BACKGROUND: Nursing home residences suffered a lockdown from the beginning of the COVID-19 pandemic. The present study prospectively evaluates the frailty, functional, and nutritional statuses of nursing home residents. METHODS: Three hundred and one residents from three nursing homes took part in the study. Frailty status was measured using the FRAIL scale. Functional status was evaluated using the Barthel Index. Additionally, Short Physical Performance Batter (SPPB), SARC-F, hand-grip strength, and gait speed were also evaluated. Nutritional status was determined using the mini nutritional assessment test (MNA) and several anthropometrical and biochemical markers. RESULTS: Mini Nutritional Assessment test scores decreased in 20% throughout the confinement (p < .001). Barthel index, SPPB and SARC-F scores also decreased, although to a lesser extent, reflecting a decrease in functional capacity. However, both anthropometric parameters, hand grip strength and gait speed, remained stable throughout confinement (p > .050 in all cases). Morning cortisol secretion significantly decreased by 40% from baseline to post-confinement. A significant reduction in daily cortisol variability was observed, which may suggest increased distress. Fifty-six residents died during the period of confinement (81.4% survival rate). Sex, FRAIL and Barthel Index scores were significant predictors of resident survival. CONCLUSION: After the first COVID-19 blockade, several alterations in residents' frailty markers were observed, which were small and potentially reversible. However, many of the residents were pre-frail after the lockdown. This fact highlights the need for preventive strategies to reduce the impact of future social and physical stressors on these vulnerable individuals.
COVID-19 , Frailty , Humans , Aged , Prospective Studies , Hand Strength , Hydrocortisone , Pandemics , Geriatric Assessment , COVID-19/epidemiology , Communicable Disease Control , Nutritional Status , Nursing Homes , Frail Elderly
Nowadays, there are plenty of programs and resources to prevent caregiver burden of patients with Alzheimer's disease. In spite of that, many caregivers suffer high levels of burden and stress, which leads to an earlier institutionalization of patients. This study aimed to explore the predictors of burden in relative caregivers of patients attending day-care centers and the moderating role of caregiver kinship in these associations. A sample of a hundred and two patient-caregiver dyads was recruited. Burden was measured with a Zarit Burden Interview. Measures of patients' cognition, insight, depression, behavioral disturbances, functional ability and overall physical health were considered as predictors. We found that apathy, irritability and delusions and, patients' mobility are the main determinants of caregivers' burden. The strength of relationship between delusions and irritability was higher in spouse caregivers. Interventions to reduce burden should be adapted to the specific needs of a particular type caregiver.
Alzheimer Disease , Activities of Daily Living , Caregiver Burden , Caregivers , Cost of Illness , Humans
Many studies that assess efficiency in health systems are based on output mean values. That approach ignores the representativeness of the average statistic, which can become a serious problem in estimation. To solve this question, this research contributes in three different ways: the first aim is to evaluate the technical efficiency in the management of European health systems considering a set of DEA (Data Envelopment Analysis) and FDEA (Fuzzy Data Envelopment Analysis) models. A second goal is to assess the bias in the estimation of efficiency when applying the conventional DEA. The third objective is the evaluation of the statistical relationship between the bias in the efficiency estimation and the macroeconomic variables (income inequality and economic freedom). The main results show positive correlations between DEA and FDEA scores. Notwithstanding traditional DEA models overestimate efficiency scores. Furthermore, the size of the bias is positively related to income inequality and negative with economic freedom in the countries evaluated.
BACKGROUND: Music interventions are promising therapies for the management of symptoms in Alzheimer's disease (AD). Globally, music interventions can be classified as active or receptive depending on the participation of the subjects. Active and receptive music tasks engage different brain areas that might result in distinctive clinical effects. This study aims to compare the clinical effects of two types of music interventions and a control activity. METHODS: Ninety AD patients from six nursing homes participated in the study. Nursing homes were randomly and blindly assigned to receive either active music intervention, receptive music intervention, or the usual care. Effects on cognition, behaviour, daily living activities, and motor function were assessed. RESULTS: Active music intervention improved cognition, behaviour, and functional state in a higher extent than both receptive music intervention and usual care. The effect size of active music intervention for cognitive deficits and behavioural symptoms was large (η2 = 0.62 and 0.61, respectively), while for functional state, it was small-to-medium sized (η2 = 0.18). Receptive music intervention had a stabilizing effect on behavioural symptoms compared to control intervention (mean change from baseline ± standard deviation = -0.76 ± 3.66 and 3.35 ± 3.29, respectively). In the active music intervention, the percentage of patients who showed improvement in cognitive deficits (85.7), behavioural symptoms (92.9), and functional state (46.4) was higher than in both receptive listening (11.8, 42.9, and 14.3, respectively) and control group (6.3, 12.2, and 17.1, respectively). CONCLUSIONS: Active music intervention is useful to improve symptoms of AD and should be prescribed as a complement to the usual treatment.
