Trajectories of quality of life in early-stage dementia: individual variations and predictors of change

Clare, Linda; Woods, Robert T.; Nelis, Sharon M.; Martyr, Anthony; Markova, Ivana S.; Roth, Ilona; Whitaker, Christopher J. and Morris, Robin G. (2014). Trajectories of quality of life in early-stage dementia: individual variations and predictors of change. International Journal of Geriatric Psychiatry, 29(6) pp. 616–623.

DOI: https://doi.org/10.1002/gps.4044

Abstract

Background:

Little evidence is available about how quality of life (QoL) changes as dementia progresses.

Objectives:

We explored QoL trajectories over a 20-month period and examined what predicted change in QoL.

Method:

Fifty-one individuals with a diagnosis of Alzheimer’s, vascular or mixed dementia (PwD) participating in the MIDAS study rated their QoL using the QoL-AD scale at baseline and at 20-month follow-up. PwD also rated their mood and quality of relationship with the carer. In each case the carer rated his/her level of stress and perceived quality of relationship with the PwD.

Results:

There was no change in mean QoL score. Nearly one-third of PwD rated QoL more positively at 20-month follow-up and nearly one-third rated QoL more negatively. These changes could be regarded as reliable in one-quarter of the sample. Participants taking AChEI medication at baseline were more likely to show a decline in QoL score. There were no other significant differences between those whose scores increased, decreased or stayed the same on any demographic or disease-related variables, or in mood or perceived quality of relationship with the carer. While baseline QoL score was the strongest predictor of QoL at 20 months, the quality of relationship with the carer as perceived by the PwD was also independently a significant predictor.

Conclusions:

There is a degree of individual variation in QoL trajectories. Use of AChEI medication appears linked to decline in QoL score, while positive relationships with carers play an important role in maintaining QoL in early-stage dementia.

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