Diagnostic criteria for Alzheimer's disease according to DSM-IV-TR
A. Decreased cognition, manifested by:
Maybe you are interested!
-
Perspectives on Improving the Quality of Law Application in Resolving Land Use Rights Disputes at the People's Court -
Quality of Law Application in Resolving Land Use Disputes at People's Courts -
Factors Affecting the Quality of Life of District 6 Residents -
Assessing the Impact of Quality of Work Life on Work Performance – Model 1 - Impact of Quality of Work Life -
Tourists' Reviews of Local People's Service Quality of Homestay Tourism in Binh Ba Island
1. Memory loss (reduced ability to learn new information and recall old information), accompanied by:
2. Have one (or more) of the following cognitive disorders:
a. Loss of language: (aphasia)
b. Apraxia: inability to perform movements despite normal motor function:
c. Agnosia: the inability to recognize and identify objects despite normal sensory function.
d. Executive dysfunction: e.g. planning, organizing, coordinating, abstracting
B. Cognitive impairment in criteria A1 and A2 significantly impairs functioning
occupational, social, and functional activities were significantly reduced compared to pre-illness levels.
C. Gradual onset and progressive cognitive decline.
D. Cognitive impairment in criteria A1 and A2 is not due to the following causes:
1. Central nervous system diseases that can cause progressive memory and cognitive deficits (eg, cerebrovascular disease, Parkinson's disease, Huntington's disease, epidural hematoma, normal pressure hydrocephalus, brain tumors).
2. Systemic diseases can cause dementia (hypothyroidism, vitamin B12 or folic acid deficiency, hypercalcemia, neurosyphilis).
3. Drug-induced conditions.
E. The above disorders are not due to delirium.
F. These disorders are not consistent with another psychiatric diagnosis (major depression, schizophrenia)
- Exclusion criteria:
Have a serious medical or surgical condition such as paralysis, heart failure,
severe renal failure, post-operative.
Alzheimer's patients do not agree to participate in the study or the patient's family does not agree to participate.
2.1.1.2. Caregiver
- Selection criteria:
Be the primary caregiver of the Alzheimer's patient included in the study (primary caregiver must be the person who directly cares for the Alzheimer's patient at least once a week, is closest to the patient, and takes care of the patient the most). Each patient must select only one primary caregiver.
18 years of age or older
Communicate.
- Exclusion criteria:
Cannot read and write to avoid information errors
Have sensory disabilities (hearing impairment, visual impairment)
Do not agree to participate in the study
2.1.2. Research design
Descriptive study through observation of a series of cases.
2.1.3. Sample size and sampling method
All Alzheimer's patients diagnosed by the Neuropsychiatric Department between January 2011 and June 2013 at the Central Geriatric Hospital who met the selection criteria were included in the study. A total of 120 Alzheimer's patients (outpatients) and 120 of their primary caregivers who met the selection criteria were included in this study.
2.1.4. Research Variables and Indicators
2.1.4.1. Research variables
- For Alzheimer's patients
+ Patient variables: age, gender, education level, occupation
pre-retirement work, sick time.
+ Mini Mental State Exam (MMSE).
+ Behavioral and mental symptoms according to the Mental Status Checklist
NeuroPsychiatric Inventory (NPI) about:
Psychotic symptoms: Delusions, Hallucinations.
Symptoms of emotional disorders: Depression or dysthymia, Anxiety,
Excitement, Apathy or indifference.
Behavioral symptoms: Agitation or aggression, Disinhibition, Irritability or emotional lability, Movement disorders, Nighttime patient behavior, Eating behavior.
+ Activity Daily Living (ADL)
+ Instrument Activity Daily Living (IADL)
+ Patient quality of life according to the Quality Assessment Questionnaire
quality of life in Alzheimer's disease (abbreviated as QOL-AD):
According to patient self-assessment
According to caregiver assessment
- For caregivers
+ Caregiver variables: age, gender, education level,
working status, relationship with patient, patient care time.
+ Burden of care according to ZBI assessment scale.
+ Health-related quality of life according to the SF-12 assessment scale (with two components: physical health and mental health).
2.1.4.2. Research index
- Alzheimer's patient
General information about the patient (age, gender, education, marital status)
time of disease detection
The patient's cognitive status level was based on the Mini-Mental State Examination (MMSE).
The proportion of patients who do not meet the normal limits on neuropsychological tests
Psychological (based on the results of neuropsychological tests).
Proportion of patients with behavioral and psychiatric symptoms (based on assessment results)
assessment of the patient's neuropsychiatric status).
Average patient-assessed quality of life score (based on the results of the Alzheimer's Disease Quality of Life Questionnaire patient-assessed version).
Internal reliability of the Alzheimer's Disease Quality of Life Questionnaire (shown through Cronbach alpha index) and the level of correlation between quality of life as assessed by patients and as assessed by caregivers (shown through correlation coefficient with p < 0.05).
Average score of patient's quality of life as assessed by caregiver (according to the results of the Alzheimer's Disease Quality of Life Questionnaire for caregiver assessment).
Differences between the group of patients who self-assessed and those who could not self-assess their quality of life (through demographic characteristics: age, gender, education, marital status; time of disease detection; cognitive status; daily activities; daily activities using tools and means; severity and impact of behavioral and mental symptoms).
Patient quality of life according to the assessor and some related factors (age, gender, cognitive impairment, neuropsychological status, neuropsychological tests).
