In this review, we study the effects of dyadic psychosocial interventions focused on community-dwelling people with dementia and their family caregivers, and the relationship of the effects with intervention components of programs.

A search from January 2005 to January 2012 led to 613 hits, which we reviewed against our inclusion criteria. We added studies from 1992 to 2005 reviewed by Smits et al. (Smits, C. H. M., De Lange, J., Droes, R.-M., Meiland, F., Vernooij-Dassen, M. and Pot, A. M. (2007). Effects of combined intervention programs for people with dementia living at home and their caregivers: a systematic review. International Journal of Geriatric Psychiatry, 22, 1181–1193). We assessed the methodological quality of 41 programs with the Cochrane criteria and two items of the Oxford Centre of Evidence-based Medicine guidelines.

Studies of moderate to high quality concerning 20 different dyadic psychosocial programs for people with dementia and caregivers were included. Nineteen of these programs show significant effects on the patient with dementia, the caregiver, or both. Due to differences in the programs and the studies, this study does not provide an unequivocal answer about which programs are most effective. Programs with intervention components that actively train one or more specific functional domains for the person with dementia and/or the caregiver seem to have a beneficial impact on that domain, although there are exceptions. Reasons can be found in the program itself, the implementation of the program, and the study design.

Dyadic psychosocial programs are effective, but the outcomes for the person with dementia and the caregiver vary. More attention is needed for matching the targeted functional domains, intervention components, and delivery characteristics of a program with the needs of the person with dementia and the family caregiver.

This study aimed to explore the experiences and challenges of informal caregivers in Singapore with the intent of identifying the multi-dimensional unmet needs from their perspective and generating caregivers’ needs checklist based on the findings.

Informal caregivers were relatives of people with dementia and were responsible for organizing care and providing regular physical and/or financial support. Using a qualitative research design, informal caregivers’ experiences were explored. A total of ten focus group discussions and 12 semi-structured interviews were conducted with adult caregivers. Caregivers’ perceived unmet needs were identified using thematic analysis. Findings from the qualitative study were combined with inputs from professionals to create a checklist of caregivers’ needs for dementia.

The average age of the participants was 52.9 years; the majority of the participants were of Chinese ethnicity (50%), followed by Indian (23%), Malay (22%), and other (3%) ethnic groups. Informal caregivers perceived four categories of unmet needs: (i) emotional and social support, (ii) information, (iii) financial support, and (iv) accessible and appropriate facilities. Caregivers strongly expressed the need for emotional support to overcome the psychological and physical burden of care. Challenges with obtaining adequate information, access to services, and financial barriers were discussed. Based on these findings and expert panel discussions, a checklist of 26 items representing their unmet needs was designed.

Informal caregivers face several challenges while caring for their relative with dementia and hence there is a clear demand to address their unmet needs for information, services, respite, and emotional and financial support.

Instruments measuring caregiver reactions usually disregard positive aspects, and focus predominately on home care. The Caregiver Reaction Assessment (CRA) scale is an exception. Until now, no German version has been available. We translated the instrument to German (G-CRA) and evaluated its psychometric properties and feasibility.

Face-to-face interviews with 234 informal caregivers of persons with dementia were performed. Half of the persons with dementia (n = 118) had been recently admitted to institutional long-term care (iLTC); the remainder (n = 116) lived at home. Exploratory factor analysis (EFA) was performed. Subscales were inter-correlated and further correlated with the Zarit Burden Interview (ZBI), the General Health Questionnaire (GHQ-12), and the EuroQuol (EQ-5D). Internal consistency was measured (Cronbach's α), and interviewers (n = 9) appraised feasibility. The time needed to apply the scale was measured in 20 interviews.

