Misplacing objects in mild to moderate Alzheimer’s disease: a descriptive analysis from the VISTA clinical trial
- 1Geriatric Medicine Research Unit, Capital District Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
- 2Division of Geriatric Medicine, Capital District Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
- Correspondence to Professor K Rockwood, Division of Geriatric Medicine, Dalhousie University, 1421-5955 Veterans’ Memorial Lane, Halifax, NS, B3H 2E1 Canada; Kenneth.Rockwood{at}Dal.ca
- Received 31 October 2008
- Revised 4 February 2009
- Accepted 24 February 2009
Abstract
Background: Misplacing objects is a commonly reported symptom of Alzheimer’s disease (AD) but it is little described systematically and conflicting characterisations (losing/forgetting the location of objects versus inappropriate placement) of this “warning sign” of dementia currently exist. Patient and carer descriptions of misplacing in clinical interviews are reported here.
Methods: This was a secondary qualitative analysis of video recorded, open ended and semistructured clinical interviews with 130 community dwelling patients with mild to moderate AD (mean age 77 (7.7) years; 63% women; 67% mild AD) and their carers who participated in the Video Imaging Synthesis of Treating Alzheimer’s Disease (VISTA) study, a 4 month, randomised, placebo controlled trial of galantamine. Employing a framework analysis approach, we summarised descriptive accounts of misplacing with relevant proportions.
Results: Recurrent incidents of misplacing were described for 96/130 (74%) study patients, 45 of whom established treatment goals to track this problem. For most (78/96, 81%), misplacing was the inability to recall where an item had been set down or put away. Fewer patients (25/96, including 18 with recall misplacing) put objects in unusual or incorrect places. Patients were commonly aware of their misplacing (56/96, 58%) and were distressed by it (31/56). Patients who misplaced also displayed tendencies towards delusions/hallucinations (51/96, but only directly related to misplacing in 17 cases) and hiding items (15%)
Conclusion: Misplacing is a common phenomenon in mild to moderate AD. Here, misplacing was usually described as an inability to recall where an item was set down, more so than the inappropriate placement of items.
Footnotes
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Funding The VISTA study was co-funded by Janssen-Ortho Inc and the Canadian Institutes of Health Research through a CIHR Research and Development operating grant (DCT-49981). These secondary analyses were funded from the Dalhousie Medical Research Foundation which support KR as the Kathryn Allen Weldon Professor of Alzheimer’s Disease Research.
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Competing interests Within the past 5 years, KR has received ad hoc consulting or speaker honoraria from GlaxoSmithKline, Lundbeck, Merck, Myriad, Novartis, Numico, Pfizer and Shire. He has no stock ownership in pharmaceutical companies. He has established DementiaGuide Inc which promotes symptom based assessments of the response to treatment for dementia. LH and SF report no conflicts of interest.
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Ethics approval The Therapeutics Product Directorate of Health Canada and the institutional research ethics boards for each study centre (including the Capital District Health Authority at the coordinating study centre in Halifax, Nova Scotia) approved the study protocol.
