Longitudinal effect of dementia carers' sense of coherence on burden.

BACKGROUND: A sense of coherence (SOC) could help us better understand why there are individuals who cope better than others in similar situations. The study aimed to assess the effect of SOC on the course of burden reports in relatives of persons with dementia. METHODS: This was a prospective cohort study of 156 dementia carers. The SOC was assessed by the Orientation to Life Questionnaire (OLQ-13), burden by Burden Interview, and personal and contextual characteristics were collected via ad hoc questions. The main dementia symptoms, including functional difficulties (Disability Assessment for Dementia), neuropsychiatric symptoms (Neuropsychiatric Inventory), and cognitive impairment (Mini-Mental State Examination), were also assessed. A general linear model was adjusted to determine the effect of SOC and other covariates on burden throughout the follow-up. Burden differences between baseline and 12 and 24 months were analysed, and the baseline OLQ-13 score was grouped by quartiles. RESULTS: The global burden reported increased after 24 months (F = 9.98; df = 2; p < 0.001), but not equally for all carers; daughters reported the greatest increase. SOC, functional disability, and neuropsychiatric disorders showed a significant effect on burden, but time did not. Carers with higher SOC at baseline tend to remain with lower burden levels, whereas carers with low SOC reported higher burden at each visit. CONCLUSIONS: This study reports evidence of the effect of SOC on burden at baseline, 12 and 24 months of follow-up. Burden scores differ by carers' SOC; those with higher SOC showed lower burden levels, whereas the low-SOC group reported a greater burden at each visit.

Caregivers' Sense of Coherence: Implications on Direct and Indirect Costs of Dementia Care.

BACKGROUND: Dementia care is associated with physical, emotional, and monetary impact on the informal carers providing unpaid care. Differences in the personal characteristics of caregivers may help explain the variations in the costs of dementia care. OBJECTIVE: The aim of this study was to analyze the effect of caregivers' sense of coherence (SOC) on direct and indirect costs in dementia care. METHODS: A cross-sectional study was conducted in community dwelling caregivers of patients with Alzheimer's disease. Data of healthcare services were obtained from clinical registries, and information was collected from caregivers regarding their use of social care resources and time spent caregiving. The transformation of all costs into Euros was made assigning a fixed cost of 10.29 € /h and 16.24 € /h for assisting in instrumental and basic activities of daily living, respectively. Caregivers' SOC was assessed using the Orientation to Life Questionnaire (OLQ-13). Adjusted regression models were developed, with different types of costs as dependent variables. RESULTS: A sample of 147 caregivers was recruited. The mean OLQ-13 score was 73.3 points (SD = 11.6). The regression models showed a small association between caregivers' SOC and direct costs, mainly linked to the use of social care resources (r2 = 0.429; ß= -15.6 € /month), and a greater association between SOC and indirect costs (r2 = 0.562; ß= -222.3 € /month). CONCLUSION: Increasing caregivers' SOC could reduce dementia care costs by decreasing the use of social care resources and caregiving time.

Antonovsky's sense of coherence and resistance resources reduce perception of burden in family carers of people with Alzheimer's disease.

Objectives: Taking care of people with dementia (PWD) has been associated with some degree of burden. The variability of the carer's burden can be partially explained by their personal characteristics. Antonovsky's model of health defined the resistance resources (RRs) as essential mechanisms to cope with stressors, and to shape the personal sense of coherence (SOC). This study identifies the RRs related with carer's SOC, and their implications in the perception of burden in family dementia carers.Methods: A sample of 308 participants from the 'SOC & DEM study' (154 carers and 154 PWD) was recruited from two memory clinics. Carer's personal characteristics of burden, SOC, self-efficacy, coping strategies, perceived social support, and depression were evaluated using standardized instruments. PWD's degree of dependence and behaviour and psychological symptoms of dementia (BPSD) were assessed too. A path analysis was used to test the relationship between caregiver burden and SOC including the personal RRs of the carers and clinical data of PWD.Results: The path model identified SOC as a major factor related to carer's burden perception (r = -.327). Self-efficacy (r = .285), two coping strategies, 'use instrumental support' (r = -.235) and 'behavioural disengagement' (r = -.219), and social support perceived (r = .304) were the main carer's personal characteristics directly related with SOC. Caring experience (r = -.281) was the main carer factor related with burden while dependence (r = .156) and BPSD (r = .157) were the dementia factors.Conclusion: The SOC has previously related with carer's burden. The results contributed to identify relevant and modifiable personal characteristics as RRs that could reduce this burden.

