Impact of an educational programme on Alzheimer's disease patients' quality of life: results of the randomized controlled trial THERAD

Effects of Dyadic Psychosocial Education on People Living with Cognitive Impairment and Their Informal Caregivers: A Systematic Review and Meta-Analysis

OBJECTIVES

Cognitive impairment places a substantial burden on both patients and caregivers. Dyadic psychosocial education may be a potential solution, but its effects have not been systematically evaluated. This study aimed to evaluate the effects of dyadic psychosocial education on outcomes and dyadic relationships among cognitively impaired adults and their informal caregivers.

DESIGN

Systematic review and meta-analysis.

SETTINGS AND PARTICIPANTS

People living with cognitive impairment and their informal caregivers.

METHODS

Six electronic databases were systematically searched from January 1, 2004, to October 13, 2024. Two researchers independently screened the literature by title, abstract, and full text. The revised Cochrane risk-of-bias tool for randomized trials was used to assess the risk of bias for included studies. A meta-analysis was performed using a random effects model, followed by subgroup and sensitivity analyses.

RESULTS

Sixteen studies representing 2446 dyads were identified. No effects were found on overall neuropsychiatric symptoms, agitation, apathy, or depression, nor caregiver quality of life and depression. Pooled results showed dyadic psychosocial education significantly reduced dyadic conflict (SMD = -0.42, 95% CI: -0.66 to -0.18, I2 = 0). No significant effects of dyadic psychosocial education were found on overall cognitive function (SMD = 0.12, 95% CI: -0.13 to 0.38, I2 = 69%) or caregiver burden (SMD = -0.20, 95% CI: -0.43 to 0.03, I2 = 56%). However, subgroup analyses indicated that interventions ≤6 months improved overall cognitive function (SMD = 0.30, 95% CI: 0.06-0.54, I2 = 19%) and reduced caregiver burden (SMD = -0.26, 95% CI: -0.51 to -0.01, I2 = 32%).

CONCLUSIONS AND IMPLICATIONS

These findings demonstrate that dyadic psychosocial education can reduce dyadic conflict. The intervention also benefited cognitive function and caregiver burden, but the intervention duration influenced the effectiveness. Given the instability of the results, the findings of this study need to be interpreted with caution.

Effects of dyadic psychosocial education on people with mild cognitive impairment or dementia and their informal caregivers: protocol for a systematic review and meta-analysis

INTRODUCTION

Mild cognitive impairment (MCI) and dementia impose a significant burden on individuals and their caregivers. Dyadic psychosocial education, which treats care recipients and their caregivers as a pair of active participants, has the potential to improve health outcomes for people with cognitive impairment and their caregivers. However, the results of recent studies on this subject are contradictory. We aim to evaluate the effectiveness of dyadic psychosocial education for people with MCI or dementia and their informal caregivers.

METHODS AND ANALYSIS

Six databases will be searched. We will include all randomised controlled trials that compare dyadic psychosocial education to usual care. The risk of bias will be assessed using the Cochrane Risk-of-Bias Assessment Tool (V.2). Meta-analyses, subgroup analyses and sensitivity analyses will be performed using Stata V.15.1. A narrative synthesis will be conducted if quantitative analysis is not feasible.

ETHICS AND DISSEMINATION

This study and subsequent systematic review will not collect individual-level data and, therefore, do not require ethics committee approval. Peer-reviewed publications will disseminate the study results.

PROSPERO REGISTRATION NUMBER

CRD42024497554.

The effect of structured education and phone follow-up on moderate stage Alzheimer's disease caregiving: Outcomes for patient and caregivers

AIM

To determine the effectiveness of a caregiver education (needs tailored) and telephone follow-up intervention for caregivers of people with moderate stage Alzheimer's disease on caregiver burden, caregiving impact on life, and patients' neuropsychiatric symptoms, dependence on activities of daily living.

METHODS

This quasi-experimental study sampled caregivers of people with moderate stage Alzheimer's. Caregivers in the intervention group received education and telephone follow-up over 12 weeks, while the control group received routine care. Caregivers were assessed for burden, changes in life, and patients for neuropsychiatric symptoms, and dependence on daily living activities.

RESULTS

The caregiver burden, life changes, distress, and patients' neuropsychiatric symptom scores showed apparent trend toward betterment, but no statistically significant differences were found in study outcomes between the two groups (P > .05).

CONCLUSION

The caregiver need-based, structured education and telephone follow-up intervention was not empirically effective. With the promising effect from this study, managing behavioral symptoms with need-based, structured, and skill-oriented training has the potential to alleviate the burden on caregivers.