The EFA yielded six factors (Kaiser criterion), but a scree plot supported the five dimensions of the original version that explained 56.2% of variance. Low-to-moderate subscales’ inter-correlation was revealed. Highest correlation (r = 0.5) was found between impact on health and impact on daily schedule, indicating slight overlap. Criterion validity was supported by reasonable correlations between subscales and ZBI and GHQ-12 (r = −0.21–0.71). Subscale impact on health was negatively correlated with the EQ-5D. The internal consistency was sufficient (α = 0.67 − 0.78). Interviewers judged the G-CRA to be appropriate. Completion took 6.50 min (median value).

Our results suggest that the G-CRA is sufficiently valid and internally reliable. The instrument is applicable in home care and iLTC as well as in the transitional phase.

Environmental influences on the rate of Alzheimer's disease (AD) progression have received little attention. Our objective was to test hypotheses concerning associations between caregiver personality traits and the rate of AD progression.

Care receivers (CR) were 161 persons with AD from a population-based dementia progression study; 55 of their caregivers were spouses and 106 were adult children. Cognitive status of the CR was measured with the Mini-Mental State Examination every six months, over an average of 5.6 (range: 1–14) years. Linear mixed models tested rate of cognitive decline as a function of caregiver personality traits from the NEO Five-Factor Inventory.

Significantly faster cognitive decline was observed with higher caregiver Neuroticism overall; however, in stratified models, effects were significant for adult child but not spouse caregivers. Neuroticism facets of depression, anxiety, and vulnerability to stress were significantly associated with faster decline. Higher caregiver Extraversion was associated with slower decline in the CR when caregivers were adult children but not spouses.

For adult child caregivers, caregiver personality traits are associated with rate of cognitive decline in CRs with AD regardless of co-residency. Results suggest that dementia caregiver interventions promoting positive care management strategies and ways to react to caregiving challenges may eventually become an important complement to pharmacologic and other approaches aimed at slower rate of decline in dementia.

Dementia is a complex and variable condition which makes recognition of it particularly difficult in a low prevalence primary care setting. This study examined the factors associated with agreement between an objective measure of cognitive function (the revised Cambridge Cognitive Assessment, CAMCOG-R) and general practitioner (GP) clinical judgment of dementia.

This was a cross-sectional study involving 165 GPs and 2,024 community-dwelling patients aged 75 years or older. GPs provided their clinical judgment in relation to each of their patient's dementia status. Each patient's cognitive function and depression status was measured by a research nurse using the CAMCOG-R and the 15-item Geriatric Depression Scale (GDS), respectively.

GPs correctly identified 44.5% of patients with CAMCOG-R dementia and 90% of patients without CAMCOG-R dementia. In those patients with CAMCOG-R dementia, two patient-dependent factors were most important for predicting agreement between the CAMCOG-R and GP judgment: the CAMCOG-R score (p = 0.006) and patient's mention of subjective memory complaints (SMC) to the GP (p = 0.040). A higher CAMCOG-R (p < 0.001) score, female gender (p = 0.005), and larger practice size (p < 0.001) were positively associated with GP agreement that the patient did not have dementia. Subjective memory complaints (p < 0.001) were more likely to result in a false-positive diagnosis of dementia.

Timely recognition of dementia is advocated for optimal dementia management, but early recognition of a possible dementia syndrome needs to be balanced with awareness of the likelihood of false positives in detection. Although GPs correctly agree with dimensions measured by the CAMCOG-R, improvements in sensitivity are required for earlier detection of dementia.

To assess the reliability, validity, and diagnostic utility of the Chinese version of General Practitioner Assessment of Cognition (GPCOG-C). The GPCOG, which is specifically designed for use in primary care to screen for cognitive impairment, consists of a patient section testing cognition, and an informant section asking about decline in cognitive and functional abilities.

The English version of GPCOG was translated, back-translated, and subsequently revised to determine the final GPCOG-C. Our sample comprised 253 community-dwelling volunteers with memory concerns aged 50 years and over and 103 outpatients of a psychogeriatric clinic with memory complaints. Participants were assessed by one of the four general practitioners or six psychogeriatricians. The Mini-Mental State Examination (MMSE), the Hasegawa's Dementia Scale (HDS), and the GPCOG-C were compared against the DSM-IV-defined dementia diagnosis.

