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Reduced Quality-of-Life Ratings in Mild Cognitive Impairment: Analyses of Subject and Informant Responses

https://doi.org/10.1097/JGP.0b013e31826ce640Get rights and content

Objectives

To determine whether quality-of-life (QOL) ratings are reduced in mild cognitive impairment (MCI) and analyze correlations between QOL ratings and cognitive, neuropsychiatric, and functional indices in MCI.

Design

Cross-sectional.

Setting

The Easton Center for Alzheimer's Disease Research at the University of California, Los Angeles.

Participants

A total of 205 individuals who met criteria for normal cognition (n = 97) or MCI (n = 108). The MCI group included amnestic (n = 72) and nonamnestic (n = 36) MCI.

Measurements

QOL was assessed using subject and informant ratings on the Quality of Life–Alzheimer's Disease (QOL-AD) scale. Cognitive performance was assessed with the National Alzheimer's Disease Coordinating Center Uniform Data Set neuropsychological battery. Neuropsychiatric symptoms were assessed with the Geriatric Depression Scale (GDS) and the Neuropsychiatric Inventory. Functional abilities were assessed with the Functional Activities Questionnaire (FAQ).

Results

The normal cognition group had significantly higher QOL-AD scores than the MCI group on both subject and informant assessments. Individual item analyses indicated that the largest group differences were seen on the mood and memory items. Similar QOL-AD scores were seen in the amnestic and nonamnestic MCI subgroups. Multiple regression analyses within the MCI group indicated that QOL-AD ratings were not correlated with neuropsychological performance. Subject QOL-AD ratings were inversely correlated with GDS scores and informant QOL-AD ratings were inversely correlated with GDS, Neuropsychiatric Inventory, and FAQ scores.

Conclusions

Significant declines in QOL are seen in MCI and are associated with neuropsychiatric symptoms and functional decline. Interventions targeting mood symptoms and/or instrumental activities of daily living may improve QOL in MCI.

Section snippets

Research Participants

Subjects were drawn from an ongoing research study coordinated through the Easton Center for Alzheimer's Disease Research at the University of California, Los Angeles (UCLA). Participants meeting criteria for MCI (n = 108) were recruited from patients assessed in the Memory Disorders Clinics at the UCLA Medical Center, Olive View-UCLA Medical Center, and Marina Campus of the Centinela-Freeman Medical Center. The normal comparison group (NC; n = 97) included individuals initially seen in the

RESULTS

Demographic, cognitive, neuropsychiatric, and functional comparisons between the NC and MCI groups are shown in Table 1. The two groups were similar in age, level of education, and gender and ethnic distribution. Analyses of cognitive data indicated that the MCI group performed more poorly on the MMSE and in each of the domains that were assessed. The MCI group exhibited greater neuropsychiatric symptoms (as measured by the NPI) than the NC group, but did not report higher levels of depression

DISCUSSION

Our results indicate that individuals meeting criteria for MCI have modest decreases in QOL relative to age-matched cognitively normal older adults. Reductions in global QOL-AD indices in our MCI cohort were driven by decreased ratings for the mood and memory items on both subject and informant questionnaires. These findings are consistent with a prior study that showed impaired psychological (but not physical, social relationship, or environmental) QOL in MCI subjects using the short version

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    This research was supported by grants from the National Institute on Aging (P50 AG 16570, K23 AG 028727 [to PL], and K08 AG 34628 [to ET; jointly sponsored by NIA, AFAR, the John A. Hartford Foundation, the Atlantic Philanthropies, the Starr Foundation and an anonymous donor]), the Alzheimer's Disease Research Centers of California, and the Sidell-Kagan Foundation.

    Disclosures: No disclosures to report.

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