Targeting Functional Decline in Alzheimer Disease

Abstract

Background Alzheimer’s disease (AD) results in progressive functional decline leading to loss of independence Objective To determine whether collaborative care plus two years of home-based occupational therapy delays functional decline Design Randomized controlled clinical trial Setting Urban public health system Patients 180 community-dwelling subjects who were diagnosed with AD and their informal caregivers Interventions All subjects received collaborative care for dementia. Intervention patients also received in-home occupational therapy delivered in 24 sessions over 2 years. Measurements The primary outcome measures was the Alzheimer’s Disease Cooperative Studies Group Activities of Daily Living Scale (ADCS ADL); performance based measures included the Short Physical Performance Battery (SPPB) and Short Portable Sarcopenia Measure (SPSM) Results At baseline, there were no significant between group differences in clinical characteristics; the mean MMSE for both groups was 19 (SD=7). The intervention group received a median of 18 home visits from the study occupational therapists. Both groups declined in ADCS ADL scores over 24 months. At the primary endpoint of 24 months, there were no between group differences in ADCS ADL scores (mean difference 2.34, 95% CI −5.27, 9.96). We were also unable to definitively demonstrate between-group differences in the mean SPPB or SPSM. Limitations The results of this trial are indeterminate and do not rule out potentially clinically important effects of the intervention. Conclusions We were unable to definitively demonstrate whether the addition of two years of in-home occupational therapy to a collaborative care management model slows the rate of functional decline among persons with AD. This trial underscores the burden undertaken by family caregivers as they provide care for persons with AD and the difficulty in slowing functional decline.

Promoting functional independence in people with Alzheimer's disease: Outcomes of a home-based occupational therapy intervention in Spain

“…The positive impact on functional independence was in line with the improvement in ADL found in a sample of people with mild to moderate dementia after receiving a community‐based OT program (Graff et al, ). However, unlike our study, two RCT did not find a significant improvement in ADL after a home‐based OT intervention (Callahan et al, ; Gitlin et al, ). Two possible explanations are the low intensity of the interventions implemented in these studies and the inclusion of people with a high level of dependence.…”

“…declined in both groups and no differences in ADL between the experimental and control groups were observed (Callahan et al, 2017). Accordingly, there is a critical need to better understand the effectiveness of OT interventions on disabilities in ADL.…”

“…compared to the scarce literature on this topic. Our program was longer and more intense: in similar previous studies, the duration of the OT intervention ranged from 5(Gitlin et al, 2001) to 18(Callahan et al, 2017) home visits within a period of between 3 and 24 months respectively. Furthermore, this strategy was unique in terms of its content (biopsychosocial and meaningful occupation-based approach), the inclusion of an intervention withdrawal period and the selection of people at an early stage of the disease.…”

“…Recently, a RCT compared a control group receiving best‐practice primary care with an intervention group receiving best‐practice primary care plus a home‐based OT intervention. At 24 months, functional independence declined in both groups and no differences in ADL between the experimental and control groups were observed (Callahan et al, ). Accordingly, there is a critical need to better understand the effectiveness of OT interventions on disabilities in ADL.…”

Effects of nonpharmacological interventions on functioning of people living with dementia at home: A systematic review of randomised controlled trials

“…45 Multicomponent interventions were diverse in both delivery and results, with 2 of 3 small studies demonstrating functional benefits. Cognitive impairment, behavioural and psychological symptoms, depression y y n y n n (Continues) ADL/IADL functioning for up to 4 months, relative to control conditions.…”