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Functional decline in Alzheimer’s disease persists despite therapy

Patients with Alzheimer’s disease who received 2 years of home-based occupational therapy did not show improvements in functionality, according to research published in Annals of Internal Medicine.

“Over the typical [Alzheimer’s] disease course of 5 to 10 years, the condition results in progressive functional disability, frequent transitions in care, and excess health care costs,” Christopher M. Callahan, MD, from Indiana University Center for Aging Research, and colleagues wrote. “In the context of the disease, functional decline is believed to be the result of progressive deficits in cognitive, emotional, and physical function.”

“During the past decade, several studies focusing on functional decline among patients with Alzheimer’s disease have shown the potential of home-based interventions to slow this decline,” they added.

Callahan and colleagues performed a randomized, controlled clinical trial of patients with Alzheimer’s disease (n = 180) to investigate if 2 years of in-home occupational therapy in addition to collaborative care slowed functional decline. Participants were separated into two groups: control and intervention. Patients in both groups received collaborative care for dementia. Those in the invention group also received 24 sessions of home-based occupational therapy over the course of 2 years.

The investigators used the Alzheimer's Disease Cooperative Study Group Activities of Daily Living Scale (ADCS ADL), Short Physical Performance Battery (SPPB) and Short Portable Sarcopenia Measure (SPSM) to evaluate patients.

Results demonstrated that there was no significant difference in clinical characteristics at baseline between the groups. Both groups had a mean Mini-Mental State Examination score of 19 (SD, 7). Occupational therapists made a median of 18 home visits to patients in the intervention group. Over the study duration of 2 years, ADCS ADL scores declined in both groups. In addition, there was no significant difference in ADCS ADL scores between groups at the primary endpoint of 2 years (mean difference, 2.34; 95% CI, –5.27 to 9.96). Mean SPPB and SPSM values did not show definite differences between groups.

Callahan and colleagues noted limitations to the study and suggest that a larger study population, a more rigorous occupational therapy intervention and an extended observation period may have produced more favorable results. However, they argued that these data do not discount potential clinically significant impacts of the intervention.

“Our findings suggest that persons with dementia face a steady decline in function that is not slowed by collaborative care and may continue even with home-based occupational therapy,” Callahan and colleagues concluded. “We report indeterminate results regarding the question of whether occupational therapy slows the rate of functional decline relative to collaborative care alone. Given the burden of caring for persons with dementia ... research must focus on identifying strategies to support caregivers in the home to provide care to persons with dementia. If the gradual functional decline attributable to Alzheimer’s disease is irreversible, a new generation of assistive devices, home modifications, community services, and technologies is needed to make longer-term support in the home a practical reality for patients and families.” – by Alaina Tedesco

Disclosure: The researchers report primary funding by the National Institute of Aging.