Hostname: page-component-8448b6f56d-sxzjt Total loading time: 0 Render date: 2024-04-23T19:39:59.065Z Has data issue: false hasContentIssue false
  • English
  • Français

Apathy in Nursing Home Residents with Dementia: Results From A Cluster-Randomized Controlled Trial☆

Published online by Cambridge University Press:  15 April 2020

Y. Treusch ,
T. Majic ,
J. Page ,
H. Gutzmann ,
A. Heinz  and
M.A. Rapp
Y. Treusch
Affiliation:
Geriatric Psychiatry Center, Psychiatric University Hospital St. Hedwig, Große Hamburger Str. 5–11, 10115Berlin, Germany Institute of Occupational Therapy, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 71, 8401Winterthur, Switzerland Social and Preventive Medicine, Department of Sports and Health Sciences, University of Potsdam, Am Neuen Palais 10, 14469Potsdam, Germany
T. Majic
Affiliation:
Geriatric Psychiatry Center, Psychiatric University Hospital St. Hedwig, Große Hamburger Str. 5–11, 10115Berlin, Germany
J. Page
Affiliation:
Institute of Occupational Therapy, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 71, 8401Winterthur, Switzerland
H. Gutzmann
Affiliation:
Department of Psychiatry, Psychotherapy and Psychosomatics, Krankenhaus Hedwigshoehe, Höhensteig 1, 12526Berlin, Germany
A. Heinz*
Affiliation:
Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charitéplatz 1, 10117Berlin, Germany
M.A. Rapp
Affiliation:
Geriatric Psychiatry Center, Psychiatric University Hospital St. Hedwig, Große Hamburger Str. 5–11, 10115Berlin, Germany Social and Preventive Medicine, Department of Sports and Health Sciences, University of Potsdam, Am Neuen Palais 10, 14469Potsdam, Germany Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charitéplatz 1, 10117Berlin, Germany
*
*Corresponding author. Tel.: +49 30 450 517 002; fax: +49 30 450 517 921. E-mail address:andreas.heinz@charite.de (A. Heinz).
Get access

Abstract

Purpose:

Here we evaluate an interdisciplinary occupational and sport therapy intervention for dementia patients suffering from apathy.

Subjects and methods:

A prospective, controlled, rater-blinded, clinical trial with two follow-ups was conducted as part of a larger cluster-randomized trial in 18 nursing homes in Berlin. n = 117 dementia patients with apathy, defined as a score of 40 or more on the apathy evaluation scale (AES) or presence of apathy on the Neuropsychiatric Inventory (NPI), were randomly assigned to intervention or control group. The intervention included 10 months of brief activities, provided once a week. The primary outcome measure was the total score on the AES scale measured directly after the intervention period and again after 12 months.

Results:

We found significant group differences with respect to apathy during the 10 month intervention period (F2,82 = 7.79, P < 0.01), which reflected an increase in apathy in the control group, but not in the intervention group. Within one year after the intervention was ceased, the treatment group worsened and no longer differed significantly from the control group (P = 0.55).

Conclusions:

Our intervention was effective for the therapy of apathy in dementia, when applied, but not one year after cessation of therapy.

Keywords

DementiaApathyNon-pharmacological interventionOccupational therapySport therapy
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 2 , February 2015 , pp. 251 - 257
Copyright
Copyright © Elsevier Masson SAS 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

☆

Trial Registration: Identifier: ISRCTN43578978.

1

Tel.: +41 58 934 6524; fax: +4158 935 6524.

2

Tel.: +49 30 23 11 – 29 75.

3

Tel.: +41 58 934 6345; fax: +41 58 935 6345.

4

Tel.: +49 3030 6741 3001; fax: +49 30 6741 3002.

5

Tel.: + 49 331 977 4095; fax: + 49 331 977 4078.

References

American Geriatrics Society and American Association for Geriatric Psychiatry. Consensus statement on improving the quality of mental health care in U.S. nursing homes: Management of depression and behavioral symptoms associated with dementia. J Am Geriatr Soc 2003;51 :1287–1298.CrossRefGoogle Scholar
Boyle, P.A., Malloy, P.F., Salloway, S., Cahn-Weiner, D.A., Cohen, R., Cummings, J.L.. Executive dysfunction and apathy predict functional impairment in Alzheimer disease. Am J Geriat Psychiat 2003;11 :214–221.CrossRefGoogle ScholarPubMed
Brodaty, H., Arasaratnam, C.. Meta-analysis of non-pharmacological interventions for neuropsychiatric symptoms of dementia. Am J Psychiatry 2012;169 :946–953.CrossRefGoogle Scholar
Brodaty, H., Burns, K.. Non-pharmacological management of apathy in dementia: a systematic review. Am J Geriat Psychiat 2011;00 :1–16.Google Scholar
Cohen, J.Statistical Power Analysis for the Behavioral Sciences. Hillsdale: Lawrence Erlbaum Associates; 1988.Google Scholar
Cohen-Mansfield, J., Thein, K., Dakheel-Ali, M., Marx, M.S.. The underlying meaning of stimuli: impact on engagement of persons with dementia. Psychiatry Res 2010;177 :216–222.CrossRefGoogle ScholarPubMed
Colling, K.B.. Passive behaviours in dementia. Clinical application of the need-driven dementia-compromised behavior model. J Gerontol Nurs 1999;25 :27–32.CrossRefGoogle ScholarPubMed
Cummings, J.L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D.A., Gornbein, J.. The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44 :2308–2314.CrossRefGoogle ScholarPubMed
Ettema, T.P., Dröes, R.M., de Lange, J., Mellenbergh, G.J., Ribbe, M.W.. Qualidem: development and evaluation of a dementia specific quality of life instrument. Scalability, reliability and internal structure. Int J Geriatr Psych 2007;22 :549–556.CrossRefGoogle ScholarPubMed
Ferrero-Arias, J., Goñi-Imízcoz, M., González-Bernal, J., Lara-Ortega, F., da Silva-González, Á., Díez-Lopez, M.. The efficacy of non-pharmacological treatment of dementia-related apathy. Alzheimer Dis Assoc Disord 2011;25 :213–219.CrossRefGoogle Scholar
Folstein, M.F., Folstein, S.E., McHugh, P.R.. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12 :189–198.CrossRefGoogle ScholarPubMed
Gauthier, S., Cummings, J., Ballard, C., Brodaty, H., Grossberg, G., Robert, P., et al.Management of behavioral problems in Alzheimer's disease. Int Psychogeriatr 2010;22 :346–372.CrossRefGoogle ScholarPubMed
Gerritsen, D.L., Jongenelis, K., Steverink, N., Ooms, M.E., Ribbe, M.W.. Down and drowsy? Do apathetic nursing home residents experience low quality of life?. Aging Ment Health 2005;9 :135–141.CrossRefGoogle ScholarPubMed
Hogan, D.B., Bailey, P., Black, S., Carswell, A., Chertkow, H., Clarke, B., et al.Diagnosis and treatment of dementia: 5. Non-pharmacologic and pharmacologic therapy for mild to moderate dementia. CMAJ 2008;179 :1016–1026.Google Scholar
Holthe, T., Thorsen, K., Josephsson, S.. Occupational patterns of people with dementia in residential care: an ethnographic study. Scand J Occup Ther 2007;14 :96–107.CrossRefGoogle ScholarPubMed
Kaufer, D.I., Cummings, J.L., Christine, D., Bray, T., Castellon, S., Masterman, D., et al.Assessing the impact of neuropsychiatric symptoms in Alzheimer's disease: the Neuropsychiatric Inventory Caregiver Distress Scale. J Am Geriatr Soc 1998;46 :210–215.CrossRefGoogle ScholarPubMed
Kielhofner, G.Model Of Human Occupation – Theory and Application. Baltimore: Lippincott Williams & Wilkins; 2008.Google Scholar
Kolanowski, A., Litaker, M., Buettner, L., Moeller, J., Costa, P.T.. A randomized clinical trial of theory-based activities for the behavioral symptoms of dementia in nursing home residents. JAGS 2011;59 :1032–1041.CrossRefGoogle ScholarPubMed
Lam, L., Lui, V., Luk, D., Chau, R., So, C., Poon, V., et al.Effectiveness of an individualized functional training program on affective disturbances and functional skills in mild and moderate dementia – a randomized controlled trial. Int J Geriatr Psych 2010;25 :133–141.CrossRefGoogle Scholar
