- A new study has revealed that older age, female gender, irregular heart rhythms and daily activity levels can predict the severity of cognitive decline in people with Alzheimer’s disease and their growing dependence on caregivers over the next two years.
- The study, involving 500 Austrian participants, underscores the importance of including caregiver support in treatment plans, as these factors were closely linked to both cognitive deterioration and increased caregiver burden.
- As a result of these findings, researchers advocate for a dual focus on both patients and their caregivers in the clinical management of early-stage Alzheimer’s disease.
Alzheimer’s disease accounts for 60 to 80% of cases of dementia, which affects a person’s memory, reasoning, and personality.
Recent research published in PLOS ONE now highlights new methods to predict cognitive deterioration and underscore the importance of including caregivers in treatment plans.
To determine which patient characteristics might most effectively predict cognitive decline, the study authors monitored an initial group of 500 Austrian patients with probable or possible Alzheimer’s disease over a 2-year period.
After documenting medical histories that included conditions like heart disease, atrial fibrillation (AFib) and diabetes, the researchers tracked cognitive function, daily living activities, depression, pain and neuropsychiatric symptoms over the 2 years.
Over the 2-year period, all patients showed significant cognitive decline, which was linked to reduced ability to perform daily activities and greater reliance on caregivers.
Factors such as age, female sex, difficulty with daily tasks and depression were predictors of cognitive decline at each assessment point.
After 2 years, the most severe cognitive decline measured in participants by the end was predicted by older age, female sex, inability to perform daily activities, and a history of AFib — characterized by rapid, irregular contractions of the heart’s upper chambers.
Health-related factors such as AFib were already present in participants at the start of the study.
The study authors further found that these cognitive changes in participants with Alzheimer’s disease were also closely associated with an increased burden on caregivers.
Although the study had a high dropout rate and did not consider lifestyle factors like physical activity, smoking or alcohol use, the authors suggest that combining demographic factors — such as age and biological sex — with assessments of daily function and prior medical conditions could be useful in predicting cognitive decline.
As a result of their findings, the researchers suggest that clinical management of early-stage Alzheimer’s should focus on both the patient and the caregiver, rather than concentrating solely on the patient.
Jennifer Bramen, PhD, senior research scientist and director of neuroimaging at the Pacific Neuroscience Institute in Santa Monica, CA, not involved in the research, told Medical News Today that these findings “confirm that even in the early stages of Alzheimer’s disease, patients experience noticeable declines not only in cognitive abilities but also in their ability to perform daily activities, which impacts independence and quality of life even early in the disease.”
“The strong correlation between caregiver load and patient cognitive/functional variables highlights the importance of supporting caregivers as part of early treatment,” Bramen further highlighted.
Jason Krellman, PhD, an associate professor of neuropsychology in the Department of Neurology at Columbia University Irving Medical Center, also not involved in this research, said that the study “had some important strengths, which included following a large number of people whose early-stage Alzheimer’s disease diagnosis was either probable or possible over a two-year period.”
“The study also followed the participants’ caregivers to examine their level of caregiver burden and its association with participants’ symptom severity,” he noted.
“These results make sense because we know that cardiovascular disease is associated with cognitive decline and more rapid progression of non-vascular causes of dementia, such as Alzheimer’s disease, and we know that caregivers experience greater stress and burden when their loved ones’ dementia symptoms are worse, whether those symptoms are cognitive, psychological, and/or affected daily functioning.”
– Jason Krellman, PhD
The experts MNT spoke to acknowledged the importance of this study to providing more targeted care for people with early-stage Alzheimer’s, and better support for their caregivers. Nevertheless, they also cautioned that the recent study may not reflect the situation of global populations.
Krellman pointed out that “the individuals enrolled in the study were all from Austria, so it’s unclear whether the findings would generalize to individuals from other cultures, including those from the United States.”
“In addition, more than half of the participants enrolled in the study dropped out before completion of the 2-year monitoring period. Therefore, the generalizability of the study is further limited because the patients and caregivers who remained in the study might have had some important characteristics in common, such as greater symptom severity or greater caregiver burden, that would have been important to consider in the data analysis,” he cautioned.
Still, Krellman also detailed the importance of the study findings. He noted that:
“Participants with Alzheimer’s disease showed some significant declines in thinking skills, mood, and ability to carry out daily activities within the 2-year period even though they were relatively early in the course of the disease when the research started. This means that significant declines that limit independent living can occur relatively soon after symptoms of the disease begin. Participants with atrial fibrillation also seemed to decline more significantly, and participant declines in cognition, mood, and daily functioning were associated with the severity of caregiver burden.”
Krellman added that “the findings are important for our approach to clinical care because they support the common-sense notion that holistic assessment of the patient and their caregivers is vital to fully addressing the needs of patients and caregivers as well as staging progression of the disease and estimating prognosis.”
“The research suggests that clinical assessments should include measurement of patients’ mood, cardiovascular health, and the degree of their caregivers’ burden as well as the patient’s cognition. Specifically,” he concluded, “the research indicates that impairments in activities of daily early in the disease course predicts worse outcomes over time and that females of advanced age with atrial fibrillation fared the worst at the end of the two-year study period.”
