Anosognosia y depresión en la percepción de la calidad de vida de los pacientes con enfermedad de Alzheimer. Evolución a los 12 meses / The influence of anosognosia and depression on the perceived quality of life of patients with Alzheimer’s disease: a 12 months follow-up

Introducción. La anosognosia y la depresión pueden influir en la valoración sobre la calidad de vida del paciente con enfermedad de Alzheimer. Objetivo. Explorar la evolución de la calidad de vida del paciente con enfermedad de Alzheimer y la influencia de la anosognosia y la depresión en la percepción de la calidad de vida de los pacientes y sus cuidadores. Pacientes y métodos. Estudio observacional, analítico y longitudinal de 12 meses. Muestra consecutiva de 221 pacientes atendidos ambulatoriamente. La media de edad fue de 77,8 ± 7,3 años y 140 fueron mujeres (63,3%). Instrumentos: Quality of Life in Alzheimer Disease, Anosognosia Questionnaire-Dementia, Geriatric Depression Scale, Disability Assessment for Dementia, Neuropsychiatric Inventory, Minimental State Examination y Global Deterioration Scale. Se calculó el tamaño del efecto en las diferencias entre dos medias y se realizó un análisis de regresión lineal con los factores asociados a la percepción de la calidad de vida de los pacientes. Resultados. Los pacientes con anosognosia presentaron puntuaciones menores en depresión y mayores en la Quality of Life in Alzheimer Disease, al contrario que los pacientes sin anosognosia, e independientemente del tratamiento farmacológico antidepresivo. Los cuidadores puntuaron más negativamente la calidad de vida de los pacientes. En la regresión lineal, las mayores discrepancias entre pacientes y cuidadores respecto a la calidad de vida se asociaron a la anosognosia, la depresión y la capacidad funcional (β = -0,21; p < 0,001), que explicaban el 35,3, 7,9 y 11,3%, respectivamente, de la varianza (AU)

Introduction. Anosognosia and depression can influence perceptions of the patient’s quality of life (QoL-p) in Alzheimer’s disease (AD). Aim. To explore changes in perceived QoL-p in AD and the influence that depression and anosognosia can have on both patient and caregiver ratings. Patients and methods. Observational, analytical and longitudinal study over 12 months of a consecutive sample of 221 outpatients. Mean age was 77.8 ± 7.3 years and there were 140 women (63.3%). Instruments: Quality of Life in AD, Anosognosia Questionnaire-Dementia, Geriatric Depression Scale, Disability Assessment for Dementia, Neuropsychiatric Inventory, Mini-Mental State Examination and Global Deterioration Scale. Effect size of the differences between two means was calculated, and a linear regression analysis involving the factors associated with perceived QoL-p was performed. Results. Patients with anosognosia had less depression and higher scores on the Quality of Life in AD, as compared with patients without anosognosia, and regardless of antidepressant drug treatment. Caregiver ratings of QoL-p were more negative. In the linear regression the largest discrepancies between patient and caregiver ratings of QoL-p were associatedwith anosognosia, depression, and functional status, factors that explained 35.3, 7.9 and 11.3% of the variance, respectively. Conclusions. Anosognosia was associated with less depression and better perceived quality of life in patients (AU)

[The influence of anosognosia and depression on the perceived quality of life of patients with Alzheimer's disease: a 12 months follow-up]. / Anosognosia y depresión en la percepción de la calidad de vida de los pacientes con enfermedad de Alzheimer. Evolución a los 12 meses.

INTRODUCTION: Anosognosia and depression can influence perceptions of the patient's quality of life (QoL-p) in Alzheimer's disease (AD). AIM: To explore changes in perceived QoL-p in AD and the influence that depression and anosognosia can have on both patient and caregiver ratings. PATIENTS AND METHODS: Observational, analytical and longitudinal study over 12 months of a consecutive sample of 221 outpatients. Mean age was 77.8 ± 7.3 years and there were 140 women (63.3%). Instruments: Quality of Life in AD, Anosognosia Questionnaire-Dementia, Geriatric Depression Scale, Disability Assessment for Dementia, Neuropsychiatric Inventory, Mini-Mental State Examination and Global Deterioration Scale. Effect size of the differences between two means was calculated, and a linear regression analysis involving the factors associated with perceived QoL-p was performed. RESULTS: Patients with anosognosia had less depression and higher scores on the Quality of Life in AD, as compared with patients without anosognosia, and regardless of antidepressant drug treatment. Caregiver ratings of QoL-p were more negative. In the linear regression the largest discrepancies between patient and caregiver ratings of QoL-p were associated with anosognosia, depression, and functional status, factors that explained 35.3, 7.9 and 11.3% of the variance, respectively. CONCLUSIONS: Anosognosia was associated with less depression and better perceived quality of life in patients.