Alzheimer Disease , Music Therapy , Music , Activities of Daily Living , Alzheimer Disease/therapy , Humans , Nursing Homes
Neuropsychiatric symptoms (NPS) are common in Alzheimer disease (AD) patients, especially in women. Stress and stress-vulnerability factors (eg, poor social support) may trigger NPS. This cross-sectional study (n=196) aimed to examine the moderating effect of sex on the relationships between both perceived social support and salivary cortisol levels and NPS of AD patients. Only in women, greater cortisol levels were associated with higher scores in Neuropsychiatric Inventory mood, agitation, and frontal subscales whereas higher Psychosocial Support Questionnaire scores were related to lower scores in Neuropsychiatric Inventory mood and psychosis subscales. Given the relevance that sex differences might have on the design of preventive strategies, present findings should be confirmed in longitudinal studies.
Alzheimer Disease , Cross-Sectional Studies , Female , Humans , Independent Living , Male , Neuropsychological Tests , Social Support , Spain
BACKGROUND: Nursing students experiencing high stress levels before exams could suffer worse academic performance. OBJECTIVE: We evaluated an intervention combining Progressive Muscle Relaxation (PMR) and music therapy on the decrease of before exams stress and the improvement of academic results. DESIGN AND METHODS: Randomized controlled trial including students from the Nursing Degree during the first semester of the 2017-2018 academic year. All participants were randomized to the control (CG) or the experimental group (EG). The CG took the exam as usual whereas in the EG, PMR and music therapy were performed before exams. Blood samples were drawn to investigate variations in biochemical parameters. The academic performance was assessed by the score obtained in the "Clinical Nursing" exam. RESULTS: We included 112 students (75% females, mean age 24.3⯱â¯6.2â¯years, 56 students in every group). There were no differences in any parameter during the first measurement. Regarding the second measurement, we observed a reduction in heart rate for the EG and an increase in blood pressure, heart rate, and cortisol for the CG. Indeed, these parameters were significantly higher compared to the EG. The EG had a mean score of 5.07⯱â¯1.59 in the Clinical Nursing exam, which was significantly higher compared to the CG (4.42⯱â¯1.58, pâ¯=â¯0.033). The proportion of fails in the CG was also higher (62.5% vs. 42.9%, pâ¯=â¯0.037). CONCLUSION: In this study including students from the Nursing degree, the combination of PMR and music therapy was effective for the control and decrease of stress before exams, and also demonstrated improvements in academic results.
