Alzheimer Disease: Shakespeare A

Shikiar R, Shakespeare A, Sagnier PP, Wilkinson D, McKeith I, Dartigues JF, Dubois B. · MEDTAP International, Seattle, Washington, USA. · J Am Geriatr Soc. · Pubmed #10733052 No free full text.

Abstract: OBJECTIVE: To assess the impact on burden reported by caregivers of patients with mild to moderate Alzheimer's disease (AD) who were treated with metrifonate during a randomized double blind clinical trial. DESIGN: Randomized clinical trial, with a 2-week screening period and a 26-week double blind, placebo controlled, treatment phase. Caregivers were assessed at baseline, at 12 weeks, and at end of trial. SETTING: Caregivers were interviewed at clinics as part of the assessment of the patients. PARTICIPANTS: Six hundred and three caregivers of AD patients who were enrolled in the MALT trial; 591 (98%) provided data suitable for analysis at baseline, and 546 (91%) provided data allowing for inclusion in the analysis of change scores. MEASUREMENTS: The Caregiver Burden Assessment consisted of the Screen for Caregiver Burden, including both subjective (SCB-subj) and objective (SCB-obj) scores; the cognitive subscale of Poulshock and Deimling (PD); an abridged version of the Relatives Stress Scale (aRSS); assessments of time spent in providing care, including the Caregiver Activity Time Scale (CATS); and demographic and background variables on both the patient and caregiver. RESULTS: Treatment of mild to moderate AD patients with metrifonate for a duration of 26 weeks significantly reduced the psychological burden of care to the caregivers, as measured by the SCB-subj, the PD, and the aRSS. There were no statistically significant differences on the measures assessing the time spent in caregiving, except for the caregiver's subjective impression of the change in time spent providing care during the trial. When comparing individual dose groups, most of the measures of burden showed the largest benefits in burden for the 60/80 mg group, followed by the 40/50 mg group, and then the placebo group. However, there was no statistically significant dose effect. CONCLUSIONS: This study provides the first evidence from a randomized clinical trial of any acetylcholinesterase inhibitor used in the treatment of AD demonstrating a positive impact on the patient's caregiver as well as benefits to the patient. These results were shown consistently across several measurement scales and were observed after six months of treatment. These findings reinforce the clinical significance of research that has shown that metrifonate has beneficial impacts on the cognitive, behavioral, and functional abilities of AD patients. Because caregiver burden is a leading factor in the decision for institutional care placement, the ability to favorably impact that burden through pharmacological treatment of the patient is important.

Andrieu S, Reynish E, Nourhashemi F, Shakespeare A, Moulias S, Ousset PJ, Sagnier P, Richard A, Albarede JL, Vellas B. · Department of Internal Medicine and Clinical Gerontology, Acute Unit for Alzheimer's Patients, Toulouse, France. · Int J Geriatr Psychiatry. · Pubmed #11994930 No free full text.

Abstract: OBJECTIVE: To evaluate the frequency of and determine predictive factors for acute hospitalization in a prospective study of patients with Alzheimer's disease (AD). DESIGN: A one year prospective study. PARTICIPANTS: 134 patients recruited from the memory clinic in Toulouse University Hospital, with AD diagnosed using the NINCDS-ADRDA criteria. MEASURES: A comprehensive geriatric and neuropsychological assessment was conducted 6 monthly. RESULTS: Among the 134 patients included in this study, at one year follow up, 32 patients had at least one acute hospitalization. Patient-related variables predictive of acute hospitalization in the univariate analysis were: level of education, ADL-bathing, ADL-toileting, ADL-feeding, total ADL score, IADL A scale (daily upkeep), history of falls, and level of behavioural disorder as measured by the Cohen scale. In the multivariate regression model, two variables were associated with acute hospitalization: dependency for ADL-bathing [Odds Ratio (OR) = 5.65, 95% Confidence Intervals (CI): 2.3-14.4] and low level of education. CONCLUSION: The results of this study demonstrate that acute hospitalization is frequent in AD patients resulting in considerable cost implications. Interventions that support patients and their cares to manage their loss of ADL may be a practical approach to reducing the need for acute hospital admissions.