Caregiver positivity as a psychosocial modifier of lecanemab‐related outcomes in Alzheimer's disease: A multicenter longitudinal study in China
Wenjing Wu, Huayan Liu, Yun Liang, Huai'an Li, Jinhong Zhang, Zhen Sun, Yehua Song, Min Fei, Hao Wu, Mo Jiang, Shiyv Fan, Chaohui Zhou, Yv Cao, Hui Chen, Shuai LiuAbstract
INTRODUCTION
Real‐world modifiers of lecanemab benefit in Alzheimer's disease (AD) remain elusive. We examined associations between caregiver positivity and longitudinal outcomes in AD.
METHODS
This seven‐center longitudinal study followed 127 biomarker‐supported AD patient–caregiver dyads over 18 months. Mixed‐effects, spline, and propensity‐score analyses evaluated continuous Positive Aspects of Caregiving (PAC) scores.
RESULTS
Higher baseline PAC scale scores were associated with more favorable 18‐month outcomes in cognition (Mini‐Mental State Examination (MMSE): β = 0.42, 95% confidence interval [CI]: 0.24–0.59; p < 0.001), daily function (Alzheimer's Disease Cooperative Study–Activities of Daily Living [ADCS‐ADL]: β = 0.68, 95% CI: 0.42–0.93; p < 0.001), disease severity (Clinical Dementia Rating–Sum of Boxes [CDR‐SB]: β = −0.26, 95% CI: −0.37 to −0.14; P < 0.001), patient quality of life (Quality of Life in Alzheimer's Disease [QOL‐AD]: β = 0.53, 95% CI: 0.34–0.71; p < 0.001), and lower apathy ( β = −0.09, 95% CI: −0.16 to −0.03; p = 0.003); these associations remained significant after multiplicity correction (all q ’s ≤ 0.004). Patient QOL‐AD showed the most consistent sensitivity‐analysis association. Apathy was associated with caregiver burden and caregiver quality of life, but mediation was not established.
DISCUSSION
Caregiver positivity may stratify lecanemab efficacy in AD, supporting psychosocial assessment in personalized, caregiver‐inclusive management pathways.