Authors: Perales, Jaime | Turró-Garriga, Oriol | Gascón-Bayarri, Jordi | Reñé-Ramírez, Ramón | Conde-Sala, Josep Lluís
Article Type: Research Article
Abstract: Background: According to cross-sectional studies, there is an association between anosognosia in people with dementia and caregiver’s burden and depression. Anosognosia in patients may be a cause of caregiver burden and depression. However, variability in caregiver anosognosia ratings may exist as caregivers with burden and depression may have a more pessimistic view of the patients’ health. Objective: To assess the variability of caregiver anosognosia ratings of patients with dementia using a widely used anosognosia scale and its longitudinal relationship with caregiver burden and depression. Methods: A convenience cohort of 221 consecutive dementia outpatient and caregiver dyads was followed up at …12 and 24 months. The main instruments used were the Anosognosia Questionnaire-Dementia (AQ-D), Caregiver Burden Interview, and Geriatric Depression Scale. Linear mixed models were used including time as a factor in every model. Multivariate analyses controlled for caregiver’s socio-demographic and possible confounding factors. Results: Attrition at 12 and 24 months was 24.9% and 42.5% respectively. Patients at baseline were on average 77.8 years of age, 63.3% were women, and 63.3% had < 5 years of education. In the bivariate analyses, caregiver burden, depression, and gender were associated with caregiver ratings of total, cognitive, and personality AQ-D of the patient at different time points. Multivariate analyses revealed burden as the caregiver variable most consistently associated with total, cognitive, and personality caregiver AQ-D ratings of the patient. Conclusion: Some caregiver characteristics, especially burden, are associated with caregiver ratings of AQ-D with regard to the patient. Show more
Keywords: Anosognosia, bias, burden of illness, caregivers, dementia, depression, longitudinal studies
DOI: 10.3233/JAD-160065
Citation: Journal of Alzheimer's Disease, vol. 53, no. 3, pp. 1133-1143, 2016
Authors: Conde-Sala, Josep L. | Turró-Garriga, Oriol | Portellano-Ortiz, Cristina | Viñas-Diez, Vanesa | Gascón-Bayarri, Jordi | Reñé-Ramírez, Ramón
Article Type: Research Article
Abstract: The objective was to analyze the factors that influence self-perceived quality of life (QoL) in patients with Alzheimer’s disease (AD), contrasting two different longitudinal models. A total of 127 patients were followed up over 24 months. The instruments applied were: Quality of Life in Alzheimer’s Disease scale (QoL-AD), Geriatric Depression Scale-15, Anosognosia Questionnaire-Dementia, Disability Assessment in Dementia, Neuropsychiatric Inventory, and the Mini-Mental State Examination. Two models for grouping patients were tested: 1) Baseline score on the QoL-AD (QoL-Baseline), and 2) Difference in QoL-AD score between baseline and follow-up (QoL-Change). Generalized estimating equations were used to analyze longitudinal data, and multinomial …regression analyses were performed. Over the follow-up period the QoL-Baseline model showed greater variability between groups (Wald χ 2 = 172.3, p < 0.001) than did the QoL-Change model (Wald χ 2 = 1.7, p = 0.427). In the QoL-Baseline model the predictive factors were greater depression (odds ratio [OR] = 1.20; 95% CI: 1.00– 1.45) and lower functional ability (OR = 0.92; 95% CI: 0.85– 0.99) for the Low QoL group (< 33 QoL-AD), and less depression (OR = 0.68; 95% CI: 0.52– 0.88), more anosognosia (OR = 1.07; 95% CI: 1.01– 1.13), and fewer neuropsychiatric symptoms (OR = 0.95; 95% CI: 0.91– 0.99) for the High-QoL group (>37 QoL-AD). The model based on baseline scores (QoL-Baseline) was better than the QoL-Change model in terms of identifying trajectories and predictors of QoL in AD. Show more
Keywords: Alzheimer’s disease, analytic models, anosognosia, depression, longitudinal study, quality of life
DOI: 10.3233/JAD-160040
Citation: Journal of Alzheimer's Disease, vol. 52, no. 3, pp. 999-1012, 2016
Authors: Turró-Garriga, Oriol | Garre-Olmo, Josep | Calvó-Perxas, Laia | Reñé-Ramírez, Ramón | Gascón-Bayarri, Jordi | Conde-Sala, Josep Lluís
Article Type: Research Article
