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PO4. Medical aspects

Detailed programme and abstracts

Medical aspects

PO4.1. Validity of current diagnostic concepts of Alzheimer’s disease


The conceptualization of Alzheimer's disease (AD) is currently undergoing a fundamental transformation from a clinical syndrome exclusively pertaining to dementia to a clinicobiological entity with pre-dementia and dementia phases. The current concepts of AD defined by the diagnostic guidelines of the American Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the International working Group 2 (IWG-2) and the National Institute on Ageing-Alzheimer’s Association are here considered. Their validity is assessed and scrutinized in the light of recent progresses in unveiling the pathomechanism of the disease and understanding the genesis of its clinical symptoms. The main validity criterion employed is the presence of clear demarcation lines between AD and normality on the one hand and neighbouring diagnostic entities on the other. The analysis challenges the conceptual and construct validity of the aforementioned AD conceptualisations. The present analytical endeavours may point to the necessity of employing more dimensional approaches to AD, since they may better reflect the biomarker and symptomatology continua between healthy ageing and dementia due to AD, which are formed by the complex interplay between brain co-pathologies and environmental factors. 

PO4.2. The role of counseling in pre-assessment dynamics process for early diagnosis

MOGLAN Maria, TUDOSE Catalina

Background: Caring for people with dementia and support their families is a concern for the whole society. In Europe, there are approximately 6.4 million people with dementia; their number will reach 10.5 million in 2030. Alzheimer's disease is diagnosed in Romania in middle-severe stage. A Romanian Alzheimer Society recent study tried to capture the information, attitudes and needs of patients and family members in their approach to get a diagnosis.

Objectives: 1) Investigate the ability of patients to understand what represent a neurocognitive assessment process and its implications in the diagnosis. 2) Investigate the attitudes of family members regarding the particularities of evaluation, its scope and implications in order to establish a diagnosis. 3) Identifying the information needs of patients and their family in order to require a cognitive assessment and to accept a possible diagnosis.

Method: We analyzed the information, attitudes and needs of patients and family members regarding their approach to get a diagnosis.

Conclusion: neurocognitive disorders are observed late by the patient and family members, when clinical signs progressed. Patient requires an assessment at the insistence of his/her family, when daily functionality, behavior or quality of relationships has changed significantly. Generally, neither the family nor the patient have information regarding the neurocognitive assessment process or know very little things about and they are unprepared, have unrealistic expectations and understand with difficulty the significance of the assessment results. Pre-assessment counseling plays an important role in the diagnostic process.

PO4.5. Management of dementia in Day Center: The Re-Cotid Model

FABBO Andrea, MANNI Barbara, GRAFF Maud, GARZETTA Glenda, ZUCCHI Patrizia

Background: dementia and cognitive decline has functional and social impact on people with dementia (PWD) and their caregivers. Most of them develop behavioural and psycological syntoms (BPSD) triggered by uncorrected relationship with caregiver, environment or organic problems.   The caregiver experiences a gap between the amount of requests and the available resources that explodes in a psychological syndrome of “burn out”: emotional exhaustion, depersonalization, and personal accomplishment. (Feast.A, 2016. Van der Lee J.2014). Considering low efficacy and drug’s side effects, BPSD can benefit of psycosocial and environment approach (Luijpen et al 2003). In particular, the “tailor made” treatment has the best results (Brodaty et al.2003).  In a recent review (Nehen HG del 2015) one of psychosocial intervention that demonstrated efficacy in improving quality of life and mood of people with mild-moderate dementia and his caregiver at home is the CoTID method (Community occupation therapy Graff MJ. 2006).  Unlucky there are not any study that explore the efficacy of Occupational therapy in Day Center or Nursing Home o Respite care.

Aim of the study: to reduce behavioral problems in PWD admitted in a Day Center through psychosocial interventions such as occupational therapy, enviromental changes and staff training and to verify reduction of burden in formal and informal caregivers.

Methods: we evaluated: 1) a sample of 14 PWD (mean age: 82aa , ds + 5,88) admitted to Day Center before (T0) and after 3 mounths (T1) of occupational therapy according to the CoTID model (sex. age, comorbidity, number of medications, cognitive (MMSE) and functional status (DAD), behavioral and affective problems (NPI, Cornell-AD), quality of life (QoLAD); 2) a sample of 4 formals (caregivers (Maslach Burnout Inventory and COPM) ; 3) a sample of 9 family caregivers (SCQ and Zarit burden interview). The project (from October 2015 to March 2016) plan included: a staff training about management of BPSD and communication with PWD, enviromental adaptations and a tailored occupational therapy intervention.

