Diagnostic accuracy of BASIC-Q for detection of cognitive impairment in a primary care setting - a cross-validation study.

OBJECTIVES: This study aims to evaluate the diagnostic accuracy and reliability of a new, brief questionnaire, 'Brief Assessment of Impaired Cognition- Questionnaire' (BASIC-Q) for detection of cognitive impairment, primarily developed for use in primary care. BASIC-Q has three components: Self-report, Informant report, and Orientation. Self-report and Orientation are completed by the individual and Informant report is answered by a close relative. METHODS: We included 275 participants ≥ 70 years, without a prior diagnosis of dementia, and with a close relative who agreed to participate as an informant. Participants were included prospectively in 14 general practices in urban and rural Denmark using a convenience sampling method. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the informant-completed Functional Activities Questionnaire (FAQ) and reported memory concern were used as a reference standard for the classification of the participants' cognitive function. RESULTS: BASIC-Q demonstrated a fair to good diagnostic accuracy to differentiate between people with cognitive impairment and normal cognition with an area under the ROC curve (AUC) of 0.84 (95% CI 0.79-0.89) and a sensitivity and specificity of 0.80 (95% CI 0.72-0.87) and 0.71 (95% CI 0.63-0.78). A prorated BASIC-Q score derived from BASIC-Q without Informant report had significantly lower classification accuracy than the full BASIC-Q. The test-retest reliability of BASIC-Q was good with an intraclass correlation coefficient of 0.84. CONCLUSION: BASIC-Q is a brief, easy-to-use questionnaire for identification of cognitive impairment in older adults. It demonstrated fair to good classification accuracy in a general practice setting and can be a useful case-finding tool when suspecting dementia in primary health care.

Neurosurgical Admission Later Than 4 h After the Emergency Call Does Not Result in Worse Long-Term Outcome in Subarachnoid Haemorrhage.

Background: Few studies have investigated the importance of the time interval between contact to the emergency medical service and neurosurgical admission in patients with spontaneous subarachnoid haemorrhage. We hypothesised that longer time to treatment would be associated with an increased risk of death or early retirement. Methods: This was a retrospective observational study with 4 years follow-up. Those who reached a neurosurgical department in fewer than 4 h were compared with those who reached it in more than 4 h. Individual level data were merged from the Danish National Patient Register, medical records, the Copenhagen Emergency Medical Dispatch Centre, the Civil Registration System, and the Ministry of Employment and Statistics Denmark. Patients were ≥18 years and had a verified diagnosis of spontaneous subarachnoid haemorrhage. The primary outcome was death or early retirement after 4 years. Results: Two hundred sixty-two patients admitted within a three-and-a-half-year time period were identified. Data were available in 124 patients, and 61 of them were in their working age. Four-year all-cause mortality was 25.8%. No significant association was found between time to neurosurgical admission and risk of death or early retirement (OR = 0.35, 95% confidence interval [CI]: 0.10-1.23, p = 0.10). Conclusion: We did not find an association between the time from emergency telephone call to neurosurgical admission and the risk of death or early retirement.

Defensive medicine in Danish general practice. Types of defensive actions and reasons for practicing defensively.

OBJECTIVE: To examine the occurrence of and types of defensive medicine (DM), and the reasons for practicing DM in general practice. DESIGN: Prospective survey registration of consecutive consultations regarding defensive medicine defined as: Actions that are not professionally well founded but are carried out due to demands and pressure. The GPs registered the degree of defensiveness, the type(s) of defensive action(s) and the reason(s) for acting defensively. SETTING: Danish general practice. SUBJECTS: A total of 26 GPs registered a total of 1,758 consultations. MAIN OUTCOME MEASURES: Defensive medical actions. RESULTS: Defensive actions were performed in 12% (210/1749) of all consultations. A fifth (46/210) of the defensive actions were characterised by the GPs as 'moderately' or 'highly' defensive. Frequent types of defensive actions were: blood tests, point-of-care-tests (POCTs) and referrals. Common reasons for defensive actions were: Influence from patients, 37% (78/210), concerns of overlooking severe disease, 32% (67/210) and influence from patient relatives, 12% (25/210). CONCLUSION: Danish GPs registered self-perceived defensive actions in a prospective survey. DM was carried out in one out of eight consultations, most often due to patient influence. The most frequent defensive actions were blood tests, POCTs and referrals.

Prescription of antibiotics to children with acute otitis media in Danish general practice.