Academic Performance/standards , Autogenic Training/standards , Music Therapy/standards , Students, Nursing/psychology , Academic Performance/statistics & numerical data , Adolescent , Adult , Autogenic Training/methods , Autogenic Training/statistics & numerical data , Blood Pressure/physiology , Education, Nursing, Baccalaureate/methods , Educational Measurement/methods , Female , Heart Rate/physiology , Humans , Male , Music Therapy/methods , Music Therapy/statistics & numerical data , Statistics, Nonparametric , Stress, Psychological/psychology , Stress, Psychological/therapy , Students, Nursing/statistics & numerical data
Antecedentes y objetivos: La enfermedad de Steinert o distrofia miotónica tipo 1 (DM1), (OMIM 160900) es la miopatía más prevalente en el adulto. Es una enfermedad multisistémica con alteración de prácticamente todos los órganos y tejidos y una variabilidad fenotípica muy amplia, lo que implica que deba ser atendida por diferentes especialistas que dominen las alteraciones más importantes. En los últimos años se ha avanzado de manera exponencial en el conocimiento de la enfermedad y en su manejo. El objetivo de la guía es establecer recomendaciones para el diagnóstico, el pronóstico, el seguimiento y el tratamiento de las diferentes alteraciones de la DM1. Material y métodos: Esta guía de consenso se ha realizado de manera multidisciplinar. Se ha contado con neurólogos, neumólogos, cardiólogos, endocrinólogos, neuropediatras y genetistas que han realizado una revisión sistemática de la literatura. Recomendaciones: Se recomienda realizar un diagnóstico genético con cuantificación precisa de tripletes CTG. Los pacientes con DM1 deben seguir control cardiológico y neumológico de por vida. Antes de cualquier cirugía con anestesia general debe realizarse una evaluación respiratoria. Debe monitorizarse la presencia de síntomas de disfagia periódicamente. Debe ofrecerse consejo genético a los pacientes con DM1 y a sus familiares. Conclusión: La DM1 es una enfermedad multisistémica que requiere un seguimiento en unidades especializadas multidisciplinares
Background and objectives: Steinert's disease or myotonic dystrophy type 1 (MD1), (OMIM 160900), is the most prevalent myopathy in adults. It is a multisystemic disorder with dysfunction of virtually all organs and tissues and a great phenotypical variability, which implies that it has to be addressed by different specialities with experience in the disease. The knowledge of the disease and its management has changed dramatically in recent years. This guide tries to establish recommendations for the diagnosis, prognosis, follow-up and treatment of the complications of MD1. Material and methods: Consensus guide developed through a multidisciplinary approach with a systematic literature review. Neurologists, pulmonologists, cardiologists, endocrinologists, neuropaediatricians and geneticists have participated in the guide. Recommendations: The genetic diagnosis should quantify the number of CTG repetitions. MD1 patients need cardiac and respiratory lifetime follow-up. Before any surgery under general anaesthesia, a respiratory evaluation must be done. Dysphagia must be screened periodically. Genetic counselling must be offered to patients and relatives. Conclusion: MD1 is a multisystemic disease that requires specialised multidisciplinary follow-up
Humans , Myotonic Dystrophy/diagnosis , Myotonic Dystrophy/physiopathology , Prognosis , Follow-Up Studies , Myotonic Dystrophy/genetics , Neurophysiology , Family Development Planning , Prenatal Diagnosis , Myotonia , Neuroimaging
Obesity has been associated with impaired cognitive performance. This study aimed to determine whether improvements in cognitive function may contribute to higher weight loss in patients with obesity. In this randomised, 12-week trial, participants with overweight/obesity were randomised into a cognitive training intervention (Cognitive) group or a cognitive-behavioural (Control) group. In addition, both groups followed a hypocaloric dietary treatment. Cognitive functioning measurements and anthropometrical parameters were evaluated. All cognitive measures improved in the intervention group (p < 0.005 in all contrasts). In controls, significant improvements in attention, flexibility and task planning were also observed. Regarding anthropometrical parameters, the effect of the intervention in the cognitive group was higher for the total percentage of weight loss, body mass index (BMI), body fat and waist circumference. Biochemical parameters improved in both groups. Attending to our data, cognitive training was more effective that the hypocaloric intervention alone, partly related to an improvement in the working memory. Despite the shortage of training interventions for executive functions in the context of weight control, this type of combined intervention could establish the first steps towards a more appropriate intervention for patients with obesity.
Cognitive Behavioral Therapy , Diet, Reducing , Energy Intake , Overweight/therapy , Adult , Cognition Disorders , Female , Humans , Male , Middle Aged
BACKGROUND AND OBJECTIVES: Steinert's disease or myotonic dystrophy type 1 (MD1), (OMIM 160900), is the most prevalent myopathy in adults. It is a multisystemic disorder with dysfunction of virtually all organs and tissues and a great phenotypical variability, which implies that it has to be addressed by different specialities with experience in the disease. The knowledge of the disease and its management has changed dramatically in recent years. This guide tries to establish recommendations for the diagnosis, prognosis, follow-up and treatment of the complications of MD1. MATERIAL AND METHODS: Consensus guide developed through a multidisciplinary approach with a systematic literature review. Neurologists, pulmonologists, cardiologists, endocrinologists, neuropaediatricians and geneticists have participated in the guide. RECOMMENDATIONS: The genetic diagnosis should quantify the number of CTG repetitions. MD1 patients need cardiac and respiratory lifetime follow-up. Before any surgery under general anaesthesia, a respiratory evaluation must be done. Dysphagia must be screened periodically. Genetic counselling must be offered to patients and relatives. CONCLUSION: MD1 is a multisystemic disease that requires specialised multidisciplinary follow-up.
