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PURPOSE We assess the effects of racial or ethnic concordance between caregivers and interventionists on  caregiver attrition , change in depression , and change in burden in a multisite r and omized clinical trial . DESIGN AND METHODS Family caregivers of patients with Alzheimer 's disease were r and omized to intervention or control groups at six sites from 1996 to 2000 . Interventionists provided psychosocial interventions aim ed at decreasing caregiver depression and burden . This analysis included 694 caregivers who received face-to-face interventions from 36 interventionists at five sites . We modeled caregiver loss to follow-up at 12 months and changes in depression and burden from baseline by racial or ethnic concordance by using r and om effects logistic and linear regression models , controlling for caregiver age , gender , race or ethnicity , relation to care recipient , interventionist race or ethnicity , and care recipient activities of daily living . The loss to follow-up model also controlled for care recipient institutionalization and death . RESULTS Overall , there was no difference in caregiver loss to follow-up or change in depression or burden by racial or ethnic concordance . African-American caregivers with an interventionist of the same race or ethnicity had greater decreases in depression than did African-American caregivers with interventionists of a different race or ethnicity . However , this finding has to be interpreted cautiously because there were only two African-American interventionists . IMPLICATION S Although these initial findings do not provide conclusive evidence on whether racial or ethnic concordance is associated with intervention outcomes for caregivers of Alzheimer 's disease patients , these results , along with the paucity of research studies evaluating this issue , suggest that the effects of racial or ethnic concordance in research should be systematic ally examined in future studies Project ACT is a r and omized controlled trial design ed to test the effectiveness of a non-pharmacological home-based intervention to reduce behavioral and psychological symptoms of dementia ( BPSD ) and caregiver distress . The study targets 272 stressed racially diverse family caregivers providing in-home care to persons with moderate stage dementia with one or more behavioral disturbances . All participants are interviewed at baseline , 4-months ( main trial endpoint ) , and 6-months ( maintenance ) . The four-month intervention involves up to 13 visits from an occupational therapist who works with families to problem-solve potential triggers ( communication style , environmental clutter ) contributing to behaviors , and instruct in strategies to reduce caregiver stress and manage targeted behaviors . To rule out infection or other potential medical contributors to behaviors , a nurse obtains blood and urine sample s from the dementia patient , and conducts a medication review . Participants in the no-treatment control group are offered the nurse arm and one in-home session following trial completion at 6-months . This paper describes the research methods , theoretical and clinical aspects of this multi-component , targeted psycho-social treatment approach , and the measures used to evaluate quality of life improvements for persons with dementia and their families BACKGROUND Based on the National Institute on Aging/National Institute of Nursing Research Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH ) r and omized controlled trial ( REACH II ) , REACH VA ( Department of Veterans Affairs ) was the first national clinical translation of a proven behavioral intervention for dementia caregivers , running from September 2007 through August 2009 . This article describes the population and outcomes of the REACH VA translation of REACH II into the VA . METHODS Clinical staff members from 24 VA Medical Center Home-Based Primary Care programs in 15 states delivered the intervention to stressed caregivers of patients with dementia . Like REACH II , the 6-month REACH VA intervention , structured through a protocol and individualized through a risk assessment , targeted education , support , and skills training to address caregiving risk areas of safety , social support , problem behaviors , depression , and health through 12 individual in-home and telephone sessions and 5 telephone support group sessions . Staff members of the Memphis VA Medical Center , Memphis , Tennessee , collected data on burden , depression , health and healthy behaviors , caregiving frustrations , social support , dementia-related behaviors , and time spent providing care and on duty . RESULTS From baseline to 6 months , caregivers reported significantly decreased burden , depression , impact of depression on daily life , caregiving frustrations , and number of troubling dementia-related behaviors . A 2-hour decrease in hours per day on duty approached significance . Caregivers ( 96 % ) believed