scholarly journals Effectiveness of cognitive–behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease

2000 ◽  
Vol 176 (6) ◽  
pp. 557-562 ◽  
Author(s):  
Alison Marriott ◽  
Catherine Donaldson ◽  
Nicholas Tarrier ◽  
Alistair Burns
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Positive Impact ◽  
Controlled Trial ◽  
Intervention Group ◽  
Family Intervention ◽  
Post Treatment ◽  
Burden Of Care ◽  
Control Groups

BackgroundThe majority of patients with Alzheimer's disease live outside institutions and there is considerable serious psychological morbidity among their carers.AimsTo evaluate whether family intervention reduces the subjective burden of care in carers of patients with Alzheimer's disease and produces clinical benefits in the patients.MethodA prospective single-blind randomised controlled trial with three-month follow-up in which the experimental group received family intervention and was compared with two control groups.ResultsThere were significant reductions in distress and depression in the intervention group compared with control groups at post-treatment and follow-up. There were significant reductions in behavioural disturbance at post-treatment and an increase in activities at three months in patients in the intervention group. Based on an improvement on the General Health Questionnaire resulting in a carer converting from a case to a non-case, the number to treat was three immediately post-treatment and two at follow-up.ConclusionsFamily intervention can have significant benefits in carers of patients with Alzheimer's disease and has a positive impact on patient behaviour.

scholarly journals Folic Acid Supplementation Mitigates Alzheimer’s Disease by Reducing Inflammation: A Randomized Controlled Trial

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Hui Chen ◽  
Shuai Liu ◽  
Lu Ji ◽  
Tianfeng Wu ◽  
Yong Ji ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Folic Acid ◽  
Repeated Measures ◽  
Mixed Model ◽  
Controlled Trial ◽  
Intervention Group ◽  
Serum Folate ◽  
Control Group ◽  
Mrna Levels

Background/Aims. Low serum folate levels can alter inflammatory reactions. Both phenomena have been linked to Alzheimer’s disease (AD), but the effect of folic acid on AD itself is unclear. We quantified folate supplementation’s effect on inflammation and cognitive function in patients with AD over the course of 6 months.Methods. Patients newly diagnosed with AD (age > 60 years;n=121; mild to severe; international criteria) and being treated with donepezil were randomly assigned into two groups with (intervention group) or without (control group) supplemental treatment with folic acid (1.25 mg/d) for 6 months. The Mini-Mental State Examination (MMSE) was administered to all patients at baseline and follow-up, and blood samples were taken before and after treatment. We quantified serum folate, amyloid beta (Aβ), interleukin-6 (IL-6), tumor necrosis factorα(TNFα), plasma homocysteine (Hcy), S-adenosylmethionine (SAM), S-adenosylhomocysteine (SAH), and the mRNA levels of presenilin (PS), IL-6, and TNFαin leukocytes. Data were analyzed using a repeated-measures mixed model.Results. The mean MMSE was slightly increased in the intervention group compared to that in the control group (P<0.05). Posttreatment, plasma SAM and SAM/SAH levels were significantly higher (P<0.05), while Aβ40, PS1-mRNA, and TNFα-mRNA levels were lower in the intervention group than in the control group (P<0.05). The Aβ42/Aβ40ratio was also higher in the intervention group (P<0.05).Conclusions. Folic acid is beneficial in patients with AD. Inflammation may play an important role in the interaction between folic acid and AD. This trial is registered with clinical trial registration numberChiCTR-TRC-13003246.

Stressor-Oriented MUlticomponent Intervention and the WeLl-Being of Patients with Alzheimer’s Disease: A Randomized Controlled Trial (SOUL-P)

2021 ◽  
Vol 79 (1) ◽  
pp. 141-152
Author(s):  
Bing Yang ◽  
Siyuan Yang ◽  
Yunmei Zhang ◽  
Wentao Liu ◽  
Yao Gan ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Randomized Controlled Trial ◽  
Perceived Stress ◽  
Family Conflict ◽  
Multidisciplinary Team ◽  
Controlled Trial ◽  
Well Being ◽  
Randomized Controlled