The internal consistency (Cronbach's α) was 0.68 for the GPCOG patient section. The test–retest was 0.98 for the GPCOG-C total. The sequential administration of both components of GPCOG-C had a sensitivity of 97% and a specificity of 89%, with a positive predictive value of 72% and a negative predictive value of 99%. Both the GPCOG-C total and sequential two-stage scoring methods performed at least well as the MMSE and HDS in detecting dementia. The administration time for the two-stage approach was 4.3 ± 2.4 min.

The GPCOG-C is a valid, time efficient instrument for dementia screening in China.

Alzheimer's disease (AD) is considered to be a disorder predominantly affecting memory. It is increasingly recognized that the cognitive profile may be heterogeneous. We hypothesized that it would be possible to define distinct “cognitive phenotypes” in older people with AD.

Participants from three individual studies were included, consisting of 109 patients with a diagnosis of probable AD, and 91 age- and gender-matched control participants. All had demographic and cognitive assessment data available, including the Cambridge Cognitive Examination of the Elderly (CAMCOG). The CAMCOG scores and sub-scores were further analyzed using hierarchical cluster analysis and factor analysis.

Three clusters were identified. The scores loaded onto three factors representing the domains of attention, praxis, calculation, and perception; memory; and language comprehension and executive function. The main difference between the clusters related to degree of memory impairment. The composite score for memory between the clusters remained significantly different despite adjustment for illness duration and age of onset (p < 0.001).

These data suggest clinical heterogeneity within an older group of people with AD. This may have implications for diagnosis, prognosis, response to currently available treatments, and the development of novel therapies.

To date evidence of the relationship between cognition and Aβ amyloid during the early stages of Alzheimer's Disease (AD) has been inconsistent. This study aimed to describe the nature and magnitude of the relationship between Aβ amyloid and cognitive performance of individuals without dementia.

Composite cognitive measures were developed from the Australian Imaging Biomarkers and Lifestyle study neuropsychological test battery using data from 768 healthy older adults and 133 adults with mild cognitive impairment (MCI). A subgroup of this sample (174 healthy, 53 MCI) underwent neuroimaging for Aβ amyloid.

Within the MCI group individuals with high Aβ amyloid showed selective impairment for memory compared with those with low Aβ amyloid; however, this difference was not evident in the healthy group.

The current findings provide further evidence of the relationship between Aβ amyloid and cognition, with memory impairment being the primary symptom of the underlying disease during the prodromal phases of AD.

Alzheimer's disease (AD) affects not only memory but also other cognitive functions, such as orientation, language, praxis, attention, visual perception, or executive function. Most studies on oral communication in AD focus on aphasia; however, speech and orofacial apraxias are also present in these patients. The aim of this study was to investigate the presence of speech and orofacial apraxias in patients with AD with the hypothesis that apraxia severity is strongly correlated with disease severity.

Ninety participants in different stages of AD (mild, moderate, and severe) underwent the following assessments: Clinical Dementia Rating, Mini-Mental State Examination, Lawton Instrumental Activities of Daily Living, a specific speech and orofacial praxis assessment, and the oral agility subtest of the Boston diagnostic aphasia examination.

The mean age was 80.2±7.2 years and 73% were women. Patients with AD had significantly lower scores than normal controls for speech praxis (mean difference=−2.9, 95% confidence interval (CI)=−3.3 to −2.4) and orofacial praxis (mean difference=−4.9, 95% CI=−5.4 to −4.3). Dementia severity was significantly associated with orofacial apraxia severity (moderate AD: β=−19.63, p=0.011; and severe AD: β=−51.68, p < 0.001) and speech apraxia severity (moderate AD: β=7.07, p = 0.001; and severe AD: β= 8.16, p < 0.001).