Síntomas depresivos y sobrecarga en los familiares cuidadores en la enfermedad de Alzheimer: un modelo de ecuaciones estructurales / Depressive symptoms and burden in family caregivers in Alzheimer’s disease: a model of structural equations

Introducción. El cuidado de los pacientes con enfermedad de Alzheimer incrementa la sobrecarga y la depresión del cuidador principal, aunque la relación entre ambas no está claramente definida. Objetivos. Explorar los factores asociados a la sintomatología depresiva y la sobrecarga en el cuidador principal y aplicar un modelo de ecuaciones estructurales para identificar la relación entre ellas. Sujetos y métodos. La muestra estuvo formada por 127 cuidadores familiares de personas con enfermedad de Alzheimer, con un seguimiento de 24 meses. Se realizaron análisis de regresión multivariante para identificar las características de pacientes y cuidadores asociadas a la sobrecarga y la depresión del cuidador principal, y se diseñó un modelo de ecuaciones estructurales para analizar la relación entre las variables. Resultados. En el modelo de ecuaciones estructurales, la sobrecarga tuvo un efecto directo sobre la depresión, tanto en la evaluación basal como a los 24 meses. Las variables asociadas a la sobrecarga fueron: la escolaridad y la menor salud mental del cuidador principal, y las alteraciones conductuales y la dependencia funcional del paciente. El menor nivel cognitivo del paciente y la menor salud mental del cuidador principal estuvieron asociados a la depresión. La correlación entre sobrecarga y depresión aumentó desde la evaluación basal hasta los dos años (r = 0,47 frente a r = 0,613). Conclusiones. El deterioro del paciente y la sobrecarga son factores de riesgo para la depresión en el cuidador principal. Serían necesarias intervenciones para reducir la carga y poder prevenir la depresión relacionada

Introduction. The care of patients with Alzheimer’s disease increases the burden and depression of the main caregiver, although the relationship between the two is not clearly defined. Aims. To explore the factors associated with depressive symptomatology and burden in the main caregiver and to apply a model of structural equations to identify the relationship between them. Subjects and methods. The sample consisted of 127 family caregivers of people with Alzheimer’s disease, with a follow-up of 24 months. Multivariate regression analyses were performed to identify the characteristics of patients and caregivers associated with burden and depression of the main caregiver, and a model of structural equations was designed to analyse the relationship between the variables. Results. In the model of structural equations, the burden had a direct effect on depression, both in the baseline assessment and at 24 months. The variables associated with burden were: schooling and the lower mental health of the main caregiver; and the behavioral alterations and the functional dependency of the patient. The lower cognitive level of the patient and the lower mental health of the main caregiver were associated with depression. The correlation between burden and depression increased from baseline to two years (r = 0.470 vs. r = 0.613). Conclusions. The deterioration of the patient and caregiver burden are risk factors for depression in the main caregiver. Interventions would be necessary to reduce the burden and prevent related depression

Depresión y variables asociadas en personas mayores de 50 años en España / Depression and associated variables in people over 50 years in Spain

Introducción: La depresión es un trastorno psiquiátrico incapacitante y frecuente en la edad adulta asociado a mayor mortalidad y discapacidad funcional. Objetivos: Determinar la asociación de las variables clínicas y sociodemográficas con la depresión, en una muestra de personas mayores de 50 años residentes en España, y comparar la prevalencia de depresión con los demás países del estudio Survey of Health, Ageing and Retirement in Europe (SHARE). Material y métodos: Muestra de 5.830 participantes de la muestra española de la «Wave 5», de 2013, del estudio SHARE. Instrumentos: EURO-D (depresión) y CASP-12 (calidad de vida). Análisis estadístico: bivariante y logístico binario. Resultados: En la regresión logística binaria, las variables asociadas a la depresión (EURO-D ≥4) fueron, principalmente, la mala percepción de salud física (OR=13,34; IC 95%: 9,74-18,27), la presencia de más de 2 dificultades en las actividades de la vida diaria (AVD) (OR=4,46; IC 95%: 3,13-6,34) y el género femenino (OR=2,16; IC 95%: 1,83-2,56). La depresión fue más frecuente en los participantes que padecían Alzheimer (76,4%), trastornos emocionales (73,9%), Parkinson (57,4%), fractura de cadera (55,4%) y reumatismos (50,9%). En la comparación con países europeos, España tenía un porcentaje de personas con depresión (29,3%) superior a la media europea (27,9%). Conclusiones: Las variables más relevantes asociadas a la depresión fueron la mala percepción de salud física, la presencia de dificultades en las AVD y el género femenino