After treatment of occupational therapy delivered through the Project Plan, there has been a significant reduction of NPI (4.6 t p.0.001) with improvement in depressive symptoms at Cornell (5.85 t p 0.000) and quality of life (QolAD), reduction in the use of neuroleptic drugs (f 2.309 0.040 Mr.) and the number of falls in the 3 months of treatment (t 2.501 0.028 Mr.), reduction of formal and informal caregiver burnout (no statistical significance).

Conclusion: Thanks to a tailored approach and occupation PWD can satisfy their needs that sometimes express as BPSD, can improve mood and quality of life. Moreover, these benefits reflect on formal and informal caregiver whom reduce stress of caregiving and comprehend skills on BPSD management.

PO4.6. Neuropsychiatric symptoms and psychotropic drug use in a Dutch sample of people with dementia in primary care

BORSJE Petra, LUCASSEN Peter, WETZELS Roland, POT Anne Margriet, KOOPMANS Raymond

Background: Neuropsychiatric symptoms (NPS) frequently occur in people with dementia (PWD) and result in lower quality of life, high caregiver burden, psychotropic drug use (PDU) and a high risk of institutionalization. To date studies on NPS in PWD have been mainly conducted in clinical centers or psychiatric services.

Aim: To assess the prevalence of NPS and PDU of Dutch PWD in primary care.

Methods: Cross-sectional analysis based on data of a prospective naturalistic cohort study in primary care in a sample of 117 PWD and their informal caregivers. Data were collected during an assessment with the PWD and the caregiver at home. NPS of the PWD were assessed with the Neuropsychiatric Inventory (NPI) and PDU was collected.

Results: The mean age of the PWD was 78.6 years (SD 7.1, range 57-91) and 52% were female. Mean NPI total score 15.8 (range 0-77). Almost all PWD (92.2%) had one or more NPS (NPI symptom score >0), whereas 65.5% had one or more clinically relevant NPS (NPI symptom score ≥4) in the previous 4 weeks. The most common NPS were agitation/aggression (54.3%), dysphoria/depression (52.6%) and irritability/lability (48.3%). The most common clinically relevant NPS were aberrant motor behavior (28.4%), agitation/aggression (23.3%) and apathy/indifference (21.6%). PDU: 9.6% antipsychotics (n=11), 5.2% anti-epileptics (n=6), 17.4% antidepressants (n=20), 2.6% anxiolytics (n=3), 3.5% hypnotics (n=4) and 33.9% anti-dementia (n=39). Excluding anti-dementia medication 71.3% (n=82) of the PWD in our study population used no PDU, 28.7% (n=33) used at least one, 7.8% (n=9) used at least two and two PWD (1.7%) used three different psychotropic drugs.

Conclusions: NPS are highly prevalent in PWD in primary care, even though the mean NPI total score was low. Less than one-third of PWD used at least one psychotropic drug, excluding anti-dementia medication.

PO4.7. Do concerns about developing Alzheimer’s and worries about cognitive functioning affect psychological well-being?

CUTLER Stephen, BRĂGARU Corina

We examine three questions related to concerns and anxieties about cognitive functioning and developing Alzheimer’s disease (AD): (1) Does fear of developing AD affect psychological well-being? (2) Do such concerns exert short-term effects, long-term effects, or both? (3) Do concerns affect well-being more so among persons with a parental history of AD?  We use three waves of data collected in 2000, 2005, and 2011 from two samples of persons ages 40-60 at T1 (total N at T3=177): (1) adult children with a parent diagnosed with probable AD, and (2) a matched control group with no parental history of AD.  Predictors are summative scores on five indicators of concerns about cognitive functioning and worries about dementia, with controls for age, education, and gender. Well-being measures include depression, stress, life satisfaction, and mastery. We use structural equation modeling to examine the effects of COGSUM1, COGSUM2, and COGSUM3 on each of the four well-being measures at the three waves. We find that (1) respondents who are more concerned about their cognitive functioning at waves 1, 2, and 3 are generally more depressed and stressed and have lower levels of life satisfaction and mastery at each of these waves; (2) in no instance is there any evidence of a long-term, lagged effect (i.e., COGSUM1 has no effect on any outcome measure at waves 2 or 3 and COGSUM2 has no effect on any outcome measure at wave 3); (3) of the control variables, only education has somewhat consistent effects on the outcomes. Using multiple group analysis within a structural equation-modeling framework, we then find these relationships are statistically similar across the groups of adult children and controls. Because concerns about cognitive functioning and developing AD are pervasive among middle-aged and older persons, practitioners should be aware of their potentially deleterious effect on psychological well-being.

