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Int Psychogeriatr. 2010 Dec;22(8):1265-79. doi: 10.1017/S104161021000150X. Epub 2010 Sep 20.

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

Collaborators (141)

Bayón AR, Iglesias G, López JM, Gómez MA, Díaz OT, Alcelay LG, Sempere ÁP, Arlandis JM, Rodríguez LP, Martínez VM, Lluch V, López TG, Rodríguez CM, Sánchez JA, Marcos VM, Gómez F, Jiménez CA, Pomar CP, De Antonio JA, Galdón SP, Campello AR, Soto AC, Elola AC, Yelamos AM, Tobias BM, Del Olmo BR, Lanfranco CC, Bravo CP, Pérez FF, Navinés FP, Almiñana IF, González JR, Idiago JM, Rojo JP, Mir JC, Regadera JH, Villanueva MH, Millán PR, Azpiazu P, Allue RC, Martínez RS, Marín SA, Mascaro J, Juanes FV, Etxenagusia II, Peña JI, Esteban JC, Franco LV, Beldarrain MG, Imizcoz MG, Zurdo JM, del Castillo MJ, Esteban GR, Varo JA, Oterino A, Colomé CR, Rebollo M, Bautista CF, Lozano MD, Oliveras FJ, Ortiz CS, López FS, Fernández-Castañón MP, Olascoaga J, Martínez JR, Pousa SL, Camello ÁG, Almazán JA, Carreras MO, Maldonado RG, Gómez CR, Abad JM, Bengoa JF, Ruiz-Cabello JM, Corujo E, Vieitez Mdel C, Gil FJ, Moran BB, Sabaté MP, Reigosa RP, Frank A, Herrero CH, Moya M, Navarro N, Vallejo JM, Olazarán J, Porta J, Gutiérrez JL, Tejeiro J, Ortiz LA, Gargallo LI, Ceballos MÁ, De la Ascensión MB, Gregorio PG, Alonso PS, Nodarse RM, Torregrosa RP, Jabbour T, Hamad H, Huelgas RG, Ortega TO, Castro VS, Comitré EC, Madrona JC, Marín JM, Román IF, Bujanda M, Lafont MA, Lomba JM, González JR, Chiva MT, Padilla FC, Delgado G, Galdo JM, Domínguez ÁM, Montoro AE, Parra CM, Fernández FV, Vera JV, Castilla-Guerra L, García-Baquero LI, Carballo M, Guinjoan AP, Alonso CM, Jiménez PE, Merino CV, Sanz FD, Catalá J, Sancho J, Avellana JA, Salvador MD, Valls MB, Toledo MB, Escrig MG, Olcina RB, Insa SD, Loza AS, Moreno EM, Barlés GP, Llerda JÁ, Pascual LF.

Author information

1
Department of Psychiatry, University Hospital 12 de Octubre, Madrid, Spain. laguerao@intersep.org

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.

PMID:
20849672
DOI:
10.1017/S104161021000150X
[Indexed for MEDLINE]
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