Objectives-Progression of Alzheimer's dementia (AD) is highly variable. Most estimates derive from convenience samples from dementia clinics or research centers where there is substantial potential for survival bias and other distortions. In a population-based sample of incident AD cases, we examined progression of impairment in cognition, function, and neuropsychiatric symptoms, and the influence of selected variables on these domains. Design-Longitudinal, prospective cohort study Setting-Cache County (Utah)Participants-328 persons diagnosed with Possible/Probable AD Measurements-Mini-Mental State Exam (MMSE), Clinical Dementia Rating sum-of-boxes (CDR-sb), and Neuropsychiatric Inventory (NPI).Results-Over a mean follow-up of 3.80 (range 0.07-12.90) years, the mean (S.D.) annual rates of change were −1.53 (2.69) on the MMSE, 1.44 (1.82) on the CDR-sb, and 2.55 (5.37) scale points on the NPI. Among surviving participants, 30-58% progressed less than one point/year on these measures, even 5-7 years after dementia onset. Rates of change were correlated between MMSE and CDR-sb (r=−0.62, df=201, p<0.001) and between the CDR-sb and NPI (r=0.20, df=206, p<0.004). Females (LR χ 2 =8.7, df=2, p=0.013) and those with younger onset (LR χ 2 =5.7, df=2, p=0.058) declined faster on the MMSE. Although one or more APOE ε4 alleles and ever-use of FDA-approved anti-dementia medications were associated with initial MMSE scores, neither was related to the rate of progression in any domain.Conclusions-A significant proportion of persons with AD progresses slowly. The results underscore differences between population-vs. clinic-based samples and suggest ongoing need to identify factors that may slow the progression of AD. KeywordsAlzheimer's disease; dementia; cognition; neuropsychiatric symptoms; progression; decline Alzheimer's dementia (AD) is a significant cause of disability and mortality among the elderly. Some 26.6 million cases presently worldwide may increase to 106.2 million by 2050,(1) unless a means of prevention can be identified. Without a cure, better understanding of the clinical course and course-modifying factors is needed.AD causes impairment not only in cognition and function, but also in behavior prompted by neuropsychiatric symptoms (NPS). Numerous studies report significant variability in the rate of cognitive and functional decline in AD. For example, a recent review reported that the mean annual rate of change (ARC) on the Mini-Mental State Exam (MMSE), a global measure of cognition, varied from 0.8 to 4.4 points.(2) Similar variability is seen in functional decline,(3) although comparisons across studies are impeded by differences in instrumentation. NPS in AD are marked by increasing incidence over time and by an episodic course. (4) These studies of the natural history of AD share several limitations. Most come from observations in clinics or clinical research centers. Compared to panels of AD cases ascertained from populations, clinic AD patients are up to 20 years younger, have higher Here, we d...

Applying Rusbult ' s investment model of dyadic relationships, we examined the effect of caregiver-care recipient relationship closeness (RC) on cognitive and functional decline in Alzheimer ' s disease. After diagnosis, 167 participants completed up to six visits, observed over an average of 20 months. Participants were 64% women, had a mean age of 86 years, and mean dementia duration of 4 years. Caregiver-rated closeness was measured using a six-item scale. In mixed models adjusted for dementia severity, dyads with higher levels of closeness (p < .05) and with spouse caregivers (p = .01) had slower cognitive decline. Effect of higher RC on functional decline was greater with spouse caregivers (p = .007). These fi ndings of attenuated Alzheimer ' s dementia (AD) decline with closer relationships, particularly with spouse caregivers, are consistent with investment theory. Future interventions designed to enhance the caregiving dyadic relationship may help slow decline in AD.

Objectives-Chronic psychosocial stress in caregivers can lead to adverse health outcomes including depression, anxiety, and cognitive decline. We examined the effects of having a spouse with dementia on one's own risk for incident dementia.Design-Population-based study of incident dementia in spouses of persons with dementia. Setting-Rural county in northern Utah.Participants-2,442 subjects (1,221 married couples) aged 65 and older.Measurements-Incident dementia was diagnosed in 255 subjects, with onset defined as age when subject met DSM-III-R criteria for dementia. Cox proportional hazards regression tested the effect of time-dependent exposure to dementia in one's spouse, adjusted for potential confounders.Results-A subject whose spouse experienced incident dementia onset had a six-fold increase in the hazard for incident dementia compared to subjects whose spouses were dementia free [Hazard Rate Ratio (HRR)=6.0, 95% CI: 2.2-16.2 (p<.001)]. In sex-specific analyses, husbands had higher risks (HRR=11.9, 95% CI: 1.7-85.5, p=.014) compared to wives (HRR=3.7, 95% CI: 1.2-11.6, p=.028). Conclusion-The chronic and often severe stress associated with dementia caregiving may exert substantial risk for the development of dementia in spouse caregivers. Additional (not mutually exclusive) explanations for findings are discussed.

Background Quality of Life (QOL) is frequently assessed in persons with dementia (PWD) via self- and/or proxy-report. Determinants of QOL ratings are multi-dimensional and may differ between patients and caregiver proxies. This study compares self-report and proxy QOL ratings in a population-based study of PWD and their caregivers, and examined the extent to which discrepancies in reports were associated with characteristics of the PWD. Methods The sample consisted of 246 patient/caregiver dyads from the initial visit of the Cache County Dementia Progression Study, with both members of the dyad rating PWD QOL. PWD age, gender, cognitive impairment (Mini-Mental State Exam), neuropsychiatric symptoms (Neuropsychiatric Inventory; NPI), dementia severity (Clinical Dementia Rating), medical comorbidities (General Medical Health Rating), and functional impairment (Dementia Severity Rating Scale) were examined as correlates of self- and proxy-reported QOL ratings and the differences between the QOL reports. Results Self- and proxy-reported PWD QOL ratings were only modestly correlated. Medical comorbidity was associated with self-report whereas NPI was associated with proxy-report. Dementia severity was associated with discrepancies in self- and proxy-report, with worse patient cognition associated with poorer proxy-reported QOL ratings. Conclusions PWD self- and proxy-reported QOL ratings are associated with different variables. Discrepancies between PWD and caregiver perceptions of PWD QOL should be recognized, particularly in cases of more severe dementia.

In-depth interviews of 10 rural Latino family triads (mother, father, and adolescent) investigated the educational and occupational aspirations of parents and youth, and factors affecting those aspirations. Using a content analysis of the interview scripts, several themes emerged that described these families' experiences. In some instances, Latino parent aspirations were found to transfer to their youth. However, only one half of the parents were aware of their youth's aspirations, and most had not discussed them with their youth. Youth and parents articulated several barriers to achieving higher educational or occupational aspirations. Implications for programmatic initiatives and research are delineated.Researchers have shown that one of the best predictors of academic achievement or dropping out of school is youth educational aspirations (