Effects of anosognosia and neuropsychiatric symptoms on the quality of life of patients with Alzheimer's disease: a 24-month follow-up study

Abstract

Objectives: Neuropsychiatric symptoms and anosognosia are known to influence the perceived quality of life of patients (QoL-p) with Alzheimer's disease (AD). This study analysed their impact on patient and caregiver ratings of QoL-p and how these ratings changed in relation to the severity of dementia. Methods: A baseline sample of 221 patients and caregivers was followed up over 24 months. Instruments: Neuropsychiatric Inventory (NPI), Anosognosia Questionnaire-Dementia (AQ-D), Quality of life-Alzheimer's Disease (QoL-AD) and the Global Deterioration Scale (GDS). Longitudinal data were analysed using generalized linear models. Results: In the multivariate analysis, greater anosognosia was always associated with higher ratings of QoL-p among patients, especially at 24 months (p < 0.001), and with more negative ratings among caregivers, especially at baseline (p < 0.001). A higher total NPI score was associated with a more negative rating of QoL-p among caregivers (p < 0.001), and it also had a smaller negative effect on patients' self-ratings (p = 0.001). The neuropsychiatric symptoms (NPI) associated with a more negative view of QoL-p were depression, for patients' self-ratings, and apathy and agitation for caregiver ratings. The discrepancy between patient and caregiver ratings increased in line with the severity of dementia. Conclusion: Neuropsychiatric symptoms had a similarly negative effect on the QoL-p ratings of both patients and caregivers, whereas the effect of anosognosia differed according to the rater (positive for patients, negative for caregivers).

Self-Perceived Quality of Life Among Patients with Alzheimer’s Disease: Two Longitudinal Models of Analysis

“…The association between greater depression and lower scores on self-perceived QoL has been widely reported in longitudinal and cross-sectional studies of community samples [5,6,8,11,18,[34][35][36][37][38] and of patients attending day centers [39] or living in residential care [2,4,40]. Furthermore, the results obtained have been similar despite the variety of instruments used to assess depression: Cornell Scale for Depression in Dementia (CSDD) [2,4], Center for Epidemiologic Studies-Depression Scale (CES-D) [6], Hospital Anxiety and Depression Scale (HADS) [8], NPI-Depression [5,11,37], Geriatric Depression Scale (GDS) [18,36,38,39], Hamilton Depression Scale (HRSD) [35], and the Beck Depression Inventory (BDI) [34].…”

“…Furthermore, the results obtained have been similar despite the variety of instruments used to assess depression: Cornell Scale for Depression in Dementia (CSDD) [2,4], Center for Epidemiologic Studies-Depression Scale (CES-D) [6], Hospital Anxiety and Depression Scale (HADS) [8], NPI-Depression [5,11,37], Geriatric Depression Scale (GDS) [18,36,38,39], Hamilton Depression Scale (HRSD) [35], and the Beck Depression Inventory (BDI) [34].…”

“…The majority of these studies have found, when considering samples as a whole, that mean QoL scores remain relatively stable over time [2][3][4][5][6][7][8][9][10][11][12][13][14], although some research conducted in residential settings has reported a decrease [15][16][17].…”

“…Greater depression appears to be the most relevant aspect and it is associated with a deteriorating QoL over time [2,[6][7][8]18]. A greater number of neuropsychiatric symptoms (higher scores on the NPI) is also associated with poorer perceived QoL [5,11,17], whereas better functional ability correlates with higher QoL scores [3,6] Cognitive changes appear to have only a weak or no effect [12,19].…”

Course and Determinants of Anosognosia in Alzheimer’s Disease: A 12-Month Follow-up

“…A further point to consider is that AQ-D scores are based on a patient-caregiver discrepancy, and therefore factors associated with caregiver perceptions should also be considered. Other authors have pointed out that instruments based on discrepancies between patients and caregivers may yield biased results, due to the effect of caregiver burden and emotional stress [45]. That said, in a previous study we found that caregiver burden had a minimal effect on the variability of the AQ-D [46].…”