Speech and orofacial apraxias were evident in patients with AD and became more pronounced with disease progression.

The Quality of Life-Alzheimer's Disease Scale (QOL-AD) is a reliable and valid self-report measure for assessing quality of life (QoL) in people with dementia in long-term care settings, but little is known yet about the number of patients with severe cognitive impairment who are able to complete this measure, and the characteristics of those unable to do so. The aim of the study is to advance knowledge of these issues.

Data on residents with dementia were collected from 11 nursing homes. The QOL-AD residential version was directly applied to residents with dementia diagnosis and Mini-Mental State Examination scores under 27, randomly selected in each center. Residents’ QoL was further assessed from the perspective of some close relative and some staff member. Altogether, 102 data sets from residents, 184 from relatives, and 197 from staff members were collected. An analysis of the characteristics of completers versus non-completers regarding levels of cognitive impairment was carried out.

People with dementia in long-term care are able to report their QoL. The QOL-AD completion rate decreases as the cognitive impairment level increases; non-completion is associated with greater overall impairment. About 30% of residents with severe cognitive impairment could self-report on their QoL with acceptable reliability.

QoL self-rating should be the first-line option when assessing residents with severe cognitive impairment. For those that are not able to complete self-report measures, proxies’ report could be an alternative, although the development of other assessment procedures (e.g. observational) should be considered.

Providing good quality care for the growing number of patients with dementia is a major challenge. There is little international comparative research on how people with dementia die in nursing homes. We compared the relative's judgment on quality of care at the end of life and quality of dying of nursing home residents with dementia in Belgium and the Netherlands.

This was a Belgian cross-sectional retrospective study (2010) combined with a prospective and retrospective study from the Netherlands (January 2007–July 2011). Relatives of deceased residents of 69 Belgian and 34 Dutch nursing homes were asked to complete questionnaires. We included 190 and 337 deceased nursing home residents with dementia in Belgium and the Netherlands, respectively.

Of all identified deceased nursing home residents with dementia, respectively 53.2% and 74.8% of their relatives in Belgium and the Netherlands responded. Comfort while dying (CAD-EOLD, range 14–42) was rated better for Dutch nursing home residents than for Belgian nursing homes residents (26.1 vs. 31.1, OR 4.5, CI 1.8–11.2). We found no differences between countries regarding Satisfaction With Care (SWC-EOLD, range 10–40, means 32.5 (the Netherlands) and 32.0 (Belgium)) or symptom frequency in the last month of life (SM-EOLD, range 0–45, means 26.4 (the Netherlands) and 27.2 (Belgium)).

Although nursing home structures differ between Belgium and the Netherlands, the quality of care in the last month of life for residents with dementia is similar according to their relatives. However, Dutch residents experience less discomfort while dying. The results suggest room for improved symptom management in both countries and particularly in the dying phase in Belgium.

Frailty may be associated with reduced life satisfaction (LS). The objectives of this paper are to determine if (1) frailty is associated with LS in community-dwelling older adults in cross-sectional analyses; (2) frailty predicts LS five years later; and (3) specific domains of LS are preferentially associated with frailty.

This paper presents analysis of an existing population-based cohort study of 1,751 persons aged 65+ who were assessed in 1991, with follow-up five years later. LS was measured using the terrible–delightful scale, which measures overall LS and LS in specific domains. Frailty was measured using the Brief Frailty Instrument. Analyses were adjusted for age, gender, education, and marital status.

Frailty was associated with overall LS at time 1 and predicted overall LS at time 2. This was seen in unadjusted analyses and after adjusting for confounding factors. Frailty was associated with all domains of LS at time 1, and predicted LS at time 2 in all domains except housing and self-esteem. However, the effect was stronger for LS with health than with other domains for both times 1 and 2.

Frailty is associated with LS, and the effect is strongest for LS with health.