Introduction: Depression is a common and disabling psychiatric disorder in adulthood and is associated with higher mortality and functional disability. Objectives: To determine the association between clinical and sociodemographic variables with depression in a sample of people over 50 years old living in Spain, and compare the prevalence of depression with the other Survey of Health, Ageing and Retirement (SHARE) countries. Material and methods: There were 5,830 participants in the Spanish sample of the Wave 5, 2013, of SHARE. Tools used: EURO-D (Depression) and CASP-12 (Quality of Life). Statistical analysis: Bivariate, and binary logistic. Results: The variables associated with depression in the binary logistic regression (EURO-D ≥4) were poor self-perceived physical health (OR=13.34; 95% CI: 9.74-18.27), having more than 2 difficulties in Activities of Daily Living (ADL) (OR=4.46; 95% CI: 3.13-6.34) and female gender (OR=2.16; 95% CI: 1.83-2.56). Depression was more common among participants with Alzheimer (76.4%), emotional disorders (73.9%), Parkinson (57.4%), hip fracture (55.4%), and rheumatism (50.9%). Compared with other European countries, Spain had a percentage of people with depression (29.3%) that was higher than the European average (27.9%). Conclusions: The most important variables associated with depression were poor perceived physical health, presence of difficulties in ADL, and female gender

Cognition and its association with the factors of the EURO-D: Suffering and Motivation. Findings from SHARE Wave 6.

The aims of this study were (1) to analyse the relationship between cognition and clinical and sociodemographic variables, (2) to explore the relationship between cognitive tests and factors of EURO-D depression scale (Suffering and Motivation), and (3) to determine the relevance of cognition with respect to clinical and sociodemographic variables in the scores of the EURO-D factors. METHOD: About 63 755 participants in the Survey of Health, Ageing and Retirement in Europe (SHARE) Wave 6 (2015) were included. Instruments are as follows: the SHARE study, the EURO-D scale, and cognitive tests. Bivariate, correlation, and multiple linear regression analyses were performed. RESULTS: In the regression analysis with cognition, the variables associated with poor cognition were higher age (ß = .29), lower educational level (ß = -.26), economic difficulties (ß = .17), and depression (ß = .10). The correlation between cognition and EURO-D factors was weak in Suffering (r = -0.139) and moderate in Motivation (r = -0.382). In the regression analysis with the EURO-D, loneliness, poor self-perceived physical health, female gender, and low cognition were associated with higher depression levels. The main differences in the predictor variables of each factor were cognition (Motivation = -0.248, P < .001; Suffering = 0.002, P = .648) and the female sex (Motivation = 0.015, P < .001, Suffering = 0.175, P < .001). CONCLUSIONS: In the EURO-D depression scale, poor cognition was associated with higher scores in the Motivation factor only, while the female gender presented higher scores in the Suffering factor.

Depression and associated variables in people over 50 years in Spain. / Depresión y variables asociadas en personas mayores de 50 años en España.

INTRODUCTION: Depression is a common and disabling psychiatric disorder in adulthood and is associated with higher mortality and functional disability. OBJECTIVES: To determine the association between clinical and sociodemographic variables with depression in a sample of people over 50 years old living in Spain, and compare the prevalence of depression with the other Survey of Health, Ageing and Retirement (SHARE) countries. MATERIAL AND METHODS: There were 5,830 participants in the Spanish sample of the Wave 5, 2013, of SHARE. Tools used: EURO-D (Depression) and CASP-12 (Quality of Life). STATISTICAL ANALYSIS: Bivariate, and binary logistic. RESULTS: The variables associated with depression in the binary logistic regression (EURO-D ≥4) were poor self-perceived physical health (OR=13.34; 95% CI: 9.74-18.27), having more than 2 difficulties in Activities of Daily Living (ADL) (OR=4.46; 95% CI: 3.13-6.34) and female gender (OR=2.16; 95% CI: 1.83-2.56). Depression was more common among participants with Alzheimer (76.4%), emotional disorders (73.9%), Parkinson (57.4%), hip fracture (55.4%), and rheumatism (50.9%). Compared with other European countries, Spain had a percentage of people with depression (29.3%) that was higher than the European average (27.9%). CONCLUSIONS: The most important variables associated with depression were poor perceived physical health, presence of difficulties in ADL, and female gender.

Factor structure of depressive symptoms using the EURO-D scale in the over-50s in Europe. Findings from the SHARE project.

