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Clinical progression of moderate-to-severe Alzheimer's disease and caregiver burden: a 12-month multicenter prospective observational study

Published online by Cambridge University Press:  20 September 2010

Luis Agüera-Ortiz ,
Ana Frank-García ,
Pedro Gil  and
Alfonso Moreno
Luis Agüera-Ortiz*
Affiliation:
Department of Psychiatry, University Hospital 12 de Octubre, Madrid, Spain
Ana Frank-García
Affiliation:
Department of Neurology, University Hospital La Paz, Madrid, Spain
Pedro Gil
Affiliation:
Geriatrics Service, Hospital Clínico San Carlos, Madrid, Spain
Alfonso Moreno
Affiliation:
Department of Pharmacology, Hospital Clínico San Carlos, Madrid, Spain
*
Correspondence should be addressed to: Luis Agüera-Ortiz, Department of Psychiatry, University Hospital 12 de Octubre, Edificio de Medicina Comunitaria, Avenida de Córdoba km 5.400, 28041 Madrid, Spain. Phone: +34 91 390 8022; Fax: +34 91 390 8538. Email: laguerao@intersep.org.
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Abstract

Background: Prospective studies on the clinical progression of Alzheimer's disease (AD) and its relationship to caregiver burden are needed to improve illness management and use of resources.

Methods: This national, multicenter, observational study evaluated 1235 moderate to severe AD patients under routine care in Spain. Baseline cross-sectional sociodemographic and clinical data, and changes from baseline to month 12 of various neuropsychological tests and clinical ratings, including Blessed Dementia Scale, Mini-mental State Examination (MMSE), Hughes Clinical Dementia Rating sum-of-boxes (CDR-SB), Clinical Global Impression of Change (CGIC) and Zarit Caregiver Burden scales, were recorded and comprehensively analyzed.

Results: Baseline data were in accordance with characteristics consistently reported to influence AD risk regarding anthropometrics, sociocultural features and comorbidities. Significant progressive functional impairments (i.e. in routine activities and essential daily tasks) and cognitive (i.e. MMSE and CDR-SB) impairments were found at month 12. However, patients' behavior and caregivers' burden improved slightly, but significantly, corroborating the major influence of behavioral symptoms on caregivers' distress. Caregivers showed significantly lower burden with patients with higher levels of education and, to a lesser extent, when patients received AD-specific medication. Physicians accurately detected AD clinical evolution as their CGIC ratings significantly correlated with all tests.

Conclusions: These findings reinforce previous AD knowledge and add data on the clinical course of advanced stages of AD. Caregiver burden depended more on patients' behavioral alterations than on their functional or cognitive declines; and it was diminished by their patients having higher levels of education and being treated with AD-specific medications. Research into unexplored factors that might reduce caregiver burden, ultimately benefiting both patients and caregivers, is encouraged.

Keywords

dementianeurodegenerative diseaseneurocognitive disorderclinical coursecognitive impairmentfunctional impairmentbehavioral symptoms
Type
Research Article
Information
International Psychogeriatrics , Volume 22 , Special Issue 8: Focus on prevention in psychogeriatrics , December 2010 , pp. 1265 - 1279
Copyright
Copyright © International Psychogeriatric Association 2010

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