AD diagnosis [OR = 1.04 (95% CI 1.00–1.08); p = 0.029].ConclusionsAwareness of diagnosis was a common phenomenon in persons with early-stage AD negatively impacting their quality of life. Understanding illness representations in earlier stages may facilitate implementing optimized care that supports improved quality of life and well-being.

Eight-week exercise program improved the quality of life of Alzheimer's patients through functional, cognitive, and biochemical parameters.

In this study, it was aimed to examine the effect of 8-week exercise in Alzheimer's disease (AD) aged 65 and over through functional, cognitive, and biochemical parameters and irisin metabolism. Two groups consisting of healthy individuals and diagnosed with Alzheimer's over the age of 65 were followed up with a combined exercise program of 45-60min, 3days a week, for 8weeks. At the end of the exercise period, various cognitive and functional tests were performed on the participants, and blood samples were taken for biochemical parameters and irisin level measurements. In functional evaluations, while there was no difference in pre-exercise measurements of timed performance and quadriceps femoris muscle strength, there was a difference between groups in all other measurements (p < 0.05). Nutritional status increased significantly after exercise in AD individuals. Although there was an increase in mental score values after exercise, it was not statistically significant. Similar to the elderly with Alzheimer's, the improvements in functional tests in the healthy also led to improvements in activities of daily living and auxiliary activities of daily living. The exercise training did not have an effect on the lipid profile in AD patients, but showed an effect on glycemia and irisin levels (p < 0.05). Changes in functional, cognitive, and biochemical parameters after the exercise program improved quality of life in Alzheimer's patients.

Improving the Identification of Frailty in Long-Term Care Residents: A Cross-Sectional Study.

To compare the capacity of blood myostatin concentration and physical, cognitive, and affective function tests to predict frailty among long-term care (LTC) residents. This cross-sectional analysis used baseline data from three randomized controlled trials involving 260 older adults in 14 LTC centers. Serum myostatin levels were analyzed by enzyme-linked immunosorbent assay. Frailty, physical fitness, cognitive and affective functions were assessed using validated tests and scales. The Timed Up and Go, gait speed, 6-minute walk, and Berg Balance Scale had excellent capabilities in identifying frail individuals in accordance with Fried's Frailty Phenotype (FFP). The best tests for identifying frailty in accordance with the Clinical Frailty Scale (CFS) were Timed Up and Go and Berg Balance Scale. For the Tilburg Frailty Indicator (TFI), the best tests were Quality of Life in Alzheimer's Disease (QoL-AD) and Goldberg Anxiety. Myostatin, along with physical, cognitive, and affective function tests, improved the capability of the hand grip, arm-curl, Montreal Cognitive Assessment, Goldberg Anxiety, Goldberg Depression, and QoL-AD to identify frailty according to FFP, while myostatin improved CFS-defined frailty identification by the hand grip, arm-curl, 6-minute walk test, Berg Balance Scale, 30-second chair-stand, gait speed, Montreal Cognitive Assessment, Goldberg Anxiety, and De Jong-Gierveld Loneliness Scale. Among LTC residents, serum myostatin was associated with being frail according to FFP and CFS. However, this measure was less discriminating of frailty than physical fitness tests (for FFP and CFS) and affective function parameters (for TFI). However, evaluated concurrently with physical, cognitive, and affective parameters, myostatin improved the capabilities of these measures to predict CFS-defined frailty.

Improvisational Movement to Improve Quality of Life in Older Adults With Early-Stage Dementia: A Pilot Study.

Alzheimer's disease has profound effects on quality of life, affecting not only cognition, but mobility and opportunities for social engagement. Dance is a form of movement that may be uniquely suited to help maintain quality of life for older adults, including those with dementia, because it inherently incorporates movement, social engagement, and cognitive stimulation. Here, we describe the methods and results of the pilot study for the IMOVE trial (NCT03333837, www.clinicaltrials.gov), a clinical trial designed to use improvisational dance classes to test the effects of movement and social engagement in people with mild cognitive impairment (MCI) or early-stage dementia. The pilot study was an 8-week investigation into the feasibility and potential effects of an improvisational dance intervention on people with MCI or early-stage dementia (PWD/MCI) and their caregivers (CG). The pilot aimed to assess changes in quality of life, balance, mood, and functional brain networks in PWD/MCI and their CG. Participants were recruited as dyads (pairs) that included one PWD/MCI and one CG. Ten total dyads were enrolled in the pilot study with five dyads assigned to the usual care control group and five dyads participating in the dance intervention. The intervention arm met twice weekly for 60 min for 8 weeks. Attendance and quality of life assessed with the Quality of Life in Alzheimer's disease (QoL-AD) questionnaire were the primary outcomes. Secondary outcomes included balance, mood and brain network connectivity assessed through graph theory analysis of functional magnetic resonance imaging (fMRI). Class attendance was 96% and qualitative feedback reflected participants felt socially connected to the group. Increases in quality of life and balance were observed, but not mood. Brain imaging analysis showed increases in multiple brain network characteristics, including global efficiency and modularity. Further investigation into the positive effects of this dance intervention on both imaging and non-imaging metrics will be carried out on the full clinical trial data. Results from the trial are expected in the summer of 2022.

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.