Luttenberger Katharina, Graessel Elmar, Behrndt Elisa-Marie, Özbe Dominik, Donath Carolin, Scheel Jennifer
Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
Front Psychiatry. 2019 Aug 21;10:587. doi: 10.3389/fpsyt.2019.00587. eCollection 2019.
Multicomponent non-pharmacological therapies have been shown to be effective at reducing cognitive symptoms and slowing deterioration in abilities to perform activities of daily living (ADL) in individuals with cognitive impairment. However, little is known about response rates and predictors of response. We used data from the German day-care study (DeTaMAKS; De = dementia, Ta = Tagespflege/day-care, M = motor stimulation, A = activities of daily living stimulation, K = k/cognitive stimulation, S = social stimulation; n = 362), which was based on a cluster-randomized trial of the non-pharmacological, multicomponent, anti-dementia MAKS therapy for people with cognitive impairment in day-care centers. We investigated response (defined as improvement or no deterioration) for three different response criteria: cognition via Mini-Mental State Examination (MMSE) score, ADL via Erlangen Test of Activities of Daily Living in Persons with Mild Dementia or Mild Cognitive Impairment (ETAM) score, and behavioral and psychological symptoms of dementia (BPSD) via Neuropsychiatric Inventory Questionnaire (NPI-Q) score. In addition, we calculated the number needed to treat (NTT) and response rates according to net gain analyses. For all three criteria, the response rates were higher in the intervention group than in the control group (chi test: = to = ). Compared with non-responders, responders according to cognition had higher ETAM scores (= better ADL abilities) at baseline; responders according to ADL had lower ETAM scores (= poorer ADL abilities) at baseline; and responders according to BPSD had higher NPI-Q scores (= more BPSD) at baseline. Classification rates based on these predictors ranged from 60.6 to 68.3%. The response rates to the non-pharmacological MAKS therapy were greater than those reported for anti-dementia drugs. There were only a few differences between responders and non-responders. Because of the low classification rates, these variables had only a small impact on response predictions. Therefore, there are no empirically substantiated selection criteria for the application of MAKS therapy in facilities. www.ClinicalTrials.gov, identifier ISRCTN16412551.
多成分非药物疗法已被证明在减轻认知症状以及减缓认知障碍患者日常生活活动（ADL）能力的衰退方面有效。然而，关于缓解率和缓解预测因素却知之甚少。我们使用了来自德国日托研究（DeTaMAKS；De = 痴呆，Ta = 日托，M = 运动刺激，A = 日常生活活动刺激，K = 认知刺激，S = 社交刺激；n = 362）的数据，该研究基于一项针对日托中心认知障碍患者的非药物、多成分抗痴呆MAKS疗法的整群随机试验。我们针对三种不同的缓解标准调查缓解情况（定义为改善或无恶化）：通过简易精神状态检查表（MMSE）评分评估认知，通过轻度痴呆或轻度认知障碍患者日常生活活动埃尔朗根测试（ETAM）评分评估ADL，以及通过神经精神科问卷（NPI - Q）评分评估痴呆的行为和心理症状（BPSD）。此外，我们根据净获益分析计算了治疗所需人数（NTT）和缓解率。对于所有这三个标准，干预组的缓解率均高于对照组（卡方检验：= 至 =）。与无缓解者相比，认知方面的缓解者在基线时ETAM评分更高（= ADL能力更好）；ADL方面的缓解者在基线时ETAM评分更低（= ADL能力更差）；BPSD方面的缓解者在基线时NPI - Q评分更高（= BPSD更多）。基于这些预测因素的分类率在60.6%至68.3%之间。非药物MAKS疗法的缓解率高于抗痴呆药物报告的缓解率。缓解者与无缓解者之间仅有少数差异。由于分类率较低，这些变量对缓解预测的影响较小。因此，在机构中应用MAKS疗法没有经实证证实的选择标准。ClinicalTrials.gov网站，标识符ISRCTN16412551。
