Affiliations: [a]
Department of Neurology, Philipps-University Marburg, Marburg, Germany
| [b]
Department of Family Medicine, Philipps-University Marburg, Marburg, Germany
| [c] Vitos Clinic for Psychiatry and Psychotherapy, Marburg and Justus-Liebig-University, Giessen, Germany
| [d]
Institute of Medical Sociology and Social Medicine, Philipps-University Marburg, Marburg, Germany
Correspondence:
[*]
Correspondence to: Richard Dodel, MD, MPH, Department of Neurology, Philipps-University Marburg, Baldingerstraße, 35043 Marburg, Germany. Tel.: +49 6421 586 6251; Fax: +49 6421 586 5474; E-mail: dodel@med.uni-marburg.de.
Abstract: The purpose of this study is to evaluate the health-related quality of life (HrQoL) of patients with Alzheimer’s disease (AD) in different care settings (institutionalized versus community-dwelling) across all severity stages of dementia. Patients were consecutively recruited with their primary caregivers (123 inpatients and 272 outpatients), and the impact of patient-related parameters such as behavioral and psychological symptoms of dementia (BPSD) (Geriatric Depression Scale [GDS] and Neuropsychiatric Inventory [NPI]) and functional capacity (Alzheimer’s Disease Cooperative Study-Activities of Daily Living [ADCS-ADL]) on HrQoL was analyzed. Patients’ HrQoL was assessed using self-reported and caregiver-rated generic (EuroQoL Instrument) and dementia-specific (Quality of Life-Alzheimer’s Disease [Qol-AD]) scales. Patients reported a considerably higher HrQoL than their caregivers on the QoL-AD, EQ-5D, and EQ VAS (p < 0.001). Different dementia severity groups showed significantly worse results in HrQoL for patients with lower MMSE scores. The mean self-reported QoL-AD decreased from 32.3±5.7 in the group with the highest MMSE scores to 27.1±5.5 in patients with the lowest MMSE scores (p < 0.001). A considerably lower HrQoL was shown for institutionalized patients versus participants in outpatient settings (proxy-rated QoL-AD 19.7±4.6 versus 26.0±7.1, p < 0.001). Depressive symptoms (GDS), BPSD (NPI), and reduced functional capacity (ADCS-ADL) were evaluated for their impact on patients’ HrQoL. Multivariate models explained between 22% and 54% of the variance in patients’ HrQoL. To analyze the causative direction of the reported associations, further longitudinal studies should be conducted.
Keywords: Alzheimer’s disease, BPSD, care, dementia, depression, quality of life
