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(激越、攻击性等；又称BPSD)是标志 阿尔茨海默病和相关痴呆症(ADRD)。BPSD主宰疾病表现，发生在 病因和疾病轨迹，并对痴呆症患者产生重大负面后果， 家庭成员和整个社会。尽管没有FDA批准的治疗BPSD的药物， 精神药物(包括抗精神病药物)是常用的药物，疗效有限，风险高。 非药物治疗被认为是一线治疗，并已被证明有效，但家庭 他们对战略知之甚少，也不了解战略，只能靠自己来管理BPSD。作为回应，我们 通过之前资助的NINR赠款(R01)开发了一个易于使用的基于Web的平台WeCareAdvisor NR014200)，供家庭照顾者使用。该工具每天为照顾者提供有关痴呆症的知识 技巧，以及系统的方法来描述、调查、创建和评估使用 我们开发的方法(骰子)系统地指导匹配症状的策略选择 演示文稿。我们的先导性随机研究(N=57；NIA-阶段1)比较了初始治疗组和1- 每月等待名单控制，护理员每周都会收到鼓励使用工具的电话和电子邮件。这 Pilot向100%使用该工具的护理人员演示了概念验证。使用1个月后， 初步治疗和等待名单对照组在照顾者(苦恼， 信心)和bpsd(频率和严重程度)结果。此外，在以下方面也有显著改善 与等待名单组相比，最初治疗组的照顾者痛苦。不清楚的是，是否提示 是使用工具和/或获得利益所必需的。为回应PAR-18-027，我们建议测试 WeCareAdvisor(NIA-第二阶段)的疗效和工具利用率在326名不同的照顾者中使用两组， 随机设计；照顾者将被分配到立即治疗组或3个月等待名单对照组。我们的 具体目的是测试：1)WeCareAdvisor对照顾者痛苦、自信的短期疗效(1个月) 管理BPSD或BPSD频率和严重程度；2)WeCareAdvisor的长期疗效(3个月) 照顾者的痛苦，管理BPSD的信心，或BPSD的频率和严重程度。我们还将检查 等待名单控制组在使用该工具超过3个月后是否表现出类似的益处； 以及3)使用不同提醒的工具利用率和结果(仅限电话+电子邮件或电子邮件)。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。 探索性目标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；中介(理论上派生的变量)和调节(种族，关系) 效果。这一建议在评估一个具有巨大影响潜力的工具的有效性和利用率方面是新颖的 通过为照顾者提供按需访问BPSD管理策略来提供痴呆症护理。

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.