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. 2020 Jul 30;12(1):90.
doi: 10.1186/s13195-020-00659-6.

Assessing what matters most to patients with or at risk for Alzheimer's and care partners: a qualitative study evaluating symptoms, impacts, and outcomes

Dana B DiBenedetti  1 , Christina Slota  2 , Samantha L Wronski  2 , George Vradenburg  3 , Meryl Comer  3 , Leigh F Callahan  4 , John Winfield  4 , Ivana Rubino  5 , Holly B Krasa  6 , Ann Hartry  7 , Dan Wieberg  8 , Ian N Kremer  9 , Debra Lappin  10 , Allison D Martin  10 , Terry Frangiosa  3 , Virginia Biggar  3 , Brett Hauber  2
Affiliations

Assessing what matters most to patients with or at risk for Alzheimer's and care partners: a qualitative study evaluating symptoms, impacts, and outcomes

Dana B DiBenedetti et al. Alzheimers Res Ther. .

Abstract

Background: The What Matters Most (WMM) study was initiated to evaluate symptoms, AD-related impacts, treatment-related needs, preferences, and priorities among individuals with or at risk for Alzheimer's disease (AD) and their care partners. The objective of this qualitative study phase was to identify a comprehensive set of concepts of interest that are meaningful to individuals across the AD continuum.

Methods: Interviews were conducted with 60 clinically referred individuals and care partners across 5 AD stages (n = 12 each): group 1 (non-clinically impaired individuals with AD pathology), group 2 (individuals with mild cognitive impairment and AD pathology), group 3 (individuals with mild AD), group 4 (individuals with moderate AD and their care partners), and group 5 (care partners of individuals with severe AD). Interviews were conducted by experienced interviewers, audio-recorded, and transcribed. Dominant trends were identified in each interview and compared across subsequent interviews to generate themes or patterns in descriptions of AD symptoms, impacts, and desired treatment outcomes.

Results: All participants endorsed current issues related to memory; nearly all participants (n = 55; 92%) across the five groups endorsed symptoms related to communication and language. Groups 1-3 reported an impact on mood/emotions (n = 23; 64%) and a decrease in social activities or outgoingness (n = 17; 47%). Current and future concerns reported by the overall sample included memory (n = 48; 80%), dependence (n = 40; 67%), and "other" concerns (n = 33; 55.0%) (e.g., uncertainty about the future, burdening others). The most desired AD treatment outcomes were improvement or restoration of memory (n = 40; 67%) and stopping AD progression (n = 35; 58.3%). Group-level differences were observed in the symptoms, impacts, and desired treatment outcomes among patients and care partners across the AD continuum.

Conclusions: Cognitive functioning issues-particularly in memory and communication-are present even in preclinical and early-stage AD, including among those without a formal AD diagnosis. While the impacts of AD vary across the disease-severity spectrum, improved memory and disease modification were treatment outcomes considered most important to participants across all 5 AD stages. Neuropsychological assessments traditionally used in AD clinical trials may not evaluate the often-subtle concepts that are important to patients and care partners. Results from this study will inform the second phase of the WMM project-a quantitative study to elicit the relative importance of these concepts of interest to people at risk for and living with AD and their care partners.

Keywords: Alzheimer’s disease; Caregiver; Outcome; Patient; Qualitative.

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Conflict of interest statement

DBD, BH, CS, and SLW are salaried employees of RTI Health Solutions, which received research funding from AD PACE during the conduct of this study.

Figures

Fig. 1
Fig. 1
Mean percentage of items endorsed as currently problematic within a symptom category, by group. Note: Data shown are the mean number of symptoms reported by patients by group over the total number of symptoms in that category
See this image and copyright information in PMC

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