What contributes to a good quality of life in early dementia? awareness and the QoL-AD: a cross-sectional study

Health and Quality of Life Outcomes

Linda Clare⁶  Robin Morris⁵  Ilona Roth³  Ivana Markova⁴  Christopher J Whitaker²  Judith Roberts⁶  Anthony Martyr⁶  Sharon M Nelis⁶  Robert T Woods¹ 

[1] DSDC Wales, Bangor University, Ardudwy, Holyhead Road, Bangor, UK;NWORTH, Bangor University, Y Wern, Holyhead Road, Bangor, UK;Department of Life Sciences, Open University, Walton Hall, Milton Keynes, UK;Department of Psychiatry, University of Hull, Hull, UK;Department of Psychology, Institute of Psychiatry, Kings College London, De Crespigny Park, London, UK;School of Psychology, Bangor University, Brigantia Building, Penrallt, Bangor, UK

关键词: Conscientiousness;    Self-concept;    Vascular dementia;    Alzheimer’s disease;    Meta‒cognition;    Self‒awareness;    Insight;    Anosognosia;    Quality of life;   

Others  :  814621
DOI  :  10.1186/1477-7525-12-94

 received in 2014-01-21, accepted in 2014-06-03,  发布年份 2014

【 摘 要 】

Background

Self-report quality of life (QoL) measures for people with dementia are widely used as outcome measures in trials of dementia care interventions. Depressed mood, relationship quality and neuropsychiatric symptoms predict scores on these measures, whereas cognitive impairment and functional abilities typically do not. This study examines whether these self-reports are influenced by personality and by the person’s awareness of his/her impairments. A strong negative association between QoL and awareness of deficits would have implications for the validity of self-report in this context and for therapeutic interventions aiming to increase adjustment and coping.

Methods

Participants were 101 individuals with early‒stage dementia and their family carers participating in the Memory Impairment and Dementia Awareness (MIDAS) Study. QoL was assessed using the QoL-AD scale, and awareness was assessed in relation to memory, activities of daily living and social functioning. Self-concept, conscientiousness, quality of relationship and mood were assessed and a brief neuropsychological battery administered. Carers rated their own stress and well-being and reported on neuropsychiatric symptoms. A series of regression analyses predicting QoL-AD were carried out, identifying key variables in each domain of assessment to take forward to an overall model.

Results

Cognitive impairment was not related to QoL. The final model accounted for 57% of the variance in QoL-AD scores, with significant contributions from depressed mood, severity of irritability shown by the person with dementia, self-concept, quality of relationship (rated by the person with dementia) and male gender. The bivariate relationships of QoL-AD with awareness of memory function, awareness of functional abilities and conscientiousness were mediated by both depressed mood and self-concept.

Conclusions

This study reports the most comprehensive approach to evaluation of awareness to date. Most of the indices of awareness used are not related to self-reported QoL. Discrepancies in evaluative judgements of memory function and functional abilities between people with dementia and carers are related to QoL, but this relationship is mediated by both depressed mood and self-concept, which have a much stronger relationship with QoL. The validity of self-report measures of QoL in people with early stage dementia is supported by these results.

【 授权许可】

   
2014 Woods et al.; licensee BioMed Central Ltd.

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