BACKGROUND: Acute otitis media (AOM) is a common and most often self-limiting infection in childhood, usually managed in general practice. Even though antibiotics are only recommended when certain diagnostic and clinical criteria are met a high antibiotic prescription rate is observed. The study's objective was to analyse associations between patient- and general practitioner (GP) characteristics and antibiotic prescribing for children with AOM in an effort to explain the high antibiotic prescribing rates. METHODS: All general practices in the Northern, Southern and Central regions of Denmark were invited to record symptoms, examinations, findings and antibiotic treatment for all children ≤7 years of age diagnosed with AOM during a four-week winter period in 2017/2018. Associations were analysed by means of multivariate logistic regressions. The study design was cross-sectional. RESULTS: GPs from 60 general practices diagnosed 278 children with AOM of whom 207 (74%) were prescribed antibiotics, most often penicillin V (60%). About half of the children had tympanometry performed. Antibiotic prescribing rates varied considerably between practices (0-100%). Antibiotic prescribing was associated with fever (odds ratio (OR) 3.69 95% confidence interval (CI) 1.93-7.05), purulent ear secretion (OR 2.35 95% CI 1.01-5.50) and poor general condition (OR 3.12 95% CI 1.31-7.46), and the practice's antibiotic prescribing rate to other patients with symptoms of an acute respiratory tract infection (OR 2.85 CI 95% 1.07-7.60) and specifically to other children with AOM (OR 4.15 CI 95% 1.82-9.47). CONCLUSION: GPs' antibiotic prescribing rates for children with AOM vary considerably even considering the of signs, symptoms, request for antibiotics, and use of tympanometry. Interventions to reduce overprescribing should be targeted high-prescribing practices.

Validation of the Brief Assessment of Impaired Cognition and the Brief Assessment of Impaired Cognition Questionnaire for identification of mild cognitive impairment in a memory clinic setting.

OBJECTIVES: The aim of this study was to validate the Brief Assessment of Impaired Cognition (BASIC) and the Brief Assessment of Impaired Cognition Questionnaire (BASIC-Q) for identification of mild cognitive impairment (MCI) in a memory clinic setting. METHODS: A total of 163 sociodemographically matched patients (MCI, n = 42, and dementia, n = 121) and 83 control participants were included in the study. Two instruments were validated: (a) BASIC, including the components self-report, informant report, and two brief cognitive tests, and (b) BASIC-Q, including the components self-report, informant report, and orientation. BASIC can be administered in 5 minutes and BASIC-Q in less than 5 minutes. RESULTS: A high discriminative validity for MCI vs control participants was found for both BASIC (sensitivity 0.86, specificity 0.89) and BASIC-Q (sensitivity 0.88, specificity 0.88). In comparison, the MMSE had low sensitivity (0.61) and moderate specificity (0.72). All components of BASIC and BASIC-Q contributed significantly to differentiate MCI from control participants. The components of BASIC and BASIC-Q also contributed significantly to differentiate MCI from dementia, except for self-report, which was identical in the two groups. CONCLUSIONS: Both BASIC and BASIC-Q are brief, valid, and effective instruments for identification of patients with possible MCI in a memory clinic setting. Further cross-validation of the instruments in a general practice or primary care setting is needed.

Accreditation in general practice in Denmark: study protocol for a cluster-randomized controlled trial.

BACKGROUND: Accreditation is used increasingly in health systems worldwide. However, there is a lack of evidence on the effects of accreditation, particularly in general practice. In 2016 a mandatory accreditation scheme was initiated in Denmark, and during a 3-year period all practices, as default, should undergo accreditation according to the Danish Healthcare Quality Program. The aim of this study is primarily to evaluate the effects of a mandatory accreditation scheme. METHODS/DESIGN: The study is conducted as a cluster-randomized controlled trial among 1252 practices (clusters) with 2211 general practitioners in Denmark. Practices allocated to accreditation in 2016 serve as the intervention group, and practices allocated to accreditation in 2018 serve as controls. The selected outcomes should meet the following criteria: (1) a high degree of clinical relevance; (2) the possibility to assess changes due to accreditation; (3) availability of data from registers with no self-reporting data. The primary outcome is the number of prescribed drugs in patients older than 65 years. Secondary outcomes are changes in outcomes related to other perspectives of safe medication, good clinical practice and mortality. All outcomes relate to quality indicators included in the Danish Healthcare Quality Program, which is based on general principles for accreditation. DISCUSSION: The consequences of accreditation and standard-setting processes are generally under-researched, particularly in general practice. This is the largest study in general practice with a randomized implementation approach to evaluate the clinical effects of a nation-wide mandatory accreditation scheme in general practice. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02762240 . Registered on 24 May 2016.

The excess mortality of patients with diabetes and concurrent psychiatric illness is markedly reduced by structured personal diabetes care: A 19-year follow up of the randomized controlled study Diabetes Care in General Practice (DCGP).

OBJECTIVE: To assess the effectiveness of an intervention in Type 2 diabetic patients with concurrent psychiatric illness (PI) and compare this with the effectiveness in patients without PI. METHOD: In the Diabetes Care in General Practice trial, 1381 patients newly diagnosed with Type 2 diabetes were randomized to 6 years of structured personal diabetes care or routine diabetes care (ClinicalTrials.gov NCT01074762). In this observational post-hoc analysis, the effectiveness of the intervention for diabetes in 179 patients with concurrent PI was analyzed. RESULTS: During the 19-year follow-up period, patients with PI in the structured personal care group experienced a lower risk for all-cause mortality [105.3 vs. 140.4 events per 1000 patient-years; hazard ratio (HR): 0.63, P=0.023, multivariably adjusted], diabetes-related death (66.0 vs. 95.1; HR: 0.57, P=0.015), any diabetes-related endpoint (169.5 vs. 417.5; HR: 0.47, P=0.0009) and myocardial infarction (54.1 vs. 104.4; HR: 0.48, P=0.013), compared to patients with PI in the routine care group. This translates into a number needed to treat over 10 years of three or lower for these outcomes. CONCLUSION: These findings suggest that in primary care, structured diabetes care allowing for individualization was highly effective among diabetic patients with co-occurring PI.

Early psychosocial intervention in Alzheimer's disease: cost utility evaluation alongside the Danish Alzheimer's Intervention Study (DAISY).

OBJECTIVE: To assess the cost utility of early psychosocial intervention for patients with Alzheimer's disease and their primary caregivers. DESIGN: Cost utility evaluation alongside a multicentre, randomised controlled trial with 3 years of follow-up. SETTING: Primary care and memory clinics in five Danish districts. PARTICIPANTS: 330 community-dwelling patients and their primary caregivers. INTERVENTION: Psychosocial counselling and support lasting 8-12 months after diagnosis and follow-up at 3, 6, 12 and 36 months in the intervention group or follow-up only in the control group. MAIN OUTCOME MEASURES: The primary outcome measure was the cost of additional quality-adjusted life years (QALYs). Costs were measured from a societal perspective, including the costs of healthcare, social care, informal care and production loss. QALYs were estimated separately for the patient and the caregiver before aggregation for the main analysis. RESULTS: None of the observed cost and QALY measures were significantly different between the intervention and control groups, although a tendency was noted for psychosocial care leading to cost increases with informal care that was not outweighed by the tendency for cost savings with formal care. The probability of psychosocial intervention being cost-effective did not exceed 36% for any threshold value. The alternative scenario analysis showed that the probability of cost-effectiveness increased over the range of threshold values used if the cost perspective was restricted to formal healthcare. CONCLUSIONS: A multifaceted, psychosocial intervention programme was found unlikely to be cost-effective from a societal perspective. The recommendation for practice in settings that are similar to the Danish setting is to provide follow-up with referral to available local support programmes when needed, and to restrict large multifaceted intervention programmes to patients and caregivers with special needs until further evidence for cost-effectiveness emerges. TRIAL REGISTRATION: The study was registered in the Clinical Trial Database as ISRCTN74848736.

The predictive value of self-rated health in the presence of subjective memory complaints on permanent nursing home placement in elderly primary care patients over 4-year follow-up.

