Alzheimer's Disease Trajectory Research Articles

End-of-life care for persons with advanced Alzheimer disease: design and baseline data from the ALFINE study.

Alzheimer disease (AD) is the most common cause of dementia. Most affected individuals survive to an advanced stage of dementia, which is under-recognized as a terminal illness. Our objectives were to better understand the clinical trajectory of advanced AD and to identify the palliative care needs of these patients. This was an observational prospective study of AD patients in severe stage of disease included after a hospitalization in geriatric wards. They were followed up every three months during 2 years. At each visit, interviews provided data regarding: pain (Elderly Pain Caring Assessment scale), pressure ulcers, eating patterns, daily medications and use of health services. This paper describes the design of the ALFINE study and the characteristics of the recruited cohort. 112 patients were recruited (mean age: 84.03 + 6.96) years; 76.79% were women. Mean time since diagnosis of AD was 5.28 years. Pressure ulcers were observed in 42 patients. Pain assessment with the EPCA showed a mean score of 8.58. One third of patients with an EPCA score of more than 7 (median) had no analgesics. More than half of patients had been treated with antibiotics during the three months before inclusion in the study and 33 patients were still receiving antibiotics at inclusion. Two third of patients had been hospitalized in the month before inclusion. End-of-life care for individuals with end-stage AD is increasingly important because of the rising number of patients with this disease. Health care systems and clinicians should make efforts to ameliorate the suffering of patients and their caregivers.

P4‐470: Characterizing biomarker dynamics along the Alzheimer's disease trajectory

P4‐470: Characterizing biomarker dynamics along the Alzheimer's disease trajectory

Alzheimer's Disease and the Disablement Process: Directions for Future Research

The purpose of this theoretical paper is fourfold. First, the evolution of disability models is reviewed. Second, critique of current models and the need for an age-specific model is discussed. Third, the clinical symptoms of Alzheimer's disease (AD) including the physical disabilities that accompany the disease are addressed. Fourth, future directions in disability research in regards to AD are proposed. Disability models that are specific to persons with progressive cognitive disorders will aid in increasing researchers and clinicians understanding of the multifaceted and complex relationship between cognitive and physical impairments that characterize the disease trajectory of AD.

Spousal interactions in alzheimer's disease and stroke caregiving: Relationship to care recipients' functional abilities and physical and emotional health*1

Background : Previous research suggests that the quantity and quality of interactions between caregivers and care recipients have an impact on health outcomes of ill persons. Building on the work of Bowlby (1988) and Wright, Hickey, Buckwalter, and Clipp (1995) , spousal interactions are conceptualized as adult attachment; it is argued that this attachment provides protective functions for ill spouses. Objectives : Our objectives in this study were to examine spousal interactions along two divergent illness trajectories, Alzheimer's disease (AD) and stroke, and to relate time 1 spousal interactions to care recipients' time 2 functional abilities and physical and emotional health. Study Design : This longitudinal pilot study compared 42 couples (84 spouses) equally divided between early phase AD, 12 weeks after stroke, and healthy controls. Baseline (time 1) data and 6-month follow-up data (time 2) were collected in home interviews. Measures included spousal interactions and illness characteristics of persons with AD and recipients of care after a stroke. Results : AD couples reported lower quantity and quality of interactions compared with stroke couples. Spousal interactions were positively correlated to physical and emotional health in AD care recipients and to functional abilities in stroke care recipients. Only AD care recipients' interactions were related to depression. Conclusions : Spousal interactions along the AD trajectory represented the protective function of attachment; along the stroke trajectory, reciprocal adult exchanges continued.

Spousal Interactions in Alzheimer's Disease and Stroke Caregiving: Relationship to Care Recipients' Functional Abilities and Physical and Emotional Health

BACKGROUND: Previous research suggests that the quantity and quality of interactions between caregivers and care recipients have an impact on health outcomes of ill per sons. Building on the work of Bowlby (1988) and Wright, Hickey, Buckwalter, and Clipp (1995), spousal interactions are conceptualized as adult attachment; it is argued that this attachment provides protective functions for ill spouses. OBJECTIVES: Our objectives in this study were to examine spousal interactions along two diver gent illness trajectories, Alzheimer's disease (AD) and stroke, and to relate time 1 spousal interactions to care recipients' time 2 functional abilities and physical and emotional health. STUDY DESIGN: This longitudinal pilot study compared 42 couples (84 spouses) equally divided between early phase AD, 12 weeks after stroke, and healthy controls. Baseline (time 1) data and 6-month follow-up data (time 2) were collected in home interviews. Measures included spousal interactions and illness characteristics of persons with AD and recipients of care after a stroke. RESULTS: AD couples reported lower quantity and quality of interactions compared with stroke couples. Spousal interactions were positively correlated to physical and emo tional health in AD care recipients and to functional abilities in stroke care recipients. Only AD care recipients' interactions were related to depression. CONCLUSIONS: Spousal interactions along the AD trajectory represented the protective function of attachment; along the stroke trajectory, reciprocal adult exchanges contin ued. (J Am Psychiatr Nurses Assoc [1998]. 4, 169-181)