Review: Quality of Life Assessments in Dementia

There is a paper on Quality of Life Assessments in Dementia by Schiffcyzk and colleagues titled ‘Generic Quality of Life Assessment in Dementia Patients: A Prospective Cohort Study’ and freely available here. Quality of life measurements are used in health research and services to assess how health treatments are impacting on a person’s life in a broader way than through very specific disease-related outcome measures. The researchers in this study are asking how dementia might impact on quality of life measures and whether the resulting scores are meaningful.

In order to answer these questions, the researchers select a moderate sample of people with dementia (n=132). One of the strengths is that the researchers have sampled a very diverse group of people with dementia in terms of age and severity which is more likely to be representative of dementia in the general population (excluding distortions from selection bias). The study is also prospective ‘between September 2008 and December 2009’. Subjects completed the Geriatric Depression Scale and severity of dementia was assessed using the MMSE (although the study would have benefitted from more detailed assessements) as well as the Behave-AD.

The researchers assess quality of life using the Euro-Qol or EQ-5D which they describe as an instrument which will

measure health related QoL in five domains: mobility, self-care, usual activities, pain/discomfort and anxiety/depression

There are two components of this scale

a description of the respondents own health in the above mentioned five domains…. and a rating fo the overall own health on a visual analog scale

For the purposes of this study, the researchers have used only the first component although I wasn’t clear why this was. The researchers have also added a cognitive component to the EQ-5D which is examined in a separate analysis from the EQ-5D. The data was analysed using SPSS and the researchers note that the data was not normally distributed.

Although the result were multifaceted, I was particularly interested in the results described in Figure 1. The researchers find a significant difference between a subject’s self-rating of quality of life and the rating by proxy. The magnitude of this difference is significantly associated with MMSE score. Although research criteria for Alzheimer’s Disease are not used and the Behave-AD is used for multiple types of dementia the researchers have produced interesting findings which suggest that the severity of dementia may significantly impact on discrepancies between quality of life measures by the sample group with dementia and by their carers.  The researchers discussion is interesting and they suggest that the caregiver variables would be a useful subject for future investigation. Perhaps the results in this study would support the developement of a specialised dementia QoL instruments and there could be scope for further stratification according to subtypes.

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