Abstract: Anosognosia in Alzheimer’s disease (AD) has been associated with greater cognitive impairment and more behavioural and psychological symptoms of dementia (BPSD). This study examines the incidence, persistence, and remission rates of anosognosia over a 12-month period, as well as the related risk factors. This was an observational 12-month prospective study. The longitudinal sample comprised 177 patients with mild or moderate AD, and their respective caregivers. Anosognosia was assessed using the Anosognosia Questionnaire in Dementia, and we also evaluated cognitive status (Mini-Mental State Examination), functional disability (Disability Assessment in Dementia), and the presence of BPSD (Neuropsychiatric Inventory). Multinomial logistic regression was …used to determine the variables associated with the incidence, persistence and remission of anosognosia. The prevalence of anosognosia was 39.5% (95% CI = 32.1–47.1) at baseline. At 12 months, incidence was 38.3% (95% CI = 28.6–48.0), persistence was 80.0% (95% CI = 69.9–90.1) and remission was 20.0% (95% CI = 9.9–30.1). The regression model identified lower age, more education, and the presence of delusions as variables associated with incidence, and more education, lower instrumental DAD score, and disinhibition as variables associated with persistence. No variables were associated with remission (n = 14). The presence of anosognosia in AD patients is high. Education and certain neuropsychiatric symptoms may explain a greater and earlier incidence of anosognosia. However, anosognosia also increases with greater cognitive impairment and disease severity. Show more
Keywords: Alzheimer’s disease, anosognosia, caregivers, epidemiological dementia study, incidence, insight, dementia, longitudinal studies, neuropsychiatric disorders
DOI: 10.3233/JAD-150706
Citation: Journal of Alzheimer's Disease, vol. 51, no. 2, pp. 357-366, 2016
Authors: Turró-Garriga, Oriol | Garre-Olmo, Josep | Reñé-Ramírez, Ramon | Calvó-Perxas, Laia | Gascón-Bayarri, Jordi | Conde-Sala, Josep-Lluís
Article Type: Research Article
Abstract: Background : Anosognosia is common in patients with Alzheimer’s disease (AD) and it is frequently related to an increase in time of care demand. Objective : The aim of the study was to examine the effect of anosognosia on the total costs of informal care in patients with AD. Methods : This was a prospective longitudinal study with community-dwelling AD patients. Anosognosia, time of informal care, and the use of support services (e.g., day care centers) were recorded at baseline and after 24 months. The cost of informal caregiving was calculated as ‘market price’. Results : At baseline, the prevalence …of anosognosia was 54.3% (n = 221), and 43.9% were classified as mild-AD. The average time of care was 5 h/day±2.4 (IADL: 1.3 h/day±1.4 and BADL: 3.6 h/day±1.5). Thirty percent of the patients used home care services, and 25.1% attended a day care center. Patients with anosognosia received more time of care and were more likely to use support services than did their no-anosognosia peers, including institutionalization. The mean cost of support services was 490.4€ /month (SD = 413.1€; range = 25–2,212.38€), while the overall cost of care (support services plus informal care) was 1,787€ /month (SD = 972.4€), ranging from 834.1€ in mild-AD without anosognosia patients, to 2,424.8€ in severe-AD with incident anosognosia patients. Conclusions : Anosognosia was associated with an increased number of hours of informal care, and a greater use of support services, regardless of the severity of the dementia, which lead to an increase of the total family-care costs. Show more
Keywords: Alzheimer’s disease, anosognosia, cost of illness, dementia, health care costs, longitudinal studies
DOI: 10.3233/JAD-160419
Citation: Journal of Alzheimer's Disease, vol. 54, no. 4, pp. 1551-1560, 2016
Authors: Conde-Sala, Josep L. | Reñé-Ramírez, Ramón | Turró-Garriga, Oriol | Gascón-Bayarri, Jordi | Juncadella-Puig, Montserrat | Moreno-Cordón, Laura | Viñas-Diez, Vanesa | Garre-Olmo, Josep
Article Type: Research Article
Abstract: 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 (β = −0.52, p < 0.001) and greater anosognosia (β = 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. Show more
Keywords: Alzheimer's disease, anosognosia, awareness, caregivers, depression, neuropsychiatry, patients, quality of life
DOI: 10.3233/JAD-2012-121360
Citation: Journal of Alzheimer's Disease, vol. 33, no. 4, pp. 1105-1116, 2013