title: Determinants of global clinical change assessment in patients with early Alzheimer's disease.
abstract: Global clinical impression (GCI) of change is assumed to integrate aspects of both cognitive and noncognitive functioning. We evaluated 140 consecutive patients with probable (n = 90) and possible (n = 50) early Alzheimer's disease at baseline and after 6 months with measurements of global cognitive function (CAMCOG), behavior, activities of daily living, and burden of the caregiver. After 6 months, both the clinician (GCI-clin) and the caregiver (GCI-care) rated clinical change on a 3-point scale (worse, no change, improved). Data were analyzed with multiple polychotomous logistic regression, adjusted for age and sex. Change in global cognitive function and GCI-care were significantly and independently related to GCI-clin, while changes in activities of daily living and in behavior were significantly and independently associated with GCI-care. The findings suggest a double dissociation. Change in cognition appears to be the major determinant of the clinician's global impression but not change in behavioral and functional parameters, while global impression of the caregiver is primarily based on change in behavioral and functional measures but not on change in cognition.
authors.affiliation: Department of Neurology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Claus
authors.forename: S
authors.initials: S
authors.lastname: Teunisse
authors.forename: G J
authors.initials: GJ
authors.lastname: Walstra
authors.forename: W A
authors.initials: WA
authors.lastname: van Gool
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000544:Alzheimer Disease / Q000503:physiopathology* / Q000523:psychology*; D001519:Behavior / Q000502:physiology; D017028:Caregivers; D003071:Cognition / Q000502:physiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D013997:Time Factors