Abstract
BackgroundCurrently available pharmacological and non-pharmacological treatments have shown only modest effects in slowing the progression of dementia. Our objective was to assess the impact of a long-term non-pharmacological group intervention on cognitive function in dementia patients and on their ability to carry out activities of daily living compared to a control group receiving the usual care.MethodsA randomized, controlled, single-blind longitudinal trial was conducted with 98 patients (follow-up: n = 61) with primary degenerative dementia in five nursing homes in Bavaria, Germany. The highly standardized intervention consisted of motor stimulation, practice in activities of daily living, and cognitive stimulation (acronym MAKS). It was conducted in groups of ten patients led by two therapists for 2 hours, 6 days a week for 12 months. Control patients received treatment as usual. Cognitive function was assessed using the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-Cog), and the ability to carry out activities of daily living using the Erlangen Test of Activities of Daily Living (E-ADL test) at baseline and after 12 months.ResultsOf the 553 individuals screened, 119 (21.5%) were eligible and 98 (17.7%) were ultimately included in the study. At 12 months, the results of the per protocol analysis (n = 61) showed that cognitive function and the ability to carry out activities of daily living had remained stable in the intervention group but had decreased in the control patients (ADAS-Cog: adjusted mean difference: -7.7, 95% CI -14.0 to -1.4, P = 0.018, Cohen's d = 0.45; E-ADL test: adjusted mean difference: 3.6, 95% CI 0.7 to 6.4, P = 0.015, Cohen's d = 0.50). The effect sizes for the intervention were greater in the subgroup of patients (n = 50) with mild to moderate disease (ADAS-Cog: Cohen's d = 0.67; E-ADL test: Cohen's d = 0.69).ConclusionsA highly standardized, non-pharmacological, multicomponent group intervention conducted in a nursing-home setting was able to postpone a decline in cognitive function in dementia patients and in their ability to carry out activities of daily living for at least 12 months.Trial Registrationhttp://www.isrctn.com Identifier: ISRCTN87391496
Highlights
Available pharmacological and non-pharmacological treatments have shown only modest effects in slowing the progression of dementia
At the 12-month follow-up, the scores for the outcome measures in the intervention group remained unchanged as tested using the t test for dependent samples in the case of the ADAS-Cog subscale and using the Wilcoxon signed rank test in the case of the E-activities of daily living (ADL) test
Multivariate regression analysis showed that participation in MAKS was a significant predictor of cognitive function and the ability to carry out ADL after 12 months (Table 2)
Summary
Available pharmacological and non-pharmacological treatments have shown only modest effects in slowing the progression of dementia. In a recent randomized trial with small sample size, for example [15], there was a significant improvement in the ADAS-Cog after a six-month-cognitive intervention This effect could only be seen in the subgroup of patients with Mild Cognitive Impairment. It seems reasonable to assume that because people who live independently are confronted in their everyday lives with multiple challenges and stimuli, interventions aimed at slowing disease progression in dementia patients should consist of multiple components [4] This has been underscored by a recent systematic review, which demonstrated the efficacy of multicomponent interventions for dementia patients in achieving a range of outcomes [18]. Practicing ADL was intended to slow the loss of independence typically seen in dementia patients [27,28]
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