The influence of neuropsychiatric and functional changes on quality of life in Alzheimer's disease

Novelli, Marcia M.P.C.; Caramelli, Paulo

doi:10.1590/S1980-57642010DN40100008

Abstract

To investigate the influence of neuropsychiatric manifestations and functional performance on quality of life (QOL) of AD patients and their caregivers/family members. Methods: The QOL-AD scale, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Cornell and Beck Scales for Depression, Physical and Instrumental-Self Maintenance scales (AIDL and ADL) and the Neuropsychiatric Inventory (NPI) were applied to 60 patients with probable AD, mild (n=30) or moderate (n=30) dementia, according to NINCDS-ADRDA and DSM-III-R criteria, respectively, and to their caregivers/family members. The total scores on the three QOL-AD versions were correlated with the measures previously mentioned. Results: The QOL-AD patients' version displayed significant correlations with GDS (-0.76 p<0.01), Cornell (-0.53 p<0.01) and NPI (-0.46 p<0.05) in the mild dementia subgroup. The caregivers' version about patients' QOL correlated with GDS (-0.48 p<0.01), Cornell (-0.57 p<0.01), NPI (-0.46 p<0.01) and AIDL (-0.36 p<0.05), while the caregivers' version about their own QOL was significantly correlated with NPI (-0.43 p<0.01), AIDL (-0.35 p<0.05) and Beck Depression (-0.67 p<0.01). In the moderate dementia subgroup, significant correlations were observed with GDS (-0.45 p<0.05) and Cornell (-0.46 p<0.01). For the caregivers' version about patients' QOL, significant correlations emerged with Cornell (-0.68 p<0.01), NPI (-0.67 p<0.01), AIDL (-0.41 p<0.05), ADL (-0.49, p<0.01) and Beck Depression (-0.33 p<0.05). For the caregivers' version about their own QOL, significant correlations with Beck Depression (-0.54 p<0.01) and ADL (-0.38, p<0.05) were found. Conclusion: The symptoms presented in AD affected the QOL in patients and caregivers/family members in both mild and moderate dementia.

Key words:
quality of life; Alzheimer's disease; neuropsychiatric symptoms; functional performance; caregivers

Resumo

Investigar avaliar a influência das manifestações neuropsiquiátricas e do desempenho funcional sobre a qualidade de vida dos pacientes com DA e de seus cuidadores/familiares. Métodos: A escala QdV-DA, Mini-exame do Estado Mental (MEM), Escala de Depressão Geriátrica (GDS), Inventário de Depressão de Beck e a Escala de Cornell para depressão, Escala de atividades de vida diária (ABVD e AIVD) de Lawton e Brody e o Inventário Neuropsiquiátrico (INP) foram administrados em uma amostra de 60 pacientes com DA provável, segundo os critérios do NINCDS-ADRDA , com gravidade de leve (n=30) a moderado (n-30) segundo os critérios do DMS-III-R. e a seus respectivos cuidadores/familiares. A pontuação total, das três versões da escala, foi correlacionada aos instrumentos previamente mencionados. Resultados: A versão de QV dos pacientes no grupo de demência leve apresentou correlações significativas com o GDS (-0,76 p<0,01), Cornell (-0,53 p<0,01) e INP (-0,46 p<0, 05). A versão do cuidador sobre a QV do paciente se correlacionou com: GDS (-0,48 p<0,01), Cornell (-0,57 p<0,01), INP (-0,62 p<0,01) e AIVD (-0,36 p<0,05) enquanto que a versão do cuidador sobre sua própria QV se correlacionou significativamente com NPI (-0,43 p<0,01), AIVD (-0,35 p<0,05) e GDS (-0,67 p<0,01). No grupo de pacientes moderados foram encontradas correlações significativas com GDS (-0,45 p<0,05) e a Escala de Cornell (-0,46 p<0,01). Para versão do cuidador sobre a QV do paciente as correlações significativas foram com: Cornell (-0,68 p<0,01), INP (-0,67 p<0,01), AIVD (-0,41 p<0,05), ABVD (-0,49 p<0,01), e Inventário de Depressão de Beck (-0,33 p<0,05). Para versão do cuidador sobre sua própria QV foram encontradas correlações significativas com: Inventário de Depressão Beck (-0,54 p<0,01) e ABVD (-0,38 p<0,05). Conclusão: Os sintomas da DA afetam a QV dos pacientes como também dos cuidadores/familiares tanto na fase leve como na fase moderada.

