The proposed study will examine the efficacy of an innovative Family-based Structural Multisystems In-home Intervention (FSMII) as well as the innovative combination of Family-based Structural Multisystems In-home Intervention and a Computer Telephone Integration System (CTIS). These approaches combine psychosocial and engineering solutions to the problems confronted by Cuban American and White American caregivers of a patient with Alzheimer's disease. The study uses an experimental design in which 300 subjects (caregivers, patients and their families) are randomized to one of three conditions: i) FSMlI, 2) FSMII + CTIS, and 3) Control defined in terms of the usual care provided by local Memory Disorders Clinics. Subjects will be assessed at baseline and at 6, 12, and 18 months after baseline on a battery of outcome variables that include caregiver burden, distress, perceived social support and caregiver satisfaction. The subject population will be obtained from the patient flow at two Memory Disorders Clinics and will be defined as patients with possible or probable Alzheimer's disease, caregiver's with moderate to high subjective rating of caregiving distress, and Cuban or American born. Considerable rigor has been introduced in the form of treatment integrity procedures, blind raters and interviewers, and use of standardized measures. Variables postulated to mediate outcome include measures of family interactional functioning and family coping. Substantial in-kind contributions will be obtained in the form of approximately $60,000 worth of specialized phone equipment required for the implementation of the Computer Telephone Integration System intervention. In addition, careful diagnosis of possible or probable Alzheimer's disease following stringent NlNCDS-ADRDA criteria are obtained at no charge to the study through the Memory Disorder Clinics that are directed by Principal Investigator. A central thrust of this study is to utilize interventions that are considered to be appropriate with Cuban American and White American populations. Special attention will be given to cultural specificity in the conduct of these interventions. This study brings together a very senior interdisciplinary team of scientists/clinicians with expertise in aging, caregiving for dementia patients, family and multi-systems therapy, cultural diversity, and human factors engineering.
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