BACKGROUND: self-rated health (SRH) predicts nursing home (NH) placement; subjective memory complaints (SMC) too. However, the predictive value of SRH in the presence of SMC is unclear. METHODS: seven-hundred fifty-seven non-nursing home residents ≥65 years from general practices in Central Copenhagen were followed for 4 years (2002-2006). Patients gave information on SRH, cognition (SMC and MMSE), quality of life (EQ-5D) and socio-demographics. Information on comorbidities and permanent NH placement came from registries. The association between SRH (dichotomised into good versus poor) and SMC, and permanent NH placement was assessed using Cox proportional hazard regression adjusted for potential confounders. RESULTS: NH placement totaled 6.5% at 4-year follow-up. Poor SRH increased NH placement [hazard ratio (HR) = 2.07, 95% CI: 1.11-3.87] adjusted for age, SMC, MMSE, sex and comorbidities. SRH was not associated with NH placement if accounting for additional health information; however, SMC was (HR = 2.47, 95% CI: 1.26-4.86). Increased placement was seen for patients with good SRH and SMC (HR = 6.64, 95% CI: 2.31-19.12), but not among patients with poor SRH and SMC (HR = 1.37, 95% CI: 0.59-3.20) when compared with the reference group (good SRH and without SMC). CONCLUSIONS: both poor SRH and SMC were associated with permanent NH placement risk among elderly primary care patients. However, when SMC was present a reverse association was found for SRH: good SRH increased NH placement. Since SRH is integrated in widely used psychometric instruments, further research is needed to establish the mechanism and implications of this finding.

Cost analysis of early psychosocial intervention in Alzheimer's disease.

BACKGROUND/AIM: To investigate the impact of early psychosocial intervention aimed at patients with Alzheimer's disease (AD) and their caregivers on resource use and costs from a societal perspective. METHODS: Dyads of patients and their primary caregiver were randomised to intervention (n = 163) or control (n = 167) and followed for 3 years. Health care use was extracted from national registers, and the Resource Utilisation in Dementia questionnaire was used to measure informal care and productivity loss. Multiple imputation was used to replace missing data, and non-parametric bootstrapping was used to estimate standard errors. RESULTS: Overall, there were no statistically significant differences because of large variation in the observations. The average additional cost of psychosocial intervention provision was estimated at EUR 3,401 per patient. This cost masked a reduced use of formal health care and an increased use of informal care. CONCLUSIONS: Early psychosocial intervention in AD could be cost-saving from a health care perspective, whereas the opposite seems to be true from a broader societal perspective.

Discrepancy between self- and proxy-rated pain in Alzheimer's disease: results from the Danish Alzheimer Intervention Study.

OBJECTIVES: To investigate the prevalence of self- and proxy-reported pain in a cohort with Alzheimer's disease (AD) and to identify characteristics of individuals with AD reporting pain. DESIGN: Data were collected at the baseline visit of the Danish Alzheimer Intervention Study. SETTING: Community. PARTICIPANTS: Three hundred twenty-one community-living individuals with AD (MMSE ≥ 20) and their primary caregivers. MEASUREMENTS: Pain was assessed as part of the EuroQol EQ-5D (caregiver- and self-rated). The Cornell Scale for Depression in Dementia, Quality of Life in Alzheimer's Disease Scale, EQ-5D visual analog scale, Mini-Mental State Examination, and Neuropsychiatric Inventory Questionnaire were also used. RESULTS: Fair agreement was found between self- and proxy ratings on pain (kappa = 0.34). Thirty-three percent of individuals with AD reported pain, whereas caregivers reported that 52% had pain ( P < .001). Individuals who had self- or proxy-rated pain were significantly more likely to be female, had more depressive and other neuropsychiatric symptoms, and rated their quality of life lower. CONCLUSION: Self- and proxy-reported pain differ in individuals with mild AD, with proxies rating more pain than the individuals with AD. Self- and proxy-rated pain was significantly associated with more neuropsychiatric and depressive symptoms and lower quality of life. In general, this study indicates that pain occurs frequently even in individuals with mild AD and that pain assessment may require self- and proxy report to identify individuals with need for possible treatment.

Is there equity in use of healthcare services among immigrants, their descendents, and ethnic Danes?