PO4.8. Beyond cognitive decline: prevalence of neuropsychiatric symptoms and their association with functional impairment in nursing home elderly

FERNANDES Lia, FERREIRA Ana Rita, MARTINS Sónia, DIAS Cláudia Camila, SIMÕES Mário 

Background: The ageing of the population and the associated higher prevalence of chronic conditions determine functional limitations in activities of daily living (ADLs). In this context, it has been shown that functional impairment can predict the worst health outcomes, nursing home placement and death. Although cognitive decline is a well-known determinant for functional impairment, the role of neuropsychiatric symptoms is less studied even though they are quite common, particularly in nursing homes.

Aim: To analyze the role of cognitive and neuropsychiatric symptoms in functional impairment in an institutionalized elderly sample.

Methods: A cross-sectional study was conducted in three nursing homes. All residents were eligible, however those with delirium or who were unresponsive were excluded. Data were collected with European Portuguese Neuropsychiatric Inventory/NPI (neuropsychiatric symptoms), Mini-Mental State Examination/MMSE (cognition) and Adults and Older Adults Functional Assessment Inventory/IAFAI. The latter is a Portuguese functional incapacity measure of basic and instrumental ADLs (total and partial scores due to incapacity in physical, cognitive and emotional domains).

Results: The sample included 151 elderly with a mean age of 79.81(sd=9.98) years and institutionalized on average 6.02(sd=9.74). From those, 53.6% scored for cognitive decline. Sleep/night-time behaviour(55.2%), dysphoria/depression(21.0%) and delusions(20.3%) were the most frequent symptoms. The mean functional impairment was 43.44% (sd=23.51%; range:0-93.56%). Significant negative correlations were found between MMSE and IAFAI (total rs=−0.618,p<0.001; cognitive rs=−0.799,p<0.001; physical rs=−0.240,p=0.003 domains). Positive significant correlations between NPI and IAFAI (cognitive rs=0.258,p=0.002; emotional rs=0.218,p=0.009 domains) were also found.

Conclusion: Cognitive and neuropsychiatric symptoms were related to more dependency. Concerning neuropsychiatric symptoms, data is in accordance with other studies, which implies that these symptoms are not only prevalent in nursing homes, but are also independently associated with higher limitations in ADLs. Clarifying the relation between neuropsychiatric symptoms and functionality could enhance and tailor more adequate interventions, ameliorating the burden of the illness.

PO4.9. Translation and linguistic validation of the German Challenging Behavior Scale (CBS-G)

HOLLE Daniela, MONIZ-COOK Esme, HALEK Margareta

Background: Psychosocial interventions are recommended for people with dementia and challenging behavior. To investigate the effect of such interventions on residents ‘challenging behavior, a comprehensive scale that incorporates both the problematic residents behaviors and the challenges experienced by formal caregivers and the resident is needed. One measurement scale that combines those two aspects is the “Challenging behavior Scale (CBS)”. The aim of this study was to translate the English Challenging Behaviour Scale (CBS) into German and test its linguistic validity in a pilot sample of formal caregivers working in different nursing homes in Germany.

Method: The two-panel approach was used to translate the CBS into German (CBS-G). 23 formal caregivers from 8 different nursing homes reviewed the unambiguity and familiarity of the CBS-G items and the adequateness of the exampled used to describe the items on a 4-point Likert scale. Content validity indexes (CVI) and a modified kappa (k) were calculated for the degree of total agreement.

Results: The two-panel approach has proven to be a useful method for translating the CBS into German. 22 of the 25 items of the CBS-G showed excellent CVI and k regarding the unambiguity of items. Twenty-three items showed excellent CVI and k in relation to the familiarity of the items. All examples were viewed as adequate. Two items of the CBS-G should be reformulated due to low CVI and k. Detailed information related to the scoring system should be added to the CBS-G instructions.

