Session Title: Alzheimer's Disease (AD) including Non-Cognitive Aspects
Presentation Date: Friday, March 14 – Saturday, March 15, 2009
RISK FACTORS FOR NURSING HOME PLACEMENT IN CHOLINESTERASE INHIBITOR TREATED NATURALISTIC ALZHEIMER PATIENTS
C. Wattmo, Å.K. Wallin, L. Minthon
Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
Aims: To analyse which factors influence nursing home placement (NHP) and time until NHP in long-term cholinesterase inhibitor treated patients with Alzheimer's disease (AD).
Methods: The Swedish Alzheimer Treatment Study (SATS) is an open, on-going, non-randomized, multicentre study in a routine clinical setting. Patients with the diagnosis of AD, living at home at the time of inclusion, receive treatment with donepezil, rivastigmine or galantamine. They are assessed with MMSE, ADAS-cog, IADL and PSMS at baseline and every 6 months over the course of 3 years. The first 883 subjects that had the opportunity to complete the full study were investigated concerning NHP; 210 of these patients were admitted to nursing homes. The following risk factors for the event NHP (Chi-square and T-tests) and the time until NHP (Cox regression) were investigated: gender, APOE4-carrier, living alone or with spouse, education level, age, illness duration, cognitive and functional level at baseline and decline in cognition and function prior to NHP.
Results: Females (p=0.002), patients living alone (p< 0.001), older age (p=0.002), longer illness duration (p=0.004) and lower cognitive and functional status at baseline (p< 0.001) are risk factors for admission to a nursing home. The distribution of time until NHP was significantly affected by gender (p=0.048), living alone (p< 0.001) and MMSE and IADL score at baseline (p< 0.001).
Conclusions: Female gender, patients living alone and lower cognitive or functional ability at baseline demonstrated larger risk of early NHP. Cognitive or functional decline prior to NHP did not influence time until NHP.