title: Targeting Functional Decline in Alzheimer Disease: A Randomized Trial.
abstract: BACKGROUND
  Alzheimer disease results in progressive functional decline, leading to loss of independence.
  
  
  OBJECTIVE
  To determine whether collaborative care plus 2 years of home-based occupational therapy delays functional decline.
  
  
  METHODS
  Randomized, controlled clinical trial. (ClinicalTrials.gov: NCT01314950).
  
  
  METHODS
  Urban public health system.
  
  
  METHODS
  180 community-dwelling participants with Alzheimer disease and their informal caregivers.
  
  
  METHODS
  All participants received collaborative care for dementia. Patients in the intervention group also received in-home occupational therapy delivered in 24 sessions over 2 years.
  
  
  METHODS
  The primary outcome measure was the Alzheimer's Disease Cooperative Study Group Activities of Daily Living Scale (ADCS ADL); performance-based measures included the Short Physical Performance Battery (SPPB) and Short Portable Sarcopenia Measure (SPSM).
  
  
  RESULTS
  At baseline, clinical characteristics did not differ significantly between groups; the mean Mini-Mental State Examination score for both groups was 19 (SD, 7). The intervention group received a median of 18 home visits from the study occupational therapists. In both groups, ADCS ADL scores declined over 24 months. At the primary end point of 24 months, ADCS ADL scores did not differ between groups (mean difference, 2.34 [95% CI, -5.27 to 9.96]). We also could not definitively demonstrate between-group differences in mean SPPB or SPSM values.
  
  
  CONCLUSIONS
  The results of this trial are indeterminate and do not rule out potential clinically important effects of the intervention.
  
  
  CONCLUSIONS
  The authors could not definitively demonstrate whether the addition of 2 years of in-home occupational therapy to a collaborative care management model slowed the rate of functional decline among persons with Alzheimer disease. This trial underscores the burden undertaken by caregivers as they provide care for family members with Alzheimer disease and the difficulty in slowing functional decline.
  
  
  BACKGROUND
  National Institute on Aging.
authors.affiliation: From Indiana University Center for Aging Research, Indiana University School of Medicine, Regenstrief Institute, and Indiana Alzheimer Disease Center, Indianapolis, Indiana, and Colorado State University, Fort Collins, Colorado.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Callahan
authors.affiliation: From Indiana University Center for Aging Research, Indiana University School of Medicine, Regenstrief Institute, and Indiana Alzheimer Disease Center, Indianapolis, Indiana, and Colorado State University, Fort Collins, Colorado.
authors.forename: Malaz A
authors.initials: MA
authors.lastname: Boustani
authors.affiliation: From Indiana University Center for Aging Research, Indiana University School of Medicine, Regenstrief Institute, and Indiana Alzheimer Disease Center, Indianapolis, Indiana, and Colorado State University, Fort Collins, Colorado.
authors.forename: Arlene A
authors.initials: AA
authors.lastname: Schmid
authors.affiliation: From Indiana University Center for Aging Research, Indiana University School of Medicine, Regenstrief Institute, and Indiana Alzheimer Disease Center, Indianapolis, Indiana, and Colorado State University, Fort Collins, Colorado.
authors.forename: Michael A
authors.initials: MA
authors.lastname: LaMantia
authors.affiliation: From Indiana University Center for Aging Research, Indiana University School of Medicine, Regenstrief Institute, and Indiana Alzheimer Disease Center, Indianapolis, Indiana, and Colorado State University, Fort Collins, Colorado.
authors.forename: Mary G
authors.initials: MG
authors.lastname: Austrom
authors.affiliation: From Indiana University Center for Aging Research, Indiana University School of Medicine, Regenstrief Institute, and Indiana Alzheimer Disease Center, Indianapolis, Indiana, and Colorado State University, Fort Collins, Colorado.
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Miller
authors.affiliation: From Indiana University Center for Aging Research, Indiana University School of Medicine, Regenstrief Institute, and Indiana Alzheimer Disease Center, Indianapolis, Indiana, and Colorado State University, Fort Collins, Colorado.
authors.forename: Sujuan
authors.initials: S
authors.lastname: Gao
authors.affiliation: From Indiana University Center for Aging Research, Indiana University School of Medicine, Regenstrief Institute, and Indiana Alzheimer Disease Center, Indianapolis, Indiana, and Colorado State University, Fort Collins, Colorado.
authors.forename: Denisha Y
authors.initials: DY
authors.lastname: Ferguson
authors.affiliation: From Indiana University Center for Aging Research, Indiana University School of Medicine, Regenstrief Institute, and Indiana Alzheimer Disease Center, Indianapolis, Indiana, and Colorado State University, Fort Collins, Colorado.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Lane
authors.affiliation: From Indiana University Center for Aging Research, Indiana University School of Medicine, Regenstrief Institute, and Indiana Alzheimer Disease Center, Indianapolis, Indiana, and Colorado State University, Fort Collins, Colorado.
authors.forename: Hugh C
authors.initials: HC
authors.lastname: Hendrie
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000544:Alzheimer Disease / Q000534:rehabilitation*; D017028:Caregivers; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D009788:Occupational Therapy; D016037:Single-Blind Method; D016896:Treatment Outcome