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P1‐167: Do standard anti‐dementia drug trial tests capture symptoms that are important to patients with mild‐moderate Alzheimer's disease and their carers?
Author(s) -
Rockwood Kenneth,
Fay Sherri
Publication year - 2011
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2011.05.446
Subject(s) - medicine , randomized controlled trial , mood , placebo , dementia , galantamine , disease , physical therapy , psychiatry , clinical psychology , donepezil , alternative medicine , pathology
responsively capture patient/caregiver preferences, but can be infeasible for routine use. TheSymptomGuide (SG )was developed to allow feasible, routine individualization. Patients/caregivers can select from 10-12 descriptions of 70 symptoms, and track changes in their profiles. SG scores reflect change from baseline, summarizing the number of goals set, their weights and the degree of change. Here, we compare the responsiveness (sensitivity to change) of SG scores to other clinical measures.Methods: SG profiles were generated for Capital Health Memory Clinic patients in Halifax, Canada. Responsiveness of the SG , Mini-Mental State Examination (MMSE), Physical Self-Maintenance Scale (PSMS), Instrumental Activities of Daily Living (IADL) scale andGlobalDeterioration Scale (GDS)were compared using standardized response means (SRM) and relative efficiency (RE) scores. Results: From 2007-2010, profiles were recorded for 335 patients treated by one clinic physician (KR). No patient declined participation. Their mean age (SD) was 77.6 (11.2) years; 188 (56.1%) were women; most (96.4%) lived with their spouse, family, or friend. Half had more than one clinic visit, allowing responsiveness to be calculated. The 10 most common symptoms were from the Executive Function and Cognition domains. Recent Memory and Verbal Repetition were each targeted in 69% or 58% of patients respectively. The SG , but not MMSE showed clinically detectable change (SG : Cohen’s d 1⁄4 0.34, MMSE: Cohen’s d 1⁄4 0.11) respectively up to 8 months. By 14 months only the SG showed significant change (Cohen’s d 1⁄4 0.44). By 24 months, statistically significant, clinically detectable, mild deterioration was seen on average. The 8 month REs were 8.22 for the SG ; 0.64 for MMSE; 0.02 for IADL; 0.99 for PSMS. Most SG worsening was seen with cognitive and behavioural symptoms.Conclusions:The SG andMMSEwere themost responsive measures used in routine clinical evaluation. The MMSE reflects cognitive change. The SG targets the most troublesome symptoms experienced by each patient, providing a more clinically recognizable picture of how patients’ daily lives have changed.