Does cognitive impairment influence burden in caregivers of patients with Alzheimer’s disease?
Germain, Sophie ; Adam, Stéphane ; Olivier, Catherine et al
in Journal of Alzheimer's Disease [=JAD] (2009), 17(1), 105-114
Alzheimer's disease is characterized by a progressive deterioration of various cognitive and behavioral abilities and it also has a health impact on the patients’ caregiver. Our aim was to determine the ... [more ▼]
Alzheimer's disease is characterized by a progressive deterioration of various cognitive and behavioral abilities and it also has a health impact on the patients’ caregiver. Our aim was to determine the patient (and to a lesser extent the caregiver’s) characteristics that contribute most to the caregiver burden. We used the baseline data from the ICTUS study, a European longitudinal cohort of patients with mild to moderate AD. Data from 1091 patients and their caregivers has been used for analysis. Three principal components analyses were performed on variables from the domains of cognition, neuropsychiatric symptoms and daily function using MMSE plus ADAS-Cog, NPI and IADL subscores respectively. These were followed by a stepwise logistic regression to identify patient characteristics which best predict caregiver burden. The regression model (R2 = 0.35, p < .001) shows that the best explanatory variables are (1) neuropsychiatric symptoms (NPI), (2) difficulties in the IADL, (3) time taken by caregiving, (4) demographic variables such as caregiver’s age and patient sex and (5) severity of cognitive impairment. In conclusion, our results demonstrate that although the strongest determinant of the caregiver burden is behavioral disturbance, the impact of the degree of cognitive impairment on burden is also significant. [less ▲]Detailed reference viewed: 140 (37 ULg)
Methodological issues in primary prevention trials for neurodegenerative dementia.
; ; et al
in Journal of Alzheimer's Disease [=JAD] (2009), 16(2), 235-70
The prevention of neurodegenerative dementias, such as Alzheimer's disease, is a public health priority. Due to the large numbers of affected patients, even interventions bringing about a relatively small ... [more ▼]
The prevention of neurodegenerative dementias, such as Alzheimer's disease, is a public health priority. Due to the large numbers of affected patients, even interventions bringing about a relatively small delay in disease onset could have large public health effects. Randomized controlled trials (RCTs) are required to demonstrate the effectiveness of preventive interventions, but such trials raise specific methodological questions because they are new in the field of neurodegenerative diseases, and require large numbers of elderly subjects and lengthy follow-up periods. We performed a literature search to identify primary prevention RCTs for neurodegenerative dementia. The methodology of the trials was summarized and discussed during two expert meetings. Overall, 39 trials were identified that assessed dementia incidence or cognitive decline as a primary or secondary study outcome. Age was the most common selection criteria for target populations. Follow-up periods ranged from one month to nine years and were longest in studies measuring dementia incidence as an outcome. Results of RCTs have so far been generally negative and conflicting with those of observational studies, perhaps due to methodological issues. Future trials must therefore carefully consider the target population, outcomes and duration of follow-up to be used, and should assess the problem of attrition. [less ▲]Detailed reference viewed: 96 (2 ULg)
New assessment of dependency in demented patients : impact on the quality of life in informal caregivers.
; ; et al
in Psychiatry & Clinical Neurosciences (2007), 61(3), 234-242Detailed reference viewed: 34 (18 ULg)