Quality of life in dementia: more than just cognition. An analysis of associations with quality of life in dementia

Banerjee, Sube; Smith, Sarah C.; Lamping, Donna L.; Harwood, Rowan H.; Foley, Beth; Smith, Paul; Murray, Joanna; Prince, Martin; Levin, Enid; Mann, Anthony; Knapp, Martín

doi:10.1136/jnnp.2005.072983

Cited by 250 publications

(242 citation statements)

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“…Neuropsychiatric symptoms frequently have several adverse clinical repercussions. Psychosis and agitation in patients with dementia decrease quality of life (Matsui et al, 2006;Banerjee et al, 2006) and may portend a worse prognosis. Several studies indicate that psychosis is associated with more rapid cognitive decline among persons with dementia (Drevets and Rubin, 1989;Rosen and Zubenko, 1991;Wilson et al, 2006).…”

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ACNP White Paper: Update on Use of Antipsychotic Drugs in Elderly Persons with Dementia

Jeste

Blazer

Casey

et al. 2007

Neuropsychopharmacol

318

273

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In elderly persons, antipsychotic drugs are clinically prescribed off-label for a number of disorders outside of their Food and Drug Administration (FDA)-approved indications (schizophrenia and bipolar disorder). The largest number of antipsychotic prescriptions in older adults is for behavioral disturbances associated with dementia. In April 2005, the FDA, based on a meta-analysis of 17 double-blind randomized placebo-controlled trials among elderly people with dementia, determined that atypical antipsychotics were associated with a significantly (1.6-1.7 times) greater mortality risk compared with placebo, and asked that drug manufacturers add a 'black box' warning to prescribing information for these drugs. Most deaths were due to either cardiac or infectious causes, the two most common immediate causes of death in dementia in general. Clinicians, patients, and caregivers are left with unclear choices of treatment for dementia patients with psychosis and/or severe agitation. Not only are psychosis and agitation common in persons with dementia but they also frequently cause considerable caregiver distress and hasten institutionalization of patients. At the same time, there is a paucity of evidence-based treatment alternatives to antipsychotics for this population. Thus, there is insufficient evidence to suggest that psychotropics other than antipsychotics represent an overall effective and safe, let alone better, treatment choice for psychosis or agitation in dementia; currently no such treatment has been approved by the FDA for these symptoms. Similarly, the data on the efficacy of specific psychosocial treatments in patients with dementia are limited and inconclusive. The goal of this White Paper is to review relevant issues and make clinical and research recommendations regarding the treatment of elderly dementia patients with psychosis and/ or agitation. The role of shared decision making and caution in using pharmacotherapy for these patients is stressed.

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mentioning

confidence: 99%

ACNP White Paper: Update on Use of Antipsychotic Drugs in Elderly Persons with Dementia

Jeste

Blazer

Casey

et al. 2007

Neuropsychopharmacol

318

273

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“…Sammenhengen mellom alder og livskvalitet er uklar i vår studie. Flere studier finner ikke sammenheng mellom alder og livskvalitet (5,42,43), mens andre studier har funnet en signifikant sammenheng mellom alder og livskvalitet (16).…”

Section: Metodeunclassified

“…Flere studier viser at personer med demens kan ha god livskvalitet uavhengig av grad av demens (10,16,27,40,45 (46,47). Det kan føre til feilvurderinger.…”

Section: Metodeunclassified

“…Mange studier viser at det er sammenheng mellom depresjon og livskvalitet (15)(16)(17). Det er imidlertid usikkert om sammenhengen mellom depressive symptomer og livskvalitet er like sterk hos personer med demens som hos dem med normal kognisjon.…”

Section: Introduksjonunclassified

“…Dette kan blant annet skyldes at pasienter med demens, saerlig av moderat til alvorlig grad, har problemer med abstrakt tenkning, hukommelse og språkforståelse. På grunn av disse problemene er det også vanskelig å vurdere livskvalitet hos denne gruppen (9,26 blant personer med demens (10,16,27), mens andre studier finner at det er en sammenheng (6,11,28). I de ulike studiene ser man en tendens til at det oftere er sammenheng mellom funksjonsnivå og livskvalitet hos personer med demens når en annen enn pasienten gir informasjon.…”

Section: Introduksjonunclassified

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Livskvalitet, depressive symptomer og funksjonssvikt hos personer med demens

