Long-term collaborative care and occupational therapy did not slow functional decline in patients with dementia

1. Regardless of treatment intervention, all patients had progressive functional decline.

2. No statistically significant difference was observed in Activity of Daily Living Scale (ADL) for patients receiving occupational therapy versus no occupational therapy after 1 year.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Alzheimer disease leads to progressive functional decline and loss of independence in patients. It has no known cure or disease modifying treatments. Due to the rapid decline of patients with this condition, Alzheimer and related dementia are high burdens for patients, families, and society. Current best practice dementia care has been shown to improve behavioural outcomes and reduce caregiver stress for Alzheimer patients; however, this care has not been shown to slow progressive functional decline. Home-based occupational therapy is one intervention currently being evaluated for its impact on patient function. The authors of this study aimed to determine whether collaborate care plus 2 years of home-based occupational therapy delays functional decline in patients. The study was limited in patient follow up; almost 1 in 5 participants died during the 2-year follow up, resulting in missing data. Additionally, the results of the study were deemed indeterminate due to the 95%CI. Overall, the authors were not able to definitely demonstrate that this home-based intervention model slowed the functional rate of decline among Alzheimer patients. This study emphasizes the complexities of Alzheimer care and challenges in slowing functional decline.

Click to read the study, published today in the Annals of Internal Medicine

Relevant Reading: The Home-Based Occupational Therapy Intervention in the Alzheimer’s Disease Multiple Intervention Trial (ADMIT)

In-Depth [randomized control trial]: This study involved 180 community-dwelling patients with Alzheimer disease. Patients we randomized into two groups: collaborative care for dementia only or collaborative care in addition to in-home occupational therapy. Clinical outcomes for this study were measured using Alzheimer’s Disease Cooperative Study Group ADL scale and performance-based measures. The 95%CI (-5.27 to 9.96) included clinically significant between-group differences; therefore, the results of the study were interpreted as indeterminate. Overall, progressive functional decline was observed in both study groups with no significant differences. Mean Mini-Mental State Exam (MMSE) scores declined from 19.37 to 16.76 in the intervention group and 19.02 to 17.26 in the control group. Furthermore, no significant difference was observed between groups regarding mortality over 2 years (20% versus 17%).

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