Myotonic Dystrophy/diagnosis , Follow-Up Studies , Humans , Myotonic Dystrophy/complications , Practice Guidelines as Topic
Objectives: Chronic stress has shown to have marked effects on learning and memory. A broader understanding of these effects has special interest in the context of Alzheimer's disease (AD). This study aims to analyze the moderating effect of cognitive impairment in the relationships between stress and verbal memory performance by considering biological and psychological measures of stress. Method: The sample consisted of 80 AD patients and 104 healthy controls. Salivary cortisol and state anxiety was measured as stress markers. Memory Alteration test (M@T) and Hopkins verbal learning test (HVLT-R) were used to measure verbal memory. Results: In controls, cortisol level was negatively associated with HVLT-R total, learning and delayed recall scores as well as M@T free recall scores, while in patients, such associations were not significant. In this group, cortisol negative effects were limited to HVLT-R learning and M@T semantic memory scores. In both groups, anxiety was associated with better M@T encoding and free recall scores. Besides, inverted U-shaped relationships were observed between anxiety and HVLT-R total recall and learning scores as well as M@T orientation scores. Conclusion: Cortisol levels and anxiety are differentially associated with memory performance in older adults. In general, the negative relationship between cortisol levels and memory observed in healthy elderly weakens in AD. However, moderate state anxiety levels seem to be associated with a better memory performance in AD patients and in healthy elderly.
Alzheimer Disease/psychology , Anxiety/psychology , Hydrocortisone/physiology , Memory , Stress, Psychological/psychology , Verbal Learning , Aged , Alzheimer Disease/physiopathology , Anxiety/physiopathology , Case-Control Studies , Female , Humans , Hydrocortisone/analysis , Male , Psychiatric Status Rating Scales , Saliva/chemistry , Stress, Psychological/physiopathology
The current economic crisis has increased the interest in analyzing the efficiency of health care systems, as their funding is a very important part of the budgets for different countries. In this work determines the efficiency in the health services in European countries applying data envelopment analysis. In addition, the combined application of data envelopment analysis methods and ACP can provide an evaluation of the efficiency with respect to differently oriented productive health systems in the different countries. The results show that models with a lower level of efficiency are those whose input is beds, followed by the models whose input is physicians. Finally, we apply the AD to select a few simple indicators that facilitate control of the level of operational efficiency of a health system.
Delivery of Health Care/organization & administration , Efficiency, Organizational , Europe , Humans , Models, Organizational , Quality Indicators, Health Care , Quality of Health Care/organization & administration
ABSTRACTObjective:We aimed at examining the relation between stress markers (cortisol levels and state anxiety) with memory for emotional information in AD patients and in healthy elderly. DESIGN, SETTING, AND PARTICIPANTS: Baseline and changes in stress markers during memory testing were assessed in a sample of 98 elderly (46 mild-to-moderate Alzheimer's disease patients and 52 controls) recruited from dementia day centers and adult day centers, respectively. MEASUREMENTS: Salivary cortisol, state anxiety, and measures of immediate recall and delayed recognition using the International Affective Pictures System. RESULTS: Patients' performance in memory tasks was not associated with either cortisol levels or anxiety. In controls, quadratic and linear associations were found between cortisol and immediate recall scores (total and bias, respectively). Besides, quadratic and linear associations were observed between anxiety and delayed recognition scores (total and bias, respectively). CONCLUSIONS: The emotional memory of patients with Alzheimer´s disease is not related to stress markers as healthy older adults' is. Future studies that include moderating variables are needed to explain the lack of association.
