Longitudinal Assessment of Patient Dependence in Alzheimer Disease

Brickman, Adam M.; Riba, Aliza; Bell, Karen L.; Marder, Karen; Albert, Marilyn; Brandt, Jason; Stern, Yaakov

doi:10.1001/archneur.59.8.1304

Cited by 67 publications

(61 citation statements)

References 28 publications

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“…Turning to the relationship between function and cognition, we found a positive association in the LPA and PNFA groups; however, no such relationship was identified for the AD group. Several other studies have also found similar weak correlations between cognition and ADLs in AD [25,26] which is interesting from the context of drug trials, which focus largely on changes in cognitive performance rather than ADLs -yet we found the greatest change over 12 months was in IADLs. The similarity in the associations between ADLs and ACE-R scores found for PNFA and LPA reflect the predominance of language dysfunction in the two PPA variants and the fact that the ACE-R is heavily dependent upon language abilities.…”

Section: Discussionsupporting

confidence: 78%

Activities of Daily Living in Progressive Non-Fluent Aphasia, Logopenic Progressive Aphasia and Alzheimers Disease

Jang

Cushing

Clemson

et al. 2012

Dement Geriatr Cogn Disord

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Background/Aims: This study examined functional changes in progressive non-fluent aphasia (PNFA) and logopenic progressive aphasia (LPA) and Alzheimer’s disease (AD) and the association between function, cognition and behaviour. Methods: 59 patients were assessed with the Disability Assessment of Dementia (DAD), Addenbrooke’s Cognitive Examination Revised (ACE-R) and the Cambridge Behavioural Inventory Revised (CBI-R). Results: No differences between groups in basic and instrumental activities of daily living (ADLs), and total ACE-R scores were found; there were correlations between total DAD and ACE-R scores for PNFA and LPA. Over 12 months, PNFA showed the marked decline of basic ADLs, whereas all three groups showed marked decline of instrumental ADLs. Conclusion: PNFA, LPA and AD appear functionally similar when matched for disease duration. The rate of decline of ADLs depends, however, on disease diagnosis.

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Section: Discussionsupporting

confidence: 78%

Activities of Daily Living in Progressive Non-Fluent Aphasia, Logopenic Progressive Aphasia and Alzheimers Disease

Jang

Cushing

Clemson

et al. 2012

Dement Geriatr Cogn Disord

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“…A comparison of R -squared for Models 1–4, suggests that the DS was the best predictor of informal care costs with the beta coefficient suggesting a 71–73% change in informal care cost with a one unit change in DS. Earlier studies have estimated that the DS worsens by 1 point per year [28]. …”

Section: Discussionmentioning

confidence: 99%

Informal Care Time and Cost in a Large Clinical Trial Sample of Patients with Mild to Moderate Alzheimer’s Disease: Determinants and Level of Change Observed

Lacey¹,

Bobula

Niecko³

et al. 2016

Neurol Ther

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IntroductionWe evaluate the association between caregiver (informal) time/cost and illness severity from two recently completed clinical trials of an investigational drug for Alzheimer’s disease (AD).MethodsChanges from baseline caregiver time were calculated and treatment effects analyzed using a restricted maximum likelihood-based mixed model for repeated measures. Four separate models were then estimated to examine the association between caregiver time costs and the clinical endpoints measured during the trials, including cognition (MMSE), function (DAD), behavior (NPI), global disability (CDR) and dependence (DS).ResultsCaregiver time cost was significantly associated with all clinical measures of illness severity with a 1-unit change in MMSE, DAD, NPI, CDR and DS associated with a 11.57%, 4.81–4.97%, 3.58–3.67%, 42.52% and 71.05% change, respectively, in primary caregiver time cost. The association between caregiver time cost and DS was the strongest of all the associations examined.ConclusionCaregiver time costs increase with increasing AD severity in all key domains of AD (cognition, function, behavior, global disability and dependence on others). Our analysis demonstrated that patient dependence is a particularly important predictor of caregiver time costs and should be considered as a potential outcome measure in intervention clinical trials in AD.FundingPfizer Inc. and Janssen Alzheimer Immunotherapy Research and Development.