Background: Patients with Alzheimer’s disease (AD) experience various stressors that negatively impact well-being. Most studies have, however, small effect size and are limited by the experiences of severe patients. Therefore, we conducted a single-blind, randomized controlled trial, which has included patients at different stages. Objective: The stressor-oriented multicomponent program was designed as an intervention for AD patients to enhance well-being. Methods: Patients were randomly assigned to control or SOUL-P conditions according to disease severity. The SOUL-P group received 15 intensive sessions over 6 months and 6 maintenance sessions over a 6-month follow-up by a multidisciplinary team comprising psychologists, occupational therapists, and community nurses. The control group received a similar number of sessions by community nurses. Stress-related outcomes (primary stressors and well-being outcomes) were obtained from in-person baseline and follow-up interviews conducted at 6- and 12-months post-baseline. A treatment compliance survey was conducted at the intervention endpoint for patients. Results: Of the 863 patients screened, 218 (25.3%) were eligible. At 6 months, compared to controls, SOUL-P patients had improved quality of life (QoL) (p < 0.001; Cohen d = 0.56), depression (p = 0.020; Cohen d = –0.33), neurobehavioral symptoms (p = 0.034; Cohen d = –0.30), perceived stress (p = 0.030; Cohen d = –0.31), and family conflict (p = 0.026; Cohen d = –0.32). QoL, depression, perceived stress, and family conflict were still significantly different at 12 months. Most patients were satisfied with SOUL-P, while caregivers in the SOUL-P group reported overloading tasks. Conclusion: SOUL-P may reduce perceived stress and improve psychological outcomes in AD patients. Stressor-based interventions, patient-oriented goals, and a multidisciplinary team are essential features for a successful SOUL-P.

scholarly journals RATIONALE AND STRUCTURE FOR A NEW CENTER FOR STUDIES ON PREVENTION OF ALZHEIMER’S DISEASE (STOP-AD)

2016 ◽  
pp. 1-7
Author(s):  
J.C.S. Breitner ◽  
J. Poirier ◽  
P.E. Etienne ◽  
J.M. Leoutsakos
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Latent Variable ◽  
Controlled Trial ◽  
Joint Probability ◽  
Cognitively Normal ◽  
Observational Cohort ◽  
Intent To Treat ◽  
Treat Analysis

We describe events spanning over 20 years that have shaped our approach to identification of interventions that may delay symptoms in Alzheimer’s disease (AD). These events motivated the development of a new Centre for Studies on Prevention of AD that includes an observational cohort of cognitively normal high-risk persons and INTREPAD, a nested two-year randomized placebo-controlled trial of the non-steroidal anti-inflammatory drug naproxen sodium. INTREPAD enrolled 217 persons and will follow 160 in a modified intent-to-treat analysis of persons who remained on-protocol through at least one follow-up evaluation. The trial employs dual endpoints: 1) a composite global cognitive score generated by a battery of 12 psychometric tests organized into five subscales; and 2) a summary Alzheimer’s Progression Score derived from latent variable modeling of multiple biomarker data from several modalities. The dual endpoints will be analyzed by consideration of their joint probability under the null hypothesis of no treatment effect, after allowing appropriately for their lack of independence. We suggest that such an approach can be used economically to generate preliminary data regarding the efficacy of potential prevention strategies, thereby increasing the chances of finding one or more interventions that successfully prevent symptoms.

scholarly journals Parietal-Hippocampal rTMS Improves Cognitive Function in Alzheimer's Disease by Inducing Increased Dynamic Functional Connectivity of Default Mode Network

2021 ◽  
Author(s):  
Lili Wei ◽  
Yingchun Zhang ◽  
Jintao Wang ◽  
Luoyi Xu ◽  
Kehua Yang ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Function ◽  
Functional Connectivity ◽  
Default Mode Network ◽  
Verbal Learning ◽  
Post Treatment ◽  
Dynamic Functional Connectivity ◽  
Default Mode