OBJECTIVES: The aims of this study are: to analyze the factor structure of the EURO-D depression scale; to explore the variables associated with depressive symptoms in the total sample and in the EURO-D factors; and to compare the presence of depressive symptoms and the factor distribution in 15 European countries. METHOD: 62,182 participants in Wave 5 (2013) of the Survey of Health, Aging and Retirement in Europe (SHARE) were included. INSTRUMENTS: The SHARE study and the EURO-D scale. Factor, bivariate and multilevel analyses were performed. RESULTS: Higher levels of depressive symptoms were associated with a poorer self-perception of physical health (η2 = 0.22) and economic difficulties (η2 = 0.07). Factor analysis of the EURO-D identified two factors: Suffering and Motivation. Higher levels of depressive symptoms were associated with female gender and younger age (≤60) in the Suffering factor, and with less activity and exercise, older age (≥71), widowhood and lower educational level in the Motivation factor. Poorer self-perception of physical health and economic difficulties were associated with higher depressive symptomatology in both factors. CONCLUSIONS: Poorer self-perception of physical health, female gender, economic difficulties, widowhood, lower levels of activity and exercise and lower educational level were associated with higher depressive symptomatology. In the countries of southern Europe, the Motivation factor predominated.

Kinship and cohabitation in relation to caregiver burden in the context of Alzheimer's disease: a 24-month longitudinal study.

OBJECTIVES: The aims of the study were to identify the clinical characteristics of three groups of caregivers: spouses, live-in adult-child or non-live-in adult-child, and their relation to the degree of perceived burden (Caregiver Burden Interview). METHODS: The sample comprised 275 Alzheimer's disease primary caregivers, with a follow-up of 24 months. Cognitive, functional and behavioural characteristics were evaluated in persons with dementia, whilst sociodemographic data, use of socio-medical resources, physical and mental health and self-perceived burden were assessed in caregivers. Generalized estimating equations were used for longitudinal data analysis. RESULTS: Spouse caregivers were 45.0% men, sole caregivers (>80%), used few external resources and had worse physical health. The number of female adult-child caregivers was higher (>75%). The live-in adult-child group, compared with the non-live-in adult-child group, was less likely to be married, had a lower level of education, was more commonly the sole caregiver and used fewer external resources. The greatest burden was observed in live-in adult-child caregivers, and the lowest in the non-live-in adult-child group, with no significant variation in the follow-up for both groups. Spouses had an intermediate level of perceived burden, which rose significantly during follow-up (p < 0.001). CONCLUSIONS: Kinship and cohabitation with the persons with dementia were associated with different scores and evolution of the burden, with an increase in the follow-up of the spouses, and with more or less burden, depending on cohabitation, in the adult-child groups. Interventions to reduce the level of burden on caregivers should consider these differences. Copyright © 2017 John Wiley & Sons, Ltd.

Consequences of Anosognosia on the Cost of Caregivers' Care in Alzheimer's Disease.

BACKGROUND: Anosognosia is common in patients with Alzheimer's disease (AD) and it is frequently related to an increase in time of care demand. OBJECTIVE: The aim of the study was to examine the effect of anosognosia on the total costs of informal care in patients with AD. METHODS: This was a prospective longitudinal study with community-dwelling AD patients. Anosognosia, time of informal care, and the use of support services (e.g., day care centers) were recorded at baseline and after 24 months. The cost of informal caregiving was calculated as 'market price'. RESULTS: At baseline, the prevalence of anosognosia was 54.3% (n = 221), and 43.9% were classified as mild-AD. The average time of care was 5 h/day±2.4 (IADL: 1.3 h/day±1.4 and BADL: 3.6 h/day±1.5). Thirty percent of the patients used home care services, and 25.1% attended a day care center. Patients with anosognosia received more time of care and were more likely to use support services than did their no-anosognosia peers, including institutionalization. The mean cost of support services was 490.4€ /month (SD = 413.1€; range = 25-2,212.38€), while the overall cost of care (support services plus informal care) was 1,787€ /month (SD = 972.4€), ranging from 834.1€ in mild-AD without anosognosia patients, to 2,424.8€ in severe-AD with incident anosognosia patients. CONCLUSIONS: Anosognosia was associated with an increased number of hours of informal care, and a greater use of support services, regardless of the severity of the dementia, which lead to an increase of the total family-care costs.

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

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.

Course and Determinants of Anosognosia in Alzheimer's Disease: A 12-Month Follow-up.

