Initial and long-term evaluation of patients with Alzheimer's after hospitalization in cognitive and behavioural units: the EVITAL study design

Elodie Pongan, Magalie Freulon, Floriane Delphin-Combe, Florence Dibie-Racoupeau, Géraldine Martin-Gaujard, Denis Federico, Aziza Waissi, Gaëlle Richard, Sophie Jacqueline, Florence Fabre, Béatrice Trombert-Paviot, Pierre Krolak-Salmon, Bernard Laurent, Isabelle Rouch, Elodie Pongan, Magalie Freulon, Floriane Delphin-Combe, Florence Dibie-Racoupeau, Géraldine Martin-Gaujard, Denis Federico, Aziza Waissi, Gaëlle Richard, Sophie Jacqueline, Florence Fabre, Béatrice Trombert-Paviot, Pierre Krolak-Salmon, Bernard Laurent, Isabelle Rouch

Abstract

Background: Alzheimer's disease and related disorders are characterized by cognitive impairment associated with behavioral and psychological symptoms of dementia. These symptoms have significant consequences for both the patient and his family environment. While risk factors for behavioral disorders have been identified in several studies, few studies have focused on the evolution of these disorders. Moreover, it is important to identify factors linked to the long-term evolution of behavioral disorders, as well as patients' and caregivers' quality of life. Our purpose is to present the methodology of the EVITAL study, which primary objective is to determine the factors associated with the evolution of behavioral disorders among patients with Alzheimer's disease and related disorders during the year following their hospitalization in cognitive and behavioral units. Secondary objectives were 1) to assess the factors related to the evolution of behavioral disorders during hospitalization in cognitive and behavioral units; 2) to identify the factors linked to patients' and caregivers' quality of life, as well as caregivers' burden; 3) to assess the factors associated with rehospitalization of the patients for behavioral disorders in the year following their hospitalization in cognitive and behavioral units.

Method/design: A multicenter, prospective cohort of patients with Alzheimer's disease and related disorders as well as behavioral disorders who are hospitalized in cognitive and behavioral units. The patients will be included in the study for a period of 24 months and followed-up for 12 months. Socio-demographic and environmental data, behavioral disorders, medications, patients and caregivers quality of life as well as caregivers burden will be assessed throughout hospitalization in cognitive and behavioral units. Follow-up will be performed at months 3, 6 and 12 after hospitalization. Socio-demographic and environmental data, behavioral disorders, medications, patients and caregivers quality of life, unplanned rehospitalization as well as caregivers burden will also be assessed at each follow-up interview.

Discussion: The present study should help better identify the factors associated with reduction or stabilization of the behavioral and psychological symptoms of dementia in patients with Alzheimer's disease. It could therefore help clinicians to better manage these symptoms.

Trial registration: Clinical Trials NCT01901263. Registered July 9, 2013.

Figures

Figure 1
Figure 1
Typical schedule for a patient included in the EVITAL protocol: a summary of different stages. T0 = inclusion visit. T1 = End of hospitalization visit. T2 = 3-month follow-up visit at home. T3 = 6-month follow-up phone call. T4 = 12-month follow-up phone call.

