Resumen de Effects of Multimodal Nondrug Therapy on Dementia Symptoms and Need for Care in Nursing Home Residents with Degenerative Dementia:: A Randomized-Controlled Study with 6-Month Follow-Up
Katharina Luttenberger, Carolin Donath, Wolfgang Uter, Elmar Graessel
Objectives: To determine the efficacy of multimodal, nondrug therapy on symptoms of dementia and need for care in institutionalized individuals with degenerative dementia.
Design: Randomized, controlled, longitudinal trial. Data were analyzed using multiple linear regression.
Setting: Five German nursing homes.
Participants: One hundred thirty-nine nursing home residents with primary degenerative dementia (Mini-Mental State Examination score < 24).
Intervention: The 6-month intervention comprised three components: motor stimulation, activities of daily living, and cognitive stimulation (MAKS). Groups of 10 patients led by two therapists participated in the standardized intervention for 2 hours, 6 days a week. The intervention was described in detail in an intervention manual. Adherence to the manual was high. Controls received treatment as usual.
Measurements: Overall geriatric symptoms were recorded using the Nurses' Observation Scale for Geriatric Patients, functional independence using the Barthel Index, and care time using the Resource Utilization in Dementia�Formal Care.
Results: Of 646 individuals screened, 146 were eligible, and 130 were included in the intention-to-treat analysis. At 6 months, results of the per-protocol analysis (n = 119) showed improvement in overall dementia symptoms in the MAKS group and no change in the control group (adjusted mean difference (AMD) = -6.8, 95% confidence interval (CI) = -10.3 to -3.3; P < .001, Cohen d = 0.66). This effect was greatest on the social behavior (AMD = -1.9, 95% CI = -2.9 to -0.8; P < .001; Cohen d = 0.54) and instrumental activity of daily living (IADL) (AMD = -1.4, 95% CI = -2.5 to -0.30; P = .01; Cohen d = 0.43) subscales. No effect was seen on functional independence or total care time.
Conclusion: This 6-month nondrug multimodal intervention improved dementia symptoms in nursing home residents, especially in social behavior and IADL capabilities.
