Loretto Lacey

Self-efficacy for managing dementia may protect against burden and depression in Alzheimer's caregivers

Background: Self-efficacy is the belief that one can perform a specific task or behaviour and is a modifiable attribute which has been shown to influence health behaviours. Few studies have examined the relationship between self-efficacy for dementia-related tasks and symptoms of burden and depression in caregivers. Methods: Eighty four patient/caregiver dyads with Alzheimers disease were recruited through a memory clinic. Patient function, cognition and neuropsychiatric symptoms were assessed together with caregiver burden, personality, depressive symptoms, coping strategies and self-efficacy for completing tasks related to dementia care. Results: 33% (28) of caregivers reported significant depressive symptoms (CES-D ≥ 10). In multivariate analyses, caregiver burden was predicted by self-efficacy for symptom management, neuroticism, patient function and neuropsychiatric symptoms while caregiver depression was predicted by self-efficacy for symptom management, caregiver educational level, neuroticism, emotion-focused coping, dysfunctional coping and patient function. In patients with moderate to severe impairment (MMSE ≤ 20), self-efficacy for symptom management behaved as a mediator between patient neuropsychiatric symptoms and symptoms of burden and depression in caregivers. Conclusions: Further longitudinal investigation is warranted to determine if self-efficacy might be usefully considered a target in future interventional studies to alleviate symptoms of burden and depression in Alzheimers caregivers.

Dependence and Caregiver Burden in Alzheimer’s Disease and Mild Cognitive Impairment

The dependence scale has been designed to be sensitive to the overall care needs of the patient and is considered distinct from standard measures of functional ability in this regard. Little is known regarding the relationship between patient dependence and caregiver burden. We recruited 100 patients with Alzheimer’s disease or mild cognitive impairment and their caregivers through a memory clinic. Patient function, dependence, hours of care, cognition, neuropsychiatric symptoms, and caregiver burden were assessed. Dependence was significantly correlated with caregiver burden. Functional decline and dependence were most predictive of caregiver burden in patients with mild impairment while behavioral symptoms were most predictive in patients with moderate to severe disease. The dependence scale demonstrated good utility as a predictor of caregiver burden. Interventions to reduce caregiver burden should address patient dependence, functional decline, and behavioral symptoms while successful management of the latter becomes more critical with disease progression.

Impact of Zanamivir Treatment on Productivity, Health Status and Healthcare Resource Use in Patients with Influenza

AbstractObjective: This study examined the impact of zanamivir treatment on patient morbidity in patients with influenza. Design and setting: This was a multicentre, randomised, double-blind, parallel-group study conducted in 14 countries in Europe and North America during the winter of 1995/1996. Patients and participants: The study included 722 individuals with virologically confirmed influenza. Interventions: Two different zanamivir treatment regimens [twice daily (bid) or 4 times daily (qid) for 5 days] were compared with placebo. Main outcome measures and results: Efficacy was measured using a number of patient-assessment questionnaires. Results showed that significantly fewer patients with influenza who were treated with zanamivir had additional contacts with healthcare professionals compared with those who received placebo (8 vs 14%; p ≤ 0.049, bid and qid vs placebo). Individuals treated with zanamivir also spent fewer days absent from work (placebo: mean = 3.28 days; qid: mean = 2.52 days; p = 0.031) or college/school (placebo: mean = 2.90 days; bid: mean = 2.24 days; p = 0.032), and showed significant improvements in productivity compared with placebo. The health status questionnaire revealed significant improvements in patient well-being over the first 5 days of the study in those treated with zanamivir compared with those who received placebo. Conclusions: Zanamivir treatment reduced absenteeism, improved patient productivity and well-being, and reduced the additional use of healthcare resources in patients with influenza.

Determinants of the Desire to Institutionalize in Alzheimer’s Caregivers

Background: The desire to institutionalize is an important predictor of future institutionalization. Few studies have examined potentially modifiable caregiver characteristics which might be the focus of future interventional strategies. Methods: A total of 102 patient/caregiver dyads with Alzheimer’s disease (n = 84) or mild cognitive impairment were recruited through a memory clinic. Cross-sectional analyses of a range of patients, caregivers, and context of care-related characteristics were conducted. Results: Caregiver desire to institutionalize was significantly associated with a number of potentially modifiable variables including caregiver coping style, self-efficacy, depression, burden, and the presence of an unmet service need. In a multivariate analysis, caregiver burden, depression, and nonspousal status were the only significant independent predictors of caregiver desire to institutionalize in a model which correctly classified 80.4% of caregivers. Conclusions: Interventions which seek to reduce caregiver desire to institutionalize should adopt a multifactorial approach to reduce symptoms of burden and depression in caregivers.

Frailty and quality of life for people with Alzheimer's dementia and mild cognitive impairment.

