Ability to perform activities of daily living is the main factor affecting quality of life in patients with dementia

Christian K Andersen, Kim U Wittrup-Jensen, Anette Lolk, Kjeld Andersen, Per Kragh-Sørensen, Christian K Andersen, Kim U Wittrup-Jensen, Anette Lolk, Kjeld Andersen, Per Kragh-Sørensen

Abstract

Background: Dementia is a chronic illness associated with a progressive loss of cognitive and intellectual abilities, such as memory, judgment and abstract thinking. The objective of this study was to assess the health utilities of patients with dementia in Europe and identify the key factors influencing their Health-Related Quality of Life (HRQol).

Methods: This study used cross-sectional data from the Odense study; a Danish cohort of patients aged 65-84 living in Odense, Denmark. A total of 244 patients with mild to severe dementia were interviewed together with a caregiver about their health status and activities of daily living (ADL). Alzheimer's disease was diagnosed according to the NINCDS-ADRDA criteria for probable dementia. Vascular dementia and other types of dementia were diagnosed according to the DSM-IIIR criteria. Severity of dementia was defined by score intervals on the Mini Mental State Examination score: mild (MMSE 20-30), moderate (MMSE 10-19), and severe (MMSE 0-9). Based on the ADL information, the patients' dependency level was defined as either dependent or independent. Questions from the Odense Study were mapped into each of the five dimensions of the EQ-5D in order to assess patients' HRQol. Danish EQ-5D social tariffs were used to value patients' HRQol.A regression analysis of EQ-5D values was conducted with backward selection on gender, age, severity, ADL level and setting in order to determine the main factor influencing HRQoL.

Results: The EQ-5D weight in patients independent upon others in ADL was 0.641 (95% CI: [0.612-0.669]), and in those dependent upon others was 0.343 (95% CI: [0.251-0.436]).

Conclusion: Dependency upon others to perform ADL was the main factor affecting HRQoL.

References

    1. Potkin SG. The ABC of Alzheimer's disease: ADL and improving day-to-day functioning of patients. Int Psychogeriatr. 2002;14:7–26. doi: 10.1017/S1041610203008640.
    1. Bullock R, Hammond G. Realistic expectations: the management of severe Alzheimer disease. Alzheimer Dis Assoc Disord. 2003;17:S80–85. doi: 10.1097/00002093-200307003-00004.
    1. Kurz X, Scuvee-Moreau J, Rive B, Dresse A. A new approach to the qualitative evaluation of functional disability in dementia. Int J Geriatr Psychiatry. 2003;18:1050–1055. doi: 10.1002/gps.1009.
    1. Bennett KJ, Torrance GW. Measuring heralth state preferences and utilities: rating scale, time trade-off, and standard gamble techniques. In: Spilker B, editor. Quality of Life and Pharmacoeconomics in Clinical Trials. 2. Philadelphia: Lippincott-Raven; 1996. pp. 253–265.
    1. Dolan P. Output measures and valuation in health. In: Drummond M, McGuire A, editor. In Economic evaluation in health Care Merging theory with Practice. Oxford University Press; 2001.
    1. Brooks R. EuroQol: the current state of play. Health Policy. 1996;37:53–72. doi: 10.1016/0168-8510(96)00822-6.
    1. Neumann PJ, Sandberg EA, Araki SS, Kuntz KM, Feeny D, Weinstein MC. A comparison of HUI2 and HUI3 utility scores in Alzheimer's disease. Med Decis Making. 2000;20:413–422.
    1. Coucill W, Bryan S, Bentham P, Buckley A, Laight A. EQ-5D in patients with dementia: an investigation of inter-rater agreement. Med Care. 2001;39:760–771. doi: 10.1097/00005650-200108000-00003.
    1. Ankri J, Beaufils B, Novella JL, Morrone I, Guillemin F, Jolly D, Ploton L, Blanchard F. Use of the EQ-5D among patients suffering from dementia. J Clin Epidemiol. 2003;56:1055–1063. doi: 10.1016/S0895-4356(03)00175-6.
    1. Andersen K, Lolk A, Nielsen H, Andersen J, Olsen C, Kragh-Sorensen P. Prevalence of very mild to severe dementia in Denmark. Acta Neurol Scand. 1997;96:82–87.
    1. Andersen K, Nielsen H, Lolk A, Andersen J, Becker I, Kragh-Sørensen P. Incidence of very mild to severe dementia and Alzheimer's disease in Denmark. Neurology. 1999;52:85–90.
    1. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology. 1984;34:939–944.
    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 3. Washington DC. American Psychiatric Association; 1987.
    1. Berg L. Clinical Dementia Rating (CDR) Psychopharmacol Bull. 1988;24:637–639.
    1. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198. doi: 10.1016/0022-3956(75)90026-6.
    1. Salling AL. Doctoral thesis. Copenhagen. Danish Nurses Organisation; 1990. Stimulation af patients aktivitie og udvikling (Stimulation of patient's activity and development. In Danish)
    1. Ullerup K. An economic evaluation of donepezil (Aricept) for the treatment of Alzheimer dementia using a Markov cohort simulations model (In Danish) Institute of Public Health Working Paper, Odense University; 1999. p. 1.
    1. Pedersen KM, Wittrup-Jensen KU, Brooks R, Gudex C. Valuation of health. The theory of quality adjusted life years and a Danish application (In Danish) University of SOuthern Denmark Press; 2003.
    1. Reisberg B, Franssen E, Souren L, Kenowski S, Auer S. Severity scales. In: Wimo A, Jönsson B, Karlsson G, Winblad B, editor. Health Economics of Dementia. Wiley: Chichester; 1998. pp. 327–357.
    1. Sharma A. Applied Multivariate Techniques. John Wiley & Sons; 1996.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться