Decreased initiation for activities in mild/moderate Alzheimer's disease patients
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Presentation from 10th Annual Halifax International Symposium on Alzheimer's Disease and other dementias. Results presented from secondary qualitative analysis of the VISTA clinical trial describing the nature of reduced initiation for regular activities in trial patients.
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- 1. Decreased initiation of usual activities in people with mild-moderate Alzheimer's disease: a descriptive analysis from the VISTA clinical trial Cheryl Cook, Sherri Fay, Kenneth Rockwood (Dalhousie University, Halifax, NS, Canada)
- 5. Patient Disposition Galantamine (n=64) Placebo (n=66) Completed 4 Months (n=56) Completed 8 Months (n=47) Completed 8 Months (n=49) Screen Failures (n=29) Did not meet inclusion criteria (n=23) Withdrew consent (n=3) Other reasons (n=3) Withdrawals (n=11) Adverse Event (AE) (n=5) Noncompliance (n=3) Insufficient response (n=2) Lost to follow-up (n=1) Withdrawals (n=6) A E (n=3) Insufficient response (n=1) Withdrew consent (n=1) Moved (n=1) Withdrawals (n=7) A E (n=5) Withdrew Consent (n=1) site closure (n=1) CMAJ 2006;174:1099-1105 Completed 4 months (n=53) Placebo controlled Open-label Randomized (n=130) Withdrawals (n=10) A E (n=2) Non-compliance (n=3) Insufficient response (n=2) Withdrew consent (n=2) Death (n=1) Assessed for eligibility (n=159)
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- 12. Figure 1. Proportion of patients by type of decreased initiation
- 13. Figure 2. Proportion of patients with decreased initiation by domain affected
- 16. Figure 3. Patients with decreased initiation by domain and co-occurring problem
Editor's Notes
- familiarisation (watching the interviews, reading the text-based data and making notations about the data ), identifying thematic framework (identifying key issues and themes related to the a priori objectives of the study as well as those that emerge from the data – these are the basis for code formulation), indexing (applying codes to the data to mark occurrences of the concepts derived in the previous stage), charting (rearranging and organising the data according to where it sits within the thematic framework, often grouped by subject or theme area – in the case of VISTA, most often by symptom or groups of related symptoms within larger domains), and mapping-interpretation (builds upon charting to grasp the overall picture of the themes, their interrelations and associations, allowing for phenomenological interpretations). For the purposes of this secondary analysis, these steps were repeated with specific attention to the theme of decreased initiation.
- Initiating less (initiates house cleaning less frequently) Initiating only with prompting (only initiates house cleaning when someone prompts them ) Not initiating (prompt or not) but will do activity if assisted ( never initiates house cleaning, but will help out if someone else starts it) Cessation of activity even if prompted (never engages in house cleaning, even if encouraged)
- (mean problems = 2.3 ± 1.4) characteristics: mean age 78 ±8 years; 64% women; 64% mild AD
- Other activities was usually a reference to activities in general – non specific.
- Again, spontaneous reports.
- More interest mentioned in leisure and social. Makes a logical sense to us as dressing yourself is less a matter of choice and interest than whether or not you go bowling.
- *ongoing work * The one not employed by carer was pt who acknowledged that he initiated less and answered the question “how do you cope with this” by saying he just doesn’t worry (He had put his future with AD in to God’s hand)
- 84% of patients describing decreased initiation had at least one goal set of for this.