Determinants of Cross-Sectional and Longitudinal Health-Related Quality of Life in Memory Clinic Patients Without Dementia

Abstract

Objective: To identify determinants within 3 different domains (ie, somatic comorbidities, cognitive functioning, and neuropsychiatric symptoms [NPS]) of health-related quality of life (HRQoL) over time in memory clinic patients without dementia. Methods: This longitudinal multicenter cohort study with a 3-year observation period recruited 315 individuals (age: 69.8 ± 8.6, 64.4% males, Mini-Mental State Examination score 26.9 ± 2.6). A multivariable explanatory model was built using linear mixed effects models (forward selection per domain) to select determinants for self-perceived HRQoL over time, as measured by the EuroQoL-5D visual analogue scale (EQ VAS). Results: Mean HRQoL at study entry was 69.4 ± 15.6. The presence of agitation, appetite and eating abnormalities, and eyes/ears/nose (ie, sensory impairment) comorbidities were associated with a change in HRQoL over time. Agitation was most strongly associated with HRQoL over time. Conclusions: The association of somatic comorbidities and NPS in memory clinic patients with course of HRQoL shows that these should receive more awareness, detection, and monitoring by clinicians.

Behavioral and Psychological Symptoms of Dementia (BPSD): Clinical Characterization and Genetic Correlates in an Italian Alzheimer’s Disease Cohort

“…Interestingly, AD patients carrying the APOE ε4 allele show a more profound loss in cholinergic activity in the hippocampus and the cortex, and in neuroimaging studies the presence of the APOE ε4 allele was associated with a greater rate of hippocampal, cortical, and whole-brain atrophy [ 10 ]. On the other hand, there are also negative studies, reporting no associations of this gene with agitation [ 49 ]. These findings, thus, further emphasize the importance of sub-grouping BPSD in distinct neuropsychiatric syndromes.…”

Association Between Cognition, Health Related Quality of Life, and Costs in a Population at Risk for Cognitive Decline

“…Although the latter did find an association between cognition and utility related to wellbeing measured by the ICECAP-O [13]. Other studies [14][15][16][17] which did not incorporate utilities, but instead looked at other HRQoL measures (Visual Analogue Scale or total scores) also showed contradictory results among older adults without dementia. The existing studies differ in, for example, setting and measurement instruments used, and evidence on this association remains inconclusive.…”

Biweekly fluctuations of neuropsychiatric symptoms according to the Neuropsychiatric Inventory: Erratic symptoms or scores?

“…The low sample size may affected the stability of correlation coefficients, especially the correlations below 0.50 27 . Furthermore, the proportion of female patients (22%) in our sample was lower than expected based on previous studies in Dutch academic memory clinics (40%–55% females) 1,28,29 . Although our within‐person analysis reduces the potential impact of the clinical heterogeneity and underrepresentation of female patients, our results need to be replicated in larger samples including a higher proportion of females, especially since NPS may manifest differently in females than males 30 .…”

“…27 Furthermore, the proportion of female patients (22%) in our sample was lower than expected based on previous studies in Dutch academic memory clinics (40%-55% females). 1,28,29 Although our within-person analysis reduces the potential impact of the clinical heterogeneity and underrepresentation of female patients, our results need to be replicated in larger samples including a higher proportion of females, especially since NPS may manifest differently in females than males. 30 Third, we found indications that NPI scores were somewhat more stable in individuals with dementia compared to individuals with CIND.…”