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“…The DS comprises 11 dichotomous items (e.g., “Does the patient need to be watched or kept company when awake?”) and two items on a 3-point Likert-type scale (e.g., “Does the patient need reminders or advice to manage chores, do shopping, cooking, play games or handle money?”) Scores range from 0 to 15, with higher scores indicating greater dependence. Psychometric properties range from acceptable to excellent (11,23). …”

Section: Methodsmentioning

confidence: 99%

Longitudinal Relationships Between Alzheimer Disease Progression and Psychosis, Depressed Mood, and Agitation/Aggression

Zahodne

Ornstein

Cosentino

et al. 2015

The American Journal of Geriatric Psychiatry

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119

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Objectives Behavioral and psychological symptoms of dementia (BPSD) are prevalent in Alzheimer’s disease (AD) and are related to poor outcomes such as nursing home placement. No study has examined the impact of individual BPSD on dependence, a clinically important feature that reflects changing patient needs and their impact on caregivers. The current study characterized independent cross-sectional and longitudinal relationships between three BPSD (i.e., psychosis, depressed mood, and agitation/aggression), cognition, and dependence to better understand the interplay between these symptoms over time. Design The Predictors Study measured changes in BPSD, cognition, and dependence in AD patients every six months. Cross-sectional and longitudinal relationships between individual BPSD, cognition, and dependence over six years were characterized using multivariate latent growth curve modeling. This approach characterizes independent changes in multiple outcome measures over time. Setting Four memory clinics in the United States and Europe. Participants 517 patients with probable Alzheimer’s disease. Measurements Columbia University Scale for Psychopathology, modified Mini-Mental State Exam, Dependence Scale. Results Both psychosis and depressed mood at study entry were associated with worse subsequent cognitive decline. Independent of cognitive decline, initial psychosis was associated with worse subsequent increases in dependence. Rates of increase in agitation/aggression separately correlated with rates of declines in both cognition and independence. Conclusions Although purely observational, findings support the poor prognosis associated with psychosis and depression in AD. Results also show that agitation/aggression tracks declines in cognition and independence independently over time. Targeted intervention for individual BPSD, particularly psychosis, could have broad impacts on not only patient well-being, but also care costs and family burden.

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Longitudinal Assessment of Patient Dependence in Alzheimer Disease

Cited by 67 publications

References 28 publications

Activities of Daily Living in Progressive Non-Fluent Aphasia, Logopenic Progressive Aphasia and Alzheimers Disease

Activities of Daily Living in Progressive Non-Fluent Aphasia, Logopenic Progressive Aphasia and Alzheimers Disease

Informal Care Time and Cost in a Large Clinical Trial Sample of Patients with Mild to Moderate Alzheimer’s Disease: Determinants and Level of Change Observed

Longitudinal Relationships Between Alzheimer Disease Progression and Psychosis, Depressed Mood, and Agitation/Aggression

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Longitudinal Assessment of Patient Dependence in Alzheimer Disease

Cited by 67 publications

References 28 publications

Activities of Daily Living in Progressive Non-Fluent Aphasia, Logopenic Progressive Aphasia and Alzheimers Disease

Activities of Daily Living in Progressive Non-Fluent Aphasia, Logopenic Progressive Aphasia and Alzheimers Disease

Informal Care Time and Cost in a Large Clinical Trial Sample of Patients with Mild to Moderate Alzheimer’s Disease: Determinants and Level of Change Observed

Longitudinal Relationships Between Alzheimer Disease Progression and Psychosis, Depressed Mood, and Agitation/Aggression

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Product

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Activities of Daily Living in Progressive Non-Fluent Aphasia, Logopenic Progressive Aphasia and Alzheimers Disease

Activities of Daily Living in Progressive Non-Fluent Aphasia, Logopenic Progressive Aphasia and Alzheimers Disease