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How Do Patients With Alzheimer Disease Rate Their Overall Quality of Life?

Received August 20, 2003; revised March 31, April 8, 2004; accepted April 14, 2004. From the Univ. of Pennsylvania (BDJ,SXX,JHTK), the Depts. of Medicine (BDJ,JHTK), and Biostatistics and Epidemiology (SXX), Div. of Geriatrics (BDJ,JHTK), Institute on Aging (BDJ,JHTK), Leonard Davis Institute of Health Economics (JHTK), Center for Bioethics (JHTK), and Alzheimer’s Disease Center (BDJ,SXX,JHTK). Send correspondence and reprint requests to Bryan D. James, M.Bioethics, Institute on Aging, 3615 Chestnut Street, Philadelphia, PA 19104. e-mail: bjames{at}mail.med.upenn.edu
© 2005 American Association for Geriatric Psychiatry

Objective: The authors asked how Alzheimer disease (AD) patients assess their overall quality of life (QOL) and sought to determine the characteristics associated with this assessment. Methods: The authors performed a cross-sectional survey of 193 persons with mild-to-severe-stage AD in a University Memory Disorders Clinic using a single-item self-assessment of overall QOL. Results: The 181 of 193 patients (94%) able to complete a single-item QOL self-rating had less severe dementia than patients not able to complete, but some had Mini-Mental State Exam scores as low as 0. Most patients rated their QOL as "good" (35%) or "very good" (36%). Latino patients, patients with less education, and depressed patients were more likely to rate their QOL lower. Among patients able to estimate how they thought their family caregiver would rate their QOL (N=173; 90%), there was moderate agreement between this estimate and their self-ratings. Conclusion: A single-item global rating of patient QOL could prove useful in assessing QOL of most mild-to-severe-stage AD patients. Affective impairment, more than cognitive or functional impairment, drives this assessment. Screening for and addressing depressive symptoms could improve AD patients’ QOL. Despite impairments in insight, patients see a difference in how their caregivers would rate their QOL.

Key Words: Alzheimer Disease • Quality of Life • Self-Rating

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