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Faieta J, Ebuenyi ID, Devos H, Reynolds CF, Rodakowski J. The Role of Rehabilitation for Early-Stage Alzheimer's Disease and Related Dementias: Practice and Priorities. Arch Phys Med Rehabil 2024; 105:792-795. [PMID: 37757939 DOI: 10.1016/j.apmr.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/10/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
The World Health Organization describes rehabilitation as interventions that focus on addressing disability through optimizing functional ability for individuals living with various health challenges in their unique daily life contexts. Rehabilitation services are typically seeking to enhance functional capacity and health, either in concert with, or in place of pharmacologic interventions. These services typically fall into 2 categories, restorative, where the client endeavors to return to a prior level of independent function, and compensatory, where s/he may not. In the latter case, clients might receive, and be trained to use, technology aids or other external supports to enable them to engage in a safe, healthy, and meaningful day-to-day life. For some populations, however, even enhanced functional capacity can present in the form of an insidious, albeit slower decline. So, what is, or should, rehabilitation's role be in progressive neurologic conditions? Specifically, what are the policy and practice implications of rehabilitation for (not in the presence of, but for) the care of persons living with neurodegenerative conditions such as Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD)?
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Affiliation(s)
- Julie Faieta
- Department of Rehab Science & Technology, University of Pittsburgh, Pittsurgh, PA.
| | - Ikenna D Ebuenyi
- Department of Rehab Science & Technology, University of Pittsburgh, Pittsurgh, PA
| | - Hannes Devos
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, The University of Kansas Medical Center, Kansas City, KA
| | - Charles F Reynolds
- University of Pittsburgh School of Medicine, Pittsurgh, PA; School of Public Health, University of Pittsburgh, Pittsurgh, PA
| | - Juleen Rodakowski
- Department of Occupational Therapy, University of Pittsburgh, Pittsurgh, PA
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Vlotinou P, Tsiakiri A, Detsaridou G, Nikova A, Tsiptsios D, Vadikolias K, Aggelousis N. Occupational Therapy Interventions in Patients with Frontotemporal Dementia: A Systematic Review. Med Sci (Basel) 2023; 11:71. [PMID: 37987326 PMCID: PMC10660551 DOI: 10.3390/medsci11040071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023] Open
Abstract
Frontotemporal dementia (FTD) is a neurodegenerative disorder characterized by progressive impairments in behavior, executive function, and language, primarily affecting individuals under the age of 65. This disorder is associated with expressive and receptive anomia, word comprehension deficits, and behavioral symptoms such as apathy, loss of empathy, and disinhibition, all of which closely correlate with functional impairment in daily activities. Despite substantial efforts, research on occupational therapy (OT) interventions has yet to demonstrate clear benefits in managing the disease. The aim of this study is to investigate OT interventions and assess their efficacy, with a specific focus on individuals suffering from FTD. We systematically conducted searches on two databases, namely Medline and Science Direct, spanning a ten-year period from 2003 to 2023, in accordance with the PRISMA guidelines. Eleven studies met the inclusion criteria. OT interventions targeted both patients and caregivers and yielded significant positive improvements in their lives. A key focus of these interventions was to teach acceptable alternatives to the behaviors exhibited by FTD patients, as these behaviors are strongly influenced by the disease itself. OT contributes positively to enhancing the quality of life of FTD patients and alleviating the caregiving burden experienced by those providing long-term care to these patients.
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Affiliation(s)
- Pinelopi Vlotinou
- Department of Occupational Therapy, University of West Attica, 12243 Athens, Greece;
| | - Anna Tsiakiri
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (G.D.); (D.T.); (K.V.)
| | - Georgia Detsaridou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (G.D.); (D.T.); (K.V.)
| | - Alexandrina Nikova
- Department of Neurosurgery, Democristus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Dimitrios Tsiptsios
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (G.D.); (D.T.); (K.V.)
| | - Konstantinos Vadikolias
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (G.D.); (D.T.); (K.V.)
