Early onset alzheimer's
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The frequency and severity of Alzheimer’s disease symptoms in community-dwelling adults receive less attention when compared to those in nursing homes residents, the authors of a new study contend. Early clinical trial findings reinforce the need for symptom control and provide targets for home-based palliative care, they say.

The investigators, from the Regenstrief Institute and Indiana University School of Medicine, analyzed the prevalence of dementia symptoms in a community population using baseline caregiver response data from an ongoing, five-year clinical trial funded by the National Institute on Aging.

Most of the study’s dementia population (88%) had severe disease. Four symptoms were present at least weekly in 40% or more of these participants, according to their caregivers: pain, agitation, anxiety and resistance to care.

“We found that both the rate and types of symptoms suffered by community-dwelling people with dementia were very similar to those in a nursing home setting,” Kurt Kroenke, M.D., said in a statement.

Targeted treatments

These frequent, unsubtle symptoms “have a significant impact on the quality of life for patients and caregivers,” but are often unreported in primary care settings and need more attention in routine care, he added. 

These preliminary results also showed that higher levels of caregiver strain, neuropsychiatric symptom severity and medical comorbidities all were associated with a greater symptom frequency and severity. But satisfaction with care was high and was only modestly linked to symptom burden, the authors reported.

The researchers will next explore the impact of targeted treatment, including palliative care, on burdensome symptoms in the ongoing clinical trial, called IN-PEACE (Indiana Palliative Excellence in Alzheimer’s Care Efforts). The trial will continue to focus on adults with dementia who still reside at home. Most studies of dementia symptom burden have so far used data obtained after nursing home placement and death, the researchers noted.

In the meantime, these initial study results show the need for providers to “make room for symptom discussion in primary care,” said researcher Greg Sachs, M.D.

The study was published in the Journal of Palliative Medicine.

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