Efficacy of the WeCareAdvisor: An Online Tool to Help Caregivers Manage Behavioral and Psychological Symptoms in Persons with Dementia

行为和心理症状（激动，侵略，其中许多;又名BPSD）是标志 阿尔茨海默病和相关痴呆症（ADRD）。BPSD主导疾病表现，发生于 病因学和疾病轨迹，并对痴呆症患者具有显著的负面影响， 家庭成员和整个社会。虽然没有FDA批准的药物来治疗BPSD， 精神科药物（包括抗精神病药物）普遍使用，但疗效有限，而且风险高。 非药物策略被认为是一线治疗，并已证明有效，但家庭 缺乏战略知识和获取战略的途径，只能靠自己管理BPSD。作为回应，我们 通过先前资助的NINR赠款（R 01），开发了一个易于使用的基于网络的平台WeCareAdvisor NR 014200）供家庭护理人员使用。该工具每天为护理人员提供有关痴呆症的知识 提示，以及使用一个系统的方法来描述，调查，创建和评估战略， 我们开发了一种方法（DICE），系统地指导选择与症状相匹配的策略 演示文稿.我们的初步随机研究（N=57; NIA-Stage 1）比较了初始治疗组和1- 一个月的等待名单控制与照顾者每周收到电话和电子邮件，鼓励工具的使用。这 试点展示了概念验证，100%的护理人员使用该工具。使用1个月后， 初始治疗组和等待名单对照组在照顾者方面显示出显著的组内益处（痛苦， 置信度）和BPSD（频率和严重程度）结果。此外， 与等待名单组相比，初始治疗组的护理人员痛苦。不清楚，是否提示 是工具使用和/或获益所必需的。根据PAR-18-027，我们建议测试 WeCareAdvisor（NIA -第二阶段）的有效性和326名不同护理人员的工具利用率， 随机设计;护理人员将被分配到立即治疗组或3个月等待名单对照组。我们 具体目标是测试：1）WeCareAdvisor对护理人员痛苦，信心的短期疗效（1个月） 管理BPSD或BPSD频率和严重程度; 2）WeCareAdvisor对以下患者的长期疗效（3个月） 护理者苦恼、管理BPSD的信心或BPSD频率和严重性。我们亦会研究 等待名单对照组在使用该工具3个月后是否表现出类似的益处; 以及3）使用不同提醒（电话+电子邮件或仅电子邮件）的工具利用率和结果。我们还将 评估初始治疗组在3-6个月内是否在没有提示的情况下持续使用工具。 探索性目的将检查工具组件的使用频率，对精神药物使用的影响， 功能，和其他结果;和中介（理论衍生变量），和调节（种族，关系） 方面的影响.这一建议在评估一种具有巨大影响潜力的工具的功效和利用方面是新颖的 通过向护理人员提供BPSD管理策略的按需访问，提供痴呆症护理。

Behavioral and psychological symptoms (agitation, aggression, among many others; aka BPSD) are hallmarks of Alzheimer's disease and related dementias (ADRD). BPSD dominate disease presentation, occur across etiologies and disease trajectories, and have significant negative consequences for persons with dementia, family members, and society at-large. Although there are no FDA approved medications to treat BPSD, psychotropic medications (including anti-psychotics) are commonly used with limited efficacy and high risk. Nonpharmacologic strategies are considered first-line treatments and have proven efficacy, but families have little knowledge of and access to strategies and are left on their own to manage BPSD. In response, we developed an easy-to-use, web-based platform, WeCareAdvisor, through a previously funded NINR grant (R01 NR014200) for use by family caregivers. The tool provides caregivers with knowledge about dementia, daily tips, and a systematic approach for describing, investigating, creating and evaluating strategies using an approach we developed (DICE) that systematically guides selection of strategies to match symptom presentation. Our pilot randomized study (N=57; NIA-Stage 1) compared an initial treatment group to a 1- month waitlist control with caregivers receiving weekly telephone calls and emails encouraging tool use. This pilot demonstrated proof-of-concept with 100% of caregivers using the tool. After 1 month of use, both the initial treatment and the waitlist control groups showed significant within group benefits in caregiver (distress, confidence) and BPSD (frequency and severity) outcomes. Additionally, there was significant improvement in caregiver distress in the initial treatment group as compared to the waitlist group. Unclear, is whether prompts were necessary for tool use and/or to derive benefit. In response to PAR-18-027, we propose to test the efficacy of WeCareAdvisor (NIA - Stage II) and tool utilization in 326 diverse caregivers using a two-group, randomized design; caregivers will be assigned to immediate treatment or 3-month waitlist control groups. Our specific aims are to test: 1) Short-term efficacy (1-month) of WeCareAdvisor on caregiver distress, confidence managing BPSD, or BPSD frequency and severity; 2) Longer-term efficacy (3-months) of WeCareAdvisor on caregiver distress, confidence managing BPSD, or BPSD frequency and severity. We will also examine whether the waitlist control group demonstrates similar benefits after using the tool over a 3-month exposure; and 3) Tool utilization and outcomes using different reminders (telephone + email or email only). We will also evaluate whether tool utilization is sustained without prompts in months 3-6 for the initial treatment group. Exploratory aims will examine frequency of use of tool components, impact on psychotropic medication use, function, and other outcomes; and mediator (theoretically-derived variables), and moderator (race, relationship) effects. This proposal is novel in assessing efficacy and utilization of a tool that has great potential to impact dementia care by providing caregivers with on-demand access to BPSD management strategies.