that the program should be provided by the VA to caregivers . CONCLUSIONS This clinical translation achieved outcomes similar to the REACH II r and omized controlled trial , providing clinical ly significant benefits for caregivers of a veteran with a progressive dementing disease . This model of caregiver support can inform public policy in providing assistance to caregivers OBJECTIVES To examine the relationships between changes from baseline to post-Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH ) intervention in caregiver ( CG ) self-reported health , burden , and bother . DESIGN R and omized , multisite clinical trial . SETTING CG and care recipient ( CR ) homes in five U.S. cities . PARTICIPANTS Four hundred ninety-five dementia CG and CR dyads ( 169 Hispanic , 160 white , and 166 African American ) receiving intervention and their controls . INTERVENTION CGs were assigned to the REACH intervention or a no-treatment control group . Intervention subjects received individual risk profiles and the REACH intervention through nine in-home and three telephone sessions over 6 months . Control subjects received two brief " check-in " telephone calls during this 6-month period . MEASUREMENTS The primary outcome was change in CG health status from baseline to after the intervention . Secondary outcomes were CG burden and bother after the intervention . RESULTS After the intervention , CGs reported better self-rated health , sleep quality , physical health , and emotional health , which was related to less burden and bother with their caregiving role than for CGs not receiving the intervention . Changes in depression appeared to mediate these relationships . Several racial and ethnic group differences existed in physical and emotional health , as well as in total frustration with caregiving , emotional burden , and CG-rated bother with CR 's activities of daily living and instrumental activities of daily living at baseline and at follow-up , although differences between baseline and posttest did not vary according to race . CONCLUSION A structured , multicomponent skills training intervention that targeted CG self-care behaviors as one of five target areas , improved self-reported health status , and decreased burden and bother in racially and ethnically diverse CGs of people with dementia CONTEXT Optimal treatment to postpone functional decline in patients with dementia is not established . OBJECTIVE To test a nonpharmacologic intervention realigning environmental dem and s with patient capabilities . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve 2-group r and omized trial ( Care of Persons with Dementia in their Environments [ COPE ] ) involving patients with dementia and family caregivers ( community-living dyads ) recruited from March 2006 through June 2008 in Pennsylvania . INTERVENTIONS Up to 12 home or telephone contacts over 4 months by health professionals who assessed patient capabilities and deficits ; obtained blood and urine sample s ; and trained families in home safety , simplifying tasks , and stress reduction . Control group caregivers received 3 telephone calls and educational material s. MAIN OUTCOME MEASURES Functional dependence , quality of life , frequency of agitated behaviors , and engagement for patients and well-being , confidence using activities , and perceived benefits for caregivers at 4 months . RESULTS Of 284 dyads screened , 270 ( 95 % ) were eligible and 237 ( 88 % ) r and omized . Data were collected from 209 dyads ( 88 % ) at 4 months and 173 ( 73 % ) at 9 months . At 4 months , compared with controls , COPE patients had less functional dependence ( adjusted mean difference , 0.24 ; 95 % CI , 0.03 - 0.44 ; P = .02 ; Cohen d = 0.21 ) and less dependence in instrumental activities of daily living ( adjusted mean difference , 0.32 ; 95 % CI , 0.09 - 0.55 ; P = .007 ; Cohen d = 0.43 ) , measured by a 15-item scale modeled after the Functional Independence Measure ; COPE patients also had improved engagement ( adjusted mean difference , 0.12 ; 95 % CI , 0.07 - 0.22 ; P = .03 ; Cohen d = 0.26 ) , measured by a 5-item scale . COPE caregivers improved in their well-being ( adjusted mean difference in Perceived Change Index , 0.22 ; 95 % CI , 0.08 - 0.36 ; P = .002 ; Cohen d = 0.30 ) and confidence using activities ( adjusted mean difference , 0.81 ; 95 % CI , 0.30 - 1.32 ; P = .002 ; Cohen d = 0.54 ) , measured by a 5-item scale . By 4 months , 64 COPE dyads ( 62.7 % ) vs 48 control group dyads ( 44.9 % ) eliminated 1 or more caregiver-identified problems ( chi(2/1 ) = 6.72 , P = . 01 ) . CONCLUSION Among community-living dyads , a nonpharmacologic biobehavioral environmental intervention compared with control result ed in better outcomes for COPE dyads at 4 months . Although no group differences were observed at 9 months for patients , COPE caregivers perceived greater benefits . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00259454 ABSTRACT Objectives : Evaluation of long-term effects of an individualized short-term telephone intervention ( seven sessions ) , based on a comprehensive cognitive behavioral therapy ( CBT ) approach . The study goal was to evaluate the maintenance of intervention effects regarding well-being , quality of life , and health at two years post treatment . Method : Participants ( n = 105 ) were ( partly ) r and omized after baseline assessment in a two-arm study ( intervention , control group/usual care ) .  Depressive symptoms were assessed with the German version of the Center for Epidemiologic Studies Depression Scale ( CES-D ) . Caregivers ’ physical complaints were measured with the Gießener Beschwerdebogen ( GBB-24 ) , and quality of life with the World Health Organization quality of life -BREF ( WHOQOL-BREF ) . Emotional well-being and perceived health status were assessed using thermometer scaling . Data were analyzed by intention-to-treat analyses , including for those who terminated the intervention prematurely but still delivered data , using ANCOVAs . Results : Long-term intervention effects were found for emotional well-being ( p = 0.019 ) . For the subgroup of caregivers who were still caring at home at follow-up , the intervention led to an increased health status ( p = 0.023 ) , fewer bodily complaints ( global measure p= 0.014 , rheumatic pain p = 0.027 , heart trouble p = 0.042 ) , and a higher quality of life ( overall p = 0.044 and subscale environment p = 0.030 ) . Conclusion : The short-term CBT intervention via telephone showed long-term effects two years after treatment on emotional well-being , health status , bodily complaints , and quality of life PURPOSE OF STUDY The authors determined short-term effects of a home environmental intervention on self-efficacy and upset in caregivers and daily function of dementia patients . They also determined if treatment effect varied by caregiver gender , race , and relationship to patient . DESIGN AND METHODS Families ( N = 171 ) of dementia patients were r and omized to intervention or usual care control group .  The intervention involved 5 90-min home visits by occupational therapists who provided education and physical and social environmental modifications . RESULTS Compared with controls , intervention caregivers reported fewer declines in patients ' instrumental activities of daily living ( p = .030 ) and less decline in self-care and fewer behavior problems in patients at 3 months post-test . Also , intervention spouses reported reduced upset ( p = .049 ) , women reported enhanced self-efficacy in managing behaviors ( p = .038 ) , and women ( p = .049 ) and minorities ( p = .037 ) reported enhanced self-efficacy in managing functional dependency . IMPLICATION S The environmental program appears to have a modest effect on dementia patients ' IADL dependence . Also , among certain subgroups of caregivers the program improves self-efficacy and reduces upset in specific areas of caregiving The goal of this study was to evaluate a community-based psychoeducational-nursing intervention design ed to teach home caregivers  to manage behavioral problems of persons with Alzheimer 's disease and related dementias ( ADRD ) using the Progressively Lowered Stress Threshold ( PLST ) model , and to compare this intervention with routine information and referrals for case management , community-based services , and support groups . Previous caregiver studies have overwhelmingly pointed to the adverse effects of caregiving on the caregivers ' physical and mental health , and high prevalence rates of depression among caregivers of persons with ADRD have consistently been reported . Therefore , a primary aim was to evaluate the impact of the intervention on caregivers ' affective responses , especially depression . Data from both the Profile of Moods States and the Geriatric Depression Rating Scale support the effectiveness of this intervention in decreasing depression among caregivers who received the experimental training . Additional analysis of factors associated with caregiver depression are also reported . The pivotal role of psychiatric nurses in the assessment and treatment of depression among caregivers of persons with ADRD is discussed OBJECTIVE To evaluate the influence of adherence to the Systematic Care Program for Dementia ( SCPD ) intervention protocol on patient and caregiver outcomes  . DESIGN Data were drawn from the SCPD study -a single-blind , multicenter , cluster-r and omized , controlled trial . Multivariate regression analyses were used to assess the influence of adherence on patient and caregiver outcomes . SETTING Six community mental health services ( CMHSs ) across the Netherl and s. PARTICIPANTS Forty-eight mental health professionals treating 125 patient-caregiver dyads who were referred to the CMHS because of suspected patient dementia . INTERVENTION Training of professionals in the SCPD and its subsequent use . The SCPD consists of a systematic assessment of caregiver problems and consequent interventions . MEASUREMENTS