Alzheimer Disease/psychology , Anxiety/psychology , Hydrocortisone/chemistry , Saliva/chemistry , Stress, Psychological/complications , Aged , Aged, 80 and over , Biomarkers/chemistry , Case-Control Studies , Female , Humans , Male , Mental Recall , Neuropsychological Tests , Regression Analysis , Spain
BACKGROUND: An understanding of the determinants of quality of life in Alzheimer's disease (AD) is required in order to develop effective interventions to promote patients' well-being. Most studies have pointed out depression, functional ability and environmental factors. However, unmeasured confounders can jeopardize the interpretation of the results. OBJECTIVES: To explore the mediating role of depression in the association between functional status and QoL, and establish a procedure to detect confounding variables. METHODS: A sample of 192 AD patients and their respective caregivers were recruited from day centers and health care centers in the region of Murcia (Spain). The mediating effect was evaluated using causal mediation analysis. Covariates were introduced into the model in a stepwise fashion and sensitivity analyses were performed to assess the influence of potential confounders. RESULTS: Self-rated depression acted as a partial mediator between functional status and quality of life. The mediating effect was positive and significant even after including both patient- and caregiver-related covariates. Only if confounders explained more than 80% of the residual variance in the mediator or in the outcome, the mediating effects would not be positive. CONCLUSIONS: The effect of lack of autonomy on the QoL is mostly explained by the negative consequences on mood status. The sensitivity analysis confirms the robustness of this finding.
Activities of Daily Living , Alzheimer Disease/psychology , Depression/psychology , Disabled Persons/psychology , Quality of Life , Aged , Aged, 80 and over , Alzheimer Disease/complications , Caregivers/psychology , Cognition , Cross-Sectional Studies , Depression/complications , Disability Evaluation , Female , Geriatric Assessment , Humans , Male , Negotiating , Regression Analysis , Self Report
Alzheimer's disease (AD) is the main cause of dementia worldwide, which implies an important socioeconomic problem in developed countries. Efforts to find biomarkers to diagnose AD have been intensified, especially, to detect cognitive impairment in its early stages, also known as mild cognitive impairment (MCI). Besides, there are individuals referring memory loss that is unnoticeable in the family environment and presenting normal neuropsychological tests. The former patients are included in a clinical picture that has been recently called subjective memory complaints (SMC). To achieve an early diagnosis, optical coherence tomography (OCT) has been used to measure macular thickness in patients diagnosed with MCI (supported by neuropsychological tests) and SMC (not based on neuropsychological battery). Statistically significant differences have been found in the macular thickness of the control group (274.96 ± 17.61 µm) and for both MCI (259.48 ± 22.39 µm) and SMC (261.45 ± 24.26 µm) patients. In the near future, OCT could become a reliable biomarker and a useful tool for AD screening as well as for the monitoring of the cognitive impairment associated with AD.
Introducción. La enfermedad de Alzheimer (EA) es la primera causa de demencia mundial. Cada vez son más los esfuerzos para lograr una detección temprana del deterioro cognitivo y surgen en el panorama científico entidades diagnósticas como el deterioro cognitivo leve (DCL) y las quejas subjetivas de memoria (QSM). Debido a ello, aparecen numerosos biomarcadores estudiados para conseguir dicho objetivo, entre ellos la tomografía de coherencia óptica. Sujetos y métodos. Se ha realizado un estudio que utiliza la tomografía de coherencia óptica para medir el grosor macular y la capa de fibras nerviosas de la retina en pacientes diagnosticados de EA (n = 36), pacientes con DCL (n = 33), en individuos con QSM (n = 24) y en sujetos control (n = 45). Resultados. Se han encontrado diferencias estadísticamente significativas en cuanto al grosor macular entre todos los grupos estudiados (QSM: 261,8 ± 25,88 μm; DCL: 259,19 ± 22,582 μm; EA leve: 258,53 ± 14,804 μm; EA moderada: 249,32 ± 18,467 μm) y sujetos control (271,96 ± 15,57 μm). Respecto a la capa de fibras nerviosas de la retina, ocurre de igual manera, y la diferencia es estadísticamente significativa frente al grupo control (94,51 ± 9,203 μm) de todos los grupos (QSM: 90,44 ± 9,059 μm; DCL: 89,4 ± 10,421 μm; EA leve: 87,12 ± 10,279 μm; EA moderada: 82,25 ± 10,636 μm). Conclusión. La tomografía de coherencia óptica podría situarse como un futuro biomarcador y una herramienta de apoyo para facilitar el diagnóstico precoz del deterioro cognitivo y de la EA (AU)