Mjørud¹,

Engedal²,

Barca³

et al. 2011

Sykepleien

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English summary sammEndrag Quality of life, depressive symptoms and impairment in people with dementiaBackground: It is uncertain whether the association between quality of life, the symptoms of depression and impairment of daily living activities is as strong in people with dementia, as in those without dementia.Objective: To investigate the association between quality of life, the symptoms of depression, impairment of daily living activities and dementia.Methods: Information about 223 nursing home patients with dementia was collected through interviews with the primary caregivers. Quality of life was examined using the Quality of Life in Late Stage Dementia (QUA-LID) scale; symptoms of depression were examined using the Cornell scale; impairment of daily living activities was examined using Lawton's Physical Self-Maintenance Scale (PSMS); and the degree of dementia was examined using the Clinical Dementia Rating scale. Results: Correlation analysisshowed that reduce quality of life was significantly associated with depressive symptoms, functional impairment and dementia. A stepwise linear regression analysis showed that four of Cornell's five sub scales: the mood, behavioural, retardation and cyclic subscales were significantly associated with QUALID. The physical sub scale was not associated with quality of life in the regression analysis because retardation and physical sub scales correlated highly. Impairment of activities of daily living and degree of dementia are significantly associated to reduced quality of life. Conclusion:Quality of life in people with dementia is associated with symptoms of depression, especially the core symptoms of depression and level of impairment of activities of daily living.Key words: quality of life, symptoms of depression, impairment of activities in daily living, dementia.Bakgrunn: Det er usikkert om sammenhengen mellom livskvalitet, depressive symptomer og funksjonssvikt er like sterk hos personer med demens som hos dem uten demens.Hensikt: Å undersøke sammenhengen mellom livskvalitet, depressive symptomer, funksjonssvikt og grad av demens. Metode:Opplysninger om 223 pasienter med demens i sykehjem ble innhentet gjennom intervju av pasientenes primaerpleiere. Livskvalitet ble kartlagt med Quality of life in late stage dementia scale (QUALID), symptomer på depresjon med Cornell skala, funksjonsevne med Lawtons ADL skala og grad av demens med Klinisk demensvurdering.Resultater: Korrelasjonsanalyser viste at livskvalitet var signifikant assosiert til depressive symptomer, grad av demens og tap av funksjonsevne. Spearman's korrelasjon varierte mellom 0,37 og 0,53. En trinnvis lineaer regresjonsanalyse viste at fire av fem subskalaer i Cornell skalaen, affekt-, adferds-, retardasjon -og syklisk subskala var signifikant assosiert med QUALID-skåren. Den fysiske sub skalaen var det ikke fordi sub skalaene retardasjon og fysisk korrelerte sterkt. Tap av funksjonsevne og grad av demens var også signifikant relatert til redusert livskvalitet.Konklusjon: Livskvalitet hos personer med ...

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Association Between False Memories and Delusions in Alzheimer Disease

et al. 2023

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ImportanceUnderstanding the mechanisms of delusion formation in Alzheimer disease (AD) could inform the development of therapeutic interventions. It has been suggested that delusions arise as a consequence of false memories.ObjectiveTo investigate whether delusions in AD are associated with false recognition, and whether higher rates of false recognition and the presence of delusions are associated with lower regional brain volumes in the same brain regions.Design, Setting, and ParticipantsSince the Alzheimer’s Disease Neuroimaging Initiative (ADNI) launched in 2004, it has amassed an archive of longitudinal behavioral and biomarker data. This cross-sectional study used data downloaded in 2020 from ADNI participants with an AD diagnosis at baseline or follow-up. Data analysis was performed between June 24, 2020, and September 21, 2021.ExposureEnrollment in the ADNI.Main Outcomes and MeasuresThe main outcomes included false recognition, measured with the 13-item Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS-Cog 13) and the Rey Auditory Verbal Learning Test (RAVLT) and volume of brain regions corrected for total intracranial volume. Behavioral data were compared for individuals with delusions in AD and those without using independent-samples t tests or Mann-Whitney nonparametric tests. Significant findings were further explored using binary logistic regression modeling. For neuroimaging data region of interest analyses using t tests, Poisson regression modeling or binary logistic regression modeling and further exploratory, whole-brain voxel-based morphometry analyses were carried out to explore the association between regional brain volume and false recognition or presence of delusions.ResultsOf the 2248 individuals in the ADNI database, 728 met the inclusion criteria and were included in this study. There were 317 (43.5%) women and 411 (56.5%) men. Their mean (SD) age was 74.8 (7.4) years. The 42 participants with delusions at baseline had higher rates of false recognition on the ADAS-Cog 13 (median score, 3; IQR, 1 to 6) compared with the 549 control participants (median score, 2; IQR, 0 to 4; U = 9398.5; P = .04). False recognition was not associated with the presence of delusions when confounding variables were included in binary logistic regression models. An ADAS-Cog 13 false recognition score was inversely associated with left hippocampal volume (odds ratio [OR], 0.91 [95% CI, 0.88-0.94], P &lt; .001), right hippocampal volume (0.94 [0.92-0.97], P &lt; .001), left entorhinal cortex volume (0.94 [0.91-0.97], P &lt; .001), left parahippocampal gyrus volume (0.93 [0.91-0.96], P &lt; .001), and left fusiform gyrus volume (0.97 [0.96-0.99], P &lt; .001). There was no overlap between locations associated with false recognition and those associated with delusions.Conclusions and RelevanceIn this cross-sectional study, false memories were not associated with the presence of delusions after accounting for confounding variables, and no indication for overlap of neural networks for false memories and delusions was observed on volumetric neuroimaging. These findings suggest that delusions in AD do not arise as a direct consequence of misremembering, lending weight to ongoing attempts to delineate specific therapeutic targets for treatment of psychosis.

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Quality of life in dementia: more than just cognition. An analysis of associations with quality of life in dementia

Abstract: These data suggest that quality of life in dementia is complex, and that simple proxy substitutions of discrete measures such as cognition or function are likely to miss important factors.

Cited by 250 publications

References 16 publications

ACNP White Paper: Update on Use of Antipsychotic Drugs in Elderly Persons with Dementia

ACNP White Paper: Update on Use of Antipsychotic Drugs in Elderly Persons with Dementia

Livskvalitet, depressive symptomer og funksjonssvikt hos personer med demens

Association Between False Memories and Delusions in Alzheimer Disease

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