OBJECTIVE: There is a need, in the absence of formal services, to design interventions aimed at improving the lives of people with dementia and their families. This study tested the effectiveness of the 10/66 caregiver intervention among people with dementia and their caregivers in Lima, Peru. METHOD: Design/participants: a randomized controlled trial was performed involving 58 caregivers of people with dementia that received the intervention in the beginning of the trial (n = 29) or six months later (n = 29). The intervention consisted of three modules: 1) assessment (one session); 2) basic education about dementia (two sessions); and 3) training regarding specific problem behaviors (two sessions). Main outcome measures: Caregivers and patients with dementia were assessed at baseline and after six months. For caregivers, the measures included strain (Zarit Burden Interview), psychological distress (SRQ-20), and quality of life (WHOQOL-BREF). Dementia patients completed scales assessing behavioral and psychological symptoms (NPI-Q) and quality of life (DEMQOL). RESULTS: Caregivers in the intervention group reported significantly decreased strain measures six months after the intervention compared to controls. No group differences were found in respect to the caregivers’ psychological distress and to quality of life in both caregivers and patients. CONCLUSION: The 10/66 intervention seems to be as effective as similar interventions used in more developed countries. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
CONTEXT: Optimal treatment to postpone functional decline in patients with dementia is not established. OBJECTIVE: To test a nonpharmacologic intervention realigning environmental demands with patient capabilities. Design, Setting, and Participants: Prospective 2-group randomized trial (Care of Persons with Dementia in their Environments [COPE]) involving patients with dementia and family caregivers (community-living dyads) recruited from March 2006 through June 2008 in Pennsylvania. INTERVENTIONS: Up to 12 home or telephone contacts over 4 months by health professionals who assessed patient capabilities and deficits; obtained blood and urine samples; and trained families in home safety, simplifying tasks, and stress reduction. Control group caregivers received 3 telephone calls and educational materials. MAIN OUTCOME MEASURES: Functional dependence, quality of life, frequency of agitated behaviors, and engagement for patients and well-being, confidence using activities, and perceived benefits for caregivers at 4 months. RESULTS: Of 284 dyads screened, 270 (95%) were eligible and 237 (88%) randomized. Data were collected from 209 dyads (88%) at 4 months and 173 (73%) at 9 months. At 4 months, compared with controls, COPE patients had less functional dependence (adjusted mean difference, 0.24; 95% CI, 0.03-0.44; <i>P</i> = .02; Cohen <i>d</i> = 0.21) and less dependence in instrumental activities of daily living (adjusted mean difference, 0.32; 95% CI, 0.09-0.55; <i>P</i> = .007; Cohen <i>d</i> = 0.43), measured by a 15-item scale modeled after the Functional Independence Measure; COPE patients also had improved engagement (adjusted mean difference, 0.12; 95% CI, 0.07-0.22; <i>P</i> = .03; Cohen <i>d</i> = 0.26), measured by a 5-item scale. COPE caregivers improved in their well-being (adjusted mean difference in Perceived Change Index, 0.22; 95% CI, 0.08-0.36; <i>P</i> = .002; Cohen <i>d</i> = 0.30) and confidence using activities (adjusted mean difference, 0.81; 95% CI, 0.30-1.32; <i>P</i> = .002; Cohen <i>d</i> = 0.54), measured by a 5-item scale. By 4 months, 64 COPE dyads (62.7%) vs 48 control group dyads (44.9%) eliminated 1 or more caregiver-identified problems (χ²₁ = 6.72, <i>P</i> = <i>.</i> 01). CONCLUSION: Among community-living dyads, a nonpharmacologic biobehavioral environmental intervention compared with control resulted in better outcomes for COPE dyads at 4 months. Although no group differences were observed at 9 months for patients, COPE caregivers perceived greater benefits. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
OBJECTIVES: To provide evidence regarding the clinical efficacy of cognitive rehabilitation (CR) in early-stage Alzheimer disease (AD). DESIGN: Single-blind randomized controlled trial comparing CR with relaxation therapy and no treatment. SETTING: Outpatient, community-based setting. Participants: Sixty-nine individuals (41 women, 28 men; mean age 77.78 years, standard deviation 6.32, range = 56–89) with a diagnosis of AD or mixed AD and vascular dementia and a Mini-Mental State Examination score of 18 or above, and receiving a stable dose of acetylcholinesterase-inhibiting medication. Forty-four family carers also contributed. Intervention: Eight weekly individual sessions of CR consisting of personalized interventions to address individually relevant goals supported by components addressing practical aids and strategies, techniques for learning new information, practice in maintaining attention and concentration, and techniques for stress management. Measurements: The primary outcomes were goal performance and satisfaction, assessed using the Canadian Occupational Performance Measure. Questionnaires assessing mood, quality of life and carer strain, and a brief neuropsychological test battery were also administered. A subset of participants underwent functional magnetic resonance imaging (fMRI). RESULTS: CR produced significant improvement in ratings of goal performance and satisfaction, whereas scores in the other two groups did not change. Behavioral changes in the CR group were supported by fMRI data for a subset of participants. CONCLUSIONS: The findings support the clinical efficacy of CR in early-stage AD. CR offers a means of assisting people with early-stage AD and their families in managing the effects of the condition. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
