Christopher M. Callahan, MD; Malaz A. Boustani, MD, MPH; Arlene A. Schmid, PhD, OTR; Michael A. LaMantia, MD, MPH; Mary G. Austrom, PhD; Douglas K. Miller, MD; Sujuan Gao, PhD; Denisha Y. Ferguson, AAS; Kathleen A. Lane, MS; Hugh C. Hendrie, MB ChB, DSc
Grant Support: By National Institute on Aging grant R01 AG034946.
Disclosures: Dr. Boustani reports ownership interest in and consulting fees from Preferred Population Health Management; he also reports membership in and honoraria from the Beacon Advisory Board, AstraZeneca. Dr. LaMantia reports grants from the National Institutes of Health during the conduct of the study; he received a travel honorarium from Merck that was administered by the American Geriatrics Society; he received an honorarium for speaking at the Indiana Academy of Family Practice winter meeting; and he has intellectual property rights in a software package used to manage the care of older adults with dementia and late-life depression. Dr. Miller and Ms. Lane report grants from the National Institutes of Health during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0830.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: See earlier study by Callahan and colleagues (17). Statistical code and data set: Available from Dr. Callahan (e-mail, email@example.com).
Requests for Single Reprints: Christopher M. Callahan, MD, Indiana University Center for Aging Research, 1101 West 10th Street, Indianapolis, IN 46202; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Callahan, Boustani, Miller, and Hendrie and Ms. Ferguson: Indiana University Center for Aging Research, 1101 West 10th Street, Indianapolis, IN 46202.
Dr. Schmid: Colorado State University, Health and Human Sciences, Department of Occupational Therapy, Integrative Rehabilitation Laboratory, 3185 Rampart Road, Building V1, Fort Collins, CO 80521.
Dr. LaMantia: University of Vermont College of Medicine, Given Courtyard, 4th Floor, Burlington, VT 05401.
Dr. Austrom: Indiana University Department of Psychiatry, 355 West 16th Street, GH 2800, Indianapolis, IN 46202.
Dr. Gao and Ms. Lane: Indiana University Department of Biostatistics, 410 West 10th Street, HS 3000, Indianapolis, IN 46202.
Author Contributions: Conception and design: C.M. Callahan, M.A. Boustani, A.A. Schmid, M.G. Austrom, D.K. Miller, S. Gao, H.C. Hendrie.
Analysis and interpretation of the data: C.M. Callahan, M.A. Boustani, A.A. Schmid, M.A. LaMantia, M.G. Austrom, D.K. Miller, S. Gao, K.A. Lane, H.C. Hendrie.
Drafting of the article: C.M. Callahan, M.A. Boustani, A.A. Schmid, M.G. Austrom, D.K. Miller, K.A. Lane, H.C. Hendrie.
Critical revision for important intellectual content: C.M. Callahan, M.A. Boustani, A.A. Schmid, M.A. LaMantia, D.K. Miller, S. Gao, H.C. Hendrie.
Final approval of the article: C.M. Callahan, M.A. Boustani, A.A. Schmid, M.A. LaMantia, M.G. Austrom, D.K. Miller, S. Gao, D.Y. Ferguson, K.A. Lane, H.C. Hendrie.
Provision of study materials or patients: C.M. Callahan, A.A. Schmid.
Statistical expertise: S. Gao, K.A. Lane.
Obtaining of funding: C.M. Callahan, M.A. Boustani, A.A. Schmid.
Administrative, technical, or logistic support: C.M. Callahan, M.A. Boustani, M.A. LaMantia.
Collection and assembly of data: C.M. Callahan, M.A. Boustani, D.Y. Ferguson, K.A. Lane.
Callahan CM, Boustani MA, Schmid AA, LaMantia MA, Austrom MG, Miller DK, et al. Targeting Functional Decline in Alzheimer Disease: A Randomized Trial. Ann Intern Med. 2017;166:164-171. doi: 10.7326/M16-0830
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Published: Ann Intern Med. 2017;166(3):164-171.
Published at www.annals.org on 22 November 2016
Alzheimer disease results in progressive functional decline, leading to loss of independence.
To determine whether collaborative care plus 2 years of home-based occupational therapy delays functional decline.
Randomized, controlled clinical trial. (ClinicalTrials.gov: NCT01314950)
Urban public health system.
180 community-dwelling participants with Alzheimer disease and their informal caregivers.
All participants received collaborative care for dementia. Patients in the intervention group also received in-home occupational therapy delivered in 24 sessions over 2 years.
The primary outcome measure was the Alzheimer's Disease Cooperative Study Group Activities of Daily Living Scale (ADCS ADL); performance-based measures included the Short Physical Performance Battery (SPPB) and Short Portable Sarcopenia Measure (SPSM).
At baseline, clinical characteristics did not differ significantly between groups; the mean Mini-Mental State Examination score for both groups was 19 (SD, 7). The intervention group received a median of 18 home visits from the study occupational therapists. In both groups, ADCS ADL scores declined over 24 months. At the primary end point of 24 months, ADCS ADL scores did not differ between groups (mean difference, 2.34 [95% CI, −5.27 to 9.96]). We also could not definitively demonstrate between-group differences in mean SPPB or SPSM values.
The results of this trial are indeterminate and do not rule out potential clinically important effects of the intervention.
The authors could not definitively demonstrate whether the addition of 2 years of in-home occupational therapy to a collaborative care management model slowed the rate of functional decline among persons with Alzheimer disease. This trial underscores the burden undertaken by caregivers as they provide care for family members with Alzheimer disease and the difficulty in slowing functional decline.
National Institute on Aging.
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