The dependent variables were caregiver 's sense of competence , caregiver 's depressive symptoms , caregiver 's distress due to the patient 's behavioral problems , and the severity of patient 's behavioral problems . The main independent variables were adherence to the SCPD intervention protocol and the intensity of the SCPD interventions . The follow-up lasted 12 months . RESULTS Caregivers treated by adhering professionals had a better sense of competence than caregivers treated by nonadhering professionals at follow-up . No differences between intervention groups and controls were found for the other outcomes . CONCLUSION Nonadherence to the intervention protocol might be a reason for the difference found in the sense of competence between the intervention groups . Furthermore , the intensity of the SCPD might have been too low . Moreover , it might be that overburdened caregivers found it difficult to make effective use of the help offered to them . A qualitative process analysis should be executed to explore more in-depth clarifications Objective To assess the efficacy at 12 months of an early psychosocial counselling and support programme for out patients with mild Alzheimer ’s disease and their primary care givers . Design Multicentre , r and omised , controlled , rater blinded trial . Setting Primary care and memory clinics in five Danish districts . Participants 330 out patients with mild Alzheimer ’s disease and their 330 primary care givers . Interventions Participating dyads ( patient and primary care giver ) were r and omised to control support during follow-up or to control support plus DAISY intervention ( multifaceted and semi-tailored counselling , education , and support ) . Main outcome measures Primary outcomes at 12 months for patients were change from baseline in mini mental state examination ( MMSE ) score , Cornell depression scale score , and proxy rated European quality of life visual analogue scale ( EQ-VAS ) score . For care givers , outcomes were change from baseline in geriatric depression scale ( GDS 30 items ) score and EQ-VAS score . Results Because of multiple testing , statistical significance was set at an adjusted P limit of < 0.0005 . At 12 months there were no significant differences between the two allocation groups in changes from baseline in the primary and secondary outcomes . However , although non-significant with the adjusted P limit , a small difference was observed for one of the primary patient outcomes ( Cornell depression scale score ) in patients in favour of the DAISY intervention group before and after adjusting for attrition ( P=0.0146 and P=0.0103 respectively ) . Conclusions The multifaceted , semi-tailored intervention with counselling , education , and support for patients with mild Alzheimer ’s disease and their care givers did not have any significant effect beyond that with well structured follow-up support at 12 months after adjustment for multiple comparisons . The small positive effect found in the unadjusted primary outcome addressing depressive symptoms in patients may call for further research focusing on patients with Alzheimer ’s disease and comorbid depression . Trial registration IS RCT N74848736 OBJECTIVE To evaluate the efficacy of a brief behaviour management training programme for family carers of patients with dementia and aggressive behaviour . DESIGN A r and omized controlled trial of a four-session , community-based behaviour management programme . The primary outcome measure was the Rating Scale for Aggressive Behaviour in the Elderly . PARTICIPANTS 62 patients with dementia , and their co-resident carers . RESULTS There were no significant differences in aggression scores between behaviour management and control groups at follow-up . After adjusting for baseline differences in Rating Scale for Aggressive Behaviour in the Elderly scores , there was a trend towards a reduction in aggressive behaviour in the patients in the behaviour management group compared with those in the control group ( F = 3.37 , P = 0.071 ) . CONCLUSIONS This study adds to the small evidence base for the effectiveness of behavioural management strategies in dementia PURPOSE Few empirical studies have compared the efficacy between psychoeducational ( skill-building ) approaches for reducing  caregivers ' psychological distress  and interventions modeled after typical community-based support groups . We compare the impact of two distinct interventions on Anglo and Latino caregivers of elderly relatives with dementia . DESIGN AND METHODS The change from pre assessment to post assessment ( baseline to 3 months ) for 213 female caregivers ( 122 Anglo and 91 Latino ) is presented . They were seen weekly for 10 weeks in either the Coping With Caregiving psychoeducational program ( instruction and practice in small groups to learn specific cognitive and behavioral skills ) or in the Enhanced Support Group condition ( guided discussion and empathic listening to develop reciprocal support within