title: Effects of multiple training modalities in patients with Alzheimer's disease: a pilot study.
abstract: OBJECTIVE
  This pilot study investigated the effects of multiple training modalities on cognition, neuropsychiatric symptoms, caregivers' burden, and quality of life in patients with Alzheimer's disease (AD).
  
  
  METHODS
  This intervention study was conducted in 24 patients with AD aged ≥65 years with a Clinical Dementia Rating (CDR) score of 0.5-1. The patients were assigned to receive multiple training modalities (1 hour for each training: Tai Chi, calligraphy, and drawing) over a 6-week period in either the experimental group (n=14) or the comparison group (n=10). A series of neuropsychological tests - namely the Traditional Chinese version Mini-Mental Status Examination, Cognitive Assessment Screening Instrument (CASI), Neuropsychiatric Inventory and the Neuropsychiatric Inventory Caregiver Distress Scale, and the Clinical Dementia Rating Sum of Boxes scale - were conducted at the baseline and after the intervention. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) and Zarit Caregiver Burden Scale were used to assess the quality of life and caregivers' burden, respectively. Independent samplet-test and paired samplet-test were used to analyze the data.
  
  
  RESULTS
  After the intervention, the experimental group reported higher scores in the orientation domain of CASI (P=0.007) and in the psychiatry domain of WHOQOL-BREF (P=0.042) compared with the comparison group. Caregivers' distress was significantly decreased in the experimental group (P=0.035) but not in the comparison group (P=0.430).
  
  
  CONCLUSIONS
  The multiple training modalities improved scores in the orientation domain of CASI and psychiatry domain of WHOQOL-BREF in patients with AD. Moreover, the intervention reduced caregivers' distress.
authors.affiliation: Department of Family Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University; Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University; Department of Family Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University; Research Center for Environmental Medicine, Kaohsiung Medical University.
authors.forename: Shu-Yu
authors.initials: SY
authors.lastname: Tai
authors.affiliation: Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University.
authors.forename: Chia-Ling
authors.initials: CL
authors.lastname: Hsu
authors.affiliation: Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University.
authors.forename: Shu-Wan
authors.initials: SW
authors.lastname: Huang
authors.affiliation: Graduate Institute of Oral Health Sciences, Kaohsiung Medical University; Mentality Protection Center, Fo Guang Shan Compassion Foundation.
authors.forename: Tzu-Chiao
authors.initials: TC
authors.lastname: Ma
authors.affiliation: Department of Social Work, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University; Department of Sociology and Social Work, Kaohsiung Medical University.
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Hsieh
authors.affiliation: Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University; Mentality Protection Center, Fo Guang Shan Compassion Foundation; Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University; Department of and Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors.forename: Yuan-Han
authors.initials: YH
authors.lastname: Yang
keywords: Alzheimer’s disease; caregivers’ burden; cognitive function; multiple training modalities; quality of life