OBJECTIVES: This article describes results of a randomized controlled trial comparing a time-limited early-stage memory loss (ESML) support group program conducted by a local Alzheimer's Association chapter to a wait-list (WL) control condition. METHODS: One hundred and forty-two dyads were randomized in blocks to ESML (<i>n</i> = 96) or WL (<i>n</i> = 46). Mean age of participants was 74.9 years, and mean Mini-Mental State Examination was 23.4. The primary outcome was participant's quality of life; secondary outcomes included mood, family communication, and perceived stress. RESULTS: On the intent-to-treat (ITT) pre-post analysis, significant differences were seen in participant quality of life (<i>p</i> < .001), depression (p < .01), and family communication (<i>p</i> < .05). Within the care partner groups, there was no significant difference between ESML and WL in the ITT analysis. A post hoc exploratory examination of changes that were associated with improved quality of life in ESML participants revealed significant reductions of depressive symptoms and behavior problems (<i>p</i> < .05), improved family communication (<i>p</i> < .05), self-efficacy (<i>p</i> < .01), Medical Outcomes Study short form (SF-36) role—emotional (<i>p</i> < .05), SF-36 social functioning (<i>p</i> < .05), and SF-36 mental health components (<i>p</i> < .01) in improvers. DISCUSSION: These results support the efficacy of ESML support groups for individuals with dementia. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
[Correction Notice: An erratum for this article was reported in Vol 8(5) of <i>The Lancet Neurology</i> (see record [rid]2010-05975-006[/rid]). The final sentence of the original paper was incorrect and should read: "If our results are replicated, the modest increase in cost per unit reduction in agitation for person-centered care warrants its systematic introduction into residential aged-care services."] BACKGROUND: Evidence for improved outcomes for people with dementia through provision of person-centred care and dementia-care mapping is largely observational. We aimed to do a large, randomised comparison of person-centred care, dementia-care mapping, and usual care. METHODS: In a cluster randomised controlled trial, urban residential sites were randomly assigned to person-centred care, dementia-care mapping, or usual care. Carers received training and support in either intervention or continued usual care. Treatment allocation was masked to assessors. The primary outcome was agitation measured with the Cohen-Mansfield agitation inventory (CMAI). Secondary outcomes included psychiatric symptoms including hallucinations, neuropsychological status, quality of life, falls, and cost of treatment. Outcome measures were assessed before and directly after 4 months of intervention, and at 4 months of follow-up. Hierarchical linear models were used to test treatment and time effects. Analysis was by intention to treat. This trial is registered with the Australia and New Zealand Clinical Trials Registry, number ACTRN12608000084381. FINDINGS: 15 care sites with 289 residents were randomly assigned. Pairwise contrasts revealed that at follow-up, and relative to usual care, CMAI score was lower in sites providing mapping (mean difference 10·9, 95% CI 0·7–21·1; p=0·04) and person-centred care (13·6, 3·3–23·9; p=0·01). Compared with usual care, fewer falls were recorded in sites that used mapping (0·24, 0·08–0·40; p=0·02) but there were more falls with person-centred care (0·15, 0·02–0·28; p=0·03). There were no other significant effects. INTERPRETATION: Person-centred care and dementia-care mapping both seem to reduce agitation in people with dementia in residential care. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
OBJECTIVES: Dementia is a rapidly growing public health problem in low and middle income countries. There is an urgent need, in the absence of formal services, to develop interventions designed to improve the lives of people with dementia, and their families. This study tests the effectiveness of the 10/66 caregiver intervention among people with dementia, and their carers. DESIGN: A single blind parallel group randomized controlled trial (ISRCTN41039907). SETTING: Moscow. Participants: Sixty family caregivers of people aged 65 and over with dementia were randomized to receive the intervention and medical care as usual (<i>n</i> = 30) or medical care as usual only (<i>n</i> = 30). Caregiver and person with dementia outcomes were assessed at baseline and after 6 months. Intervention: The caregiver education and training intervention was delivered over five, weekly, half-hour sessions and was made up of three modules: (i) assessment (one session); (ii) basic education about dementia (two sessions); and (iii) training regarding specific problem behaviors (two sessions). Measurements: Dementia was diagnosed using DSM-IV criteria. Caregiver: Zarit Carer Burden Interview; carer psychological distress (SRQ 20); and carer Quality of Life (WHOQOL-BREF). Person with dementia: Behavioral and Psychological symptoms (NPI-Q); quality of life (DEMQOL). RESULTS: Caregivers in the intervention group reported large and statistically significant net improvements at 6-month follow-up in burden compared to controls. No group differences were found on caregiver psychological distress and patient and caregiver quality of life. CONCLUSIONS: The low-level intervention seems to be as, if not more, effective than similar interventions applied in high income countries. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