References

    1. Finkel SI, Costa e Silva J, Cohen G, Miller S, Sartorius N. Behavioral and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment. Int Psychogeriatr. 1996;8(Suppl 3):497–500.
    1. Wragg RE, Jeste DV. Overview of depression and psychosis in Alzheimer’s disease. Am J Psychiatry. 1989;146(5):577–587.
    1. Lyketsos CG, Steinberg M, Tschanz JT, Norton MC, Steffens DC, Breitner JC. Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. Am J Psychiatry. 2000;157(5):708–714. doi: 10.1176/appi.ajp.157.5.708.
    1. Benoit M, Staccini P, Brocker P, Benhamidat T, Bertogliati C, Lechowski L, Tortrat D, Robert PH. [Behavioral and psychologic symptoms in Alzheimer’s disease: results of the study] Rev Med Interne. 2003;24(Suppl 3):319s–324s. doi: 10.1016/S0248-8663(03)80690-2.
    1. Robert PH, Verhey FR, Byrne EJ, Hurt C, De Deyn PP, Nobili F, Riello R, Rodriguez G, Frisoni GB, Tsolaki M, Kyriazopoulou N, Bullock R, Burns A, Vellas B. Grouping for behavioral and psychological symptoms in dementia: clinical and biological aspects. Consensus paper of the European Alzheimer disease consortium. Eur Psychiatry. 2005;20(7):490–496. doi: 10.1016/j.eurpsy.2004.09.031.
    1. Aalten P, Verhey FR, Boziki M, Bullock R, Byrne EJ, Camus V, Caputo M, Collins D, De Deyn PP, Elina K, Frisoni G, Girtler N, Holmes C, Hurt C, Marriott A, Nobili F, Ousset PJ, Reynish E, Salmon E, Tsolaki M, Vellas B, Robert PH. Neuropsychiatric syndromes in dementia. Results from the European Alzheimer Disease Consortium: part I. Dement Geriatr Cogn Disord. 2007;24(6):457–463. doi: 10.1159/000110738.
    1. Gonzalez-Salvador MT, Arango C, Lyketsos CG, Barba AC. The stress and psychological morbidity of the Alzheimer patient caregiver. Int J Geriatr Psychiatry. 1999;14(9):701–710. doi: 10.1002/(SICI)1099-1166(199909)14:9<701::AID-GPS5>;2-#.
    1. Stern Y, Tang MX, Albert MS, Brandt J, Jacobs DM, Bell K, Marder K, Sano M, Devanand D, Albert SM, Bylsma F, Tsai WY. Predicting time to nursing home care and death in individuals with Alzheimer disease. JAMA. 1997;277(10):806–812. doi: 10.1001/jama.1997.03540340040030.
    1. Black W, Almeida OP. A systematic review of the association between the Behavioral and Psychological Symptoms of Dementia and burden of care. Int Psychogeriatr. 2004;16(3):295–315. doi: 10.1017/S1041610204000468.
    1. Donaldson C, Tarrier N, Burns A. The impact of the symptoms of dementia on caregivers. Br J Psychiatry. 1997;170:62–68. doi: 10.1192/bjp.170.1.62.
    1. Sink KM, Covinsky KE, Barnes DE, Newcomer RJ, Yaffe K. Caregiver characteristics are associated with neuropsychiatric symptoms of dementia. J Am Geriatr Soc. 2006;54(5):796–803. doi: 10.1111/j.1532-5415.2006.00697.x.
    1. Cohen-Mansfield J. Agitation in the elderly. Adv Psychosom Med. 1989;19:101–113.
    1. Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA. 2002;288(12):1475–1483. doi: 10.1001/jama.288.12.1475.
    1. Hope T, Keene J, Gedling K, Fairburn CG, Jacoby R. Predictors of institutionalization for people with dementia living at home with a carer. Int J Geriatr Psychiatry. 1998;13(10):682–690. doi: 10.1002/(SICI)1099-1166(1998100)13:10<682::AID-GPS847>;2-Y.
    1. Sink KM, Holden KF, Yaffe K. Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA. 2005;293(5):596–608. doi: 10.1001/jama.293.5.596.
    1. Koskas P, Feugeas MC, Saad S, Belqadi S, Daraux J, Drunat O. Management of behavioral and psychological symptoms of dementia in a dedicated psychogeriatric unit: a pilot experience. Alzheimer Dis Assoc Disord. 2011;25(2):184–186. doi: 10.1097/WAD.0b013e3181fa2f81.
    1. Delphin-Combe F, Roubaud C, Martin-Gaujard G, Fortin ME, Rouch I, Krolak-Salmon P. Effectiveness of a cognitive-behavioral unit on behavioral and psychological symptoms of dementia. Rev Neurol. 2013;169(6–7):490–494. doi: 10.1016/j.neurol.2012.10.017.
    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. Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44(12):2308–2314. doi: 10.1212/WNL.44.12.2308.
    1. Robert PH, Médecin I, Vincent S, Staccini P, Cattelin F, Goni S. L’inventaire Neuropsychiatrique: validation de la version Française d’un instrument destiné à évaluer les troubles du comportement chez les sujets déments. L’année Gérontologique. 1998;5:63–87.
    1. Rabin R, deCharro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33:337–343. doi: 10.3109/07853890109002087.
    1. Thomas P, Hazif-Thomas C, Delagnes V, Bonduelle P, Clement JP. [Facilitating environment for dementia patients–the Pixel study] Encéphale. 2007;33(3 Pt 1):317–325. doi: 10.1016/S0013-7006(07)92045-X.
    1. Revel Da Rocha V, Haritchabalet I, Kervinio C, Drode M, Sauvanier M, Geny C, Placines B, Roux C, Albert D, Delafournière F, Dartigues JF. Construction d’une échelle simplifiée pour la détection en médecine générale du fardeau de l’aidant d’une personne âgée dépendante. L’année gérontologique. 2002;16:131–137.
    1. Thomas P, Hazif-Thomas C, Delagnes V, Bonduelle P, Clément JP. La vulnérabilité de l’aidant principal des malades déments à domicile L’étude Pixel. Psychol NeuroPsychiatr Viell. 2005;3:207–220.

Source: PubMed

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