Targeting Functional Decline in Alzheimer Disease: A Randomized Trial.

BACKGROUND

Alzheimer disease results in progressive functional decline, leading to loss of independence.

OBJECTIVE

To determine whether collaborative care plus 2 years of home-based occupational therapy delays functional decline.

DESIGN

Randomized, controlled clinical trial. (ClinicalTrials.gov: NCT01314950).

SETTING

Urban public health system.

PATIENTS

180 community-dwelling participants with Alzheimer disease and their informal caregivers.

INTERVENTION

All participants received collaborative care for dementia. Patients in the intervention group also received in-home occupational therapy delivered in 24 sessions over 2 years.

MEASUREMENTS

The primary outcome measure was the Alzheimer's Disease Cooperative Study 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, clinical characteristics did not differ significantly between groups; the mean Mini-Mental State Examination score for both groups was 19 (SD, 7). The intervention group received a median of 18 home visits from the study occupational therapists. In both groups, ADCS ADL scores declined over 24 months. At the primary end point of 24 months, ADCS ADL scores did not differ between groups (mean difference, 2.34 [95% CI, -5.27 to 9.96]). We also could not definitively demonstrate between-group differences in mean SPPB or SPSM values.

LIMITATION

The results of this trial are indeterminate and do not rule out potential clinically important effects of the intervention.

CONCLUSION

The authors could not definitively demonstrate whether the addition of 2 years of in-home occupational therapy to a collaborative care management model slowed the rate of functional decline among persons with Alzheimer disease. This trial underscores the burden undertaken by caregivers as they provide care for family members with Alzheimer disease and the difficulty in slowing functional decline.

PRIMARY FUNDING SOURCE

National Institute on Aging.