Conclusion: A German version of the Challenging Behavior Scale (CBS-G) that is equivalent to the original version of the CBS is now available. Further research is needed to test the psychometric properties of the CBS-G, as translation and linguistic validation is the first step in the process of adapting a health-related instrument.

PO4.10. Regional differences in opioid use in elderly patients with dementia: a nationwide study

JENSEN-DAHM Christina, ZAKARIAS Johanne Købstrup, GASSE Christiane, WALDEMAR Gunhild

Introduction: A recent study reported that use of opioids was frequent in elderly with dementia (Jensen-Dahm 2014), though the indications for prescriptions were unknown. However, opioids have severe side-effects and the appropriateness of frequent use has been questioned. To determine possible factors contributing to the high consumption in Denmark, we aimed to investigate potential geographical differences, which might reflect variances in clinical practice.

Methods: A register-based cross-sectional study in the entire elderly (≥65 years) population of Denmark in 2012. Data included place of residence, prescriptions, and discharge diagnosis from hospital contacts. Opioid use among elderly patients with dementia (N=34,536) and without dementia (N= 931,203) was compared across 5 regions and 98 municipalities.

Results: Overall prevalence of opioid use was 33.5% for elderly with dementia and 17.6% for elderly without dementia. The prevalence of opioid use in elderly patients with dementia ranged from 24.3% to 46.2% across the 98 municipalities, demonstrating an almost two-fold difference, with large differences within the same region. For elderly without dementia opioid use ranged from 13.4% to 22.0% in the municipalities.

Conclusion:Opioid use in elderly with dementia was frequent and two-fold higher than for elderly without dementia, which is concerning as it may challenge patient safety. The large difference for both groups within municipalities, even within the same region, suggests variance in how chronic pain is treated in primary care. Our study suggests that more guidance on how to treat pain in elderly with dementia is needed.

PO4.12. Geographical variation in antipsychotic drug use in elderly patients with dementia: a nationwide study

ZAKARIAS Johanne Købstrup, JENSEN-DAHM Christina, GASSE Christiane, NØRGAARD Ane, STEVNSBORG Lea, ANDERSEN Bodil Gramkow, JAKOBSEN Søren, WALDORFF Frans Boch, MOOS Torben, WALDEMAR Gunhild

Background: Use of antipsychotics in elderly patients with dementia has decreased in the past decade, partly due to safety regulations. However, use is still high. Geographical variation may indicate discrepancies in clinical practice and lack of adherence to evidence-based guidelines for the management of behavioral symptoms. To determine possible factors contributing to the high consumption, we aimed to investigate potential geographical variances in use of antipsychotic drugs in dementia care.

Methods: A registry-based cross-sectional study in the entire elderly population of Denmark (≥65 years) conducted in 2012. Data included place of residence, prescriptions filled, and hospital discharge diagnoses. Antipsychotic drug use among elderly with (n=34,536) and without (n=931,203) a dementia diagnosis was compared across the five regions and 98 municipalities in Denmark, and adjusted for age and sex.    

Results: In 2012, the national prevalence of antipsychotic drug use was 20.7% for elderly patients with dementia, with a national incidence of 3.9%. The prevalence ranged from 17.0% to 23.3% in the five regions. A logistic regression analysis demonstrated significant differences in the five regions, also after adjustment for age, sex and comorbidity. The age and sex standardized prevalence ranged from 7.7% to 32.9% in the 98 municipalities, demonstrating an almost five-fold difference.

Conclusion: The observed geographical variation was more pronounced at municipal level as compared to regional level, suggesting that the variation may be related to variances in clinical practice in primary care. This study highlights an urgent need for further educating professional carers and physicians to guide non-pharmacological as well as pharmacological management of behavioral symptoms in elderly patients with dementia.

PO4.13. Adjunctive traditional Chinese medicine decreases the risk of injurious fall and hip fracture in dementia patients

LIN Shun-Ku, HUANG Huai-Ti, LAI Jung-Nien, HUANG Yu-Ling, HSIEH Hsu-Tung

Objectives: To determine whether traditional Chinese medicine (TCM) therapy might decrease hip fracture risk in elderly people with dementia.

Design: Retrospective cohort study.

