title: Health-Related Quality of Life in Patients with Alzheimer's Disease in Different German Health Care Settings.
abstract: The purpose of this study is to evaluate the health-related quality of life (HrQoL) of patients with Alzheimer's disease (AD) in different care settings (institutionalized versus community-dwelling) across all severity stages of dementia. Patients were consecutively recruited with their primary caregivers (123 inpatients and 272 outpatients), and the impact of patient-related parameters such as behavioral and psychological symptoms of dementia (BPSD) (Geriatric Depression Scale [GDS] and Neuropsychiatric Inventory [NPI]) and functional capacity (Alzheimer's Disease Cooperative Study-Activities of Daily Living [ADCS-ADL]) on HrQoL was analyzed. Patients' HrQoL was assessed using self-reported and caregiver-rated generic (EuroQoL Instrument) and dementia-specific (Quality of Life-Alzheimer's Disease [Qol-AD]) scales. Patients reported a considerably higher HrQoL than their caregivers on the QoL-AD, EQ-5D, and EQ VAS (p <  0.001). Different dementia severity groups showed significantly worse results in HrQoL for patients with lower MMSE scores. The mean self-reported QoL-AD decreased from 32.3±5.7 in the group with the highest MMSE scores to 27.1±5.5 in patients with the lowest MMSE scores (p <  0.001). A considerably lower HrQoL was shown for institutionalized patients versus participants in outpatient settings (proxy-rated QoL-AD 19.7±4.6 versus 26.0±7.1, p <  0.001). Depressive symptoms (GDS), BPSD (NPI), and reduced functional capacity (ADCS-ADL) were evaluated for their impact on patients' HrQoL. Multivariate models explained between 22% and 54% of the variance in patients' HrQoL. To analyze the causative direction of the reported associations, further longitudinal studies should be conducted.
authors.affiliation: Department of Neurology, Philipps-University Marburg, Marburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Heßmann
authors.affiliation: Department of Neurology, Philipps-University Marburg, Marburg, Germany.
authors.forename: Greta
authors.initials: G
authors.lastname: Seeberg
authors.affiliation: Department of Neurology, Philipps-University Marburg, Marburg, Germany.|Institute of Medical Sociology and Social Medicine, Philipps-University Marburg, Marburg, Germany.
authors.forename: Jens Peter
authors.initials: JP
authors.lastname: Reese
authors.affiliation: Department of Neurology, Philipps-University Marburg, Marburg, Germany.
authors.forename: Judith
authors.initials: J
authors.lastname: Dams
authors.affiliation: Department of Family Medicine, Philipps-University Marburg, Marburg, Germany.
authors.forename: Erika
authors.initials: E
authors.lastname: Baum
authors.affiliation: Vitos Clinic for Psychiatry and Psychotherapy, Marburg and Justus-Liebig-University, Giessen, Germany.
authors.forename: Matthias J
authors.initials: MJ
authors.lastname: Müller
authors.affiliation: Department of Neurology, Philipps-University Marburg, Marburg, Germany.
authors.forename: Richard
authors.initials: R
authors.lastname: Dodel
authors.affiliation: Department of Neurology, Philipps-University Marburg, Marburg, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Balzer-Geldsetzer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D017028:Caregivers / Q000523:psychology; D003863:Depression / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007297:Inpatients; D008297:Male; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D010045:Outpatients; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012112:Residential Facilities; D057566:Self Report; D012720:Severity of Illness Index
keywords: Alzheimer’s disease; BPSD; care; dementia; depression; quality of life