TITLE: Anosognosia y depresion en la percepcion de la calidad de vida de los pacientes con enfermedad de Alzheimer. Evolucion a los 12 meses.Introduccion. La anosognosia y la depresion pueden influir en la valoracion sobre la calidad de vida del paciente con enfermedad de Alzheimer. Objetivo. Explorar la evolucion de la calidad de vida del paciente con enfermedad de Alzheimer y la influencia de la anosognosia y la depresion en la percepcion de la calidad de vida de los pacientes y sus cuidadores. Pacientes y metodos. Estudio observacional, analitico y longitudinal de 12 meses. Muestra consecutiva de 221 pacientes atendidos ambulatoriamente. La media de edad fue de 77,8 ± 7,3 años y 140 fueron mujeres (63,3%). Instrumentos: Quality of Life in Alzheimer Disease, Anosognosia Questionnaire-Dementia, Geriatric Depression Scale, Disability Assessment for Dementia, Neuropsychiatric Inventory, Minimental State Examination y Global Deterioration Scale. Se calculo el tamaño del efecto en las diferencias entre dos medias y se realizo un analisis de regresion lineal con los factores asociados a la percepcion de la calidad de vida de los pacientes. Resultados. Los pacientes con anosognosia presentaron puntuaciones menores en depresion y mayores en la Quality of Life in Alzheimer Disease, al contrario que los pacientes sin anosognosia, e independientemente del tratamiento farmacologico antidepresivo. Los cuidadores puntuaron mas negativamente la calidad de vida de los pacientes. En la regresion lineal, las mayores discrepancias entre pacientes y cuidadores respecto a la calidad de vida se asociaron a la anosognosia, la depresion y la capacidad funcional (ß = ­0,21; p < 0,001), que explicaban el 35,3, 7,9 y 11,3%, respectivamente, de la varianza. Conclusion. La anosognosia se asociaba a una menor depresion y mejor percepcion de la calidad de vida en los pacientes.

Factors associated with the variability in caregiver assessments of the capacities of patients with Alzheimer disease.

BACKGROUND: Several studies have identified certain caregiver factors that can produce variability in their assessments of the capacities of patients with Alzheimer disease (AD). OBJECTIVES: To identify the caregiver variables associated with variability in their ratings of patients' capacities. METHODS: Consecutive sample of 221 outpatients with AD and their family caregivers. The capacities evaluated by caregivers were the degree of functional disability, using the Disability Assessment for Dementia (DAD); psychological and behavioral symptoms, via the Neuropsychiatric Inventory (NPI); anosognosia, with the Anosognosia Questionnaire-Dementia (AQ-D); and quality of life, using the Quality of Life in AD (QOL-AD). The relationship between these measures and caregiver's gender, burden, depression, and health was analyzed by means of a bivariate analysis, calculating the effect size (Cohen d) and subsequently by a regression analysis, calculating the contribution coefficient (CC). RESULTS: The greatest variability in caregiver assessments was observed in relation to patients with early-stage dementia, where caregiver's burden was the main factor associated with a more negative evaluation (d = 1.02-1.25). Depression in the caregiver was associated with less variability and only in the assessments of patients with moderate dementia (d = 0.38-0.69). In the regression analysis, caregiver factors were associated with greater variance in scores on the NPI (CC = 37.4%) and QOL-AD (CC = 27.2%), and lower variance in AQ-D (CC = 21.6%) and DAD (CC = 10.3%) scores. CONCLUSIONS: Caregiver's burden and depression were associated with more negative assessments of patients' psychological and behavioral symptoms and quality of life.

Clinical differences in patients with Alzheimer's disease according to the presence or absence of anosognosia: implications for perceived quality of life.

This study aimed to determine the factors that predict anosognosia in patients with Alzheimer's disease (AD) and to examine the effect of anosognosia on patient and caregiver perceptions of the patient's quality of life (QoL-p), using a cross-sectional design with 164 patients and their caregivers. Instruments of measurement included Anosognosia Questionnaire-Dementia, Geriatric Depression Scale, Quality of Life in AD (QoL-AD), Disability Assessment for Dementia, Neuropsychiatric Inventory, and the Global Deterioration Scale (GDS). A binary logistic regression analysis was performed to identify the factors that predict anosognosia, while a linear regression analysis was conducted to determine the factors associated with QoL-AD. The degree of anosognosia increased in line with GDS stage (F (2,161) = 41.3, p < 0.001). In the binary regression analysis, the variables that predicted anosognosia were more neuropsychiatric symptoms (OR = 1.11, 95% CI: 1.06-1.17, p < 0.001), deficits in ADL (OR = 0.88, 95% CI: 0.83-0.94, p < 0.001), less depression (OR = 0.66, 95% CI: 0.54-0.82, p < 0.001), and older age (OR = 1.08, 95% CI: 1.00-1.15, p = 0.027). With regards to QoL-p, the multiple linear regression analysis for patients (r2 = 0.486) showed that less depression (ß = -0.52, p < 0.001) and greater anosognosia (ß = 0.40, p < 0.001) explained 33% and 10% of the variance in QoL-AD, respectively. Greater anosognosia was associated with better perceived QoL-p, especially in advanced GDS stages. Anosognosia was associated with greater caregiver burden and a greater discrepancy between patient and caregiver ratings of QoL-p.