Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-22T14:19:19.514Z Has data issue: false hasContentIssue false
  • English
  • Français

Decreased initiation of usual activities in people with mild-to-moderate Alzheimer's disease: a descriptive analysis from the VISTA clinical trial

Published online by Cambridge University Press:  11 April 2008

Cheryl Cook ,
Sherri Fay  and
Kenneth Rockwood
Cheryl Cook
Affiliation:
Geriatric Medicine Research Unit, Capital District Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
Sherri Fay
Affiliation:
Geriatric Medicine Research Unit, Capital District Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
Kenneth Rockwood*
Affiliation:
Geriatric Medicine Research Unit, Capital District Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada Division of Geriatric Medicine, Capital District Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
*
Correspondence should be addressed to: Kenneth Rockwood, Division of Geriatric Medicine, Dalhousie University, 1421–5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1Canada. Phone: +1 902 473 8687; Fax: +1 902 473 1050. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Decreased initiation of activities is a common symptom in Alzheimer's disease (AD) and creates significant burden for carers, yet little is known about how patients, carers and treating physicians describe this problem.

Methods: This is a secondary, qualitative analysis of video-recorded, semi-structured and open-ended interviews with the 130 community-dwelling patients with mild-to-moderate AD from the Video-Imaging Synthesis of Treating Alzheimer's Disease (VISTA) study – a four-month, randomized, placebo-controlled trial of galantamine. Interviews were coded and organized using Atlas.ti. By applying a framework analysis approach, patient/carer descriptions of dementia-related decreased initiation of usual tasks and activities were categorized and summarized.

Results: Decreased initiation of instrumental activities of daily living (IADLs) and/or leisure and social activities was reported in 85/130 patients at baseline, 71 (84%) of whom specifically targeted increased initiation as a goal of treatment. The most common manifestations of decreased initiation were initiating only with prompting (55%), and no longer initiating but willing to engage in the activity (42%; note that these groups can overlap). Many patients were also described as having less interest (44%) or impaired performance (34%) in the activity in which decreased initiation was noted. Coping strategies were employed by 69/85 carers, most commonly verbal prompts to begin an activity.

Conclusion: Decreased initiation is a common and problematic symptom in people with mild-to-moderate Alzheimer's disease who seek treatment for dementia. Information offered voluntarily about interest in or ability to perform activities which are initiated less often gives additional data compared with routine questioning about initiation of function. This is a potentially rich area for the elucidation of disease and treatment effects.