OBJECTIVE: To test whether the Tailored Activity Program (TAP) reduces dementia-related neuropsychiatric behaviors, promotes activity engagement, and enhances caregiver well-being. DESIGN: Prospective, two-group (treatment, wait-list control), randomized, controlled pilot study with 4 months as main trial endpoint. At 4 months, controls received the TAP intervention and were reassessed 4 months later. SETTING: Patients' homes. Participants: Sixty dementia patients and family caregivers. Intervention: The eight-session occupational therapy intervention involved neuropsychological and functional testing, selection, and customization of activities to match capabilities identified in testing, and instruction to caregivers in use of activities. Measurements: Behavioral occurrences, activity engagement, and quality of life in dementia patients; objective and subjective burden and skill enhancement in caregivers. RESULTS: At 4 months, compared with controls, intervention caregivers reported reduced frequency of problem behaviors, and specifically for shadowing and repetitive questioning, and greater activity engagement including the ability to keep busy. Fewer intervention caregivers reported agitation or argumentation. Caregiver benefits included fewer hours doing things and being on duty, greater mastery, self-efficacy, and skill enhancement. Wait-list control participants following intervention showed similar benefits for reductions in behavioral frequency and caregiver hours doing things for the patient and mastery. Caregivers with depressed symptoms derived treatment benefits similar to nondepressed caregivers. CONCLUSIONS: Tailoring activities to the capabilities of dementia patients and training families in activity use resulted in clinically relevant benefits for patients and caregivers. Treatment minimized trigger behaviors for nursing home placement and reduced objective caregiver burden. Noteworthy is that depressed caregivers effectively engaged in and benefited from the intervention. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
There is a major need to develop an appropriate therapy for Alzheimer's disease (AD). Impairment of cholinergic transmission [1, 2] is important for the defects, and cholinesterase inhibitors (e.g. donepezil) [3, 4] cause symptomatic improvement. In Japan, only donepezil is available, and the drug has been reported to maintain cognitive function up to 6 months [5].Given the lack of a curative treatment for AD, psychosocial interventions have emerged over the years that are directed at optimising the function of patients and supporting their families. One of the most common approaches is reminiscence [6–9]. The primary goal is to facilitate recall of past experiences to promote intra/inter-personal functioning and improve quality of life (QOL). Relatively reserved remote memory [10] can provide a neurological basis to support the effectiveness. Reality orientation (RO) [6, 9, 11] is also used which stimulates time and place orientation. Reminiscence and RO are the most popular interventions [12, 13]. Lai et al. [14] performed a randomised controlled trial (RCT) to investigate whether a reminiscence program leads to higher levels of psychosocial well-being in dementia and found a significant improvement in QOL, although the intervention did not lead to significant cognitive improvement.Although the effect of donepezil in slowing cognitive decline in AD has been established, and psychosocial interventions were known to exhibit positive effects, a combined effect has not been fully investigated [11]. We hypothesized that donepezil has an effect in slowing cognitive deterioration, and that the additional psychosocial intervention would increase their QOL.
This study was designed to investigate the impact of staff education on the behaviour and quality of life of residents with dementia and on staff members' attitudes about working with people with dementia and level of burnout. Staff from three aged care facilities participated in the study (n=52). These facilities were randomly assigned to one of two intervention groups or a control group. Staff assigned to the intervention groups received an eight-week behaviourally-based programme. Staff from one aged care facility also participated in a peer support group designed to reinforce educational material and facilitate positive changes among staff members. Behavioural symptoms displayed by residents (n=76) in each of the facilities were also assessed. Assessments were conducted at pre-intervention, post-intervention, three- and six-month follow-up. The results of this study indicated that education or peer support was not associated with an improvement in resident behaviour or quality of life. Education or peer support also did not impact on staff members' level of burnout. There was, however, a change in staff members' attitudes about working with people with dementia. Possible explanations for these findings and implication for further research are considered.
There is a need, in the absence of formal services, to design interventions aimed at improving the lives of people with dementia and their families. This study tested the effectiveness of the 10/66 caregiver intervention among people with dementia and their caregivers in Lima, Peru.
METHOD:
Design/participants: a randomized controlled trial was performed involving 58 caregivers of people with dementia that received the intervention in the beginning of the trial (n = 29) or six months later (n = 29). The intervention consisted of three modules: 1) assessment (one session); 2) basic education about dementia (two sessions); and 3) training regarding specific problem behaviors (two sessions). Main outcome measures: Caregivers and patients with dementia were assessed at baseline and after six months. For caregivers, the measures included strain (Zarit Burden Interview), psychological distress (SRQ-20), and quality of life (WHOQOL-BREF). Dementia patients completed scales assessing behavioral and psychological symptoms (NPI-Q) and quality of life (DEMQOL).
RESULTS:
Caregivers in the intervention group reported significantly decreased strain measures six months after the intervention compared to controls. No group differences were found in respect to the caregivers’ psychological distress and to quality of life in both caregivers and patients.
CONCLUSION:
The 10/66 intervention seems to be as effective as similar interventions used in more developed countries. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
