Adjunctive Therapy to Manage Neuropsychiatric Symptoms in Moderate and Severe Dementia: Randomized Clinical Trial Using an Outpatient Version of Tailored Activity Program

Article type: Research Article

Authors: Oliveira, Alexandra Martini^{a; b; *} | Radanovic, Marcia^b | Mello, Patricia Cotting Homem de^a | Buchain, Patricia Cardoso^a | Vizzotto, Adriana Dias Barbosa^a | Harder, Janaína^c | Stella, Florindo^b | Gitlin, Laura N.^{d; e; f} | Piersol, Catherine Verrier^g | Valiengo, Leandro L.C.^b | Forlenza, Orestes Vicente^b

Affiliations: [a] Serviço de Terapia Ocupacional, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil | [b] Laboratorio de Neurociencias (LIM-27), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil | [c] Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, Brazil | [d] Johns Hopkins University School of Nursing, Baltimore, MD, USA | [e] Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD, USA | [f] Drexel College of Nursing and Health Professions, Philadelphia, PA, USA | [g] Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA, USA

Correspondence: [*] Correspondence to: Alexandra Martini de Oliveira, Ovidio Pires de Campos Street, Number 785, Cerqueira Cesar, Sao Paulo, Sao Paulo State 05403-010, Brazil. Tel.: +55 11 26618043; E-mail: to.alexandramartini@gmail.com.

Abstract: Background:Neuropsychiatric symptoms (NPS) such as aggression, apathy, agitation, and wandering may occur in up to 90%of dementia cases. International guidelines have suggested that non-pharmacological interventions are as effective as pharmacological treatments, however without the side effects and risks of medications. An occupational therapy method, called Tailored Activity Program (TAP), was developed with the objective to treat NPS in the elderly with dementia and has been shown to be effective. Objective:Evaluate the efficacy of the TAP method (outpatient version) in the treatment of NPS in individuals with dementia and in the burden reduction of their caregivers. Methods:This is a randomized, double-blind, controlled clinical trial for the treatment of NPS in dementia. Outcome measures consisted of assessing the NPS of individuals with dementia, through the Neuropsychiatric Inventory-Clinician rating scale (NPI-C), and assessing the burden on their caregivers, using the Zarit Scale. All the participants were evaluated pre-and post-intervention. Results:54 individuals with dementia and caregivers were allocated to the experimental (n = 28) and control (n = 26) groups. There was improvement of the following NPS in the experimental group: delusions, agitation, aggressiveness, depression, anxiety, euphoria, apathy, disinhibition, irritability, motor disturbance, and aberrant vocalization. No improvement was observed in hallucinations, sleep disturbances, and appetite disorders. The TAP method for outpatient settings was also clinically effective in reducing burden between caregivers of the experimental group. Conclusion:The use of personalized prescribed activities, coupled with the caregiver training, may be a clinically effective approach to reduce NPS and caregiver burden of individuals with dementia.

Keywords: Caregiver burden, dementia, family caregiving, neuropsychiatric behaviors, non-pharmacologic intervention, occupational therapy

DOI: 10.3233/JAD-210142

Journal: Journal of Alzheimer's Disease, vol. 83, no. 1, pp. 475-486, 2021