Outcomes of a multimodal cognitive and physical rehabilitation program for persons with mild dementia and their caregivers: a goal-oriented approach

Abstract

BackgroundNonpharmacological interventions such as exercise and cognitive rehabilitation programs have shown promise in reducing the impact of dementia on the individual and the caregiver. In this study, we examine the effect of a multimodal cognitive and physical rehabilitation program for persons with mild dementia and their caregivers using conventional measures of cognition, behavior, quality of life (QoL), and caregiver burden together with goal attainment scaling (GAS), an individualized outcome measure.MethodsGoals were set at baseline, and GAS score was calculated at the end of the program. Participants were also assessed with the Chinese Mini-Mental State Examination, functional and behavioral scales (Barthel Index), Instrumental Activities of Daily Living, Neuropsychiatric Inventory Questionnaire, QoL, and caregiver burden using EuroQol-five dimension questionnaire and Zarit Burden Interview (ZBI). Differences in median scores postintervention were obtained. Further analysis of caregiver burden was undertaken utilizing the multidimensional classification of burden on the ZBI.ResultsThirty-four (61.8%) patients were assessed to have met their goals (GAS score≥50). Mean (standard deviation) GAS score was 48.6 (6.5). Cognition goals were set in only 20.6%, followed by goals to improve engagement and socialization; reduce caregiver stress; and improve physical function, behavior, and mood. Median scores in the cognitive, functional, and QoL measures did not differ significantly pre- and postintervention. The intervention had a positive impact on role strain, a unique dimension of caregiver burden.ConclusionThis study provides evidence that a multimodal approach combining physical exercise and cognitive rehabilitation improves goal attainment and caregiver burden in individuals and caregivers of persons with mild dementia.

A mixed methods systematic review of multimodal non-pharmacological interventions to improve cognition for people with dementia

“…This is about collaborative engagement -co-ownership throughout the process. Another paper by Tay et al (2016) went into more depth about their goal-oriented approach (Chew, Chong, Fong, & Tay, 2015). Cognition goals as well as goals to improve engagement and socialization; reduce caregiver stress; and improve physical function, behaviour and mood were set and 61.8% of participants met them.…”

Impacts of a multicomponent intervention programme on neuropsychiatric symptoms in people with dementia and psychological health of caregivers: A feasibility pilot study

“…22 Another approach often has multiple components and tends to employ a combination of cognitive rehabilitation, education, management of behavioural and psychological symptoms of dementia (BPSD), and skills training support. [23][24][25][26] However, these intervention studies were designed without considering the comorbidity condition of PWD. Dyadic comorbidity-specific exercise interventions for PWD appear to be lacking.…”

“…For example, a dyadic exercise programme providing 4 weeks of Tai Chi group training and 12 weeks of home practice appeared to be successful for keeping dyads active . Another approach often has multiple components and tends to employ a combination of cognitive rehabilitation, education, management of behavioural and psychological symptoms of dementia (BPSD), and skills training support . However, these intervention studies were designed without considering the comorbidity condition of PWD.…”

“…A clinical trial of a dyadic exercise intervention has shown the beneficial effects on neuropsychiatric symptoms in PWD and has reduced caregiver burden . However, the available studies predominantly evaluated the benefits of dyadic exercise interventions on caregivers by using caregiver burden as an outcome measure . The findings have appeared to be contradictory.…”

“…The findings have appeared to be contradictory. While some studies indicated that caregiver burden can be attenuated, other studies showed negative results . In short, the benefits of dyadic exercise interventions on caregivers are still undetermined.…”