Josep Garre-Olmo

Differential features of burden between spouse and adult-child caregivers of patients with Alzheimer's disease: an exploratory comparative design

BACKGROUND Research into burden among spouse and adult-child caregivers of patients with Alzheimers disease has generated contradictory results as regards the group which suffers the greatest burden and the factors underlying any differences. OBJECTIVES The aim of the present study was to identify and compare the factors associated with caregiver burden among spouse and adult-child caregivers. DESIGN Cross-sectional analytic study. SETTINGS All clinical subjects had been referred on an out-patient basis to the Memory and Dementia Assessment Unit of the Santa Caterina Hospital in Girona (Spain). PARTICIPANTS Data were collected from 251 patients and their caregivers, 112 with spouse and 139 with adult-child caregivers. METHODS The association between caregiver burden and the socio-demographic and clinical variables of both patients and caregivers was analysed, the results being compared for spouse vs. adult-child caregivers. Burden was analysed using a multivariate linear regression including all the variables for the two groups of caregivers. RESULTS The results show greater burden among adult-child caregivers (p<.05), who experience more feelings of guilt (p<.001). In both groups the behavioural and psychological symptoms of patients were correlated with burden (p<.001). Living with the patient has a notable influence on burden among adult children (p<.001). Husbands, wives, daughters and sons, in this order, showed increasing levels of burden (p<.05) and progressively worse mental health (p<.01). However, the correlations between burden and mental health were strongest in daughters (p<.001). CONCLUSION The differences in burden between spouse and adult-child caregivers were not associated with age, physical health or clinical factors of the patients. Overall burden was greater among adult-child caregivers, especially those who lived with the patient and who had other family duties. Feelings of guilt were associated with not living with the patient, and there was a strong correlation between burden and mental health. These results support the hypothesis that spouses regard caregiving as part of their marital duties, whereas for adult children such tasks imply an important change in their lifestyle.

Factors related to perceived quality of life in patients with Alzheimer's disease: the patient's perception compared with that of caregivers

To compare care recipient and caregiver perceptions of quality of life in patients (QoL‐p) with Alzheimers disease (AD). To identify associated factors, and the concordances‐discrepancies.

Prevalence and risk factors of suspected elder abuse subtypes in people aged 75 and older.

OBJECTIVES: To assess the prevalence of suspected elder abuse subtypes and to identify related factors.

Incidence and subtypes of early-onset dementia in a geographically defined general population

Objective: To estimate the incidence of early-onset dementia (EOD) and to compare the clinical characteristics of EOD vs late-onset dementia (LOD) in a geographically defined area. Methods: We used data from the Registry of Dementia of Girona (ReDeGi), an epidemiologic surveillance system of dementia. The ReDeGi is a standardized clinical registry of new dementia cases diagnosed in the 7 hospitals of the Health Region of Girona (Catalonia, Spain), which encompasses an area of 5,517 km2 and 690,207 inhabitants. EOD cases were defined as those patients residing in the target area at the time of diagnosis who were diagnosed with dementia with an age at onset of symptoms before 65 years. Results: The ReDeGi registered 2,083 patients between January 1, 2007, and December 31, 2009 (6.9% EOD). The incidence rate of EOD for the age range 30–64 was 13.4 cases per 100,000 person-years (95% confidence interval 11.3–15.8). Alzheimer disease was the most frequent cause of EOD (42.4%), followed by secondary dementia (18.1%), vascular dementia (13.8%), and frontotemporal dementia (9.7%). EOD cases at the time of diagnosis were less impaired on the Mini-Mental State Examination and had a greater score on the Blessed Dementia Rating Scale behavior subscale than LOD cases. The frequency of a personal history of depression was higher in EOD cases. Conclusions: The incidence of EOD was less than 6 cases per 100,000 person-years in the age group 30–49 years; in the age group 50–64 years, the incidence rate was 3-fold higher and doubled with each 5-year increase.

evolution of Depressive Symptoms in Alzheimer Disease : one-year Follow-up

&NA; The current longitudinal study analyzes the natural course of depressive symptoms in patients with Alzheimer disease (AD). The goals were to identify the clinical and sociodemographic variables related to depressive symptoms, to assess the effect of depressive symptoms on the course of cognitive and functional impairment and on associated neuropsychiatric disorders, and to identify which factors are associated with remission, persistence, and emergence of depressive symptoms at 12 months. A sample of 150 patients with mild or moderate severity was assessed at baseline and at 12 months using the neuropsychologic battery Cambridge Cognitive Examination. The Neuropsychiatric Inventory and Rapid Disability Rating Scale were administered to the caregiver. Prevalence, persistence, and emergence of depressive symptoms at baseline were 51%, 55%, and 20%, respectively. Remission of depressive symptoms at 12 months leads to a decreased frequency of other noncognitive disorders and to a slight improvement in the assessment of global function. The presence of depressive symptoms does not affect the course of cognitive impairment at 12 months, and a psychiatric history of the patient and the number of depressive symptoms at baseline are risk factors for the emergence and persistence of depressive symptoms at 12 months.