Abstract Background Alzheimer’s disease, a neurodegenerative disease with significant social and economic impact, is mainly treated by focusing on decelerating cognition decline. Parietal-hippocampal repetitive transcranial magnetic stimulation (rTMS) improves memory and cognitive function in Alzheimer’s disease, however, the underlying therapeutic mechanism has not been elucidated. Methods A double-blind, randomized, sham-controlled parietal-hippocampal rTMS trial of mild-to-moderate Alzheimer's disease patients was conducted in the current study. High-frequency rTMS was applied to a subject-specific left lateral parietal region with the highest functional connectivity with the hippocampus based on resting-state fMRI. Patients were randomized to either rTMS or sham treatment (five sessions/week for a total of 10 sessions). A multimodal MRI scan and a complete neuropsychological battery of tests were conducted at baseline, immediately after the intervention and 12-week follow-up after the rTMS treatment. Primary outcomes were differences in the Mini Mental State Examination (MMSE) and Philadelphia Verbal Learning Test (PVLT) scores between the groups and between pre- and post-treatment. Moreover, flexible least squares (FLS) method was used to calculate the dynamic functional connectivity (dFC) of the default mode network (DMN), and dFC changes were compared between the groups and between pre- and post-treatment. Results Patients undergoing active rTMS treatment (n = 31) for two weeks showed higher MMSE, PVLT-Immediate recall, and PVLT-Short Delay recall scores, whereas those who underwent sham rTMS (n = 27) treatment did not show significant changes in these measures. Dynamic functional connectivity (dFC) magnitude of the default mode network (DMN) was significantly higher after two weeks of rTMS treatment in the patients who underwent active-rTMS treatment, however, no significant changes were observed in patients who received sham-rTMS treatment. dFC magnitude reduced to baseline level at 12-week follow-up, which resembled the trajectory of the cognitive measures. A significant positive correlation was observed between changes in MMSE and changes in the dFC magnitude of DMN in patients who underwent active-rTMS treatment, but not in those who received sham-rTMS treatment. Conclusions The findings of the current study indicate that fMRI-guided rTMS treatment improves memory and cognitive function of Alzheimer's disease patients. In addition, the findings indicate that the DMN functional connectivity contributes to therapeutic effectiveness of rTMS. Trial registration: China National Medical Research Platform (http://114.255.48.20/login, No:MR-33-20-004217), retrospectively registered 2020-12-23.

scholarly journals Individual Cognitive Stimulation Therapy in Alzheimer’s Disease: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Yu-chen Qiao ◽  
Hong Chang ◽  
Rui Wang ◽  
Jia-Mei Wang ◽  
Xiao-ying Wang ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Intervention Group ◽  
Cognitive Stimulation ◽  
Control Group ◽  
Randomized Controlled ◽  
Cognitive Stimulation Therapy ◽  
Individual Cognitive Stimulation Therapy

Abstract Background: Individual cognitive stimulation therapy (ICST) can benefit cognition and quality of life for people with dementia, but the evidence for nurses-led individual cognitive stimulation interventions is limited.Objectives: The current study aimed to develop the process of planning and implementing ICST, and evaluate the effect of ICST on cognitive function and therapeutic effect in patients with mild Alzheimer’s disease (AD). Methods: It was a randomized controlled trial lasting for a half year. 38 patients with mild AD were recruited. The control group was given the “Individual Cognitive Stimulation Therapy Manual for AD” to deliver the sessions at home. The intervention group was given 90 minutes ‘cognitive stimulation sessions, completed up to three times weekly over 24 weeks. The outcomes were measured at baseline and 24weeks by the scales widely used in AD evaluation (MMSE, MoCA and ADL).Results: There were statistical significance between the two groups, especially the scores of memory, delayed memory in MMSE and scores of memory, delayed memory, immediate memory, attention in MoCA were significantly improved in the intervention group compared with control group. ICST show positive effects that may help preserve memory in mild AD.Conclusions: The ICST can improve the memory and attention cognitive domains in patients with mild AD. And the feedback from patient and caregiver in ICST was favorable.

scholarly journals Physical Exercise with Multicomponent Cognitive Intervention for Older Adults with Alzheimer's Disease: A 6-Month Randomized Controlled Trial

2016 ◽  
Vol 6 (2) ◽  
pp. 222-232 ◽  
Author(s):  
Min-Ji Kim ◽  
Chang-Wan Han ◽  
Kyoung-Youn Min ◽  
Chae-Yoon Cho ◽  
Chae-Won Lee ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Randomized Controlled Trial ◽  
Physical Exercise ◽  
Controlled Trial ◽  
Intervention Group ◽  
Cognitive Intervention ◽  
Total Load ◽  
Randomized Controlled

