Alzheimer's:  Efficacy of Home Stimulation and Support

Quayhagen, Mary

Abstract

This pilot study is designed to investigate the efficacy of a new family-based management program of cognitive stimulation for Alzheimer's families when implemented by single family units (caregiver + patient) vs. dual (paired) family units. Efficacy will be determined by: 1) caregiver and patient outcomes, and 2) potential for implementation by families. It is hypothesized that such a program will enhance caregiver well-being and the functional status of the patient, and will be more effectively executed by the dual family approach. Twenty-four older family units with patients (60 to 75 years of age) in the mild to moderate stage of Alzheimer's disease will be selected from an Alzheimer's Disease Research Center. In addition to neuropsychological, medical, and neurological screening, patients will be assessed on cognitive and behavioral functioning, exercise patterns, and drug use. Caregivers will be assessed on physical and mental health status, perceived burden, kinship support, and respite time. The management program of cognitive stimulation will provide the caregiver with a structured plan that can be incorporated into the daily schedule of the family. The activities (communication, memory, and problem solving skills) are designed to challenge the dementia patient while allowing for cognitive fluctuations. In the training, the caregivers will be provided with a taxonomy of activities of increasing complexity. An experimental design with crossover arrangement of treatment (implementation) conditions will be used to evaluate the impact of the program. Family units will be randomly assigned to either the single family or dual family condition for implementing the 12-week program, after which they will be placed in the alternate condition for 12 weeks. Although retraining will intervene, carry-over effects will be studied. Participants will be reassessed after each 12-week program. Repeated measures analyses of covariance will be used to test the hypotheses. Qualitative analyses of caregiver logs will evaluate the effectiveness of program content and related issues. If the family implemented management program approach is feasible, future research will focus on sex and caregiver differences in program use and management, as well as cost effectiveness issues and long range consequences for the caregivers.