Clinic for Psychiatry and Psychotherapy, Friedrich-Alexander-University of Erlangen-Nuremberg, Germany.
J Am Geriatr Soc. 2012 May;60(5):830-40. doi: 10.1111/j.1532-5415.2012.03938.x. Epub 2012 Apr 3.
To determine the efficacy of multimodal, nondrug therapy on symptoms of dementia and need for care in institutionalized individuals with degenerative dementia.
Randomized, controlled, longitudinal trial. Data were analyzed using multiple linear regression.
Five German nursing homes.
One hundred thirty-nine nursing home residents with primary degenerative dementia (Mini-Mental State Examination score < 24).
The 6-month intervention comprised three components: motor stimulation, activities of daily living, and cognitive stimulation (MAKS). Groups of 10 patients led by two therapists participated in the standardized intervention for 2 hours, 6 days a week. The intervention was described in detail in an intervention manual. Adherence to the manual was high. Controls received treatment as usual.
Overall geriatric symptoms were recorded using the Nurses' Observation Scale for Geriatric Patients, functional independence using the Barthel Index, and care time using the Resource Utilization in Dementia-Formal Care.
Of 646 individuals screened, 146 were eligible, and 130 were included in the intention-to-treat analysis. At 6 months, results of the per-protocol analysis (n = 119) showed improvement in overall dementia symptoms in the MAKS group and no change in the control group (adjusted mean difference (AMD) = -6.8, 95% confidence interval (CI) = -10.3 to -3.3; P < .001, Cohen d = 0.66). This effect was greatest on the social behavior (AMD = -1.9, 95% CI = -2.9 to -0.8; P < .001; Cohen d = 0.54) and instrumental activity of daily living (IADL) (AMD = -1.4, 95% CI = -2.5 to -0.30; P = .01; Cohen d = 0.43) subscales. No effect was seen on functional independence or total care time.
This 6-month nondrug multimodal intervention improved dementia symptoms in nursing home residents, especially in social behavior and IADL capabilities.
确定多模式、非药物疗法对退行性痴呆住院患者痴呆症状和护理需求的疗效。
随机、对照、纵向试验。采用多元线性回归分析数据。
五家德国养老院。
139 名患有原发性退行性痴呆（简易精神状态检查评分<24）的养老院居民。
为期 6 个月的干预措施包括三个组成部分：运动刺激、日常生活活动和认知刺激（MAKS）。由两名治疗师带领的 10 名患者小组每周 6 天、每天 2 小时参加标准化干预。干预措施在干预手册中详细描述。对手册的遵守程度很高。对照组接受常规治疗。
使用护士观察老年患者量表记录总体老年症状，使用巴氏指数记录功能独立性，使用资源利用量表记录痴呆症正式护理的护理时间。
在 646 名接受筛查的患者中，有 146 名符合条件，有 130 名符合意向治疗分析。在 6 个月时，对方案分析（n=119）的结果显示，MAKS 组的痴呆症状总体改善，对照组无变化（调整平均差异（AMD）=-6.8，95%置信区间（CI）=-10.3 至-3.3；P<.001，Cohen d=0.66）。这一效果在社会行为（AMD=-1.9，95%CI=-2.9 至-0.8；P<.001；Cohen d=0.54）和工具性日常生活活动（IADL）（AMD=-1.4，95%CI=-2.5 至-0.30；P=.01；Cohen d=0.43）亚量表上最大。对功能独立性或总护理时间没有影响。
这种为期 6 个月的非药物多模式干预措施改善了养老院居民的痴呆症状，特别是在社会行为和 IADL 能力方面。