Anosognosia in Alzheimer's disease (AD) has been associated with greater cognitive impairment and more behavioural and psychological symptoms of dementia (BPSD). This study examines the incidence, persistence, and remission rates of anosognosia over a 12-month period, as well as the related risk factors. This was an observational 12-month prospective study. The longitudinal sample comprised 177 patients with mild or moderate AD, and their respective caregivers. Anosognosia was assessed using the Anosognosia Questionnaire in Dementia, and we also evaluated cognitive status (Mini-Mental State Examination), functional disability (Disability Assessment in Dementia), and the presence of BPSD (Neuropsychiatric Inventory). Multinomial logistic regression was used to determine the variables associated with the incidence, persistence and remission of anosognosia. The prevalence of anosognosia was 39.5% (95% CI = 32.1-47.1) at baseline. At 12 months, incidence was 38.3% (95% CI = 28.6-48.0), persistence was 80.0% (95% CI = 69.9-90.1) and remission was 20.0% (95% CI = 9.9-30.1). The regression model identified lower age, more education, and the presence of delusions as variables associated with incidence, and more education, lower instrumental DAD score, and disinhibition as variables associated with persistence. No variables were associated with remission (n = 14). The presence of anosognosia in AD patients is high. Education and certain neuropsychiatric symptoms may explain a greater and earlier incidence of anosognosia. However, anosognosia also increases with greater cognitive impairment and disease severity.

Anosognosia y depresión en la percepción de la calidad de vida de los pacientes con enfermedad de Alzheimer. Evolución a los 12 meses / The influence of anosognosia and depression on the perceived quality of life of patients with Alzheimer’s disease: a 12 months follow-up

Introducción. La anosognosia y la depresión pueden influir en la valoración sobre la calidad de vida del paciente con enfermedad de Alzheimer. Objetivo. Explorar la evolución de la calidad de vida del paciente con enfermedad de Alzheimer y la influencia de la anosognosia y la depresión en la percepción de la calidad de vida de los pacientes y sus cuidadores. Pacientes y métodos. Estudio observacional, analítico y longitudinal de 12 meses. Muestra consecutiva de 221 pacientes atendidos ambulatoriamente. La media de edad fue de 77,8 ± 7,3 años y 140 fueron mujeres (63,3%). Instrumentos: Quality of Life in Alzheimer Disease, Anosognosia Questionnaire-Dementia, Geriatric Depression Scale, Disability Assessment for Dementia, Neuropsychiatric Inventory, Minimental State Examination y Global Deterioration Scale. Se calculó el tamaño del efecto en las diferencias entre dos medias y se realizó un análisis de regresión lineal con los factores asociados a la percepción de la calidad de vida de los pacientes. Resultados. Los pacientes con anosognosia presentaron puntuaciones menores en depresión y mayores en la Quality of Life in Alzheimer Disease, al contrario que los pacientes sin anosognosia, e independientemente del tratamiento farmacológico antidepresivo. Los cuidadores puntuaron más negativamente la calidad de vida de los pacientes. En la regresión lineal, las mayores discrepancias entre pacientes y cuidadores respecto a la calidad de vida se asociaron a la anosognosia, la depresión y la capacidad funcional (β = -0,21; p < 0,001), que explicaban el 35,3, 7,9 y 11,3%, respectivamente, de la varianza (AU)

Introduction. Anosognosia and depression can influence perceptions of the patient’s quality of life (QoL-p) in Alzheimer’s disease (AD). Aim. To explore changes in perceived QoL-p in AD and the influence that depression and anosognosia can have on both patient and caregiver ratings. Patients and methods. Observational, analytical and longitudinal study over 12 months of a consecutive sample of 221 outpatients. Mean age was 77.8 ± 7.3 years and there were 140 women (63.3%). Instruments: Quality of Life in AD, Anosognosia Questionnaire-Dementia, Geriatric Depression Scale, Disability Assessment for Dementia, Neuropsychiatric Inventory, Mini-Mental State Examination and Global Deterioration Scale. Effect size of the differences between two means was calculated, and a linear regression analysis involving the factors associated with perceived QoL-p was performed. Results. Patients with anosognosia had less depression and higher scores on the Quality of Life in AD, as compared with patients without anosognosia, and regardless of antidepressant drug treatment. Caregiver ratings of QoL-p were more negative. In the linear regression the largest discrepancies between patient and caregiver ratings of QoL-p were associatedwith anosognosia, depression, and functional status, factors that explained 35.3, 7.9 and 11.3% of the variance, respectively. Conclusions. Anosognosia was associated with less depression and better perceived quality of life in patients (AU)

[The influence of anosognosia and depression on the perceived quality of life of patients with Alzheimer's disease: a 12 months follow-up]. / Anosognosia y depresión en la percepción de la calidad de vida de los pacientes con enfermedad de Alzheimer. Evolución a los 12 meses.