Introduction. Alzheimers disease (AD) is the leading cause of dementia in the world today. Increasingly greater efforts are being made to be able to detect cognitive impairment in earlier stages, and diagnostic entities such as mild cognitive impairment (MCI) and subjective memory complaints (SMC) are appearing. The number of biomarkers studied with the aim of reaching this goal continues to rise, and include optical coherence tomography. Subjects and methods. The study conducted employed optical coherence tomography to measure the macular thickness and the retinal nerve fibre layer in patients diagnosed with AD (n = 36), in patients with MCI (n = 33), in individuals with SMC (n = 24) and in control subjects (n = 45). Results. Statistically significant differences have been found in terms of the macular thickness among all the groups studied (SMC: 261.8 ± 25.88 μm; MCI: 259.19 ± 22.582 μm; mild AD: 258.53 ± 14.804 μm; moderate AD: 249.32 ± 18.467 μm) and control subjects (271.96 ± 15.57 μm). The same occurs as regards the retinal nerve fibre layer and the difference is statistically significant compared with the control group (94.51 ± 9.203 μm) of all the groups (SMC: 90.44 ± 9.059 μm; MCI: 89.4 ± 10.421 μm; mild AD: 87.12 ± 10.279 μm; moderate AD: 82.25 ± 10.636 μm). Conclusion. Optical coherence tomography could be a future biomarker and support tool to facilitate the early diagnosis of cognitive impairment and AD (AU)
Humans , Tomography, Optical Coherence/methods , Dementia/diagnosis , Alzheimer Disease/diagnosis , Cognitive Dysfunction/diagnosis , Macular Degeneration/diagnosis , Biomarkers/analysis , Case-Control Studies , Memory Disorders/diagnosis , Aging
UNLABELLED: BACKGROUND/STUDY CONTEXT: Quality of life (QoL) has become an important outcome measure in clinical trials for Alzheimer's disease (AD). The Quality of Life in Alzheimer's Disease (QoL-AD) Scale is widely used for assessing QoL of patients with AD. This research aims to determine the factor structure of the QoL-AD Scale in AD patients. METHODS: One hundred thirty-nine patients with mild-to-moderate AD were administered the QoL-AD Scale. Based on the model proposed for healthy people, confirmatory factor models were built using modification indices and residual analysis to improve the model fit. RESULTS: Confirmatory factor analysis indicated poor fit for both the initial model and the single-factor model. Two models showed a good fit: a three-factor model (perceived health, perceived environment and perceived functional ability) and a two-factor model (perceived physical health and perceived psychological health). Because no differences in fit were found between both models, the authors proposed the more parsimonious solution as the best model. CONCLUSION: These results provide evidence supporting the construct validity of the QoL-AD Scale. This instrument seems to measure the perception of two related constructs (behavioral competence and environment) and could be used together with instruments measuring psychological well-being and the perception of health.
Activities of Daily Living , Aging/psychology , Alzheimer Disease/psychology , Disability Evaluation , Quality of Life/psychology , Aged , Aged, 80 and over , Alzheimer Disease/diagnosis , Factor Analysis, Statistical , Female , Follow-Up Studies , Humans , Male , Mental Status Schedule , Retrospective Studies , Surveys and Questionnaires
Fundamento y objetivo. Para el desarrollo de la investigación y la práctica clínica centrada en el paciente con demencia, es esencial considerar variables subjetivas reportadas por el propio sujeto como la calidad de vida. La finalidad de este trabajo es medir la calidad de vida de los pacientes con enfermedad de Alzheimer (EA) según una doble perspectiva (paciente y cuidador) y estimar el acuerdo entre ambos evaluadores. Material y métodos. Se administró la escala QoL-AD a 40 díadas formadas por pacientes con EA leve y sus cuidadores. Se obtuvo la matriz de correlaciones, se realizó un análisis comparativo de las valoraciones y se midió el acuerdo en las puntuaciones totales y en cada ítem. Resultados. Las puntuaciones totales otorgadas por los pacientes en la escala QoL-AD fueron significativamente superiores a las de sus cuidadores, siendo el tamaño del efecto moderado. Las puntuaciones de pacientes y cuidadores en los ítems 1-3, 6, 9 y 13 se correlacionaron significativa y positivamente. El acuerdo paciente-cuidador fue significativo y moderado para las puntuaciones totales y sin significado clínico en el examen ítem a ítem. Conclusiones. Los pacientes tienen una percepción de su calidad de vida más positiva que sus cuidadores; además, el acuerdo entre observadores es débil. Sería de interés analizar los factores de pacientes y cuidadores que contribuyen a estas diferencias y considerar otras fuentes de información complementarias en los casos en que exista una alta discrepancia(AU)
