Collaborative care decreases some symptoms of dementia for patients with Alzheim...( otocols stressed management without med...),Health

otocols stressed management without medications. The minimum intervention that all treatment group caregivers and patients received included education on communication skills; caregiver coping skills; legal and financial advice; patient exercise guidelines with a guidebook and videotape; and a caregiver guide. All of the components of this minimum intervention were provided by a geriatric nurse practitioner, who served as the care manager.

Augmented usual care included participants and their caregivers being provided written materials and information describing local community resources and receiving face-to-face counseling by a geriatric nurse practitioner.

The researchers found through various surveys that intervention patients had significantly fewer behavioral and psychological symptoms of dementia at 12 months and at 18 months. Intervention caregivers also reported significant improvements in distress at 12 months; at 18 months, caregivers showed improvement in depression. There was no evidence that the intervention improves or worsens cognition, activities of daily living, or rates of nursing home placement.

"In summary, application of the current treatment guidelines for the care of older primary care patients with Alzheimer disease results in significant improvements in behavioral and psychological symptoms of dementia and significant improvement in caregiver stress. These improvements exceed those previously reported in studies focusing on pharmacological therapy alone. Achieving a guideline-level dose and duration of the intervention required a care manager who supported the patient's caregiver and physician and adhered to recommended treatment protocols. The intervention demonstrates that care for patients with Alzheimer disease can be improved in the primary care setting but not without substantial changes in the system of care," the authors conclude.

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Contact: Cindy Fox Aisen
317-274-7722
JAMA and Archives Journals
9-May-2006

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