INTRODUCTION: Anosognosia and depression can influence perceptions of the patient's quality of life (QoL-p) in Alzheimer's disease (AD). AIM: To explore changes in perceived QoL-p in AD and the influence that depression and anosognosia can have on both patient and caregiver ratings. PATIENTS AND METHODS: Observational, analytical and longitudinal study over 12 months of a consecutive sample of 221 outpatients. Mean age was 77.8 ± 7.3 years and there were 140 women (63.3%). Instruments: Quality of Life in AD, Anosognosia Questionnaire-Dementia, Geriatric Depression Scale, Disability Assessment for Dementia, Neuropsychiatric Inventory, Mini-Mental State Examination and Global Deterioration Scale. Effect size of the differences between two means was calculated, and a linear regression analysis involving the factors associated with perceived QoL-p was performed. RESULTS: Patients with anosognosia had less depression and higher scores on the Quality of Life in AD, as compared with patients without anosognosia, and regardless of antidepressant drug treatment. Caregiver ratings of QoL-p were more negative. In the linear regression the largest discrepancies between patient and caregiver ratings of QoL-p were associated with anosognosia, depression, and functional status, factors that explained 35.3, 7.9 and 11.3% of the variance, respectively. CONCLUSIONS: Anosognosia was associated with less depression and better perceived quality of life in patients.

TITLE: Anosognosia y depresion en la percepcion de la calidad de vida de los pacientes con enfermedad de Alzheimer. Evolucion a los 12 meses.Introduccion. La anosognosia y la depresion pueden influir en la valoracion sobre la calidad de vida del paciente con enfermedad de Alzheimer. Objetivo. Explorar la evolucion de la calidad de vida del paciente con enfermedad de Alzheimer y la influencia de la anosognosia y la depresion en la percepcion de la calidad de vida de los pacientes y sus cuidadores. Pacientes y metodos. Estudio observacional, analitico y longitudinal de 12 meses. Muestra consecutiva de 221 pacientes atendidos ambulatoriamente. La media de edad fue de 77,8 ± 7,3 años y 140 fueron mujeres (63,3%). Instrumentos: Quality of Life in Alzheimer Disease, Anosognosia Questionnaire-Dementia, Geriatric Depression Scale, Disability Assessment for Dementia, Neuropsychiatric Inventory, Minimental State Examination y Global Deterioration Scale. Se calculo el tamaño del efecto en las diferencias entre dos medias y se realizo un analisis de regresion lineal con los factores asociados a la percepcion de la calidad de vida de los pacientes. Resultados. Los pacientes con anosognosia presentaron puntuaciones menores en depresion y mayores en la Quality of Life in Alzheimer Disease, al contrario que los pacientes sin anosognosia, e independientemente del tratamiento farmacologico antidepresivo. Los cuidadores puntuaron mas negativamente la calidad de vida de los pacientes. En la regresion lineal, las mayores discrepancias entre pacientes y cuidadores respecto a la calidad de vida se asociaron a la anosognosia, la depresion y la capacidad funcional (ß = ­0,21; p < 0,001), que explicaban el 35,3, 7,9 y 11,3%, respectivamente, de la varianza. Conclusion. La anosognosia se asociaba a una menor depresion y mejor percepcion de la calidad de vida en los pacientes.

Abridged scale for the screening anosognosia in patients with dementia.

The objective of this cross-sectional study was to validate an abridged version of the Anosognosia Questionnaire--Dementia (AQ-D) for screening anosognosia in daily practice. The authors reduce the AQ-D from 30 items to 9, with a large sample (n = 352) of patients with Alzheimer disease (AD). The Cronbach α was .793 and an area under the receiver-operating characteristic curve was 0.946. The κ index between new abridged AQ-D (AAQ) and original AQ-D was .800. The AAQ presents good validity and reliability indicators and kept concordance with the original scale. It is quick and easy to administer and it can simplify the clinical screening of anosognosia in patients with AD.

[Prevalence of anosognosia in Alzheimer's disease]. / Prevalencia de anosognosia en la enfermedad de Alzheimer.