Aims: This study aimed to investigate the effect of 6-month physical exercise with a multicomponent cognitive program (MCP) on the cognitive function of older adults with moderate to severe Alzheimer's disease (AD). Methods: We included 33 participants with AD in a 6-month randomized controlled trial. The intervention group participated in physical exercise and received a MCP. The control group received only the MCP. Before and after the intervention, cognitive outcomes were assessed using the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog), Mini-Mental State Examination, and the Clock Drawing Test. Physical performance was evaluated by exercise time, the number of pedal rotation, total load, grip strength, and the Berg Balance Scale (BBS). Results: In all cognitive measures, there were no significant improvements between the two groups after 6 months in the baseline value-adjusted primary analysis. However, the ADAS-cog score was significantly lower between the two groups in secondary analysis adjusted for baseline value, age, sex, and education years. All physical outcomes were significantly higher in the intervention group except for total load compared with baseline measurements. Conclusion: This study indicates that it is possible to improve cognitive function in older adults with moderate to severe AD through 6-month physical exercise with a multicomponent cognitive intervention.

Sustained effects of a brief and standardised acupuncture approach on menopausal symptoms: post hoc analysis of the ACOM randomised controlled trial

2020 ◽  
Vol 38 (6) ◽  
pp. 396-406
Author(s):  
Kamma Sundgaard Lund ◽  
Volkert Siersma ◽  
Christine Winther Bang ◽  
John Brodersen ◽  
Frans Boch Waldorff
Keyword(s):  
Treatment Effect ◽  
Acupuncture Treatment ◽  
Controlled Trial ◽  
Intervention Group ◽  
Post Treatment ◽  
Menopausal Symptoms ◽  
Scale Scores ◽  
Pre Treatment ◽  
Randomised Controlled

Background Our objective was to investigate whether the effect of a brief and standardised acupuncture approach persists after the end of the acupuncture treatment (post-treatment effect) and whether the anticipation of future acupuncture treatment affects menopausal symptoms (pre-treatment effect). Method This study is a post hoc analysis of data from a randomised controlled trial where women with moderate to severe menopausal symptoms were offered weekly acupuncture treatment over five consecutive weeks and randomised (1:1) to an early intervention group that received treatment immediately and a late intervention group with a 6-week delay. The acupuncture style was Western medical, administered at CV3, CV4 and bilateral LR8, SP6 and SP9. Acupuncturists were general practitioners. The effect was evaluated repeatedly during and after the interventions using scales from the validated MenoScores Questionnaire (MSQ) for hot flushes (HF), day and night sweats (DNS), general sweating (GS) and menopausal-specific sleeping problems (MSSP) with a 26-week follow-up period (corresponding to 21 or 15 weeks post-treatment for the early and late intervention groups, respectively). Multivariable linear mixed models were used to analyse the extent and duration of effects. Results Seventy participants were included in the study. Four participants dropped out. Furthermore, one participant was excluded from the short- and long-term follow-up analyses after the insertion of a hormonal intrauterine device, and nine participants were excluded from the long-term follow-up analysis due to the initiation of co-interventions. For each of the four outcomes, the effect was sustained up to 21 weeks post-treatment with an effect size that was only slightly diminished. A small, but significant, pre-treatment effect was observed in the HF scale scores. The same trend, although not significant, was observed in the DNS and MSSP scale scores. No serious harms were reported. Conclusion This study demonstrated that the overall effect of a brief and standardised acupuncture treatment on menopause-relevant outcomes was sustained up to 21 weeks post-treatment and that there was a small pre-treatment effect.

