Leiden University Scholarly Publications

Beek, M. van de; Steenoven, I. van; Ramakers, I.H.G.B.; Aalten, P.; Koek, H.L.; Rikkert, M.G.M.O.; ... ; Flier, W.M. van der 2019

Trajectories and determinants of quality of life in dementia with Lewy bodies and Alzheimer's disease

Article / Letter to editor

open access

Background: Quality of Life (QoL) is an important outcome measure in dementia, particularly in the context of interventions. Research investigating longitudinal QoL in dementia with Lewy bodies ... Show moreBackground: Quality of Life (QoL) is an important outcome measure in dementia, particularly in the context of interventions. Research investigating longitudinal QoL in dementia with Lewy bodies (DLB) is currently lacking.Objective: To investigate determinants and trajectories of QoL in DLB compared to Alzheimer's disease (AD) and controls.Methods: QoL was assessed annually in 138 individuals, using the EQ5D-utility-score (0-100) and the health-related Visual Analogue Scale (VAS, 0-100). Twenty-nine DLB patients (age 69 +/- 6), 68 AD patients (age 70 +/- 6), and 41 controls (age 70 +/- 5) were selected from the Dutch Parelsnoer Institute-Neurodegenerative diseases and Amsterdam Dementia Cohort. We examined clinical work-up over time as determinants of QoL, including cognitive tests, neuropsychiatric inventory, Geriatric Depression Scale (GDS), and disability assessment of dementia (DAD).Results: Mixed models showed lower baseline VAS-scores in DLB compared to AD and controls (AD: beta +/- SE = - 7.6 +/- 2.8, controls: beta +/- SE = -7.9 +/- 3.0, p < 0.05). An interaction between diagnosis and time since diagnosis indicated steeper decline on VAS-scores for AD patients compared to DLB patients (beta +/- SE = 2.9 +/- 1.5, p < 0.1). EQ5D-utility-scores over time did not differ between groups. Higher GDS and lower DAD-scores were independently associated with lower QoL in dementia patients (GDS: VAS beta +/- SE = -1.8 +/- 0.3, EQ5D-utility beta +/- SE = -3.7 +/- 0.4; DAD: VAS = 0.1 +/- 0.0, EQ5D-utility beta +/- SE = 0.1 +/- 0.1, p < 0.05). No associations between cognitive tests and QoL remained in the multivariate model.Conclusion: QoL is lower in DLB, while in AD QoL shows steeper decline as the disease advances. Our results indicate that non-cognitive symptoms, more than cognitive symptoms, are highly relevant as they impact QoL. Show less