Palavras-chave:
qualidade de vida; doença de Alzheimer; sintomas neuropsiquiátricos; desempenho funcional; cuidadores

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References

¹
Whitehouse PJ, Rabins PV. Quality of life and dementia. Alzheimer Dis Assoc Disord 1992;6:135-137.
²
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th Ed. Washington, DC: American Psychiatric Association; 1994.
³
Logsdon RG, Gibbons LE, McCurry SM, Teri L. Quality of life in Alzheimer's disease: patient and caregiver reports. J Mental Health Aging 1999;5:21-32.
⁴
Whitehouse PJ. Quality of life: Future directions In: Albert SM, Logsdon RG. (Editors). Assessing quality of life in Alzheimer's disease. New York: Springer; 2000:179-184.
⁵
Logsdon RG, Albert SM. Assessing quality of life in Alzheimer's disease: Conceptual and methodological Issues. In: Assessing quality of life in Alzheimer's disease. Springer Publishing Company; 2000:ix-xi.
⁶
Logsdon RG, Gibbons, LE, McCurry SM, Teri L. Assessing quality of life in older adults with cognitive impairment. Psychosom Med 2002;64:510-519.
⁷
Selai CE, Trimble MR, Rossor MN, Harvey RJ. The Quality of Life Assessment Schedule (QOLAS): a new method for assessing quality of life(QOL) in dementia. In: Albert SM, Logsdon RG (Eds). Assessing quality of life in Alzheimer's disease. New York: Springer ; 2000:31-48.
⁸
Albert SM, Castanada CC, Jacobs DM, et al. Proxy-reported quality of life in Alzheimer's patients: comparison of clinical and population-based samples. In: Albert SM, Logsdon RG (Eds). Assessing quality of life in Alzheimer's disease. New York: Springer ; 2000:69-80.
⁹
Thorgrimsen, L, Selwood A, Spector A, Royan L, De Madariaga- Lopez M, Woods RT . Whose quality of life is it anyway? The validity and reliability of the quality of life-Alzheimer's disease (QOL-AD) Scale. Alzheimer Dis Assoc Disord 2003; 201-208.
¹⁰
Hoe J, Katona C, Roch B, Livingston G. Use of the QOL-AD for measuring quality of life in people with severe dementia: the LASER-AD study. Age Ageing 2005;34:130-135.
¹¹
Matsui T, Nakaaki S, Murata Y, et al. Determinants of quality of life in Alzheimer's disease patients as assessed by Japanese version of the quality of life: Alzheimer's disease scale. Dement Geriatr Cogn Disord 2006;21:182-191.
¹²
Tatsumi H, Nakaaki S, Torii K, et al. Neuropsychiatric symptoms predict change in quality of life of Alzheimer disease patients: a two-year follow-up study 2009;63:374-384.
¹³
Berwing M, Leicht H, Gertz HJ. Critical evaluation of self-rated quality of life in mild cognitive impairment and Alzheimer's disease: further evidence for the impact of anosognosia and global cognitive impairment. J Nutr Health Aging 2009;13:226-30.
¹⁴
Vellone E, Piras G, Talucci Cohen MZ. Quality of life for caregivers of people with Alzheimer's disease. J Adv Nurs. 2008; 61:222-231.
¹⁵
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspice of department of health and human services task force on Alzheimer's disease. Neurology 1994;34:939-944.
¹⁶
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. (3rd ed). Washington. DC: American Psychiatric Association; 1987.
¹⁷
Folstein MF, Folstein SE, Mchugh PR. Mini mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
¹⁸
Brucki SM, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para uso do Mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.
¹⁹
Novelli MMPC, Rovere HH, Nitrini R, Caramelli P. Cross-Cultural adaptation of the quality of life assessment scale on Alzheimer disease. Arq Neuropsiquiatr 2005;63:201-206.
²⁰
Novelli MMPC. Validação da escala de qualidade de vida (QdV-DA) para pacientes com doença de Alzheimer e seus respectivos cuidadores/familiares. Tese de doutorado. Faculdade de Medicina da Universidade de São Paulo. 2006
²¹
Logsdon RG, Gibbons LE, McCurry SM, Teri L. Assessing quality of life in older adults with cognitive impairment. Psychosom Med 2002;64:510-519.
²²
Lawton MP, Brody EM. Assessment of older people: Self maintaining and instrumental activities of daily living. Gerontologist 1969;9:179-185.
²³
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatry Inventory: assessing psychopathology in dementia patients. Neurology 1994;44:2308-2314.
²⁴
Camozzato AL, Kochhann R, Simeoni C, Konrath CA, Pedro Franz A, Carvalho A, Chaves ML. Reliability of the Brazilian Portuguese version of the Neuropsychiatric Inventory (NPI) for patients with Alzheimer's disease and their caregivers. Int Psychogeriatr 2008;20:383-393.
²⁵
Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiat Res 1982;17:17-49.
²⁶
Almeida OP, Almeida SA. Reliability of the Brazilian version of the abbreviated form of Geriatric Depression Scale (GDS) short form. Arq Neuropsiquiatr 1999;57:421-426.
²⁷
Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell scale for depression in dementia. Biol Psychiatry 1988; 23:271-284.
²⁸
Alexopoulos GS, Chester JG. Outcomes of geriatric depression. Clin Geriatr Med 1992;8:363-376.
²⁹
Carthery-Goulart MT, Areza-Fegyveres R, Schultz RR, et al. Brazilian version of the Cornell depression scale in dementia. Arq Neuropsiquiatr 2007;65:912-915.
³⁰
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh, J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4:561-571.
³¹
Gorenstein C, Andrade L. Inventário de depressão de Beck: propriedades psicométricas da versão em Português. In: Gorenstein C, Andrade LHS, Zuardi AW. Escalas de avaliação clinica em psiquiatria e psicofarmacologia. São Paulo: Editorial Lemos; 2000:89-95.
³²
Doria Filho U. Introdução à bioestatística para simples mortais. São Paulo: Negócio Editora; 1999.
³³
Marra TA, Pereira LSM, Faria CDCM, Pereira DS, Martins MAA, Tirado MGA. Avaliação das atividades de vida diária de idosos com diferentes níveis de demência. Rev Bras Fisioter 2007;11:267-273.
³⁴
Liu KPY, Chan CCH, Chu MML, et al. Activities of daily living performance in dementia. Acta Neurol Scand 2007;116:91-95.
³⁵
Tatsch MF, Bottino CM, Azevedo D, et al. Neuropsychiatric symptoms in Alzheimer disease and cognitively impaired, nondemented elderly from a community-based sample in Brazil: prevalence and relationship with dementia severity. Am J Geriatr Psychiatry. 2006;4:438-45.

