Targeting Functional Decline in Alzheimer Disease: A Randomized Trial

Area of Science:

• Gerontology
• Neuroscience
• Rehabilitation Medicine

Background:

• Alzheimer disease (AD) is a progressive neurodegenerative disorder.
• AD leads to significant functional decline and loss of independence.
• Caregiver burden is substantial in managing AD progression.

Purpose of the Study:

• To evaluate if collaborative care combined with 2 years of home-based occupational therapy can delay functional decline in individuals with Alzheimer disease.
• To assess the impact of this combined intervention on daily living activities and physical performance.

Main Methods:

• A randomized, controlled trial involving 180 community-dwelling participants with Alzheimer disease and their informal caregivers.
• Participants received standard collaborative care; the intervention group additionally received 24 sessions of in-home occupational therapy over 2 years.
• Primary outcome: Alzheimer's Disease Cooperative Study Group Activities of Daily Living Scale (ADCS ADL). Secondary outcomes: Short Physical Performance Battery (SPPB) and Short Portable Sarcopenia Measure (SPSM).

Main Results:

• No significant difference in baseline characteristics between the intervention and control groups (mean Mini-Mental State Examination score ~19).
• Functional decline (ADCS ADL scores) occurred in both groups over 24 months.
• No statistically significant difference in ADCS ADL scores, SPPB, or SPSM between groups at the 24-month endpoint.

Conclusions:

• The trial results are indeterminate, failing to definitively prove or disprove a clinically significant effect of the intervention.
• The study highlights the challenges in slowing functional decline in Alzheimer disease.
• The findings underscore the significant burden placed on caregivers of individuals with Alzheimer disease.