Abstract
BackgroundLittle is known about the long-term success of non-drug therapies for treating dementia, especially whether the effects are sustained after therapy ends. Here, we examined the effects of a one-year multimodal therapy 10 months after patients completed the therapy.MethodsThis randomised, controlled, single-blind, longitudinal trial involved 61 patients (catamnesis: n = 52) with primary degenerative dementia in five nursing homes in Bavaria, Germany. The highly standardised intervention, MAKS, consisted of motor stimulation, practice of activities of daily living (ADLs), and cognitive stimulation. Each group of 10 patients was treated for 2 h, 6 days a week for 12 months. Control patients received standard nursing home care. At baseline, at the end of therapy (month 12), and 10 months thereafter (month 22), cognitive functioning was assessed using the cognitive subscale of the Alzheimer’s Disease Assessment Scale, and the ability to perform ADLs was assessed using the Erlangen Test of Activities of Daily Living.ResultsDuring the therapy phase, the MAKS patients maintained their cognitive function and ability to carry out ADLs. After the end of therapy, both the control and the MAKS groups deteriorated in both their cognitive function (control, p = 0.02; MAKS, p < 0.001) and their ability to carry out ADLs (control, p < 0.001; MAKS, p = 0.001). However, in a confound-adjusted multiple regression model, the ability of the MAKS group to perform ADLs remained significantly higher than that of the control group even 10 months after the end of therapy (H0: βMAKS + βMAKS month 22 = 0; χ2 = 3.8568, p = 0.0496). Cohen’s d for the difference between the two groups in ADLs and cognitive abilities 10 months after the end of therapy was 0.40 and 0.22, respectively.ConclusionsA multimodal non-drug therapy of dementia resulted in stabilisation of the ability to perform ADLs, even beyond the end of therapy. To prevent functional decline for as long as possible, therapy should be performed continuously until the benefit for the patient ends. Follow-up studies on larger numbers of patients are needed to definitively confirm these results.Trial registrationhttp://www.isrctn.com Identifier: ISRCTN87391496
Highlights
Little is known about the long-term success of non-drug therapies for treating dementia, especially whether the effects are sustained after therapy ends
Whereas it would be expected that the cognitive performance of Alzheimer patients who respond to drug therapy will inevitably deteriorate when the medication is withdrawn [8,9], preliminary evidence indicates that non-drug therapies may result in greater sustainability of cognition and the ability to carry out activities of daily living (ADLs) [10,11]
In a blinded Randomised controlled trial (RCT) design, we have demonstrated the efficacy of our multimodal activation therapy developed for institutionalised patients [14] with respect to cognition and the ability to carry out Activities of daily living (ADLs) after a 12-month therapy [5,15]
Summary
Little is known about the long-term success of non-drug therapies for treating dementia, especially whether the effects are sustained after therapy ends. Whereas it would be expected that the cognitive performance of Alzheimer patients who respond to drug therapy will inevitably deteriorate when the medication is withdrawn [8,9], preliminary evidence indicates that non-drug therapies may result in greater sustainability of cognition and the ability to carry out activities of daily living (ADLs) [10,11]. In the re-analysis of the 3 other studies that examined the efficacy 1 to 3 months after the end of therapy, a significant effect on cognition was found (p = 0.05) [12] These 3 studies did not examine ADLs. Further high-quality methodological studies of the sustainability of non-drug therapies are needed, because of their importance for cost savings in the health system [13]
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