Epilepsy in Early Onset Alzheimer’s Disease

2021 ◽  
pp. 1-12
Author(s):  
Sarah Haoudy ◽  
Thérèse Jonveaux ◽  
Salomé Puisieux ◽  
Jonathan Epstein ◽  
Lucie Hopes ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Decline ◽  
Early Onset ◽  
Positive Impact ◽  
Severe Form ◽  
Csf Biomarkers ◽  
Early Onset Alzheimer’S Disease

Background: Epilepsy seems to be an important comorbidity in patients with early onset Alzheimer’s disease (EOAD). Currently, seizures are still underestimated in this population. However, seizures may interact with AD evolution with possible acceleration of cognitive decline and early institutionalization. Objective: To better define the epileptic disorders observed in patients with EOAD. Methods: All patients diagnosed as EOAD in our hospital between 2013 and 2019 and with positive CSF biomarkers for AD were selected. The usual follow-up was extended with a 3 h EEG and a consultation with an epilepsy expert. Information on epilepsy and AD were collected and analyzed. Results: Among the 25 included patients, 10 (40%) were classified as epileptic. Considering the seizure types, patients presented tonic-clonic seizures (n = 3), typical temporal seizures (n = 3), myoclonus (n = 3), focal extra-temporal seizures (n = 1), and other seizure types (n = 2). AD-E patients had a significant lower MMSE (15.3±8.4 AD-E versus 22.1±5.1 AD-NE, p = 0.036) and a lower autonomy (IADL 4.1±2.7 AD-E versus 6.4±1.9 AD-NE, p = 0.046) at AD diagnosis with comparable ages between AD-E and AD-NE. Epileptic patients seemed to present a faster cognitive decline compared to AD patients without seizures ([ΔMMSE per year 1.7±1.3 AD-E versus 0.9±1.4 AD-NE; p = 0.09). All patients with severe cognitive impairment (MMSE ≤ 10) had an epileptic comorbidity. Conclusion: Epilepsy is a frequent comorbidity in EOAD patients, with a percentage of 40% in our study. This comorbidity may be associated with a severe form of EOAD. The role of epilepsy in the acceleration of cognitive decline and the positive impact of antiepileptic drugs on cognition need further research.

scholarly journals Orthostatic Blood Pressure Recovery Is Associated With the Rate of Cognitive Decline and Mortality in Clinical Alzheimer’s Disease

2020 ◽  
Vol 75 (11) ◽  
pp. 2169-2176
Author(s):  
Rianne A A de Heus ◽  
Daan L K de Jong ◽  
Anne Rijpma ◽  
Brian A Lawlor ◽  
Marcel G M Olde Rikkert ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Blood Pressure ◽  
Alzheimer's Disease ◽  
Confidence Interval ◽  
Cognitive Decline ◽  
Controlled Trial ◽  
Intervention Group ◽  
Disease Assessment ◽  
Progression Rate ◽  
Initial Drop

Abstract Background Impaired recovery of blood pressure (BP) after standing has been shown to be related to cognitive function and mortality in people without dementia, but its role in people with Alzheimer’s disease (AD) is unknown. The aim of this study was to investigate the association of the orthostatic BP response with cognitive decline and mortality in AD. Methods In this post hoc analysis of a randomized controlled trial (Nilvad), we measured the beat-to-beat response of BP upon active standing in mild-to-moderate AD. This included the initial drop (nadir within 40 seconds) and recovery after 1 minute, both expressed relative to resting values. We examined the relationship between a small or large initial drop (median split) and unimpaired (≥100%) or impaired recovery (&lt;100%) with 1.5-year change in Alzheimer’s Disease Assessment—cognitive subscale (ADAS-cog) scores and all-cause mortality. Results We included 55 participants (age 73.1 ± 6.2 years). Impaired BP recovery was associated with higher increases in ADAS-cog scores (systolic: β [95% confidence interval] = 5.6 [0.4–10.8], p = .035; diastolic: 7.6 [2.3–13.0], p = .006). During a median follow-up time of 49 months, 20 participants died. Impaired BP recovery was associated with increased mortality (systolic: HR [95% confidence interval] = 2.9 [1.1–7.8], p = .039; diastolic: HR [95% confidence interval] = 5.5 [1.9–16.1], p = .002). The initial BP drop was not associated with any outcome. Results were adjusted for age, sex, and intervention group. Conclusions Failure to fully recover BP after 1 minute of standing is associated with cognitive decline and mortality in AD. As such, BP recovery can be regarded as an easily obtained marker of progression rate of AD.

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