Tarja Välimäki

Neuropsychiatric symptoms and Quality of Life in patients with very mild and mild Alzheimer's disease

Neuropsychiatric symptoms (NPS) are common manifestations of Alzheimers disease (AD).

Caregiver depression is associated with a low sense of coherence and health-related quality of life

Objectives: The main objective is to examine the sense of coherence (SOC) of spouse caregivers. The aim was further investigate the association of SOC, health-related quality of life (HRQoL), depressive symptoms, distress and how severity of Alzheimers disease (AD) affects SOC. Method: 17O patient–spouse caregiver dyads in which the patient has recently diagnosed mild AD. Caregivers completed SOC scale (SOC-29), HRQoL (15D), Beck depression and general health questionnaire scale. The assessment of AD-related symptoms was made using mini mental state examination, clinical dementia rating, neuropsychiatric inventory and functional performance using activities of daily living (ADCS-ADL) scale. Results: Male caregivers’ SOC was significantly higher than female caregivers. The main predictor for low SOC was depression, with 37% of spousal caregivers reporting depressive symptoms. Women reported more depressive symptoms and distress. Caregivers’ HRQoL was as high as 0.8714, and a significant correlation was found between SOC and depression, r = −0.632 and distress r = −0.579. Furthermore, significant correlations were found between HRQoL and depression (r = −0.572) and distress (r = −0.568). The main predictors for high HRQoL were female gender and low distress. Conclusion: Spouse caregivers with low SOC seem to be a vulnerable group of caregivers. The many negative effects of perceived health accumulate in these caregivers during the very early phases of the caregiving process. Vulnerable caregivers need to be recognized at the time of AD diagnosis so that they can receive psychological support and counselling in addition to prevent morbidity in these caregivers.

Progression of Alzheimer's disease during a three-year follow-up using the CERAD-NB total score: Kuopio ALSOVA study

BACKGROUND We studied the suitability of The Consortium to Establish a Registry for Alzheimers Disease Neuropsychological Battery (CERAD-NB) total score for monitoring Alzheimers disease (AD) progression in early-diagnosed medicated patients. We also investigated possible differences in progression between patients with very mild or mild baseline AD. METHODS In this three-year follow-up of 115 ALSOVA study patients with clinical dementia ratings (CDR) of very mild (0.5) or mild (1) AD, we analyzed total CERAD-NB, Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), The Alzheimers Disease Cooperative Study-Activities of Daily Living Inventory, and Clinical Dementia Rating Sum of Boxes scores. Correlations were identified with efficacy parameters. RESULTS Over three years, total CERAD-NB declined significantly in both groups. Annual change rates of total CERAD-NB were also significant. Total CERAD-NB revealed annual differences in cognition between study groups, while MMSE did not. Total CERAD-NB correlated well with other cognitive and global measures, but not with NPI. For almost two years, the CDR-0.5 group maintained a higher activities of daily living than the CDR-1 group exhibited at baseline. Furthermore, the CDR-0.5 group showed milder neuropsychiatric symptoms at the end of follow-up than the CDR-1 group showed at baseline. CONCLUSIONS The CERAD total score is a suitable and sensitive follow-up tool in longitudinal AD trials. Cognition progression rates did not significantly differ between study groups; however, patients with very mild AD at baseline had milder neuropsychiatric symptoms after long-term follow-up. This emphasizes the importance of early diagnosis and assessment of neuropsychiatric symptoms at the diagnostic visit and during follow-up.

Early psychosocial intervention does not delay institutionalization in persons with mild Alzheimer disease and has impact on neither disease progression nor caregivers' well-being: ALSOVA 3-year follow-up.

Early diagnosis, initiation of Alzheimers disease (AD) therapy and programs that support care of persons with AD at home are recommended. The objective of this study was to assess the effect of early psychosocial intervention on delaying the institutionalization of persons with AD. We also assessed the influence of intervention on AD progression, behavioral symptoms, and health‐related quality of life (HRQoL) in persons with AD and caregivers.

Cognitive and Neuropsychiatric Symptom Differences in Early Stages of Alzheimer’s Disease: Kuopio ALSOVA Study

Background/Aim: Alzheimer’s disease (AD) causes impairment in memory and other cognitive functions as well as neuropsychiatric symptoms and limitations in the activities of daily living (ADL). The aim of this study was to examine whether demographic variables, dementia severity, ADL and neuropsychiatric symptoms are associated with cognition in very mild or mild AD. Methods: We analyzed the baseline data of 236 patients with very mild or mild AD participating in a prospective AD follow-up study (ALSOVA). The Consortium to Establish a Registry for Alzheimer’s Disease neuropsychological battery total score was used in the evaluation of the global cognitive performance. Results: Cognition was associated with dementia severity and ADL but not with neuropsychiatric symptoms. ADL functions were associated with both cognitive performance and neuropsychiatric symptoms. Conclusion: Even patients with very mild or mild AD may exhibit neuropsychiatric symptoms not related to cognitive impairment. The results of this study emphasize the importance of taking a multidimensional approach to the diagnostic and prognostic evaluation of AD patients already in the early stages of the disease.