Incidence of dementia in a rural community in Spain: The Girona cohort study

Background: Information on dementia incidence in Spanish populations is still scarce, and there is a dearth of prospective studies. Objective: To estimate the incidence rates of dementia, Alzheimer’s disease (AD) and vascular dementia (VaD) in a population cohort aged 75 and over in a rural area in Spain. Methods: A prospective population cohort study over a 5-year period in 8 rural villages in the province of Girona. The baseline study in 1990 identified 200 prevalent cases of dementia. The dementia-free cohort included 1,260 persons aged 75 and over. This was the sample used for the incidence study. We rescreened and selectively reexamined this group in 1995 using a two-phase procedure consisting of a screening interview at home using the MMSE. Diagnoses of dementia, AD and VaD were established using the Cambridge Examination for Mental Disorders of the Elderly for surviving participants. For deceased participants, we used the Retrospective Collateral Dementia Interview to establish a diagnosis of dementia and AD according to DSM-III-R diagnostic criteria. Results: Information was obtained for 91% of the subjects at risk; 122 incident cases of dementia were identified. Incidence rates per 1,000 person-years at risk were 23.2 (95% CI = 19.1–27.3) for dementia, 10.8 (95% CI = 7.8–13.7) for AD and 9.5 (95% CI = 6.7–12.1) for VaD. All dementia subtypes showed an age-dependent pattern. Females had a relative risk of 1.8 (95% CI = 1.0–3.4) to develop AD. The inclusion of deceased cases with manifestations of dementia increased the rate of dementia incidence in 7.1 cases/1,000 person-years at risk. Conclusion: Incidence rates were similar to those reported by other cohort studies. All dementia subtypes increased with age, but incidence rates did not increase exponentially in the oldest old. Females were at increased risk for AD. The inclusion of information about dementia symptoms from relatives of deceased participants was useful in order to avoid underestimation of the dementia incidence rates. Underestimation of the incidence rates was more important in those aged 75–84 years.

Quality of Life of Patients with Alzheimer’s Disease: Differential Perceptions between Spouse and Adult Child Caregivers

Background/Aims: Little research has been conducted into differences in the perceived quality of life of patients (QoL-p) when comparing spouse and adult child caregivers of people with Alzheimer’s disease (AD). The aim of this study was to identify the differential variables in perceived QoL-p between patients and carers, distinguishing between spouse and adult child caregivers. Method: Cross-sectional analytic study of 251 patients and their carers (spouses: 112; adult children: 139) using the QoL-AD scale and sociodemographic and clinical data. Results: The more positive perception of spouses was associated with higher educational levels of the caregiver and greater functional autonomy in the patient. The more negative perception of adult children was associated with greater caregiver burden and higher levels of depression in the patient. The perception of daughter caregivers showed the strongest association with mental health and burden. Conclusions: Spouse caregivers have a more positive perception of the patient’s quality of life than adult child caregivers.

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

Anosognosia is the lack of deficit awareness, and it is a common symptom in patients with Alzheimers disease (AD). The objective of this study was to assess the relationship between anosognosia and caregiver burden.

Prevalence of frailty phenotypes and risk of mortality in a community-dwelling elderly cohort

OBJECTIVES to determine the prevalence of three independent, disability-free and operationally defined frailty phenotypes and the associated risk of mortality in a community-dwelling older people cohort over 74 years of age. METHODS observational, prospective and population-based design. Bio-psycho-social variables were assessed using a range of standardised instruments. The physical frailty phenotype (PFP), mental frailty phenotype (MFP) and social frailty phenotype (SFP) were operationally defined using a deficit accumulation model that excluded disability. Logistic regression analyses explored associations of the frailty phenotypes with sex, age and marital status, and a Cox proportional hazard regression analysis was performed to evaluate the association between frailty phenotypes and mortality. RESULTS of the eligible individuals, 82% (n = 875) participated. The prevalence of any frailty phenotype in an individual was 38.8%; 17.3% exhibited the PFP, 20.2% exhibited the MFP, and 8.9% exhibited the SPF. Older and female were more likely to exhibit the PFP, and widowhood was associated with the SFP. The hazard ratios of mortality were 3.09 (95% CI = 1.54-6.17) for the PFP and 2.69 (95% CI = 1.01-7.25) for the SFP. CONCLUSION three different disability-free frailty phenotypes were differentially related to the socio-demographical characteristics of sex, age and marital status and independently predicted risk of mortality.

Environmental Determinants of Quality of Life in Nursing Home Residents with Severe Dementia

To determine the relationship between quality of life (QOL) and environmental factors of temperature, noise, and lighting in nursing home residents with severe dementia.