Although the prevalence of dementia increases with advancing age, and the disability, which accompanies dementia is far-reaching, few effective treatment programs exist. Capitalizing on our knowledge of physical frailty in older adults, behavioral and affective disturbance in AD, and the impact of these problems on caregivers' affective health, this project is designed to develop, implement, and evaluate an integrated model of medical, behavioral, and psychosocial intervention. Treatment is designed to reduce the physical, behavioral, and affective problems in patients with AD and to alleviate the depression and burden in their caregivers. Two hundred community residing AD patient-caregiver pairs will be randomly assigned to the active treatment or to treatment-as-usual (acute medical care, advice and support, and crisis intervention). The active intervention is designed to simulate clinical practice by providing a step-up approach to care for all AD patients and their caregivers. The specific goals of intervention are to reduce physical disability by improving patient mobility, maintaining adequate nutrition, decreasing adverse drug reactions, and decreasing falls and fractures; to reduce affective disability by identifying and treating depressive symptoms in patients and caregivers; to decrease patient behavior problems; and to decrease caregiver burden. All subjects are members of a community-based HMO and are enrolled in an ongoing Alzheimer's Disease Patient Registry that identifies and follows incident cases of AD. Subjects will be assessed upon enrollment in the investigation, and at six month intervals for a period of at least two years to evaluate their cognitive, physical, behavioral, and affective status. Health care utilization and costs will also be evaluated. It is hypothesized that AD patients in the active intervention will show significantly better outcome than controls, as deflected in better health, fitness, and mobility, less depression, and fewer behavior problems over the two year period. Further, it is hypothesized that caregivers in the active treatment will be less depressed and burdened than caregivers in the control condition. Finally, reduced health care utilization is expected in the active treatment group compared with the control group.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG010845-02
Application #
2052064
Study Section
Epidemiology and Disease Control Subcommittee 2 (EDC)
Project Start
1993-09-30
Project End
1998-06-30
Budget Start
1994-07-10
Budget End
1995-06-30
Support Year
2
Fiscal Year
1994
Total Cost
Indirect Cost
Name
University of Washington
Department
Psychiatry
Type
Schools of Medicine
DUNS #
135646524
City
Seattle
State
WA
Country
United States
Zip Code
98195
Millard, Steven P; Lutz, Franziska; Li, Ge et al. (2014) Association of cerebrospinal fluid A?42 with A2M gene in cognitively normal subjects. Neurobiol Aging 35:357-64
Tsuang, Debby; Leverenz, James B; Lopez, Oscar L et al. (2013) APOE ?4 increases risk for dementia in pure synucleinopathies. JAMA Neurol 70:223-8
Teri, Linda; McKenzie, Glenise; Logsdon, Rebecca G et al. (2012) Translation of two evidence-based programs for training families to improve care of persons with dementia. Gerontologist 52:452-9
Christie, Drew; Shofer, Jane; Millard, Steven P et al. (2012) Genetic association between APOE*4 and neuropsychiatric symptoms in patients with probable Alzheimer's disease is dependent on the psychosis phenotype. Behav Brain Funct 8:62
Tsuang, Debby; Leverenz, James B; Lopez, Oscar L et al. (2012) GBA mutations increase risk for Lewy body disease with and without Alzheimer disease pathology. Neurology 79:1944-50
Logsdon, Rebecca G; McCurry, Susan M; Pike, Kenneth C et al. (2009) Making physical activity accessible to older adults with memory loss: a feasibility study. Gerontologist 49 Suppl 1:S94-9
McCurry, Susan M; Gibbons, Laura E; Logsdon, Rebecca G et al. (2009) Insomnia In Caregivers Of Persons With Dementia: Who Is At Risk And What Can Be Done About It? Sleep Med Clin 4:519-526
Leverenz, James B; Lipton, Anne M (2008) Clinical aspects of hippocampal sclerosis. Handb Clin Neurol 89:565-7
Leverenz, James B; Hamilton, Ronald; Tsuang, Debby W et al. (2008) Empiric refinement of the pathologic assessment of Lewy-related pathology in the dementia patient. Brain Pathol 18:220-4
Teri, L; Logsdon, R G; McCurry, S M (2008) Exercise interventions for dementia and cognitive impairment: the Seattle Protocols. J Nutr Health Aging 12:391-4

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