Publication Dates

Publication in this collection
Jan-Mar 2010

History

Received
30 Oct 2008
Accepted
27 Jan 2010

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Whitehouse PJ, Rabins PV. Quality of life and dementia. Alzheimer Dis Assoc Disord 1992;6:135-137.

[2] ²
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th Ed. Washington, DC: American Psychiatric Association; 1994.

[3] ³
Logsdon RG, Gibbons LE, McCurry SM, Teri L. Quality of life in Alzheimer's disease: patient and caregiver reports. J Mental Health Aging 1999;5:21-32.

[4] ⁴
Whitehouse PJ. Quality of life: Future directions In: Albert SM, Logsdon RG. (Editors). Assessing quality of life in Alzheimer's disease. New York: Springer; 2000:179-184.

[5] ⁵
Logsdon RG, Albert SM. Assessing quality of life in Alzheimer's disease: Conceptual and methodological Issues. In: Assessing quality of life in Alzheimer's disease. Springer Publishing Company; 2000:ix-xi.

[6] ⁶
Logsdon RG, Gibbons, LE, McCurry SM, Teri L. Assessing quality of life in older adults with cognitive impairment. Psychosom Med 2002;64:510-519.

[7] ⁷
Selai CE, Trimble MR, Rossor MN, Harvey RJ. The Quality of Life Assessment Schedule (QOLAS): a new method for assessing quality of life(QOL) in dementia. In: Albert SM, Logsdon RG (Eds). Assessing quality of life in Alzheimer's disease. New York: Springer ; 2000:31-48.

[8] ⁸
Albert SM, Castanada CC, Jacobs DM, et al. Proxy-reported quality of life in Alzheimer's patients: comparison of clinical and population-based samples. In: Albert SM, Logsdon RG (Eds). Assessing quality of life in Alzheimer's disease. New York: Springer ; 2000:69-80.

[9] ⁹
Thorgrimsen, L, Selwood A, Spector A, Royan L, De Madariaga- Lopez M, Woods RT . Whose quality of life is it anyway? The validity and reliability of the quality of life-Alzheimer's disease (QOL-AD) Scale. Alzheimer Dis Assoc Disord 2003; 201-208.

[10] ¹⁰
Hoe J, Katona C, Roch B, Livingston G. Use of the QOL-AD for measuring quality of life in people with severe dementia: the LASER-AD study. Age Ageing 2005;34:130-135.