Landes, A.M., Sperry, S.D., Strauss, M.E., Geldmacher, D.S.. Apathy in Alzheimer's disease. JAGS 2001;49 :1700–1707.CrossRefGoogle ScholarPubMed
Leone, E., Deudon, A., Bauchet, M., Laye, M., Bordone, N., Lee, J.H., et al.Management of apathy in nursing homes using a teaching program for care staff: the STIM-EHPAD study. Int J Geriatr Psychiatry 2013;28 :383–392.CrossRefGoogle ScholarPubMed
Levy, R., Dubois, B.. Apathy and the functional anatomy of the prefrontal cortex-basal ganglia circuits. Cereb Cortex 2006;16 :916–928.CrossRefGoogle ScholarPubMed
Lueken, U., Seidl, U., Schwarz, M., Völker, L., Naumann, D., Mattes, K., et al.Die Apathie Evaluation Scale: Erste Ergebnisse zu den psychometrischen Eigenschaften einer deutschsprachigen Übersetzung der Skala. Psychometric properties of a german version of the Apathy Evaluation Scale. Fortschr Neurol Psychiat 2006;74 :1–9.CrossRefGoogle Scholar
Majic, T., Pluta, J.P., Mell, T., Aichberger, M.C., Treusch, Y., Gutzmann, H., et al.The pharmacotherapy of neuropsychiatric symptoms of dementia: a cross-sectional study in 18 homes for the elderly in Berlin. Dtsch Arztebl Int 2010;107 :320–327.Google ScholarPubMed
Marin, R.S., Wilkosz, P.A.. Disorders of diminished motivation. J Head Trauma Rehabil 2005;20 :377–388.CrossRefGoogle ScholarPubMed
Marin, R.S., Biedrzycki, R.C., Firinciogullari, S.. Reliability and validity of the Apathy Evaluation Scale. Psychiat Res 1991;38 :143–162.CrossRefGoogle ScholarPubMed
Moore, J.R.Familiar physical activity to familiar music: the effects on apathy, agitation, eating ability and dietary intake in institutionalized older adults with dementia.[Open Access Dissertations] University of Massachusetts; 2010.Google Scholar
Politis, A.M., Vozzella, S., Mayer, L.S., Onyike, C.U., Baker, A., Lyketsos, C.G., et al.A randomized, controlled, clinical trial of activity therapy for apathy in patients with dementia residing in long-term care. Int J Geriatr Psych 2004;19 :1087–1094.CrossRefGoogle ScholarPubMed
Potter, R., Ellard, D., Rees, K., Thorogood, M.. A systematic review of the effects of physical activity on physical functioning, quality of life and depression in older people with dementia. Int J Geriatr Psych 2011;26 :1000–1011.CrossRefGoogle ScholarPubMed
Reisberg, B.. Functional Assessment Staging (FAST). Psychopharmacol Bull 1984;24 :653–659.Google Scholar
Robert, P.H., Darcourt, G., Koulibaly, M.P., Clairet, S., Benoit, M., Garcia, R., et al.Lack of initiative and interest in Alzheimer's disease: a single photon emission computed tomography study. Eur J Neurol 2006;13 :729–735.CrossRefGoogle ScholarPubMed
Rocha, V., Marques, A., Pinto, M., Sousa, L., Figueiredo, D.. People with dementia in long-term care facilities: an exploratory study of their activities and participation. Disabil Rehabil 2013;35 :1501–1508.CrossRefGoogle ScholarPubMed
Sims, A.Symptoms in the mind. London: Saunders; 2003.Google Scholar
Staal, J.A., Sacks, A., Matheis, R., Collier, L., Calia, T., Hanif, H., et al.The effects of Snoezelen (multi-sensory behavior therapy) and psychiatric care on agitation, apathy, and activities on daily living in dementia patients on a short term geriatric psychiatric inpatient unit. Int J Psychiatry Med 2007;27 :357–370.CrossRefGoogle Scholar
Starkstein, S.E.. Apathy in Parkinson's disease: diagnostic and etiological dilemmas. Mov Disord 2012;27 :174–178.CrossRefGoogle ScholarPubMed
Sunderland, T., Minichiello, M.. Dementia Mood Assessment Scale. Int Psychogeriatr 1996;8 :329–331.CrossRefGoogle ScholarPubMed
Treusch, Y., Page, J., Niemann-Mirmehdi, M., Gutzmann, H., Heinz, A., Rapp, M.. Apathy and its non-pharmacological treatment in dementia. Geropsych 2011;24 :155–164.CrossRefGoogle Scholar
United Nations General Assembly Convention on the Rights of Person with Disabilities. New York; 2006.Google Scholar
Submit a response

Comments

No Comments have been published for this article.