Defining 'early dementia' and monitoring intervention: What measures are useful in family caregiving?

Abstract

Measures of cognition are often used to define and measure the progress of dementia and outcomes of intervention. This paper examines whether measures of psychosocial disability used with those of cognition are more useful than measures of cognition alone, particularly in early dementia. A measure of cognition and two instruments of caregiver burden, used as routine clinical outcome measures of three types of Old Age Psychiatry dementia services, were examined. All cases with dementia in a memory clinic (MC; n = 149), a community mental health service for older people (CMHT; n = 120) and a specialist dementia day hospital (DH; n = 118), in one NHS district were followed up at 12 months. Measures of cognition (MMSE), behaviour, caregiver coping (Problem Checklist; PC) and caregiver mood (Hospital Anxiety and Depression Scale; HAD) were taken at baseline (MC, n = 48; CMHT, n = 113; DH, n = 55) and at follow-up (MC, n = 35; CMHT, n = 34; DH, n = 23). At baseline, all three groups had an average MMSE score of "mild impairment" but measures of behaviour and caregiver burden showed subtle between-group differences. At the 12-month follow-up, cognition remained stable in all groups, but the frequency of day-to-day problems increased and caregiver mood deteriorated in families receiving DH support. The use of psychosocial measures of disability in conjunction with those of cognition, are important in the definition and longitudinal measurement of intervention and support in early dementia.

Systematic review of respite care in the frail elderly

“…Four studies evaluated day care services 29,47,48,55 and two home care. 40,44 Using a fixed-effects model significant effects in terms of a reduction in depression were not observed for day care services ( Figure 9).…”

“…29,40,44,47,48,55 Two studies 29,55 measured depression at two follow-up times (6 and 12 months and 3 and 12 months respectively). Two separate analyses were therefore carried out examining the effects of both short-and long-term follow-up.…”

“…55 The third study assessed a combined day and home care intervention for dementia care recipients in the UK. 48 The followup period for all studies was 12 months. As the test for heterogeneity was significant in this instance, the effect of fitting a random model was evaluated (Figure 8), which showed a non-significant overall effect.…”

“…29,48,55 Two studies were carried out in the USA, 29,55 assessing day care in the frail elderly 29 and in care recipients with dementia. 55 The third study assessed a combined day and home care intervention for dementia care recipients in the UK.…”

“…When disagreements occurred papers were selected for full retrieval. Inter-rater agreement ranged from fair to moderate (kappa coefficient range [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52]. 16 At the full paper stage all exclusions were checked by a second reviewer selected from within the project management team.…”