The efficacy of dyadic interventions for community-dwelling people with dementia and their caregivers: A systematic review and meta-analysis

Most people with dementia live at home and depend on informal caregivers for care. Both caregivers and persons with dementia can experience negative psychological and behavioural effects as the disease progresses. Non-pharmacological interventions can alleviate these effects and dyadic interventions, involving both caregiver and person with dementia, may be particularly effective. In this systematic review, the effect of dyadic interventions involving community-dwelling persons with dementia and their informal caregivers was researched. This article is an update of a review of dyadic interventions up to 2012 (Van't Leven et al., 2013). Twenty-two randomized controlled trials published between January 2012 and March 2023 met eligibility criteria, representing 3857 dyads. Results of a meta-analysis showed no overall intervention effect. Thirteen studies reported positive intervention effects, 9 studies reported no intervention effects. Intervention content and participant characteristics and knowledge of the disease varied widely between the studies reviewed. Effective interventions were those that matched activities for the person with dementia to their interests and abilities and educating the caregiver about dementia and communication. Interventions of moderate length (3-4 months) tended to be more effective than longer or shorter interventions. Future studies should further explore the factors contributing to the effects of dyadic interventions.

Educational care for patients with Alzheimer's disease and their caregivers in France: A mapping proposal

OBJECTIVES

To formalize a proposal for educational approach for patients with Alzheimer's disease and related dementias (ADRD) and caregivers across existing diagnosis/care organizations and structures.

METHODS

Three steps:1/ identifying the existing organizations and structures that could be involved in educational care; 2/ identifying the main educational skills of interest for ADRD patients and caregivers; 3/ conducting a survey among these organizations and structures to achieve a mapping proposal of educational care.

RESULTS

Nine organizations and structures, and 29 educational skills of interest were identified for the step 3 survey. Overall, 423 organizations/structures completed the step 3 survey. Twelve of 29 educational skills were covered by 50% of organizations/structures included. The most covered skills were "Maintaining autonomy in daily living activities", "coping with cognitive disorders", and "coping with behavioral disorders".

CONCLUSIONS

A mapping of educational care that could be provided by the different structures and organizations involved in the ADRD care pathway was proposed regarding their missions and intervention place.

PRACTICE IMPLICATIONS

Policy makers and funding bodies will need to invest in the healthcare professionals' training about educational approach and ADRD in order to extend educational care throughout the patient's care pathway.

An innovative therapeutic educational program to support older drivers with cognitive disorders: Description of a randomized controlled trial study protocol

Older drivers face the prospect of having to adjust their driving habits because of health problems, which can include neurocognitive disorders. Self-awareness of driving difficulties and the interaction between individual with neurocognitive disorders and natural caregiver seem to be important levers for the implementation of adaptation strategies and for the subsequent voluntary cessation of driving when the cognitive disorders become too severe. This study aims to evaluate an educational program for patient/natural caregiver dyads who wish to implement self-regulation strategies in driving activity, and to improve self-awareness of driving ability. The ACCOMPAGNE program is based on seven group workshops, which target the dyad. The workshops deal with the impact of cognitive, sensory and iatrogenic disorders on driving. They tackle questions about responsibility, and about autonomy and social life. They also provide alternative solutions aimed at maintaining outward-looking activities even if driving is reduced or stopped. A randomized controlled trial is planned to evaluate the effectiveness of the program 2 months and 6 months after inclusion, and to compare this to the effectiveness of conventional approaches. The main outcome of this trial (i.e., the implementation of self-regulated driving strategies), will be measured based on scores on the “Current Self-Regulatory Practices” subscale of the Driver Perception and Practices Questionnaire. The Driving Habits Questionnaire will be used to measure secondary outcomes (indicators of driving changes; indicators of changes in mood, quality of life and caregiver burden; and self-awareness of driving abilities). Indicators will be collected for both patients and natural caregivers. This cognitive, social and psychological program should allow older individuals with cognitive disorders to drive more safely, and help to maintain the quality of life and mood of both patient and natural caregiver despite driving limitations. The patient's care path would be optimized, as he/she would become an actor in the process of giving up driving, which will, most certainly, be needed at some point in the progress of neurocognitive disorders. This process ranges from becoming aware of driving difficulties, to implementing self-regulation strategies, through to complete cessation of driving when necessary.

Clinical trial registration number

NCT04493957.

Depression among caregivers of patients with dementia: Associative factors and management approaches

As elderly people increasingly come to represent a higher proportion of the world’s population, various forms of dementia are becoming a significant chronic disease burden. The World Health Organization emphasizes dementia care as a public health priority and calls for more support for family caregivers who commonly play a significant, central role in dementia care. Taking care of someone with dementia is a long-term responsibility that can be stressful and may lead to depression among family caregivers. Depression and related behavioral and cognitive changes among caregivers could in turn affect the status and prognosis of the dementia patient. This review article explores depression in dementia caregivers and summarizes proposed mechanisms, associated factors, management and research findings, and proposes future research directions.