Multivariate regression model (with the dependent variable being quality of life as assessed by the patient or caregiver and the independent variables including: age, gender, time of disease detection, cognitive impairment, severity, level of influence of behavioral and psychological symptoms).
mental, daily activities, daily activities using tools, means).
- Caregiver
General information about the caregiver (age, gender, education, marital status; employment status, relationship with the patient).
Average caregiver burden score calculated according to the Zarit Caregiver Burden Interview (ZBI) scale; Average caregiver burden score according to some caregiver characteristics (age, gender, working status, relationship with patient, time caring for patient, level of patient cognitive impairment, level of impact of patient's behavioral and psychiatric symptoms).
Average score of quality of life related to physical and mental health of caregivers; Average score of physical and mental health according to a number of related factors (age, gender, working status, relationship with patient, time caring for patient, level of cognitive impairment of patient, level of influence of behavioral and mental symptoms of patient).
2.1.5. Data collection tools
2.1.5.1. For Alzheimer's patients
- Research case
Collect general patient information (age, gender, education level)
pre-illness occupation, medical history).
- Mini Mental State Assessment Test
The Mini Mental State Examination (MMSE) is being standardized in Vietnamese and is being used as a routine test at the Central Geriatric Hospital to assess cognitive disorders in the elderly. The assessment test is
many areas of cognitive functioning such as: memory, orientation, attention, language, reading, writing, and motor skills. The test takes about 10 minutes.
Procedure: This test is conducted in a private, quiet room so that the patient can concentrate. The patient is required to: answer questions oriented to time (what year, month, season, day, day of the week it is); to space (name of country, province, district, hospital, floor); immediately and with delay repeat three words; do five calculations; repeat a non-rhyming and unconnected sentence; read and follow a command; perform a three-phase action according to instructions; write any sentence; copy a drawing.
The maximum score for this test is 30 points. Below 26 points is considered cognitive impairment; 0-9 points: severe cognitive impairment; 10-19 points: moderate cognitive impairment; ≥ 20-25 points: mild cognitive impairment.
- Alzheimer's quality of life assessment toolkit
The Quality of Life in Alzheimer's Disease (QOL-AD) is a tool to assess the quality of life of Alzheimer's patients through the assessment of both patients and caregivers. This toolkit includes two identical versions, but one is for patients to self-assess and one is for caregivers to assess the patient's quality of life. This toolkit takes about 10 minutes to complete.
Procedure: Interview the patient and caregiver separately, asking 13 questions according to the Guide based on 13 criteria (physical health, functional capacity, mood, living conditions, memory, family, marriage, friends, ability to do chores, entertainment, money, about yourself, life in general). The patient and caregiver answer the questions by giving a score.
Each question is scored on a 4-point scale (1 = poor, 2 = fair, 3 = good, 4 = excellent) across all questions and is rated according to the patient's current quality of life. The corresponding score for each answer is circled on the Assessment Sheet. The total score ranges from 13 to 52 points with higher scores corresponding to better quality of life.
When the patient cannot answer two or more questions, he/she is considered unable to self-assess. The investigator circles the line: Patient cannot answer himself/herself and ends the assessment.
- Neuropsychiatric Assessment Questionnaire (NPI)
NeuroPsychiatry Inventory
is being used routinely at the Central Geriatric Hospital.
Procedure: Interview the primary caregiver regarding the presence of 12 behavioral and psychiatric symptoms (delusions, hallucinations, agitation, anxiety, euphoria, apathy, disinhibition, irritability, nighttime behavior, changes in eating) based on changes in the patient on the screening question: yes or no. Circle Yes if the symptoms occurred in the previous month, circle No if they did not. For each statement circled in the Yes box :
Assess the severity of each symptom (how much the symptom affects the patient). Score according to the level: 1: Mild (noticeable but not much change); 2: Moderate (much change but not too severe); 3: Severe (dominant symptom causes severe change in the patient). The severity of behavioral and mental symptoms is the total score of all scores assessing the severity of each behavioral and mental symptom. The maximum severity score is 36; the higher the score, the more severe the level.
Assess the level of impact of the patient's symptoms on the informant. Score according to the level: 0: Not at all bothersome; 1: Minimal (mildly bothersome, not difficult to cope with); 2: Mild (mildly bothersome, generally easy to cope with); 3: Moderate (quite bothersome but not always easy to cope with); 4: Severe (very bothersome, difficult to cope with); 5: Very severe (extremely bothersome, unable to cope). The level of impact of behavioral and mental symptoms is the sum of the impact scores of each symptom. The maximum score is 60; the higher the score, the more severe the impact on the caregiver.
- Activities of Daily Living (ADL) Assessment Sheet
The Activity Daily Living (ADL) assessment is being used routinely at the Central Geriatric Hospital. Procedure: interview the caregiver about the patient's daily activities according to 6 questions about the activities: eating, going to the toilet, dressing, self-care, walking, bathing. The caregiver answers each question by scoring according to the patient's condition (1 or 0 points). The maximum score for a healthy person is 6 points; below 6 points is a decline in daily functioning. The lower the score, the lower the patient's autonomy and the more the caregiver has to serve the patient.
- Daily activity assessment table using means and tools
(IADL)
The Instrument Activity Daily Living (IADL) assessment is being used routinely at the Central Geriatric Hospital. Procedure: interview the caregiver about the patient's daily activities about activities: to interview the caregiver with 8 questions about daily activities