Introduction and objective. Assessing subjective, patientreported outcomes such as quality of life (QoL) is crucial to patient-centered health care and research. This study aims to evaluate QoL as perceived patients with Alzheimers disease (AD) and their caregivers and to measure agreement between raters. Subjects and methods. QoL-AD scale was administered to 40 mild AD patients and their caregivers. ANOVA and correlational analyses were performed and agreement was estimated for both total scores and each items score. Results. Patients ratings on all items were significantly higher than caregivers ratings with moderate size effect. Significant positive correlations between patients ratings and caregivers ratings were found for item 1, 2, 3, 6, 9 and 13. Patient-caregiver agreement was significant but only moderate for total scores. Moreover, the agreement on each item was not clinically significant. Conclusions. Not only have patients a more positive perspective of their QoL, but patient-caregiver agreement is not satisfactory as well. It would be advisable to determine the factors predicting agreement and search for complementary information when there was high discrepancy(AU)
Humans , Male , Female , Quality of Life/psychology , Alzheimer Disease/diagnosis , Psychiatric Status Rating Scales/statistics & numerical data , Psychiatric Status Rating Scales/standards , Alzheimer Disease/psychology , Analysis of Variance , Caregivers/psychology , Caregivers , 28599 , Statistics, Nonparametric
BACKGROUND: Alzheimer's disease (AD) is a chronic medical condition with symptoms that compromise patients' quality of life (QoL). The identification of the factor predicting QoL in AD is essential to develop more effective interventions. Recent research suggests that these factors could be different for the distinct informants. This study explores the QoL predictors considering three different sources of information: patients, caregivers, and healthcare staff. METHODS: In this cross-sectional study, a sample of 102 patients, their primary caregivers, and 15 members of the healthcare staff evaluated patients' QoL (QoL-AD Scale). Patients' and caregivers' demographic and clinical data (cognitive function, neuropsychiatric symptoms, depression, and caregivers' burden) were considered as QoL predictors. RESULTS: In multivariate-adjusted linear regression analyses, we observed that patients' ratings were mainly affected by their mood whereas caregivers' ratings were also negatively influenced by patients' irritability and burden. According to staff ratings, both psychotic symptoms and neuroleptics were associated with lower QoL. CONCLUSIONS: Our findings suggest that depression is the main variable related to patients' QoL and that more careful management of neuropsychiatric disorders is necessary. Both proxies' ratings are not equivalent to patients' reports in terms of predictors but they are complementary. Thus, a thorough QoL assessment should consider separately the perspective of the different informants.
Alzheimer Disease , Antipsychotic Agents/therapeutic use , Caregivers/psychology , Health Personnel/psychology , Mental Competency , Quality of Life , Aged , Aged, 80 and over , Alzheimer Disease/complications , Alzheimer Disease/diagnosis , Alzheimer Disease/psychology , Attitude of Health Personnel , Behavioral Symptoms/etiology , Cognition Disorders/etiology , Cross-Sectional Studies , Female , Humans , Interpersonal Relations , Irritable Mood/drug effects , Male , Psychiatric Status Rating Scales , Psychotic Disorders/drug therapy , Psychotic Disorders/etiology , Regression Analysis , Sickness Impact Profile , Spain
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Immunoglobulin G/adverse effects , Multiple Sclerosis/chemically induced , Adult , Arthritis, Psoriatic/drug therapy , Etanercept , Female , Glucocorticoids/therapeutic use , Humans , Magnetic Resonance Imaging/methods , Methylprednisolone Hemisuccinate/therapeutic use , Multiple Sclerosis/cerebrospinal fluid , Multiple Sclerosis/drug therapy , Multiple Sclerosis/pathology , Prednisolone/therapeutic use , Receptors, Tumor Necrosis Factor , Tumor Necrosis Factor-alpha/cerebrospinal fluid