[11] ¹¹
Matsui T, Nakaaki S, Murata Y, et al. Determinants of quality of life in Alzheimer's disease patients as assessed by Japanese version of the quality of life: Alzheimer's disease scale. Dement Geriatr Cogn Disord 2006;21:182-191.

[12] ¹²
Tatsumi H, Nakaaki S, Torii K, et al. Neuropsychiatric symptoms predict change in quality of life of Alzheimer disease patients: a two-year follow-up study 2009;63:374-384.

[13] ¹³
Berwing M, Leicht H, Gertz HJ. Critical evaluation of self-rated quality of life in mild cognitive impairment and Alzheimer's disease: further evidence for the impact of anosognosia and global cognitive impairment. J Nutr Health Aging 2009;13:226-30.

[14] ¹⁴
Vellone E, Piras G, Talucci Cohen MZ. Quality of life for caregivers of people with Alzheimer's disease. J Adv Nurs. 2008; 61:222-231.

[15] ¹⁵
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspice of department of health and human services task force on Alzheimer's disease. Neurology 1994;34:939-944.

[16] ¹⁶
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. (3rd ed). Washington. DC: American Psychiatric Association; 1987.

[17] ¹⁷
Folstein MF, Folstein SE, Mchugh PR. Mini mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.

[18] ¹⁸
Brucki SM, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para uso do Mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.

[19] ¹⁹
Novelli MMPC, Rovere HH, Nitrini R, Caramelli P. Cross-Cultural adaptation of the quality of life assessment scale on Alzheimer disease. Arq Neuropsiquiatr 2005;63:201-206.

[20] ²⁰
Novelli MMPC. Validação da escala de qualidade de vida (QdV-DA) para pacientes com doença de Alzheimer e seus respectivos cuidadores/familiares. Tese de doutorado. Faculdade de Medicina da Universidade de São Paulo. 2006

[21] ²¹
Logsdon RG, Gibbons LE, McCurry SM, Teri L. Assessing quality of life in older adults with cognitive impairment. Psychosom Med 2002;64:510-519.

[22] ²²
Lawton MP, Brody EM. Assessment of older people: Self maintaining and instrumental activities of daily living. Gerontologist 1969;9:179-185.

[23] ²³
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatry Inventory: assessing psychopathology in dementia patients. Neurology 1994;44:2308-2314.

[24] ²⁴
Camozzato AL, Kochhann R, Simeoni C, Konrath CA, Pedro Franz A, Carvalho A, Chaves ML. Reliability of the Brazilian Portuguese version of the Neuropsychiatric Inventory (NPI) for patients with Alzheimer's disease and their caregivers. Int Psychogeriatr 2008;20:383-393.

[25] ²⁵
Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiat Res 1982;17:17-49.

[26] ²⁶
Almeida OP, Almeida SA. Reliability of the Brazilian version of the abbreviated form of Geriatric Depression Scale (GDS) short form. Arq Neuropsiquiatr 1999;57:421-426.

[27] ²⁷
Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell scale for depression in dementia. Biol Psychiatry 1988; 23:271-284.

[28] ²⁸
Alexopoulos GS, Chester JG. Outcomes of geriatric depression. Clin Geriatr Med 1992;8:363-376.

[29] ²⁹
Carthery-Goulart MT, Areza-Fegyveres R, Schultz RR, et al. Brazilian version of the Cornell depression scale in dementia. Arq Neuropsiquiatr 2007;65:912-915.

[30] ³⁰
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh, J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4:561-571.

[31] ³¹
Gorenstein C, Andrade L. Inventário de depressão de Beck: propriedades psicométricas da versão em Português. In: Gorenstein C, Andrade LHS, Zuardi AW. Escalas de avaliação clinica em psiquiatria e psicofarmacologia. São Paulo: Editorial Lemos; 2000:89-95.

[32] ³²
Doria Filho U. Introdução à bioestatística para simples mortais. São Paulo: Negócio Editora; 1999.

[33] ³³
Marra TA, Pereira LSM, Faria CDCM, Pereira DS, Martins MAA, Tirado MGA. Avaliação das atividades de vida diária de idosos com diferentes níveis de demência. Rev Bras Fisioter 2007;11:267-273.

[34] ³⁴
Liu KPY, Chan CCH, Chu MML, et al. Activities of daily living performance in dementia. Acta Neurol Scand 2007;116:91-95.

[35] ³⁵
Tatsch MF, Bottino CM, Azevedo D, et al. Neuropsychiatric symptoms in Alzheimer disease and cognitively impaired, nondemented elderly from a community-based sample in Brazil: prevalence and relationship with dementia severity. Am J Geriatr Psychiatry. 2006;4:438-45.

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