title: Early psychosocial intervention does not delay institutionalization in persons with mild Alzheimer disease and has impact on neither disease progression nor caregivers' well-being: ALSOVA 3-year follow-up.
abstract: OBJECTIVE
  Early diagnosis, initiation of Alzheimer's disease (AD) therapy and programs that support care of persons with AD at home are recommended. The objective of this study was to assess the effect of early psychosocial intervention on delaying the institutionalization of persons with AD. We also assessed the influence of intervention on AD progression, behavioral symptoms, and health-related quality of life (HRQoL) in persons with AD and caregivers.
  
  
  METHODS
  Kuopio ALSOVA study, a prospective, randomized intervention study with a 3-year follow-up, was carried out at memory clinics. Home-dwelling persons with very mild or mild AD (n = 236) and AD-targeted therapy and their family caregivers (n = 236) were randomized to the intervention or control group (1:2). Psychosocial intervention including education, counseling, and social support was given during the first 2 years (16 days). The primary outcome was the cumulative risk (controlled for death) of institutionalization over 36 months. Secondary outcomes were adjusted mean changes from baseline in disease severity, cognition, daily activities, behavior, and HRQoL for persons with AD; and change in psychological distress, depression, and HRQoL for caregivers.
  
  
  RESULTS
  No differences were found in nursing home placement after the 36-month follow-up between intervention and control groups. No beneficial effects of the intervention were found on the secondary outcomes.
  
  
  CONCLUSIONS
  The psychosocial intervention did not delay nursing home placement in persons with AD and had no effect on patient well-being, disease progression, or AD-related symptoms or caregiver well-being. Instead of automatically providing psychosocial intervention courses, individualized support programs may be more effective.
authors.affiliation: Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland.|Neurology of NeuroCentre, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Koivisto
authors.affiliation: Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland.|School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland.
authors.forename: Ilona
authors.initials: I
authors.lastname: Hallikainen
authors.affiliation: University of Eastern Finland, Department of Nursing Science, Kuopio, Finland.
authors.forename: Tarja
authors.initials: T
authors.lastname: Välimäki
authors.affiliation: Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland.|Institute of Public Health and Clinical Nutrition, Department of Geriatrics, University of Eastern Finland, Kuopio, Finland.
authors.forename: Kristiina
authors.initials: K
authors.lastname: Hongisto
authors.affiliation: Department of Neurology, North Carelian Central Hospital, Joensuu, Finland.
authors.forename: Asta
authors.initials: A
authors.lastname: Hiltunen
authors.affiliation: Memory Clinic, Mikkeli Central Hospital, Finland.|Memory Clinic, Jyväskylä Central Hospital, Finland.
authors.forename: Pertti
authors.initials: P
authors.lastname: Karppi
authors.affiliation: Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland.|Brain Research and Rehabilitation Center Neuron, Kuopio, Finland.
authors.forename: Juhani
authors.initials: J
authors.lastname: Sivenius
authors.affiliation: Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland.|Neurology of NeuroCentre, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Hilkka
authors.initials: H
authors.lastname: Soininen
authors.affiliation: Pharmacoeconomics and Outcomes Research Unit, School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
authors.forename: Janne
authors.initials: J
authors.lastname: Martikainen
mesh_terms: D000328:Adult; D000368:Aged; D000544:Alzheimer Disease / Q000523:psychology / Q000534:rehabilitation*; D017028:Caregivers / Q000523:psychology*; D003072:Cognition Disorders / Q000209:etiology; D003376:Counseling; D018450:Disease Progression; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D012944:Social Support; D013997:Time Factors
keywords: Alzheimer's disease; caregiver studies; dementia; follow-up studies; psychosocial intervention