Targeting Functional Decline: Results from the Alzheimer’s Disease Multiple Intervention Trial

Abstract

Background Alzheimer’s disease (AD) results in progressive functional decline leading to loss of independence Objective To determine whether collaborative care plus two years of home-based occupational therapy delays functional decline Design Randomized controlled clinical trial Setting Urban public health system Patients 180 community-dwelling subjects who were diagnosed with AD and their informal caregivers Interventions All subjects received collaborative care for dementia. Intervention patients also received in-home occupational therapy delivered in 24 sessions over 2 years. Measurements The primary outcome measures was the Alzheimer’s Disease Cooperative Studies Group Activities of Daily Living Scale (ADCS ADL); performance based measures included the Short Physical Performance Battery (SPPB) and Short Portable Sarcopenia Measure (SPSM) Results At baseline, there were no significant between group differences in clinical characteristics; the mean MMSE for both groups was 19 (SD=7). The intervention group received a median of 18 home visits from the study occupational therapists. Both groups declined in ADCS ADL scores over 24 months. At the primary endpoint of 24 months, there were no between group differences in ADCS ADL scores (mean difference 2.34, 95% CI −5.27, 9.96). We were also unable to definitively demonstrate between-group differences in the mean SPPB or SPSM. Limitations The results of this trial are indeterminate and do not rule out potentially clinically important effects of the intervention. Conclusions We were unable to definitively demonstrate whether the addition of two years of in-home occupational therapy to a collaborative care management model slows the rate of functional decline among persons with AD. This trial underscores the burden undertaken by family caregivers as they provide care for persons with AD and the difficulty in slowing functional decline.