BACKGROUND AND OBJECTIVE: Anosognosia is a disorder that affects the clinical presentation of Alzheimer's disease (AD), increasing in frequency with the evolution of AD. The objective was to determine the prevalence of anosognosia and analyze the associated factors and predictors. PATIENTS AND METHOD: Multicenter transversal and observational study of 345 AD patients. Anosognosia was assessed by Anosognosia Questionnaire-Dementia and the evolutionary stage with the Global Deterioration Scale (GDS). Tests used were Mini-Mental State Examination, Disability Assessment for Dementia and Neuropsychiatric Inventory to assess cognition, functional status and neuropsychiatric symptoms, respectively. We adjusted linear regression models to determine the associated variables and binary logistic regression (RLog) to identify predictors of anosognosia. RESULTS: The overall prevalence of anosognosia was 46.7% (95% confidence interval [95% CI] 41.3 to 52.1). The prevalence in stages was 28.4% (GDS 4), 64.6% (GDS 5) and 91.4% (GDS 6). The RLog identified as predictors older age (odds ratio [OR] 1.04; 95% CI 1.01-1.09), lower functional capacity (OR 0.96; 95% CI 0.93-0.98), lower cognitive level (OR 0.9; 95% CI 0.88-0.99), and greater apathy (OR 1.1; 95% CI 1.03-1.18), disinhibition (OR 1.2; 95% CI 1.09-1.50), irritability (OR 1.1; 95% CI 1.09-1.50) and motor disorders (OR 1.2; 95% CI 1.09-1.50). CONCLUSIONS: Anosognosia increases with further deterioration. In patients with a mild impairment, predictor variables were apathy, disinhibition and motor disorders.

[Cognitive decline in Alzheimer's disease. A follow three or more years of a sample of patients]. / Declive cognitivo en la enfermedad de Alzheimer. Seguimiento de mas de tres años de una muestra de pacientes.

INTRODUCTION: The rates of cognitive decline in patients with Alzheimer's disease show variations due to various factors. AIM. To determine the influence of age, education, gender, activities of daily living (ADL) and acetylcholinesterase inhibitors (IAChE) and memantine in the rhythm and rate of cognitive decline. PATIENTS AND METHODS: Retrospective study of a sample of 383 patients with Alzheimer's disease, with neuropsychological assessments over three years. Cognitive measure was used as the Cambridge Cognitive Examination (CAMCOG). Patients were grouped according to their rate of annual decline (RAD) and performed a bivariate and multivariate regression analysis using as dependent variable the difference in scores on the CAMCOG (baseline-final). RESULTS: The younger age (beta = -0.23; p < 0.001), more educated (beta = 0.26; p < 0.001) and the greater deterioration of ADL (beta = 0.24; p < 0.001) were associated with a greater decline in all patients. The drugs had a beneficial effect (beta = -0.18; p = 0.011) in the group with lower and slower decline (RAD < 5%). CONCLUSIONS: The lower age, higher education and the deterioration of ADL are associated with a greater cognitive decline. The IAChE and memantine had a beneficial effect, slowing the decline in the group of patients with lower RAD.

TITLE: Declive cognitivo en la enfermedad de Alzheimer. Seguimiento de mas de tres años de una muestra de pacientes.Introduccion. Las tasas de declive cognitivo en los pacientes con enfermedad de Alzheimer presentan variaciones debido a diversos factores. Objetivo. Determinar la influencia de la edad, escolaridad, genero, actividades de la vida diaria (AVD) e inhibidores de la acetilcolinesterasa (IAChE) y memantina en el ritmo y tasas de declive cognitivo. Pacientes y metodos. Estudio retrospectivo de una muestra de 383 pacientes con enfermedad de Alzheimer, con evaluaciones neuropsicologicas durante un periodo superior a tres años. Se utilizo como medida cognitiva el Cambridge Cognitive Examination (CAMCOG). Se agruparon los pacientes segun su tasa de declive anual (TDA) y se realizaron analisis bivariante y de regresion lineal multivariante utilizando como variable dependiente la diferencia de puntuaciones en el CAMCOG (basal-final). Resultados. La menor edad (beta = ­0,23; p < 0,001), la mayor escolaridad (beta = 0,26; p < 0,001) y el mayor deterioro de las AVD (beta = 0,24; p < 0,001) estuvieron asociados a un mayor declive en todos los pacientes. Los farmacos tuvieron un efecto benefico (beta = ­0,18; p = 0,011) en el grupo con menor y mas lento declive (TDA < 5%). Conclusiones. La menor edad, la mayor escolaridad y el deterioro de las AVD se relacionan con un mayor declive cognitivo. Los IAChE y la memantina tuvieron un efecto benefico, enlenteciendo el declive en el grupo de pacientes con menor TDA.