Quality of Life in relation to neuropsychiatric symptoms in Alzheimer's disease: 5‐year prospective ALSOVA cohort study

To examine the association between neuropsychiatric symptoms (NPS) with self‐ and caregiver‐rated Quality of Life (QoL) for patients with Alzheimers disease (AD) during a 5‐year follow‐up.

Depressed spousal caregivers have psychological stress unrelated to the progression of Alzheimer disease: a 3-year follow-up report, Kuopio ALSOVA Study

Objective: To explore family caregiver (FC) long-term psychological distress after Alzheimer disease (AD) diagnosis in a family member. Methods: FC (n = 236) and patients with AD were prospectively followed up to 36 months after AD diagnosis. FC psychological distress was evaluated using the General Health Questionnaire (GHQ). Furthermore, caregiver depressive symptoms and sense of coherence, along with AD patient measurements, were measured at baseline and annually. Generalized estimating equation models were applied to study associations of these baseline factors to caregiver GHQ. Results: After 36 months of follow-up, spousal caregivers (SCs) GHQ was significantly higher (P < .001) than in the nonspousal caregivers (NSCs). The difference in GHQ scores was associated by depressive symptoms (P < .001) at baseline, and the depressed SCs have more severe distress than NSCs over the observation period. Conclusion: During longitudinal caregiving, spousal and depressed caregivers of patients with AD report higher and increasing psychological stress than nonspousal and nondepressed caregivers. Spousal relationship, caregivers’ depressive symptoms, and the severity of patients’ neuropsychological symptoms at the time of AD diagnosis predict the trajectory of psychological distress. The current study highlights the need for evaluating AD caregiver mental health and level of coping.

Associations Across Caregiver and Care Recipient Symptoms: Self-Organizing Map and Meta-analysis

Purpose of the Study The main objective of this study was to reveal generalizable associations across caregiver burden (CGB), caregiver depression (CGD), care recipient cognitive ability (CRCA), and care recipient behavioral and psychological symptoms of dementia (BPSD). Design and Methods Studies published between 2004 and 2014 and reporting CGB and/or CGD together with CRCA and/or BPSD were included. Only 95 out of 1,955 studies provided enough data for data clustering with the Self-Organizing Map (SOM) and 27 of them for meta-analyses based on correlation coefficients. Results Caregiver and care recipient symptoms were not tightly associated with each other, except for the CGB-BPSD interaction at the individual level. SOM emphasized the cluster comprising studies reporting low CGB, low CGD, high CRCA, and few BPSD. Meta-analyses indicated high heterogeneity between the original studies. Implications Relationships between caregiver and care recipient symptoms should be treated as situation-specific phenomena, at least when the symptoms are moderate at most. Dementia caregiving per se should not be understood as a source of stress and mental health problems. More systematic and coherent use of measures is necessary to enable a comprehensive analysis of caregiving.

The Progression of Alzheimer's Disease Can Be Assessed with a Short Version of the CERAD Neuropsychological Battery: The Kuopio ALSOVA Study

Background/Aims: Measuring and predicting Alzheimers disease (AD) progression is important in order to adjust treatment and allocate care resources. We aimed to identify a combination of subtests from the Consortium to Establish a Registry for Alzheimers Disease Neuropsychological Battery (CERAD-NB) that best correlated with AD progression in follow-up as well as to predict AD progression. Method: A total of 236 participants with very mild [Clinical Dementia Rating (CDR) = 0.5] or mild AD (CDR = 1.0) at baseline were followed up for 3 years. The CERAD-NB and Mini-Mental State Examination (MMSE) were used to assess cognition, and the CDR scale sum of boxes (CDR-sb) was employed to evaluate AD progression. Generalized estimating equations were used to develop models to predict and follow up disease progression. Results: Performance declined on all CERAD-NB subtests. The ability of the separate subtests to distinguish between groups (baseline CDR = 0.5 or 1.0) diminished during follow-up. The best combination of subtests that explained 62% of CDR-sb variance in follow-up included verbal fluency, constructional praxis, the clock drawing test, and the MMSE. Baseline values of the same combination predicted 37% of the CDR-sb change. Conclusion: A short version of the CERAD-NB subtests provides a promising and time-efficient alternative for measuring cognitive deterioration during AD follow-up. Although the initial signs of AD include memory difficulties, it may be useful to assess non-memory tasks in follow-up.

Neuropsychatric Sympions and Quality of Life in Patients with very mild and mild aizheimer's disease

OF LIFE IN PATIENTS WITH VERY MILD AND MILD AIZHEIMER’S DISEASE Anne Koivisto, Kristiina Hongisto (former Karttunen), Hilkka Soininen, Pertti Karppi, Asta Hiltunen, Tarja V€alim€aki, University of Eastern Finland, Kuopio, Finland; Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland; 3 Mikkeli Central Hospital, Mikkeli, Finland; Department of Neurology, North Carelia Central Hospital, Joensuu, Finland.