Two years of in-home occupational therapy, added to collaborative care, did not slow the rate of functional decline — the progressive loss of cognitive, emotional, and physical abilities — in patients with Alzheimer disease (AD), a new study reported.
The study, “Targeting Functional Decline in Alzheimer Disease: A Randomized Trial,” was published in Annals of Internal Medicine.
“Over the typical [Alzheimer’s] disease course of 5 to 10 years, the condition results in progressive functional disability, frequent transitions in care, and excess health care costs,” Christopher M. Callahan, MD, with the Indiana University Center for Aging Research, and colleagues wrote, according to a news release. “During the past decade, several studies focusing on functional decline among patients with Alzheimer’s disease have shown the potential of home-based interventions to slow this decline.”
To determine whether collaborative care plus extended, home-based occupational therapy could delay functional decline, Callahan and colleagues conducted a randomized, controlled clinical trial (NCT01314950), in 180 people with a diagnosis of possible or probable AD.
Patients were randomly assigned to either a control group, receiving best practices primary care, or to an intervention group receiving best practice primary care plus a 24 sessions of occupational therapy at their home over the course of two years.
The primary endpoint was the assessment of improved cognition and slowed rate of decline as measured by the Alzheimer’s Disease Cooperative Study Activities of Daily Living Scale (ADCS ADL). The Short Physical Performance Battery (SPPB) and Short Portable Sarcopenia Measure (SPSM) served as the main secondary measures of improved functioning.
There were no differences between groups in terms of clinical characteristics at study entry. Both groups had a mean Mini-Mental State Examination (a measure of cognitive function) score of 19, suggesting moderate dementia.
Over the course of two years, ADCS ADL scores declined in both groups, and at the study’s end, no difference in these scores was evident between the groups. There were also no notable differences in the mean SPPB or SPSM values between the groups.
Researchers considered that these results are indeterminate, and did not rule out potential clinically important effects of the intervention. They believe that a larger sample of patients and a more rigorous intervention for a longer period may have produced more encouraging results.
“Our findings suggest that persons with dementia face a steady decline in function that is not slowed by collaborative care and may continue even with home-based occupational therapy,” the researchers concluded, according to the release. “We report indeterminate results regarding the question of whether occupational therapy slows the rate of functional decline relative to collaborative care alone.
“Given the burden of caring for persons with dementia … research must focus on identifying strategies to support caregivers in the home to provide care to persons with dementia. If the gradual functional decline attributable to Alzheimer’s disease is irreversible, a new generation of assistive devices, home modifications, community services, and technologies is needed to make longer-term support in the home a practical reality for patients and families.”
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