Background: Our aim was to investigate the relationship between frailty and health-related quality of life (HR-QOL) in cognitively impaired elderly individuals. Methods: A cross-sectional observational study of a convenience sample of 115 patients with a diagnosis of Alzheimer’s dementia or mild cognitive impairment. Frailty was measured using the biological syndrome model and HR-QOL was measured using the DEMQOL-Proxy. Regression models were constructed to establish the factors associated with HR-QOL. Results: Frailty and neuropsychiatric symptoms were associated with HR-QOL, with Mini-Mental State Examination (MMSE) scores ≥21 (P = .037, P ≤ .001, and R 2 = .362). Functional limitation was associated with HR-QOL, with MMSE scores ≤20 (P = .017 and R 2 = .377). Conclusion: Frailty and neuropsychiatric symptoms were the determinants of HR-QOL in the earlier stages of cognitive impairment. Functional limitation predicted HR-QOL in the later stages of cognitive impairment. Frailty may represent a novel modifiable target in early dementia to improve HR-QOL for patients.

A Model to Assess the Cost Effectiveness of Statins in Achieving the UK National Service Framework Target Cholesterol Levels

AbstractBackground: Coronary heart disease (CHD) is a public health priority in theUK. The National Service Framework (NSF) has set standards for the prevention, diagnosis and treatment of CHD, which include the use of cholesterol-lowering agents aimed at achieving targets of blood total cholesterol (TC) < 5.0 mmol/L and low density lipoprotein-cholesterol (LDL-C) < 3.0 mmol/L. In order to achieve these targets cost effectively, prescribers need to make an informed choice from the range of statins available. Aim: To estimate the average and relative cost effectiveness of atorvastatin, fluvastatin, pravastatin and simvastatin in achieving the NSF LDL-C and TC targets. Design: Model-based economic evaluation. Methods: An economic model was constructed to estimate the number of patients achieving the NSF targets for LDL-C and TC at each dose of statin, and to calculate the average drug cost and incremental drug cost per patient achieving the target levels. The population baseline LDL-C and TC, and drug efficacy and drug costs were taken from previously published data. Estimates of the distribution of patients receiving each dose of statin were derived from the UK national DINLINK database.Results:Methods: The estimated annual drug cost per 1000 patients treated with atorvastatin was £289 000, with simvastatin £315 000, with pravastatin £333 000 and with fluvastatin £167 000. The percentages of patients achieving target are 74.4%, 46.4%, 28.4% and 13.2% for atorvastatin, simvastatin, pravastatin and fluvastatin, respectively. Incremental drug cost per extra patient treated to LDL-C and TC targets compared with fluvastatin were £198 and £226 for atorvastatin, £443 and £567 for simvastatin and £1089 and £2298 for pravastatin, using 2002 drug costs. Conclusions: As a result of its superior efficacy, atorvastatin generates a favourable cost-effectiveness profile as measured by drug cost per patient treated to LDL-C and TC targets. For a given drug budget, more patients would achieve NSF LDL-C and TC targets with atorvastatin than with any of the other statins examined.

Dependence in Alzheimer's disease and service use costs, quality of life, and caregiver burden: The DADE study

Most models determining how patient and caregiver characteristics and costs change with Alzheimers disease (AD) progression focus on one aspect, for example, cognition. AD is inadequately defined by a single domain; tracking progression by focusing on a single aspect may mean other important aspects are insufficiently addressed. Dependence has been proposed as a better marker for following disease progression.

The effects of dependence and function on costs of care for Alzheimer's disease and mild cognitive impairment in Ireland†

To explore the incremental effects of patient dependence and function on costs of care for patients with Alzheimers disease (AD) and amnestic mild cognitive impairment (MCI) in Ireland.

Correlates of frailty in Alzheimer's disease and mild cognitive impairment

SIR—The global prevalence of dementia is rising with Alzheimer’s disease (AD) accounting for 50–60% of all cases and mild cognitive impairment (MCI) its precursor [1, 2]. Although the clinical hallmark of AD is progressive loss of memory and cognition, several studies have also shown changes in mobility and body composition suggesting frailty [3, 4]. Frailty represents age-related reduction in physiological reserve and resistance to stressors that can be delineated from comorbidity [5, 6]. It infers increased risk of health decline, disability and mortality regardless of concurrent illnesses. Intervention in the early stages may lead to reversal of frailty and prevent some of its adverse outcomes [6]. Individual components of frailty; impaired grip strength, slowed gait and low body mass index (BMI), have been shown to predict development of dementia and are associated with incident MCI [7–10]. The frailty syndrome within cognitively impaired patients may represent an important area for intervention that has yet been adequately investigated. A diagnosis of AD or MCI can mean considerable heterogeneity in terms of age, comorbidity, course of illness, cognitive impairment, functional limitations and abnormalities of behaviour. This study enables a consideration of the relation, if any, between frailty and these domains of clinical heterogeneity in a group of patients with AD and MCI.

The relationship between changes in quality of life outcomes and progression of Alzheimer's disease: results from the dependence in AD in England 2 longitudinal study.

The relationship between conventional indicators of Alzheimers disease (AD) progression and quality of life (QoL) outcomes is unclear. Dependence on others has been recommended as a unifying construct in defining AD severity. This study examined the relationship between indicators of disease severity (including dependence) and changes in QoL and utility over 18 months.