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece;
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Guzzon A, Rebba V, Paccagnella O, Rigon M, Boniolo G. The value of supportive care: A systematic review of cost-effectiveness of non-pharmacological interventions for dementia. PLoS One 2023; 18:e0285305. [PMID: 37172047 PMCID: PMC10180718 DOI: 10.1371/journal.pone.0285305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/20/2023] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND Almost 44 million people are currently living with dementia worldwide. This number is set to increase threefold by 2050, posing a serious threat to the sustainability of healthcare systems. Overuse of antipsychotic drugs for the management of the symptoms of dementia carries negative consequences for patients while also increasing the health expenditures for society. Supportive care (SC) interventions could be considered a safer and potentially cost-saving option. In this paper we provide a systematic review of the existing evidence regarding the cost-effectiveness and cost-utility of SC interventions targeted towards persons living with dementia and their caregivers. METHODS A systematic literature review was performed between February 2019 and December 2021 through searches of the databases PubMed (MEDLINE), Cochrane Library, CENTRAL, Embase and PsycINFO. The search strategy was based on PRISMA 2020 recommendations. We considered studies published through December 2021 with no lower date limit. We distinguished between five categories of SC strategies: cognitive therapies, physical activity, indirect strategies (organisational and environmental changes), interventions primarily targeted towards family caregivers, and multicomponent interventions. RESULTS Of the 5,479 articles retrieved, 39 met the inclusion criteria. These studies analysed 35 SC programmes located at different stages of the dementia care pathway. Eleven studies provided evidence of high cost-effectiveness for seven interventions: two multicomponent interventions; two indirect interventions; two interventions aimed at caregivers of community-dwelling persons with dementia; one community-based cognitive stimulation and occupational programme. CONCLUSION We find that the most promising SC strategies in terms of cost-effectiveness are multicomponent interventions (targeted towards both nursing home residents and day-care service users), indirect strategies (group living and dementia care management at home), some forms of tailored occupational therapy, together with some psychosocial interventions for caregivers of community-dwelling persons with dementia. Our results suggest that the adoption of effective SC interventions may increase the economic sustainability of dementia care.
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Affiliation(s)
- Angelica Guzzon
- CRIEP (Interuniversity Research Centre on Public Economics), Veneto, Italy
- Department of Economics, Ca' Foscari University of Venice, Venice, Italy
| | - Vincenzo Rebba
- CRIEP (Interuniversity Research Centre on Public Economics), Veneto, Italy
- Department of Economics and Management "Marco Fanno", University of Padova, Padova, Italy
| | - Omar Paccagnella
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | | | - Giovanni Boniolo
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
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Alexopoulos P, Novotni A, Novotni G, Vorvolakos T, Vratsista A, Konsta A, Kaprinis S, Konstantinou A, Bonotis K, Katirtzoglou E, Siarkos K, Bekri ES, Kokkoris I, Como A, Gournellis R, Stoyanov DS, Politis A. Old age mental health services in Southern Balkans: Features, geospatial distribution, current needs, and future perspectives. Eur Psychiatry 2020; 63:e88. [PMID: 32921324 PMCID: PMC7576530 DOI: 10.1192/j.eurpsy.2020.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/06/2020] [Accepted: 09/07/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Healthcare services are increasingly confronted with challenges related to old age mental disorders. The survey aimed to provide an overview of existing psychogeriatric services in Albania, Bulgaria, Greece, and North Macedonia. METHODS After identification of psychogeriatric units across the four countries, their head physicians were asked to provide data on their clinical, teaching, and research activity, as well as staff composition. Moreover, the attitudes of head physicians to current needs and future service development were explored. RESULTS A total of 15 psychogeriatric units were identified (3 in Bulgaria, 8 in Greece, and 4 in North Macedonia). Results show wide variation regarding the location, team size and composition, service availability, numbers of patients attending, and inpatient treatment length. Most head physicians underscored the urgent need for breakthroughs in the graduate and postgraduate education in psychogeriatrics of medical and nonmedical professionals, as well as in the interconnection of their units with community primary healthcare services and long-term care facilities for seniors via telemedicine. They would welcome the development of national standards for psychogeriatric units, potentially embodying clear pointers for action. A number of head physicians advocated the development of nationwide old age mental health registries. CONCLUSIONS Regional disparities in resources and services for seniors' mental health services were unveiled. These data may enrich the dialogue on optimizing psychogeriatric services through planning future cross-border collaborations mainly based on telemedicine services, especially in the era of the novel coronavirus pandemic, and training/education in psychogeriatrics of mental health professionals.
