Disturbing behavioral symptoms of Alzheimer's disease (AD) are a major cause of stress and burden for caregivers and a frequent reason for patient institutionalization. Although pharmacologic and non-pharmacologic treatment methods have been attempted , limited information is available on a combined caregiver/patient approach to manage these AD symptoms and alleviate caregiver stress and burden. Subjects currently being studied and treated as part of an NIA-funded pharmacologic treatment study, and their caregivers, will be enrolled in the proposed study (N = 60 dyads) and randomly assigned to either treatment or control condition. The primary objectives are to assess the effect of nonpharmacologic interventions on: (1) a reduction in the magnitude and severity of disturbing patient behaviors; (2) a reduction in the caregiver's level of perceived stress; and (3) a reduction in the caregiver's level of burden. Secondary objectives are to assess possible impact of the proposed interventions on (1) a reduction in psychotropic patient medication; and (2) on postponement or prevention of institutionalization of the patient. Specifically, we will investigate whether a combination of the following interventions, individually tailored to each caregiver/patient dyad, will influence outcome: (1) developing, with the caregiver and the patient, a daily schedule of planned activities based on the patient's present cognitive and functional level, past interests and activities, and circumstances of their home environment; and (2) educating the caregiver regarding the cognitive, behavioral and functional course of AD, and the use of behavior-management techniques to avert or minimize the most difficult problems of behavior and activities of daily living (ADLs). A home visit will be made to determine the adaptability of the activities schedule to the home environment. The activities schedule will be reevaluated monthly with the caregiver to determine the appropriateness and effectiveness of the proposed interventions. The hypothesis that problem-focused educational and therapeutic interventions with caregivers, aimed at developing practical skills in behavior management, combined with meaningful pleasant activities performed with patients, may reduce the frequency and severity of behavioral disturbance and alleviate caregiver burden will be rigorously evaluated. It is hoped that this preliminary investigation will elicit valuable initial information on the efficacy of these approaches which may be of immediate relevance in AD community treatment settings.
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