Setting: The cohort dataset was obtained from The National Health Insurance Research Database (NHIRD), the nationwide database of medical records includes more than 97% of the Taiwanese population. Longitudinal Health Insurance Database 2005 (LHID2005) contains all the original claim data of 1,000,000 beneficiaries, randomly sampled from the year 2005 Registry for Beneficiaries of the NHIRD.

Participants: 6712 new diagnosis dementia patients from January 1997 to December 2003 were obtained. To examine the effect of TCM treatment on hip fracture admission, we divided the study patients into TCM users (n = 3670) and non-TCM users (n= 3042).

Measurements: Each patient was individually tracked from 1997 to 2012 to identify injurious fall and hip fracture (onset after 3 month of dementia diagnosis). Demographic characteristics, Charlson comorbidity index, comorbidity, behavioral and psychological symptoms of dementia, psychotropic drugs were also investigated.

Results: There were 227 cases (6.2%) of hip fracture in the TCM cohort and 346 cases (11.4%) in the non-TCM cohort identified during the average 6.2-year follow-up period. The multivariate-adjusted hazard ratios for hip fracture admission, hip pinning procedure and hip replacement were 0.72(0.53-0.84), 0.61(0.52-0.69) and 0.48(0.39-0.57) for patients with TCM treatments, respectively. Patients received TCM therapy for higher cumulative doses or time experienced more protection from hip fracture admission.Ba-Wei-Di-Huang-Wan, Du-Huo-Ji-Sheng-Tang, and Ji-Sheng-Shen-Qi-Wanmight be the possible formulae reducing the incidence of hip fracture.

Conclusion: These results suggest that TCM might be associated with a reduced risk of injurious fall and hip fracture in dementia patients.

PO4.14. E-learning for junior doctors – on demand training on dementia diagnosis and treatment

REFSGAARD Elsebeth, FREDERIKSEN Kristian Steen, JØRGENSEN Kasper, HASSELBALCH Steen Gregers, HANSEN Mette andrup, WALDEMAR Gunhild

Introduction: As the number of persons suffering from a dementia disease increases worldwide, the need for qualified and well-trained doctors similarly grows.

Health-care systems are under increasing economic pressure, with one possible consequence being less time for medical training and supervision of junior doctors.

Online e-learning offers a way to convey knowledge in a flexible, on-demand format, incorporating e.g. videos, scan images and other multimedia features.

Objective: ABC Dementia for doctors (ABC Demens for læger) is an E-learning course aimed at junior doctors primarily in their residency in neurology, gerontology, psychiatry or general practice medicine. The aim of the course is to increase knowledge of dementia diseases including diagnosis, care and treatment.

Methods: We focused on two main subjects: diagnosis and treatment including history taking, choices of tests, neuropsyhological assessment, pharmacological and non-pharmacological treatment, follow-up, caring for caregivers and social aspects. A case-based approach was opted to make the course as close to clinical practice as possible, and furthermore to try and emulate the mentorship of a senior doctor advising a junior doctor under training. Two medical doctors and a neuropsychologist with extensive dementia knowledge and experience wrote the script.

3 junior doctors were recruited to give feedback during the development process and a larger panel of junior and senior doctors were asked to test the course at a later stage, and respond to an online survey about the course.

Results: ABC dementia for doctors contains a basic introduction to dementia and 6 cases, which presents users to patients in different phases of a typical disease-course. Cases are constructed to vary in content and different aspects. Content includes both text and illustrations to underscore important aspects such as mechanisms of action of treatment etc. Furthermore, users are challenged with interactive elements such as multiple choice tests, personal reflection and video sequences with 1-2 minute lectures. Lastly, knowledge about dementia is tested in a quiz. The course is in Danish.

PO4.15. Factor analysis of the Locus of Control of Behavior scale among people with dementia

HALSE Ingeborg, BJØRKLØF Guro Hanevold, ENGEDAL Knut, ROKSTAD Anne Marie, PERSSON Karin, ELDHOLM Rannveig, BARCA Maria Lage

Background: Coping, and particularly ones sense of control, has been shown to correlate with levels of depressive symptoms. In Norway, the Locus of Control of Behavior scale has becomes a often used scale to measure this aspect of coping. The scale gives an indication of level of external locus of control, i.e. to which degree one tends to believe that a certain outcome is due to luck, chance or other external factors such as helpful others. There is little, if none, research of this coping structure among people with dementia (PWD).  

Aims: To perform a factor analysis of Locus of Control of Behavior scale (LoC) on a population with dementia. Investigate the relationship between the scale and sub scales with cognitive and depression measurements.

