Neuropsychiatric symptoms predict change in quality of life of Alzheimer disease patients: A two‐year follow‐up study

Abstract

Aim:To examine the effect of neuropsychiatric symptoms on longitudinal changes in the quality of life (QOL) of patients with Alzheimer disease (AD).Methods: First, we investigated whether neuropsychiatric symptoms at baseline predict changes in the QOL of AD patients over time. Then we examined the associations between changes in neuropsychiatric symptoms and changes in QOL. QOL was assessed using the Japanese version of the Quality of LifeAlzheimer Disease (QOL-AD) scale and other clinical instruments [the Mini-Mental State Examination, The Neuropsychiatry Inventory (NPI)] at baseline and again two years later in 96 AD patients among 140 AD patients at baseline. We performed a multiple regression analysis of the baseline QOL-AD score, NPI score (mood, psychosis, and euphoria factor), Mini-Mental State Examination score, and other clinical instrument variables (e.g. Activities-ofDaily-Living scores) to determine their contribution to the change in QOL-AD score.Results: While the total QOL-AD score based on the patients' responses did not change significantly, the total QOL-AD score derived from the caregivers' responses declined. Both the Activities-of-DailyLiving score and the mood factor of the NPI score predicted the change in the QOL-AD score as assessed by the caregivers' responses. In addition, there was a significant correlation between the changes in two factors of the NPI, i.e. the mood and psychosis factor, and the changes in the QOL-AD score based on the caregivers' responses. Conclusions:The presence of specific neuropsychiatric symptoms (mood and psychosis symptoms) was associated with changes in the QOL of AD patients during the follow-up period.

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].…”

“…Although depression is the neuropsychiatric symptom most widely reported to be associated with poorer QoL, this association with impaired QoL has also been found for the total NPI score [5,11,17], as well as for other specific neuropsychiatric symptoms, including apathy [39], anxiety [2,4], agitation [40], and psychotic symptoms assessed by the NPI (Delusions, Hallucinations) [5].…”

“…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].…”