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Affiliation(s)
- P. Alexopoulos
- Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Faculty of Medicine, Technische. Technische Universität München, Munich, Germany
| | - A. Novotni
- University Clinic of Psychiatry, Medical Faculty, University “Ss Cyril and Methodius”, Skopje, North Macedonia
| | - G. Novotni
- University Clinic of Neurology, Medical Faculty, University “Ss Cyril and Methodius”, Skopje, North Macedonia
| | - T. Vorvolakos
- Department of Psychiatry, Alexandroupolis University General Hospital, Faculty of Medicine, School of Health Sciences, Democritus University of Thrace, Alexandroupolis, Greece
| | - A. Vratsista
- Department of Psychiatry, Arta General Hospital, Arta, Greece
| | - A. Konsta
- 1 Department of Psychiatry, “Papageorgiou” General Hospital, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S. Kaprinis
- 3 Department of Psychiatry. Psychiatric Hospital of Thessaloniki, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A. Konstantinou
- Department of Psychiatry, Larissa University General Hospital, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - K. Bonotis
- Department of Psychiatry, Larissa University General Hospital, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - E. Katirtzoglou
- 1st Department of Psychiatry, “Eginition” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - K. Siarkos
- 1st Department of Psychiatry, “Eginition” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - E. S. Bekri
- Environmental Engineering Laboratory, Department of Civil Engineering, School of Engineering, University of Patras, Patras, Greece
| | - I. Kokkoris
- Division of Plant Biology, Department of Biology, School of Basic Sciences, University of Patras, Patras, Greece
| | - A. Como
- Psychiatry Division, Department of Neuroscience, Tirana University Hospital Center “Mother Teresa”, Tirana Medical University, Tirana, Albania
| | - R. Gournellis
- 2nd Department of Psychiatry, “Attikon” University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - D. S. Stoyanov
- Department of Psychiatry and Medical Psychology, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - A. Politis
- 1st Department of Psychiatry, “Eginition” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins Medical School, Baltimore, USA
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Möhler R, Renom A, Renom H, Meyer G. Personally tailored activities for improving psychosocial outcomes for people with dementia in community settings. Cochrane Database Syst Rev 2020; 8:CD010515. [PMID: 32786083 PMCID: PMC8094398 DOI: 10.1002/14651858.cd010515.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND People with dementia living in the community, that is in their own homes, are often not engaged in meaningful activities. Activities tailored to their individual interests and preferences might be one approach to improve quality of life and reduce challenging behaviour. OBJECTIVES To assess the effects of personally tailored activities on psychosocial outcomes for people with dementia living in the community and their caregivers. To describe the components of the interventions. To describe conditions which enhance the effectiveness of personally tailored activities in this setting. SEARCH METHODS We searched ALOIS: the Cochrane Dementia and Cognitive Improvement Group's Specialized Register on 11 September 2019 using the terms: activity OR activities OR occupation* OR "psychosocial intervention" OR "non-pharmacological intervention" OR "personally-tailored" OR "individually-tailored" OR individual OR meaning OR involvement OR engagement OR occupational OR personhood OR "person-centred" OR identity OR Montessori OR community OR ambulatory OR "home care" OR "geriatric day hospital" OR "day care" OR "behavioural and psychological symptoms of dementia" OR "BPSD" OR "neuropsychiatric symptoms" OR "challenging behaviour" OR "quality of life" OR depression. ALOIS contains records of clinical trials identified from monthly searches of a number of major healthcare databases, numerous trial registries and grey literature sources. SELECTION CRITERIA We included randomised controlled trials and quasi-experimental trials including a control group offering personally tailored activities. All interventions comprised an assessment of the participant's present or past interests in, or preferences for, particular activities for all participants as a basis for an individual activity plan. We did not include interventions offering a single activity (e.g. music or reminiscence) or activities that were not tailored to the individual's interests or preferences. Control groups received usual care or an active control intervention. DATA COLLECTION AND ANALYSIS Two review authors independently checked the articles for inclusion, extracted data, and assessed the methodological quality of all included studies. We assessed the risk of selection bias, performance bias, attrition bias, and detection bias. In case of missing information, we contacted the study authors. MAIN RESULTS We included five randomised controlled trials (four parallel-group studies and one cross-over study), in which a total of 262 participants completed the studies. The number of participants ranged from 30 to 160. The mean age of the participants ranged from 71 to 83 years, and mean Mini-Mental State Examination (MMSE) scores ranged from 11 to 24. One study enrolled predominantly male veterans; in the other studies the proportion of female participants ranged from 40% to 60%. Informal caregivers were mainly spouses. In four studies family caregivers were trained to deliver personally tailored activities based on an individual assessment of interests and preferences of the people with dementia, and in one study such activities were offered directly to the participants. The selection of activities was performed with different methods. Two studies compared personally tailored activities with an attention control group, and three studies with usual care. Duration of follow-up ranged from two weeks to four months. We found low-certainty evidence indicating that personally tailored activities may reduce challenging behaviour (standardised mean difference (SMD) -0.44, 95% confidence interval (CI) -0.77 to -0.10; I2 = 44%; 4 studies; 305 participants) and may slightly improve quality of life (based on the rating of family caregivers). For the secondary outcomes depression (two studies), affect (one study), passivity (one study), and engagement (two studies), we found low-certainty evidence that personally tailored activities may have little or no effect. We found low-certainty evidence that personally tailored activities may slightly improve caregiver distress (two studies) and may have little or no effect on caregiver burden (MD -0.62, 95% CI -3.08 to 1.83; I2 = 0%; 3 studies; 246 participants), caregivers' quality of life, and caregiver depression. None of the studies assessed adverse effects, and no information about adverse effects was reported in any study. AUTHORS' CONCLUSIONS Offering personally tailored activities to people with dementia living in the community may be one approach for reducing challenging behaviour and may also slightly improve the quality of life of people with dementia. Given the low certainty of the evidence, these results should be interpreted with caution. For depression and affect of people with dementia, as well as caregivers' quality of life and burden, we found no clear benefits of personally tailored activities.
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Affiliation(s)
- Ralph Möhler
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Anna Renom
- Department of Geriatrics, Parc de Salut Mar, Barcelona, Spain
| | - Helena Renom
- Physical Medicine and Rehabilitation (MFRHB), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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