Management of patients with Alzheimer’s disease: pharmacological treatment and quality of life

Abstract

Abstract:A methodological approach to quality of life (QoL) assessment in Alzheimer's disease (AD) is challenging and few clinical trials have included it among outcomes, with conflicting results. In this review an indirect appraisal of evidence has been performed, searching the literature for the effect of drug treatments on determinants of QoL in AD. Among clinical factors associated with QoL, possible targets of drugs include cognition, which seems to be associated with QoL in early disease and can be positively affected by cholinesterase inhibitors (CIs) in this stage; functional decline, the risk of which can be decreased by CIs and memantine (MEM); behavioral and psychological symptoms, which can be reduced by MEM and atypical antipsychotics. Long-term observational studies have associated CIs and MEM treatment with a reduced institutionalization risk. According to the evidence, drug treatment of depression associated with AD should not be first choice from a QoL perspective, while treatment of pain can have beneficial effects on wellbeing indicators also in the late stages of the disease. Possible drug-related adverse events can affect QoL and should always be weighed against expected benefits from the patient's perspective. For this reason antipsychotic treatment is often problematic in AD and should be limited to severe psychosis and aggression, using the lowest effective doses for the shortest possible period. Conversely titration of CIs is necessary to reach the most effective dosages, although dose-related risk of adverse events has to be taken into account. Finally, CIs and MEM have been shown to reduce caregiver burden in randomized trials, possibly affecting caregivers' QoL.

Predictors of the health‐related quality of life of Chinese people with major neurocognitive disorders and their caregivers: The roles of self‐esteem and caregiver's burden

“…[2][3][4][5] There is currently no consensus on the definition of health-related QoL (HRQoL) in the treatment of major neurocognitive disorders. [3][4][5] In the present study, HRQoL is defined as an individual's perception on the impact of a health condition on their everyday life. Accordingly, the assessment of HRQoL is subjective and multidimensional, and places emphasis on the personal evaluation of objective life conditions.…”

“…4,5 Although they have reduced cognitive ability, people with major neurocognitive disorder (PwND) can still provide meaningful data on their HRQoL. [3][4][5][6][7] However, self-reported HRQoL of PwND might be unreliable because of the deterioration in language, comprehension and levels of awareness. 3,8 Proxy reports from caregivers can provide important and valid information on HRQoL of PwND.…”

“…3,8 Proxy reports from caregivers can provide important and valid information on HRQoL of PwND. 3,4,6 Despite the necessity of proxy HRQoL assessment, the self-rated HRQoL is found to be only moderately related to the caregiver-rated In addition, the factors that predict self-rated HRQoL have been found to differ from those that predict caregiver-rated HRQoL. 3,[9][10][11][12][13] In particular, research studies have repeatedly reported that self-rated HRQoL is negatively related to current depression, 3,4,6,11,12 functional abilities 3,4 and physical health 3,11 but not to cognitive impairment.…”

“…Recent research findings have reported that self-rated HRQoL is predicted by nonclinical factors, such as PwND's self-concept 15 and awareness of illness, 9,13 whereas caregiver-rated HRQoL is predicted by caregiver's burden. 3,11,12,14 Thus, it is important to identify non-clinical factors that would predict self-rated HRQoL and caregiver-rated HRQoL.…”

Why Diagnose and Treat Memory Loss, Alzheimer's Disease, and Dementia?

“…It follows logically that, if the patient is showing improvements, life for family members and other caregivers will also improve (Mossello & Ballini, 2012). It follows logically that, if the patient is showing improvements, life for family members and other caregivers will also improve (Mossello & Ballini, 2012).…”