A non-pharmacological intervention for patients with Alzheimer s disease and family caregivers

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Abstract An increasing number of adults in the U.S. provide care to someone aged 50+ years with Alzheimer's disease (AD). Alzheimer's disease is a devastating illness affecting patients, family members and society. There is a need to identify interventions that decrease the cognitive and functional manifestations of the condition in the patient and the negative consequences experienced by family caregivers. Evidence suggests that non- pharmacological intervention approaches can be beneficial to both caregivers and AD patients. However, most intervention programs have exclusively focused on the caregiver or the patient, despite emerging evidence of a reciprocal interaction between the dyad. Also, most caregiver programs have targeted caregivers of patients in the moderate to severe stages of the illness. In addition, cognitive interventions for individuals with AD have been dependent on facility based training approaches, which limit feasibility and cost effectiveness. The proposed study will develop and test the efficacy and feasibility of a dyadic-based intervention program (DT), delivered through state-of-the art computer tablet technology. A novel feature of the investigation is its focus on both the caregiver and the recipient of care (person with AD) and the integration of an evidenced- based caregiver intervention and evidenced-based cognitive/functional training for the care recipient. The program will be tailored for the caregiver and emphasize issues important to caregivers, not only in the earlier stages of caregiving, but will also target issues across the caregiving trajectory to help prepare the caregiver for changes in their role. The cognitive/functional training will be targeted to the needs of the care recipient. The DT intervention will be 6 months in duration and compared to a control condition (CC) that combines standard a nutrition intervention for the caregiver and mental stimulation exercises for care recipient. Two hundred and forty Hispanic, African American and White/Caucasian dyads will be randomized to the DT intervention or CC condition. Measures at baseline and the 6 and 12-month follow-ups will include indices of care recipient cognitive and functional status, and caregiver outcomes such as; quality of life, distress, and caregiving efficacy. Information will also be gathered on ethnic differences in response to the intervention and estimates of cost effectiveness of the intervention. The DT intervention is highly innovative given the focus on a dyadic approach, the use of state-of-the-art technology for intervention delivery, a community-based and stage-model approach to intervention development, the inclusion of the caregiver as a therapy extender and cultural tailoring of the program.