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

摘要 在美国，越来越多的成年人为50岁以上的阿尔茨海默病患者提供护理 (Ad)。阿尔茨海默病是一种影响患者、家庭成员和社会的毁灭性疾病。有一个 需要确定干预措施，以减少这种情况的认知和功能表现 病人和家庭照顾者所经历的负面后果。有证据表明非- 药物干预方法对照顾者和AD患者都是有益的。然而，大多数 干预计划只专注于照顾者或患者，尽管有证据表明 二分体之间的相互作用。此外，大多数护理者计划都是针对病人的护理者 在疾病的中度到重度阶段。此外，对阿尔茨海默病患者的认知干预 依赖于以设施为基础的培训方法，这限制了可行性和成本效益。 这项拟议的研究将开发和测试基于二元的干预计划的有效性和可行性 (DT)，通过最先进的电脑平板电脑技术提供。调查的一个新特点是它的 关注照顾者和接受者(患有AD的人)，并整合有证据的- 基于护理者干预和基于证据的护理接受者认知/功能培训。这个 计划将为照顾者量身定做，并强调对照顾者重要的问题，而不仅仅是早期的 护理阶段，但也将针对护理轨迹中的问题，帮助照顾者做好准备 对于他们角色的改变。认知/功能培训将针对护理接受者的需要。 DT干预将持续6个月，并与对照条件(CC)进行比较 对照顾者进行标准的营养干预，对照顾者进行心理刺激练习。二 140名西班牙裔、非裔美国人和白人/高加索二人将被随机分配到DT 干预或CC状态。基线的衡量标准以及6个月和12个月的后续行动将包括 接受照料者的认知和功能状态，以及照顾者的结果，例如：生活质量、痛苦和 照看功效。还将收集关于种族差异的信息，以回应干预和 估计干预措施的成本效益。DT干预是非常创新的，因为重点是 二元方法，使用最先进的技术进行干预交付，以社区为基础和 制定干预措施的阶段性模型方法，将照顾者纳入为治疗延伸者，并 节目的文化剪裁。

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.