BACKGROUND: Legislation in Denmark explicitly states the right to equal access to healthcare. Nevertheless, inequities may exist; accordingly evidence is needed. Our objective was to investigate whether differences in healthcare utilisation in immigrants, their descendents, and ethnic Danes could be explained by health status, socioeconomic factors, and integration. METHODS: We conducted a nationwide survey in 2007 with 4952 individuals aged 18-66 comprising ethnic Danes; immigrants from the former Yugoslavia, Iran, Iraq, Lebanon, Pakistan, Somalia, Turkey; and Turkish and Pakistani descendents. Data were linked to registries on healthcare utilisation. Using Poisson regression models, contacts to hospital, emergency room (ER), general practitioner (GP), specialist in private practice, and dentist were estimated. Analyses were adjusted for health symptoms, sociodemographic factors, and proxies of integration. RESULTS: In adjusted analyses, immigrants and their descendents had increased use of ER (multiplicative effect 1.19-5.02 dependent on immigrant and descendent group) and less frequent contact to dentist (multiplicative effect 0.04-0.80 dependent on the group). For hospitalisation, GP, and specialist doctor, physical health symptoms had positive but different explanatory effects within groups; however, most immigrant and descendent groups had increased use of services compared with that of ethnic Danes. Socioeconomic factors and integration had no systematic effect on the use in the different groups. CONCLUSIONS: The Danish healthcare system seems responsive to health across different population groups. We found no systematic pattern of inequity in use of free-of-charge healthcare services, but for dentists, who require co-payment, we found inequity among immigrants and descendents compared with ethnic Danes.

Proxy-rated quality of life in Alzheimer's disease: a three-year longitudinal study.

BACKGROUND: The study investigated the change in proxy rated quality of life (QoL) of a large cohort of home living patients with Alzheimer's disease (AD) over a period of 36 months. METHODS: The sample consisted of 102 patients with mild AD and their primary caregivers from the Danish Alzheimer's Disease Intervention Study. QoL was assessed with the proxy-rated (primary caregivers) Quality of Life in Alzheimer Disease scale (QOL-AD) and the EuroQuol Visual Analogue Scale (EQ-VAS) scale. The Cornell Scale for Depression in Dementia (CSDD), Alzheimer's Disease Cooperative Study, Activities of Daily living Inventory (ADCS-ADL), Mini-Mental State Examination (MMSE) and Neuropsychiatric Inventory (NPI-Q) were also applied. Evaluations were conducted at baseline and at 12 and 36 months follow-up. RESULTS: There was a significant decline in mean QoL assessed by both the QOL-AD and the EQ-VAS (p < 0.001). There were vast individual differences in the QoL scores on both scales at 12 and 36 months' follow-up. Mean change from baseline in QOL-AD was significantly associated with change in CSDD, ADCS-ADL and MMSE scores at 12 months and with ADCS-ADL score at 36 months. CONCLUSION: QoL is a subjective concept and may not be influenced by the degree of cognitive dysfunction. Future studies should investigate the factors for individual variations in order to understand the nature of change of QoL in AD and the wide variation in QoL scores over time.

The efficacy of computer reminders on external quality assessment for point-of-care testing in Danish general practice: rationale and methodology for two randomized trials.

BACKGROUND: Point-of-care testing (POCT) is increasingly being used in general practice to assist general practitioners (GPs) in their management of patients with diseases. However, low adherence to quality guidelines in terms of split test procedures has been observed among GPs in parts of the Capital Region in Denmark. Computer reminders embedded in GPs electronic medical records (ComRem) may facilitate improved quality control behaviour, but more research is needed to identify what types of reminders work and when. The overall aim of this study is to evaluate the efficacy of ComRem to improve GPs adherence to quality guidelines. This article describes the rationale and methods of the study that constitute this research project. METHODS/DESIGN: The study is conducted as two randomised controlled trials (RCTs) among general practices in two districts of the Capital Region in Denmark. These districts contain a total of 739 GPs in 567 practices with a total of 1.1 million patients allocated to practice lists. In the first RCT (RCT A), ComRem is compared to postal reminder letters. In the second RCT (RCT B), ComRem is compared to usual activities (no reminders) with a crossover approach. In both of these studies, outcomes are measured by the number of split tests received by the laboratory. CONCLUSIONS: This study will contribute to knowledge on the efficacy of ComRem in primary care. Because the study does not explore GPs' perceptions and experiences with regard to ComRem, we will subsequently conduct a qualitative survey focusing on these aspects. TRIAL REGISTRATIONS: Study A: ClinicalTrials.gov identifier: NCT01152151Study B: ClinicalTrials.gov identifier: NCT01152177.

Prognostic factors for weight loss over 1-year period in patients recently diagnosed with mild Alzheimer Disease.

