Volume 7, Issue 4S_Part_5 p. S164-S165
Abstract
Free Access

P1-166: Assessing treatment responsiveness of anti-dementia drugs with the SymptomGuide™

Kenneth Rockwood

Kenneth Rockwood

Dalhousie University, DementiaGuide Inc., Halifax, Nova Scotia

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Arnold Mitnitski

Arnold Mitnitski

Dalhousie University, DementiaGuide Inc., Halifax, Nova Scotia

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An Zeng

An Zeng

DementiaGuide Inc., Halifax, Nova Scotia

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Laura (Dong) Lin

Laura (Dong) Lin

DementiaGuide Inc., Halifax, Nova Scotia

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First published: 01 July 2011

Background

Evaluation of individual patients’ treatment responses can be complicated. This reflects both the high dimensionality of dementia (e.g. impairments in cognition, function, behaviour) and that patients show different response profiles. Individualized approaches such as Goal Attainment Scaling responsively capture patient/caregiver preferences, but can be infeasible for routine use. The SymptomGuide (SG™) was developed to allow feasible, routine individualization. Patients/caregivers can select from 10-12 descriptions of 70 symptoms, and track changes in their profiles. SG™ scores reflect change from baseline, summarizing the number of goals set, their weights and the degree of change. Here, we compare the responsiveness (sensitivity to change) of SG™ scores to other clinical measures.

Methods

SG™ profiles were generated for Capital Health Memory Clinic patients in Halifax, Canada. Responsiveness of the SG™, Mini-Mental State Examination (MMSE), Physical Self-Maintenance Scale (PSMS), Instrumental Activities of Daily Living (IADL) scale and Global Deterioration Scale (GDS) were compared using standardized response means (SRM) and relative efficiency (RE) scores.

Results

From 2007-2010, profiles were recorded for 335 patients treated by one clinic physician (KR). No patient declined participation. Their mean age (SD) was 77.6 (11.2) years; 188 (56.1%) were women; most (96.4%) lived with their spouse, family, or friend. Half had more than one clinic visit, allowing responsiveness to be calculated. The 10 most common symptoms were from the Executive Function and Cognition domains. Recent Memory and Verbal Repetition were each targeted in 69% or 58% of patients respectively. The SG™, but not MMSE showed clinically detectable change (SG™: Cohen's d = 0.34, MMSE: Cohen's d = 0.11) respectively up to 8 months. By 14 months only the SG™ showed significant change (Cohen's d = 0.44). By 24 months, statistically significant, clinically detectable, mild deterioration was seen on average. The 8 month REs were 8.22 for the SG™; 0.64 for MMSE; 0.02 for IADL; 0.99 for PSMS. Most SG™ worsening was seen with cognitive and behavioural symptoms.

Conclusions

The SG™ and MMSE were the most responsive measures used in routine clinical evaluation. The MMSE reflects cognitive change. The SG™ targets the most troublesome symptoms experienced by each patient, providing a more clinically recognizable picture of how patients’ daily lives have changed.