The Role of Palliative Care Interventions to Reduce Circadian Rhythm Disorders in Persons with Dementia

姑息治疗干预措施在减少痴呆症患者昼夜节律紊乱方面的作用

• 批准号: 9334318
• 负责人: Nancy A Hodgson
• 金额: $ 56.01万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-17 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9334318
• 关键词: Address; Advocate; Affect; Agitation; Alzheimer' s Disease; American; Attention; Behavior Therapy; Biological; Caregiver Burden; Caregivers; Caring; Chronic Disease; Circadian Dysregulation; Circadian Rhythms; Cognitive; Control Groups; Cues; Dementia; Disease; Distress; Educational Intervention; Family; Family Caregiver; Frequencies; Health; Home environment; Hormonal; Hydrocortisone; Hypersomnias; Individual; Institutionalization; Intervention; Knowledge; Light; Light Exercise; Link; Measures; Mediating; Melatonin; Mental Depression; Methods; Modeling; Nature; Nerve Degeneration; Neurosecretory Systems; Outcome; Pain; Palliative Care; Participant; Patient-Focused Outcomes; Patients; Pattern; Periodicity; Personhood; Persons; Pharmaceutical Preparations; Pharmacology; Phase; Physiological; Population; Process; Protocols documentation; Proxy; Quality of life; Randomized; Reporting; Research Priority; Research Support; Role; Safety; Salivary; Sampling; Science; Sensory; Sleep; Sleep Disorders; Specialist; Structure; Symptoms; System; Terminal Disease; Testing; Time; United States; Work; actigraphy; attentional control; base; biobehavior; caregiver education; dementia care; design; efficacy trial; end of life; end of life care; functional status; improved; indexing; innovation; interest; intervention effect; medical specialties; neuropsychiatric symptom; novel; palliative; predicting response; preference; public health priorities; public health relevance; reduce symptoms; sleep onset; social; standard of care; success; symptom cluster; therapy design

 DESCRIPTION (provided by applicant): Over 5 million Americans have Alzheimer's disease or a related dementia, a progressive and fatal neurodegenerative condition, affecting close to 15 million family caregivers (CG). A palliative model of care is advocated "upstream" for persons with dementia in order to enhance quality of life (QOL) and reduce symptom burden. Circadian rhythm disorders (CRD's) occur in the majority of persons with dementia and include late afternoon/evening agitation and irregular sleep-wake rhythms such as daytime hypersomnia, frequent night awakenings, and poor sleep efficiency. CRD symptoms pose a great burden to CG, and are the principal causes of distress, poor QOL, and institutionalization. Regulating the circadian system through the use of light and activity has been shown to alter core clock processes that drive CRD symptoms and suggests that a combination of cognitive, physical and sensory-based activities, delivered at strategic times, may be an effective mechanism through which to reduce CRD symptoms. A growing body of research supports the importance of activity-based interventions as a palliative approach to reduce the frequency and intensity of CRD symptoms, enhance personhood and dignity, and improve QOL. To date, there are no trials linking the nature and timing of activities with key palliative and biobehavioral outcomes. We propose a definitive Phase III efficacy trial of the "Healthy Patterns" intervention, a home-based activity intervention designed to improve CRDs and QOL that builds on our pilot work. We will use a randomized two-group parallel design of 200 people with dementia and their CGs (dyads) assigned to the "Healthy Patterns" intervention or a control intervention of equivalent in-home attention and social contact. Specific components of the intervention include: 1) assessing health/functional status and preferences/interests; 2) educating CG on environmental cues to promote activity and sleep; and 3) training of CG in using timed morning, afternoon, and evening activities based on circadian needs. The success of the intervention will be determined by its impact on palliative outcomes including measures of QOL as well as actigraphic and proxy reported measures of CRD symptoms. CG outcomes of interest will be burden, subjective sleep quality, and QOL. We will also examine the mechanism of action of the intervention on CRD symptoms through diurnal neuroendocrine activity measured via salivary cortisol and dim light melatonin. Results from the proposed study will provide fundamental new knowledge regarding the nature and timing of activity participation based on circadian needs, and the mechanisms underlying timed activities, has the potential to change how and when activities for persons with dementia are provided.