Quality of life and neuropsychiatric symptoms in patients with Alzheimer’s disease – the ALSOVA follow-up study
Public examination of a doctoral dissertation in the field of Neurology
Doctoral candidate: Kristiina Hongisto, Lic Med, Specialist in Geriatrics
Date and venue: 3.2.2017 at 12 noon, Mediteknia, MD100, Kuopio Campus
Language of the public examination: Finnish
Language of the dissertation: English
Alzheimer´s disease (AD) is characterized by progressive cognitive impairment together with declining activities of daily living, neuropsychiatric symptoms (NPS), and behavioral changes. Early diagnosis of AD and an early onset of AD-targeted medication to promote and maintain the Quality of Life (QoL) are among the main aims in AD patient care.
The aims of this doctoral study were to compare self- and caregiver-rated patient QoL measures in relation to disease progression and examine the ability of patients to complete QoL questionnaires with or without assistance. Additional aims were to examine the prevalence and significance of NPS in patients with very mild and mild AD with an emphasis on their influence on the QoL of AD patients, and furthermore, to investigate the association of self- and caregiver-rated patient QoL with NPS of patients at baseline and during a five-year follow-up.
This study formed part of the ALSOVA project, conducted by the Department of Neurology, University of Eastern Finland. The participants were 236 patients with very mild (CDR 0.5) or mild (CDR 1) AD and their caregivers from three Finnish hospital districts. Participants were recruited during the first year after the AD diagnosis and then followed-up annually for three years after an initial baseline visit, with an additional fifth-year visit. At baseline, 5 of the 241 examined patients were excluded from the follow-up.
NPS were common, even in the early stages of AD. The most frequent symptoms were apathy, depression, irritability, and agitation. The strongest predictor of decreased self-reported QoL-AD scores was depressive symptoms, whereas functional decline and the presence of NPS predicted poor patient QoL rated by caregivers. The ability of patients to complete QoL questionnaires with or without assistance declined at early moderate stage of AD, and the self- and caregiver-rated QoL scores began to diverge in patients with very mild AD. Over the 5-year follow-up period, patient self-reported QoL did not change significantly, despite the progression of AD and increase in NPS. However, caregiver-rated patient QoL declined significantly during the follow-up as the disease progressed and total NPI scores increased.
In conclusion, the ability of AD patients to complete QoL questionnaires diminishes earlier than previously estimated. Moreover, the patients themselves are unable to notice the deterioration in their QoL, even with severe AD-related symptoms. However, caregiver-rated QoL-AD scores correlated well with disease progression and increased NPS.
The doctoral dissertation of Kristiina Hongisto, Licentiate of Medicine, entitled Quality of life and neuropsychiatric symptoms in patients with Alzheimer’s disease – the ALSOVA follow-up study will be examined at the Faculty of Health Sciences. The Opponent in the public examination be Professor Timo Strandberg of the University of Helsinki, and the Custos will be Professor Pekka Jäkälä of the University of Eastern Finland.
Photo available for download at