title: Apathy and Its Response to Antipsychotic Review and Nonpharmacological Interventions in People With Dementia Living in Nursing Homes: WHELD, a Factorial Cluster Randomized Controlled Trial.
abstract: Apathy is common, impactful, and difficult to manage in people with dementia. We evaluated the efficacy of nonpharmacological interventions, exercise, and social interaction, in combination with antipsychotic review, to reduce apathy in people with dementia living in nursing homes in a cluster randomized controlled trial (RCT).
  
  
  
  Well-being and health for people with dementia (WHELD) program included a 2 × 2 × 2 factorial cluster RCT involving people with dementia living in 16 nursing homes in the United Kingdom. All homes received training in person-centered care, and were randomized to receive antipsychotic review, social interaction, and exercise, either alone or in combinations. Apathy was one of the secondary outcomes of the WHELD trial, and it was measured by the Neuropsychiatric Inventory-nursing home version at baseline and 9 months (n = 273). We used multilevel mixed effects linear regression models to assess the impact of the interventions on apathy.
  
  
  
  Prevalence of apathy was 44.0% (n = 120; 95% confidence interval [CI] 38.1%-49.9%) at baseline. Severity of apathy had significant positive correlations with dementia severity, neuropsychiatric symptoms, depressive symptoms, agitation, and the needs of the people with dementia (P < .001). Antipsychotic review reduced antipsychotic use, but it significantly increased apathy (β = 5.37; SE = 0.91; P < .001). However, antipsychotic review in combination with either social interaction (β = -5.84; SE = 1.15; P < .001) or exercise (β = -7.54; SE = 0.93; P < .001) significantly reduced apathy.
  
  
  
  Antipsychotic review can play a significant role in improving apathy in people with dementia living in nursing homes, when combined with psychosocial interventions such as social interaction and exercise. Guidance must be adapted to reflect this subtlety in care.
authors.affiliation: Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; Mental Health of Older Adults and Dementia Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK; Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark. Electronic address: Anto.Rajamani@kcl.ac.uk.
authors.forename: Anto P
authors.initials: AP
authors.lastname: Rajkumar
authors.affiliation: Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; Mental Health of Older Adults and Dementia Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK.
authors.forename: Clive
authors.initials: C
authors.lastname: Ballard
authors.affiliation: Oxford Health NHS Foundation Trust, Oxford, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Fossey
authors.affiliation: Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Corbett
authors.affiliation: North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK.
authors.forename: Bob
authors.initials: B
authors.lastname: Woods
authors.affiliation: Institute of Mental Health, University of Nottingham, Nottingham, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Orrell
authors.affiliation: University College London, London, UK.
authors.forename: Rohan
authors.initials: R
authors.lastname: Prakash
authors.affiliation: Faculty of Health and Social Sciences, University of Hull, Hull, UK.
authors.forename: Esme
authors.initials: E
authors.lastname: Moniz-Cook
authors.affiliation: Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
authors.forename: Ingelin
authors.initials: I
authors.lastname: Testad
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D057565:Apathy; D016000:Cluster Analysis; D003704:Dementia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D009735:Nursing Homes; D006113:United Kingdom
chemical_list: D014150:Antipsychotic Agents
keywords: Apathy; dementia; randomized controlled trial