Predictors of Family Caregiver Ratings of Patient Quality of Life in Alzheimer Disease: Cross-Sectional Results from the Canadian Alzheimer's Disease Quality of Life Study

Abstract

Objectives-To assess whether the core symptoms of Alzheimer's disease (AD) and caregiver factors consistently predict family caregiver ratings of patient quality of life (QOL) as assessed by a variety of QOL measures in a large national sample. Design-Cross-sectional.Setting-Fifteen dementia and geriatric clinics across Canada. Participants-Family caregivers (n = 412) of community-living patients with AD of all severities.Measurements-Caregiver ratings of patient QOL using three utility indexes, the EQ-5D, Quality of Well-Being Scale and Health Utilities Index, a global QOL visual analogue scale, a disease-specific measure, the QOL-AD, and a generic health status measure, the Short Form-36. Patient cognition was assessed with the AD Assessment Scale-Cognitive Subscale and MiniMental State Examination, function with the Disability Assessment for Dementia, and behavioral and psychological symptoms with the Neuropsychiatric Inventory and the Geriatric Depression Naglie et al.Page 2 Am J Geriatr Psychiatry. Author manuscript; available in PMC 2012 October 01. CIHR Author ManuscriptCIHR Author Manuscript CIHR Author ManuscriptScale. Caregiver burden was assessed with the Zarit Burden Interview and caregiver depression with the Center for Epidemiologic Studies-Depression scale. One-way analysis of variance and fully adjusted multiple linear regression were used to assess the relationship between patient dementia symptom and caregiver variables with QOL ratings.Results-In multivariable analyses, caregiver ratings of patient function and depressive symptoms were the only consistent independent predictors of caregiver-rated QOL across the QOL measures.Conclusions-Caregiver ratings of patient function and depression were consistent independent predictors of caregiver-rated QOL using a spectrum of QOL measures, while measures of patient cognition and caregiver burden and depression were not. These findings support the continued use of caregiver ratings as an important source of information about patient QOL and endorse the inclusion in AD clinical trials of caregiver-rated measures of patient function, depression and QOL. KeywordsAlzheimer's disease; dementia; quality of life; utility; family caregiver; depression; functionIn keeping with the increasing recognition of the importance of health-related quality of life (QOL) in Alzheimer's disease (AD), the International Working Group for the Harmonization of Dementia Guidelines has recommended that QOL be included as an outcome measure in all dementia trials.[1] There are two basic types of QOL measures: generic instruments, including health profile and utility measures, and disease-specific instruments.[2] Diseasespecific measures are considered to be more sensitive at detecting disease-related changes, while generic measures facilitate comparisons across different diseases, as is often required in policy decision making. Utility measures, which can be used in cost-effectiveness analyses, include utility indexes and direct elicitation methods.[2]Patient and caregive...

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