Targeting Behavioral Symptoms and Functional Decline in Dementia: A Randomized Clinical Trial
Targeting Behavioral Symptoms and Functional Decline in Dementia: A Randomized Clinical Trial
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DOI：
10.1111/jgs.15194
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发表时间：
2018-02-01
影响因子：
6.3
通讯作者：
Mann, William C.
中科院分区：
文献类型：
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作者：
Gitlin, Laura N.;Arthur, Paul;Mann, William C.
背景/目标痴呆症相关的行为症状和功能依赖性导致痴呆症患者及其护理人员的生活质量较差。目标是确定家庭活动计划（定制活动计划；TAP-VA）是否会减少患有痴呆症的退伍军人的行为症状和功能依赖以及照顾者的负担。设计单盲（访谈者）、平行、随机、对照试验（Clinicaltrials.gov：NCT01357564）。设置退伍军人的家。参与者患有痴呆症的退伍军人及其家庭照顾者（N = 160 双人）。干预 TAP-VA 中的双人接受了职业治疗师的 8 次治疗，根据退伍军人的兴趣和能力定制活动，并对他们的护理人员进行关于痴呆症和定制活动使用的教育。被分配进行注意力控制的护理人员与研究团队成员一起接受了多达 8 次基于电话的痴呆症教育课程。测量主要结果包括行为数量及其发生频率乘以发生严重程度；次要结果是功能依赖性、疼痛、情绪健康、护理人员负担（护理时间、行为不安）以及 4 个月（主要终点）和 8 个月时的影响。 结果 160 名二人组（n = 76 TAP-VA；n = 84 对照）中，111 人完成了 4 个月的访谈（n = 51 TAP-VA；n = 60 对照），103 人完成了 8 个月的访谈（n = 50 TAP-VA；n = 53 对照）。 4 个月时，与对照组相比，TAP-VA 组表现出行为症状数量（与基线的平均变化差 = -0.68，95% CI = -1.23 至 -0.13）和按严重程度划分的频率（-24.3，95% CI = -45.6 至 -3.1）、需要协助的活动数量（-0.80，95% CI = -1.41 至-0.20）、功能依赖性水平（4.09，95% CI = 1.06、7.13）和疼痛（-1.18，95% CI = -2.10 至 -0.26）。 TAP-VA 退伍军人的护理人员报告的与行为相关的困扰较少。获益并未延长至 8 个月。结论 TAP-VA 具有积极的即时效果，并且没有不良事件。由于 TAP-VA 可以减少行为症状、减缓功能依赖性并减轻疼痛和护理人员的痛苦，因此它对于家庭来说是一种可行的治疗选择。
Background/ObjectivesDementia-related behavioral symptoms and functional dependence result in poor quality of life for persons with dementia and their caregivers. The goal was to determine whether a home-based activity program (Tailored Activity Program; TAP-VA) would reduce behavioral symptoms and functional dependence of veterans with dementia and caregiver burden.DesignSingle-blind (interviewer), parallel, randomized, controlled trial (Clinicaltrials.gov: NCT01357564).SettingVeteran's homes.ParticipantsVeterans with dementia and their family caregivers (N = 160 dyads).InterventionDyads in TAP-VA underwent 8 sessions with occupational therapists to customize activities to the interests and abilities of the veterans and educate their caregivers about dementia and use of customized activity. Caregivers assigned to attention control received up to 8 telephone-based dementia education sessions with a research team member.MeasurementsPrimary outcomes included number of behaviors and frequency of their occurrence multiplied by severity of occurrence; secondary outcomes were functional dependence, pain, emotional well-being, caregiver burden (time spent caregiving, upset with behaviors) and affect at 4 (primary endpoint) and 8 months.ResultsOf 160 dyads (n = 76 TAP-VA; n = 84 control), 111 completed 4-month interviews (n = 51 TAP-VA; n = 60 control), and 103 completed 8-month interviews (n = 50 TAP-VA; n = 53 control). At 4 months, compared to controls, the TAP-VA group showed reductions in number (difference in mean change from baseline = -0.68, 95% CI = -1.23 to -0.13) and frequency by severity (-24.3, 95% CI = -45.6 to -3.1) of behavioral symptoms, number of activities needing assistance with (-0.80, 95% CI = -1.41 to -0.20), functional dependence level (4.09, 95% CI = 1.06, 7.13), and pain (-1.18, 95% CI = -2.10 to -0.26). Caregivers of veterans in TAP-VA reported less behavior-related distress. Benefits did not extend to 8 months.ConclusionTAP-VA had positive immediate effects and no adverse events. Because TAP-VA reduces behavioral symptoms, slows functional dependence, and alleviates pain and caregiver distress, it is a viable treatment option for families.