Keywords

initiationAlzheimer's diseasegalantaminephenomenology
Type
Research Article
Information
International Psychogeriatrics , Volume 20 , Issue 5 , October 2008 , pp. 952 - 963
Copyright
Copyright © International Psychogeriatric Association 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andersen, C. K., Wittrup-Jensen, K. U., Lolk, A., Andersen, K. and Kragh-Sorenson, P. (2004). Ability to perform activities of daily living is the main factor affecting quality of life in patients with Dementia. Health and Quality of Life Outcomes, 21, 52.CrossRefGoogle Scholar
Boyle, P. A., Malloy, P. F., Salloway, S., Cahn-Weiner, D. A., Cohen, R. and Cummings, J. L. (2002). Executive dysfunction and apathy predict functional impairment in Alzheimer's disease. American Journal Geriatric Psychiatry, 11, 214–221.CrossRefGoogle Scholar
Della Barba, G., Nedjam, Z. and Dubois, B. (1999). Confabulation, executive functions and source memory in Alzheimer's disease. Cognitive Neuropschyology, 16, 385–398.CrossRefGoogle Scholar
Gauthier, S., Gélinas, I. and Gauthier, L. (1997). Functional disability in Alzheimer's disease. International Psychogeriatrics, 9, 163–165.CrossRefGoogle ScholarPubMed
Gélinas, I., Gauthier, L., MacIntyre, M. and Gauthier, S. (1999). Development of a functional measure for persons with Alzheimer's disease: the disability assessment for dementia. American Journal of Occupational Therapy, 53, 471–481.CrossRefGoogle ScholarPubMed
Gerritsen, J. C. and Van Der Ende, P. C. (1994). The development of a care-giving burden scale. Age & Ageing, 23, 483–491.CrossRefGoogle ScholarPubMed
Joffres, C. and Rockwood, K. (2006). The use of qualitative research. In: Rockwood, K. and Gauthier, S. (eds.), Trial Designs and Outcomes in Dementia Therapeutic Research (pp. 45–64). London: Taylor and Francis.Google Scholar
Joffres, C., Graham, J. and Rockwood, K. (2000). Qualitative analysis of the clinician interview-based impression of change (plus): methodological issues and implications for clinical research. International Psychogeriatrics, 12, 403–413.CrossRefGoogle ScholarPubMed
Joffres, C., Bucks, R. S., Haworth, J., Wilcock, G. K. and Rockwood, K. (2003). Patterns of clinically detectable treatment effects with galantamine: a qualitative analysis. Dementia and Geriatric Cognitive Disorders, 15, 23–33.CrossRefGoogle ScholarPubMed
Kiresuk, T. J. and Sherman, R. E. (1968). Goal Attainment Scaling: a general method for evaluating comprehensive community mental health programs. Community Mental Health Journal, 4, 443–453.CrossRefGoogle Scholar
Landes, A. M., Sperry, S. D., Strauss, M. E. and Geldmacher, D. S. (2001). Apathy in Alzheimer's disease. Journal of the American Geriatrics Society, 49, 1700–1707.CrossRefGoogle ScholarPubMed
Marin, R. (1990). Differential diagnosis and classification of apathy. American Journal of Psychiatry, 147, 22–30.Google ScholarPubMed
Muhr, T. (2004). Users' Manual for Atlas.ti 5.0. Berlin: Atlas.ti. Scientific Software Development GmbH.Google Scholar
Pope, C., Ziebland, S. and Mays, N. (2000). Analysing qualitive data. In: Pope, C. and Mays, N. (eds.), Qualitative Research in Health Care (pp. 75–87). London: BMJ Books.Google ScholarPubMed
Potkin, S. G. (2002). The ABC of Alzheimer's disease: ADL and improving the day-to-day functioning of patients. International Psychogeriatrics, 14, 7–26.CrossRefGoogle ScholarPubMed
Ritchie, J. and Spencer, L. (1993). Qualitative data analysis for applied policy research. In Bryman, A. and Burgess, R. (eds.), Analysing Qualitative Data (pp. 173–194). London: Routledge.Google Scholar
Robert, P. H. et al. (2006). Neuropsychological performance in mild cognitive impairment with and without apathy. Dementia and Geriatric Cognitive Disorders, 21, 192–197.CrossRefGoogle ScholarPubMed
Rockwood, K. (2007). The measuring, meaning and importance of activities of daily living (ADLs) as an outcome. International Psychogeriatrics, 19, 467–482.CrossRefGoogle ScholarPubMed
Rockwood, K., Fay, S., Song, X., MacKnight, C. and Gorman, M. on behalf of the VISTA Investigators (2006). Attainment of treatment goals by people with Alzheimer's disease receiving galantamine: a randomized controlled trial. Canadian Medical Association Journal, 174, 1099–1105.CrossRefGoogle ScholarPubMed
Rockwood, K., Fay, S., Jarrett, P. and Asp, E. (2007). Effect of galantamine on verbal repetition in AD: a secondary analysis of the VISTA trial. Neurology, 68, 1116–1121.CrossRefGoogle Scholar
Rosen, W. G., Mohs, R. C. and Davis, K. L. (1984). A new ratings scale for Alzheimer's disease. American Journal of Psychiatry, 141, 1356–1364.Google ScholarPubMed
Royall, D. R., Chiodo, L. K. and Polk, M. J. (2003). Executive dyscontrol in normal aging: normative data, factor structure, and clinical correlates. Current Neurology and Neuroscience Reports, 3, 487–493.CrossRefGoogle ScholarPubMed
Schneider, L. S. et al. (1997). Validity and reliability of the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change. The Alzheimer's Disease Cooperative Study. Alzheimer's Disease Associated Disorders, 11, S22–32.CrossRefGoogle ScholarPubMed
Spencer, L., Ritchie, J., Lewis, J., Dilon, L. and National Centre for Social Research (2003). Quality in Qualitative Evaluation: A Framework for Assessing Research Evidence. London: Strategy Unit, Cabinet Office.Google Scholar
Starkstein, S. E., Petracca, G., Chemerinski, E. and Kremer, J. (2001). Syndromic validity of apathy in Alzheimer's disease. American Journal of Psychiatry, 158, 872–877.CrossRefGoogle ScholarPubMed
Swanberg, M. M., Tractenberg, R. E., Mohs, R., Thal, L. J. and Cummings, J. L. (2004). Executive dysfunction in Alzheimer disease. Archives of Neurology, 61, 556–560.CrossRefGoogle ScholarPubMed
Voss, S. E. and Bullock, R. A. (2004). Executive function: the core feature of dementia? Dementia and Geriatric Cognitive Disorders, 18, 207–216.CrossRefGoogle ScholarPubMed