Method: A sample of 283 PWD were assessed using the LoC, Montgomery Aasbergs Depression Rating Scale (MADRS), Mini Mental Status Examination-NR (MMSE-NR) and Clinical Dementia Rating (CDR). Factor analysis of the LoC scale using Principal Component Analysis (Varimax rotation). We computed sum scores for each of the three factors, and analyzed differences between groups.

Results: 52,2% were female, average age 75,5 (SD 9,1), 39,6% lived alone. Average MMSE score was 23,17 (SD4,08), MADRS score 5,13 (SD5,67) LoC score 30,7 (SD10,26).

The factor analysis yielded three factors; internal control, external control and chance/fate. Depressed participants according to the MADRS scale had significantly higher LoC Total Sum and sum of the factors internal and external control, but not on the factor chance/fate. There were no differences between CDR groups regarding LoC total sum or the sub scales.

Conclusion: Three factors were found, that resonates the literature on the concept of locus of control. This indicates that the Locus of Control of Behavior scale is a valid for use also among PWD.

PO4.16. Polypharmacotherapy in gerontology institute –treatment of dementia


Objective: Dementia is disorder that efects haw the brain works. Symptoms of dementia vary from person to person, but can include: loss of memory, difficuls control movmens of the body, confusion and agitation, halutinations and delusions. Dementia is more likely to affect older people, but younger people can also develop the condition.The aim of this study was to investigate the correlation between the number of type of psychotropics drugs in the tretman of patients with dementia, acuteness of beginning.Hypothesis haw the patients is older and acuteness beginnig of current episode is, the number of psychotropic drugs in th tretment of dementia increases.

Method: The study included all male patientes diagnosed with dementia (F 00.1- F09 to ICD-10) who were treated at the Gerontology Institute of psychiatric department and hronical department durig the year2010- 2013. We analyzed their tretman and type of psychotropic drugs, to 86 male, 52 up 75 yars old.

Results: There is statisticcaly significant correlation between pataient age and number of prescribed psychotropic medication, with a significant reduction in the number of psychotropic drugs over 75 years.

Conclusion:  Polypharmacotherapy is reality in tretment of dementia disorders. These studies, aimed to look for the reasons for polypharmacoteraphy, should facilitate the creation of therapeutic recommendation that would to better treatman with fewer side effects.

PO4.18. A comparison of self- and proxy-rated quality of life for people with dementia and its relationship to (un)met need in Ireland

HOPPER Louise, OSULLIVAN Oonagh, JOYCE Rachael, JELLEY Hannah, WOODS Bob, ORRELL Martin, IRVING Kate, and VERHEY Frans, on behalf of the Actifcare Study Group

Measuring quality of life in dementia is challenging for many reasons: for example, poor recall, time perception, insight and communication. However, recent studies indicate that meaningful measurements can be made using subjective and proxy ratings on condition-specific measures. In this study, as part of the Access to Timely Formal Care (Actifcare) JPND-funded research project, the quality of life and the (un)met needs of people with moderate dementia and their informal caregivers are measured at baseline, 6- and 12-months using a variety of self- and proxy-rated instruments (QoL-AD, DEMQOL-U, PAI, EQ5D5L, ICECAP-O, CANE). This paper presents baseline data from forty-three Irish people with dementia and their carer dyads, living at home, and not availing of formal dementia care services. No significant differences in self-rated quality of life scores for any demographic variables or for severity of dementia (MMSE, CDR) were found, however, self-rated and proxy-rated scores were significantly different for all quality of life measures. There were also significant gender differences in proxy-rated PAI and EQ5D5L scores; that is, carers rated females with dementia as having a significantly lower quality of life than males, but female carers rated relationship quality significantly higher than male carers. Similarly, significant differences were found between self-, carer-, and researcher-rated (un)met needs, as measured by the CANE. These results illustrate the lack of consistency between the person with dementia’s own perception of their quality of life and that of their caregiver. These findings are interpreted in light of the complex pattern of met and unmet needs evident for people with dementia and their informal caregivers. Further research is needed to explore these differences and to examine the gender bias found in proxy ratings of quality of life and relationship quality.



Last Updated: Friday 09 September 2016


  • Acknowledgements

    The 26th AE Conference in Copenhagen received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe and Alzheimerforeningen gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche