Severity of Dementia, Anosognosia, and Depression in Relation to the Quality of Life of Patients with Alzheimer Disease: Discrepancies Between Patients and Caregivers

Conde-Sala, Josep Lluís; Reñé-Ramírez, Ramón; Turró‐Garriga, Oriol; Gascón‐Bayarri, Jordi; Campdelacreu-Fumadó, Jaume; Juncadella-Puig, Montserrat; Rico-Pons, Imma; Garré-Olmo, Josep

doi:10.1016/j.jagp.2012.07.001

Cited by 66 publications

(89 citation statements)

References 46 publications

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“…This finding is in line with those of other studies that have indicated that lack of awareness contributed to the discrepancy between proxy-and self-ratings of QoL. 13,41,42 Mood was relatively stable in our sample over time. Although depressive symptoms did not increase significantly, there is an indication that PwD mood has an impact on caregivers' ratings of PwD QoL regardless of cognitive status or functional impairment.…”

Section: Discussionsupporting

confidence: 93%

“…Caregivers witnessing the losses experienced by PwD may interpret these losses as a source of distress. 6,11 Other more recent studies have sought to explore predictors for the discrepancies between self-reported and caregiver perceptions of PwD QoL, incorporating associations with PwD characteristics such as mood, 12,13 neuropsychiatric symptoms, 14 and unawareness of impairment and behavioral disturbances 15 as well as caregiver factors such as perceived burden of care. The nature of the PwD-caregiver relationship has also been considered.…”

Section: Introductionmentioning

confidence: 99%

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Quality of life in mild dementia: patterns of change in self and caregiver ratings over time

Dourado

Sousa

Santos

et al. 2016

Rev. Bras. Psiquiatr.

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Objectives: To determine changes over time in self and caregiver ratings of quality of life (QoL) in people with dementia (PwD) and to identify factors associated with changes in QoL ratings. Methods: In this longitudinal study, 69 people with mild Alzheimer's disease and their caregivers were assessed at baseline and after 1 year. We examined the association of QoL ratings with the following variables at the two time points: awareness of disease, cognitive status, mood, functionality, neuropsychiatric symptoms, and caregiver burden. Multivariate regression analyses were conducted to examine the contribution of co-factors. Results: At baseline, PwD self-ratings of QoL were associated with caregiver ratings of PwD QoL (p = 0.001). Caregiver ratings were associated with PwD mood (p = 0.001) and self-rated QoL (p = 0.001). After 1 year, caregiver ratings of PwD QoL changed significantly (p = 0.049, d = -0.27), whereas PwD selfratings did not (p = 0.89, d = 0.09). PwD awareness of disease changed significantly (p = 0.001) at 1 year, having declined in 25.4% and improved in 12.3% of participants. PwD QoL self-ratings were associated with caregiver ratings (p = 0.001). Caregiver ratings of PwD QoL after 1 year were associated with PwD mood (p = 0.029), self-reported QoL (p = 0.001), and awareness of disease (p = 0.033). Conclusions:The association between self and caregiver ratings of PwD QoL was maintained over 1 year. The primary factors accounting for the change in caregiver ratings were PwD mood and awareness of disease. QoL and cognitive impairment seem to be relatively independent in mild dementia.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Quality of life in mild dementia: patterns of change in self and caregiver ratings over time

Dourado

Sousa

Santos

et al. 2016

Rev. Bras. Psiquiatr.

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“…These results provide evidence supporting a mechanism in which burden related to taking care of people with dementia may lead to more negative caregiver ratings of the patients health [4,9]. This variability is not specific of anosognosia and has been found in several other caregiver ratings including functional capacities [4,21,22], neuropsychiatric symptoms [4,21,23], and quality of life [4,24,25]. Caregiver AQ-D ratings were not consistently associated with caregiver depression.…”

Section: The Association Of Caregiver Factors With Caregiver Anosognomentioning

confidence: 61%

The Longitudinal Association Between a Discrepancy Measure of Anosognosia in Patients with Dementia, Caregiver Burden and Depression

Perales

Turró‐Garriga

Gascón‐Bayarri

et al. 2016

JAD

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Abstract.Background: According to cross-sectional studies, there is an association between anosognosia in people with dementia and caregiver's burden and depression. Anosognosia in patients may be a cause of caregiver burden and depression. However, variability in caregiver anosognosia ratings may exist as caregivers with burden and depression may have a more pessimistic view of the patients' health. Objective: To assess the variability of caregiver anosognosia ratings of patients with dementia using a widely used anosognosia scale and its longitudinal relationship with caregiver burden and depression. Methods: A convenience cohort of 221 consecutive dementia outpatient and caregiver dyads was followed up at 12 and 24 months. The main instruments used were the Anosognosia Questionnaire-Dementia (AQ-D), Caregiver Burden Interview, and Geriatric Depression Scale. Linear mixed models were used including time as a factor in every model. Multivariate analyses controlled for caregiver's socio-demographic and possible confounding factors. Results: Attrition at 12 and 24 months was 24.9% and 42.5% respectively. Patients at baseline were on average 77.8 years of age, 63.3% were women, and 63.3% had < 5 years of education. In the bivariate analyses, caregiver burden, depression, and gender were associated with caregiver ratings of total, cognitive, and personality AQ-D of the patient at different time points. Multivariate analyses revealed burden as the caregiver variable most consistently associated with total, cognitive, and personality caregiver AQ-D ratings of the patient. Conclusion: Some caregiver characteristics, especially burden, are associated with caregiver ratings of AQ-D with regard to the patient.

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“…Es un resultado contrastado con múltiples investigaciones 16,[27][28][29] , aunque algunos autores no encontraron esta relación 25,26 y otros autores consideraron que los síntomas depresivos podían confundir la relación entre la anosognosia y la gravedad de la demencia, poniendo el acento en la relación entre anosognosia y declive cognitivo 30 .…”

Section: Discussionunclassified

“…La presencia de altos niveles de sobrecarga en el cuidador asociada a la presencia de anosognosia puede influir en la valoración objetiva de las capacidades de los pacientes e incrementar la discrepancia entre paciente y cuidador 34,35 . La valoración de la calidad de vida, un factor importante en la evaluación de tratamientos, también presenta alteraciones asociadas a la presencia de anosognosia 27,28 . Por ello, en este trabajo profundizamos el estudio en pacientes con fase inicial, por la dificultad de evaluar en fases más avanzadas, aunque también por la relevancia que puede tener en el tratamiento de la enfermedad a lo largo de su evolución, por el mayor impacto que supone para el entorno del paciente y por el apoyo al diagnostico que puede suponer el mayor conocimiento de este trastorno.…”

Section: Discussionunclassified

Prevalencia de anosognosia en la enfermedad de Alzheimer

et al. 2014

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RESUMENFundamento y objetivo: La presencia de anosognosia es un trastorno que afecta a la presentación clínica de la enfermedad de Alzheimer (EA), incrementándose su frecuencia con la evolución de la EA. El objetivo fue determinar la prevalencia de anosognosia y analizar los factores asociados y predictores.Pacientes y método: Estudio multicéntrico transversal, observacional y analítico de 345 pacientes con EA. La anosognosia se evaluó mediante la Anosognosia Questionnaire in Dementia (AQ-D) y el estadio evolutivo con la Global Deterioration Scale (GDS). Se utilizaron los tests MMSE, DAD y NPI para valorar la cognición, el estado funcional y los síntomas neuropsiquiátricos, respectivamente. Se ajustaron modelos de regresión lineal para determinar las variables asociadas y de regresión logística binaria (RLog) para analizar los factores predictores de la anosognosia. Resultados: La prevalencia global de la anosognosia fue del 46,7% (intervalo de confianza del 95% [IC 95%] 41,3-52,1). La prevalencia en los estadios fue de 28,4% (GDS 4), 64,6%(GDS 5) y 91,4% (GDS 6). La RLog identificó como variables predictoras la mayor edad (odds ratio [OR] 1,04; IC 95% 1,01-1,09), la menor capacidad funcional (OR 0,96; IC 95% 0,93-0,98), el menor nivel cognitivo (OR 0,9; IC 95% 0,88-0,99), y la mayor apatía (OR 1,1; IC 95% 1,03-1,18), desinhibición (OR 1,2; IC 95% 1,09-1,50), irritabilidad (OR 1,1; IC 95% 1,09-1,50) y trastornos motores (OR 1,2; IC 95% 1,09-1,50).Conclusiones: La anosognosia se incrementa con el mayor deterioro. En los pacientes en fase leve las variables predictoras fueron la apatía, la desinhibición y los trastornos motores.

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Severity of Dementia, Anosognosia, and Depression in Relation to the Quality of Life of Patients with Alzheimer Disease: Discrepancies Between Patients and Caregivers

Abstract: -Pons I, Garre-Olmo J. Severity of dementia, anosognosia and depression in relation to the quality of life of patients with Alzheimer's disease: discrepancies between patients and caregivers.

Cited by 66 publications

References 46 publications

Quality of life in mild dementia: patterns of change in self and caregiver ratings over time

Quality of life in mild dementia: patterns of change in self and caregiver ratings over time

The Longitudinal Association Between a Discrepancy Measure of Anosognosia in Patients with Dementia, Caregiver Burden and Depression

Prevalencia de anosognosia en la enfermedad de Alzheimer

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