“…if I ask him to [vacuum] he will…he always did it before for me…if I ask him, he will.” (carer wife of patient)
Decreased initiation of tasks/activities is a common symptom in Alzheimer’s disease (AD) and creates a great deal burden for carers, who often have to encourage patients to start activities, or in some cases take them over. Usually it is discussed, measured and described as part of apathy, functional decline, executive dysfunction, caregiver burden and patient quality of life. Despite this, little is known about how patients and carers cope with this problem.
To address this, we performed a secondary qualitative analysis of video-recorded, semi-structured, interviews with 130 community-dwelling patients with mild-to-moderate AD and their carers. The 130 patients were all participants in the Video-Imaging Synthesis of Treating Alzheimer's Disease (VISTA) study. The interviews were coded and analysed to capture and summarize patient/carer descriptions of decreased initiation of tasks and activities as a symptom of dementia.
From this we learned that decreased initiation of daily household and/or leisure and social activities was reported in 85/130 patients at their first visit, 71 (84%) of whom specifically targeted increased initiation as a goal of treatment.
Many patients were also described as having less interest (43%) or impaired performance (35%) in the activity in which decreased initiation was noted. Coping strategies were employed by 65 carers, most commonly verbal prompts to begin an activity.
After the first visit, patients and carers typically talked about change in terms of how often the patient initiated tasks/ activities, and how much more or less often the carer needed to offer prompts or other strategies.
From our analysis we can conclude that decreased initiation is common and problematic in people with mild-moderate Alzheimer’s disease who seek treatment for dementia. Spontaneously offered information about interest in or ability to perform activities which are initiated less often suggests this is a rich area for the illumination of disease and treatment effects.
Decreased initiation of usual activities in people with mild-to-moderate Alzheimer's disease: a descriptive analysis from the VISTA clinical trial. Cook C, Fay S, Rockwood K. Int Psychogeriatr. 2008 Oct;20(5):952-63. Epub 2008 Apr 11.