Risk Factors for Nursing Home Placement in Alzheimer's Disease: A Longitudinal Study of Cognition, ADL, Service Utilization, and Cholinesterase Inhibitor Treatment

Wattmo, Carina; Wallin, Åsa; Londos, Elisabet; Minthon, Lennart

doi:10.1093/geront/gnq050

Cited by 95 publications

(114 citation statements)

References 31 publications

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“…The reduced risk of nursing home placement in this study contradicts the findings by Wattmo et al [24], who aimed to identify risk factors for nursing home placement. Among other predictors, they found that solitary living was a significant risk factor for nursing home placement.…”

Section: Discussioncontrasting

confidence: 99%

Health Economic Analysis on a Psychosocial Intervention for Family Caregivers of Persons with Dementia

Dahlrup¹,

Nordell²,

Carlsson

et al. 2013

Dement Geriatr Cogn Disord

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Background/Aims: Psychosocial intervention has shown positive effects on the caregivers' burden and satisfaction. The aims of this study were to describe the cost and cost-effectiveness of such an intervention. Methods: We analyzed resource use and costs of formal care for 308 persons with dementia and their caregivers' health-related quality of life (HRQoL). Results: The costs of home help services were lower in the subgroup of spouse caregivers in the intervention group and the cost of nursing home placement was lower in the intervention group. While the person with dementia lived at home, caregivers in the intervention group reported a higher HRQoL (p < 0.01). After the person with dementia had moved to a nursing home, spouses in the control group had a lower HRQoL (p < 0.001). Conclusion: The result can be interpreted as a positive effect of the intervention focusing on the identified specific needs of the family caregivers.

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Section: Discussioncontrasting

confidence: 99%

Health Economic Analysis on a Psychosocial Intervention for Family Caregivers of Persons with Dementia

Dahlrup¹,

Nordell²,

Carlsson

et al. 2013

Dement Geriatr Cogn Disord

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“…The SATS is a prospective, open-label, observational, nonrandomized, multicenter study that has been described in several publications [18,19,20,21]. In total, 1,258 participants were recruited until April 2008 by 14 memory clinics that cover different parts of Sweden.…”

Section: Methodsmentioning

confidence: 99%

Risk Factors That Affect Life Expectancy in Alzheimer's Disease: A 15-Year Follow-Up

Wattmo

Londos

Minthon³

2014

Dement Geriatr Cogn Disord

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Backgrounds/Aims: Future disease-modifying therapies might affect the expected life span in Alzheimer's disease (AD). Our aim was to identify factors that influence life expectancy in cholinesterase inhibitor (ChEI)-treated patients. Methods: This study included 791 deceased individuals with a clinical diagnosis of AD and a Mini-Mental State Examination score of 10-26 at baseline who were recruited from a 3-year, prospective, multicenter study of ChEI therapy in clinical practice. The participants' date of death was recorded and their survival was compared with the gender- and age-matched general population. Results: The mean survival time after the start of ChEI therapy (time of AD diagnosis) was 5.10 years for men and 6.12 years for women. Better cognitive ability, less impaired basic functional capacity, and fewer medications, but not education level or apolipoprotein E (APOE) genotype, were independent prognostic factors of longer survival after diagnosis, after controlling for gender and age. Conclusion: AD shortens life expectancy in ChEI-treated patients diagnosed before the age of 85 years, similar to that reported previously for untreated individuals. A longer life span was observed in the eldest patients (≥85 years) compared with untreated cohorts, which did not differ from that observed in the general population. Higher education or carrying two APOE ε4 alleles were risk factors for earlier death.

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“…Of note, the risk of such events is clearly dose dependent (as seems to be the case for efficacy), and this was shown, at least for donepezil and rivastigmine, in a meta-analysis of randomized clinical trials [Ritchie et al 2004]. The clinical benefit of reaching higher doses from a QoL perspective is supported by a large 3-year, prospective, observational study of 880 patients with AD treated with CIs, in which a higher dose of CIs (donepezil >6.9 mg/ day, oral rivastigmine >6 mg/day, galantamine >16 mg/day) was independently associated with a lower institutionalization risk [Wattmo et al 2011]. The risk of gastrointestinal side effects leading to treatment withdrawal is particularly high for the oral formulation of rivastigmine, both in clinical trials [Birks et al 2009] and in clinical practice [Mossello et al 2004].…”

Section: Adverse Events Risk Versus Efficacymentioning

confidence: 99%

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

Mossello¹,

Ballini

2012

Therapeutic Advances in Chronic Disease

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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.

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Risk Factors for Nursing Home Placement in Alzheimer's Disease: A Longitudinal Study of Cognition, ADL, Service Utilization, and Cholinesterase Inhibitor Treatment

Cited by 95 publications

References 31 publications

Health Economic Analysis on a Psychosocial Intervention for Family Caregivers of Persons with Dementia

Health Economic Analysis on a Psychosocial Intervention for Family Caregivers of Persons with Dementia

Risk Factors That Affect Life Expectancy in Alzheimer's Disease: A 15-Year Follow-Up

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

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