The aim of the study was to identify prognostic factors for weight loss in patients recently diagnosed with mild Alzheimer disease (AD), with special emphasis on the patients' social participation and living arrangements. The data used in this study was part of the Danish Alzheimer Intervention StudY. The patients were home-living patients with a clinical diagnosis, within the past 12 months, of probable AD or mixed AD; age ≥50 years; mini-mental state examination score ≥20; informed consent; and data available at 1-year follow-up. In total, 268 patients were included. We used a cut off of 4% in 1 year for defining weight loss. The mean age at inclusion was 76.1 years. Sixty-six patients (24.6%) lost more than 4% of their body weight during the study period. A logistic regression showed that an increase of 1 baseline body mass index point significantly increased the odds of weight loss by 9%. Furthermore, the results suggested a trend that for men, living alone was a risk factor for losing weight, whereas for women living with somebody was associated with a higher risk. However, further studies are pertinent within this area. As weight loss is a predictor of mortality in patients with AD, clinicians should be aware of prognostic social indicators to prevent or halt a potential negative development.

Generic and disease-specific measures of quality of life in patients with mild Alzheimer's disease.

BACKGROUND/AIM: The aim of the study was to investigate the pattern of association of generic and disease-specific quality of life (QoL) scales with standard clinical outcome variables in Alzheimer's disease (AD). METHODS: The participants were 321 home-living patients with mild AD and their primary caregivers from the Danish Alzheimer Intervention Study. QoL was assessed using the generic EuroQol-5D with visual analogue scale (VAS) and the disease-specific Quality of Life in Alzheimer's Disease (QOL-AD) scales (both caregiver and patient rated). Depression, activities of daily living, cognitive performance and neuropsychiatric symptom severity were also assessed. RESULTS: All 3 caregiver-rated QoL scales correlated significantly with each other (p < 0.001) and with clinical measures. Patient-rated QoL versions correlated inversely with depression (p < 0.001) but not significantly with any other clinical variables. CONCLUSION: The caregiver-rated QoL scales showed stronger interscale correlation as well as a similar correlation pattern with standard clinical outcome variables compared to the patient-rated versions. There is some indication that the EQ-5D + VAS could be a suitable alternative to the QOL-AD scale in specific research designs.

Private costs almost equal health care costs when intervening in mild Alzheimer's: a cohort study alongside the DAISY trial.

BACKGROUND: Alzheimer's disease is the leading cause of dementia and affects about 25 million people worldwide. Recent studies have evaluated the effect of early interventions for dementia, but few studies have considered private time and transportation costs associated with the intervention. This study assessed the total economic costs associated with a multifaceted intervention for mild Alzheimer's disease, including an estimate of the ratio of public to private costs. METHODS: The study sample comprised 163 dyads of patients and caregivers who received a multifaceted intervention of counselling sessions, courses and informational packages. The typical duration of the intervention was 7 months. A micro-costing approach was applied using prospectively collected data on resource utilisation that included estimates of participant time and transportation. Precision estimates were calculated using a bootstrapping technique and structural uncertainty was assessed with sensitivity analysis. RESULTS: The direct intervention cost was estimated at EUR 1,070 (95% CI 1,029;1,109). The total cost (including private costs) was estimated at EUR 2,020 (95% CI 1,929;2,106) i.e. the ratio of private to public costs was almost 1:1. CONCLUSION: Intervention for mild Alzheimer's disease can be undertaken at a relatively low cost to public funds. However, policy planners should pay attention to the significant private costs associated with an intervention, which may ultimately pose a threat to equity in access to health care. TRIAL REGISTRATION: Current Controlled Trials ISRCTN74848736.

Early counselling and support for patients with mild Alzheimer's disease and their caregivers: a qualitative study on outcome.

OBJECTIVES: The aim of this qualitative study was to identify and analyse the participants' experienced outcome of an intensive structured psychosocial intervention programme with tailored counselling, education and support groups for home-living patients with mild Alzheimer's disease and their spousal caregivers. METHOD: Data were collected by semi-structured in-depth interviews conducted separately with each person in 10 couples before the intervention and 1-3 months after completed intervention. For the analysis, a template organizing style of interpretation was used. RESULTS: The analysis revealed that patients found support groups relevant: they found it stimulating to be with peers, it supported their self-esteem, and it supported them in finding new ways of managing everyday life and social relations. During and after the intervention, caregivers were better able to cope with the challenges their partner's disease involved, and they were able to face everyday life and social relations with more serenity and competence. After the intervention, both patients and caregivers sought suitable support groups they could join as a permanent activity and caregivers sought permanent counselling. CONCLUSION: Early tailored counselling and support may improve patients' and caregivers' opportunities to adapt to the challenges of Alzheimer's disease and to maintain well-being.