Effects of anosognosia and neuropsychiatric symptoms on the quality of life of patients with Alzheimer's disease: a 24-month follow-up study

ObjectivesNeuropsychiatric symptoms and anosognosia are known to influence the perceived quality of life of patients (QoL-p) with Alzheimer's disease (AD). This study analysed their impact on patient and caregiver ratings of QoL-p and how these ratings changed in relation to the severity of dementia. MethodsA baseline sample of 221 patients and caregivers was followed up over 24months. Instruments: Neuropsychiatric Inventory (NPI), Anosognosia QuestionnaireDementia (AQ-D), Quality of lifeAlzheimer's Disease (QoL-AD) and the Global Deterioration Scale (GDS). Longitudinal data were analysed using generalized linear models. ResultsIn the multivariate analysis, greater anosognosia was always associated with higher ratings of QoL-p among patients, especially at 24months (p<0.001), and with more negative ratings among caregivers, especially at baseline (p<0.001). A higher total NPI score was associated with a more negative rating of QoL-p among caregivers (p<0.001), and it also had a smaller negative effect on patients' self-ratings (p=0.001). The neuropsychiatric symptoms (NPI) associated with a more negative view of QoL-p were depression, for patients' self-ratings, and apathy and agitation for caregiver ratings. The discrepancy between patient and caregiver ratings increased in line with the severity of dementia. ConclusionNeuropsychiatric symptoms had a similarly negative effect on the QoL-p ratings of both patients and caregivers, whereas the effect of anosognosia differed according to the rater (positive for patients, negative for caregivers). Copyright (c) 2015 John Wiley & Sons, Ltd.