Declive cognitivo en la enfermedad de Alzheimer. Seguimiento de más de tres años de una muestra de pacientes / Cognitive decline in Alzheimer’s disease. A follow three or more years of a sample of patients

Introducción. Las tasas de declive cognitivo en los pacientes con enfermedad de Alzheimer presentan variaciones debido a diversos factores. Objetivo. Determinar la influencia de la edad, escolaridad, género, actividades de la vida diaria (AVD) e inhibidores de la acetilcolinesterasa (IAChE) y memantina en el ritmo y tasas de declive cognitivo. Pacientes y métodos. Estudio retrospectivo de una muestra de 383 pacientes con enfermedad de Alzheimer, con evaluaciones neuropsicológicas durante un período superior a tres años. Se utilizó como medida cognitiva el Cambridge Cognitive Examination (CAMCOG). Se agruparon los pacientes según su tasa de declive anual (TDA) y se realizaron análisis bivariante y de regresión lineal multivariante utilizando como variable dependiente la diferencia de puntuaciones en el CAMCOG (basal-final). Resultados. La menor edad (β = –0,23; p < 0,001), la mayor escolaridad (β = 0,26; p < 0,001) y el mayor deterioro de las AVD (β = 0,24; p < 0,001) estuvieron asociados a un mayor declive en todos los pacientes. Los fármacos tuvieron un efecto benéfico (β = –0,18; p = 0,011) en el grupo con menor y más lento declive (TDA < 5%). Conclusiones. La menor edad, la mayor escolaridad y el deterioro de las AVD se relacionan con un mayor declive cognitivo. Los IAChE y la memantina tuvieron un efecto benéfico, enlenteciendo el declive en el grupo de pacientes con menor TDA (AU)

Introduction. The rates of cognitive decline in patients with Alzheimer’s disease show variations due to various factors. Aim. To determine the influence of age, education, gender, activities of daily living (ADL) and acetylcholinesterase inhibitors (IAChE) and memantine in the rhythm and rate of cognitive decline. Patients and methods. Retrospective study of a sample of 383 patients with Alzheimer’s disease, with neuropsychological assessments over three years. Cognitive measure was used as the Cambridge Cognitive Examination (CAMCOG). Patients were grouped according to their rate of annual decline (RAD) and performed a bivariate and multivariate regression analysis using as dependent variable the difference in scores on the CAMCOG (baseline-final). Results. The younger age (β = –0.23; p < 0.001), more educated (β = 0.26; p < 0.001) and the greater deterioration of ADL (β = 0.24; p < 0.001) were associated with a greater decline in all patients. The drugs had a beneficial effect (β = –0.18; p = 0.011) in the group with lower and slower decline (RAD < 5%). Conclusions. The lower age, higher education and the deterioration of ADL are associated with a greater cognitive decline. The IAChE and memantine had a beneficial effect, slowing the decline in the group of patients with lower RAD (AU)

Burden associated with the presence of anosognosia in Alzheimer's disease.

OBJECTIVES: Anosognosia is the lack of deficit awareness, and it is a common symptom in patients with Alzheimer's disease (AD). The objective of this study was to assess the relationship between anosognosia and caregiver burden. METHODS: This was a cross-sectional, analytical study of patients who were diagnosed with AD and their caregivers. Anosognosia was evaluated using the Experimenter Rating Scale, and caregiver burden was evaluated using the Burden Interview (BI). Using the BI's comprehensive scoring and each of its five factors as dependent variables, we adjusted six linear regression models to determine the effect of anosognosia on caregiver burden. RESULTS: The sample consisted of 124 patients and 124 caregivers. The mean patient age was 78.9 years (SD = 6.9); the mean caregiver age was 59.7 years (SD = 13.6), and 66.6% of the caregivers were women. The prevalence of anosognosia was 24.2% (95% confidence interval = 16.7-33.3). The degree of caregiver burden was associated with the degree of anosognosia (r(2) = 0.426; standardised beta [ßs] = 0.346; p < 0.001), which explained 14.7% of the variance. For the BI factors, the Experimenter Rating Scale was associated with physical and social burden (r(2) = 0.452; ßs = 0.378; p < 0.001), relationship of dependence (r(2) = 0.301; ßs = 0.203; p = 0.010) and emotional stress (r(2) = 0.212; ßs = 0.227; p = 0.014). CONCLUSIONS: The presence of anosognosia in patients with AD is an independent factor that increases caregiver burden by increasing physical wear, social isolation, dependence and tension related to patient care.