Targeting functional decline in Alzheimer disease: A randomized trial

Christopher Callahan, Malaz Boustani, Arlene A. Schmid, Michael A. La Mantia, Mary Austrom, Douglas K. Miller, Sujuan Gao, Denisha Y. Ferguson, Kathleen A. Lane, Hugh Hendrie

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)164-171
Number of pages8
JournalAnnals of Internal Medicine
Volume166
Issue number3
DOIs
StatePublished - Feb 7 2017

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Alzheimer Disease
Occupational Therapy
Activities of Daily Living
Sarcopenia
Caregivers
National Institute on Aging (U.S.)
Urban Health
Independent Living
House Calls
Dementia
Randomized Controlled Trials
Public Health
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Internal Medicine

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Targeting functional decline in Alzheimer disease : A randomized trial. / Callahan, Christopher; Boustani, Malaz; Schmid, Arlene A.; La Mantia, Michael A.; Austrom, Mary; Miller, Douglas K.; Gao, Sujuan; Ferguson, Denisha Y.; Lane, Kathleen A.; Hendrie, Hugh.

In: Annals of Internal Medicine, Vol. 166, No. 3, 07.02.2017, p. 164-171.

Research output: Contribution to journalArticle

Callahan, Christopher ; Boustani, Malaz ; Schmid, Arlene A. ; La Mantia, Michael A. ; Austrom, Mary ; Miller, Douglas K. ; Gao, Sujuan ; Ferguson, Denisha Y. ; Lane, Kathleen A. ; Hendrie, Hugh. / Targeting functional decline in Alzheimer disease : A randomized trial. In: Annals of Internal Medicine. 2017 ; Vol. 166, No. 3. pp. 164-171.
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abstract = "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.",
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