the group ) . Both programs were tailored to be sensitive to the cultural concerns of Anglo and Latino caregivers , and they were delivered in either English or Spanish by trained interventionists . RESULTS Overall , participants in the Coping With Caregiving condition reported a significant reduction in depressive symptoms , increased use of adaptive coping strategies , and a trend toward decreased use of negative coping strategies when compared with those in the Enhanced Support Group condition . Results were similar for both ethnic groups : there were no main effects for ethnicity , and no significant ethnicity by treatment interaction effects . IMPLICATION S This study provides empirical support that female caregivers benefit more from a skill-building approach to managing their distress than from support group membership alone . We find it very encouraging that the Latino caregivers responded well on key outcome variables , suggesting that Latinos will participate in clinical research and will benefit from their involvement when services are provided to meet their specific needs CONTEXT Most older adults with dementia will be cared for by primary care physicians , but the primary care practice environment presents important challenges to providing quality care . OBJECTIVE To test the effectiveness of a collaborative care model to improve the quality of care for patients with Alzheimer disease . DESIGN , SETTING , AND PATIENTS Controlled clinical trial of 153 older adults with Alzheimer disease and their caregivers who were r and omized by physician to receive collaborative care management ( n = 84 ) or augmented usual care ( n = 69 ) at primary care practice s within 2 US university-affiliated health care systems from January 2002 through August 2004 . Eligible patients ( identified via screening or medical record ) met diagnostic criteria for Alzheimer disease and had a self-identified caregiver . INTERVENTION Intervention patients received 1 year of care management by an interdisciplinary team led by an advanced practice nurse working with the patient 's family caregiver and integrated within primary care . The team used st and ard protocol s to initiate treatment and identify , monitor , and treat behavioral and psychological symptoms of dementia , stressing nonpharmacological management . MAIN OUTCOME MEASURES Neuropsychiatric Inventory ( NPI ) administered at baseline and at 6 , 12 , and 18 months . Secondary outcomes included the Cornell Scale for Depression in Dementia ( CSDD ) , cognition , activities of daily living , re source use , and caregiver 's depression severity . RESULTS Initiated by caregivers ' reports , 89 % of intervention patients triggered at least 1 protocol for behavioral and psychological symptoms of dementia with a mean of 4 per patient from a total of 8 possible protocol s. Intervention patients were more likely to receive  cholinesterase inhibitors  ( 79.8 % vs 55.1 % ; P = .002 ) and  antidepressants  ( 45.2 % vs 27.5 % ; P = .03 ) . Intervention patients had significantly fewer behavioral and psychological symptoms of dementia as measured by the total NPI score at 12 months ( mean difference , -5.6 ; P = .01 ) and at 18 months ( mean difference , -5.4 ; P = .01 ) . Intervention caregivers also reported significant improvements in distress as measured by the caregiver NPI at 12 months ; at 18 months , caregivers showed improvement in depression as measured by the Patient Health Question naire-9 . No group differences were found on the CSDD , cognition , activities of daily living , or on rates of hospitalization , nursing home placement , or death . CONCLUSIONS Collaborative care for the treatment of Alzheimer disease result ed in significant improvement in the quality of care and in behavioral and psychological symptoms of dementia among primary care patients and their caregivers . These improvements were achieved without significantly increasing the use of antipsychotics or sedative-hypnotics . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00246896 PURPOSE This study examined the efficacy of a newly developed intervention , Acquiring New Skills While Enhancing Remaining Strengths ( ANSWERS ) , for family caregivers of individuals with dementia .  ANSWERS was design ed for dyads comprised of an individual with dementia and his/her family caregiver . Using a strength-based approach , ANSWERS combined educational skills ( traditionally used with caregivers ) and cognitive rehabilitation skills training ( traditionally used with individuals with dementia ) into a single protocol for addressing the dyad 's care issues and needs . Key domains addressed by the intervention included : education about dementia and memory loss ; effective communication ; managing memory ; staying active ; and recognizing emotions and behaviors . This analysis focused on outcomes for caregivers . DESIGN & METHODS The Stress Process Model guided the study 's hypotheses and design . Caregiving dyads were r and omly assigned to the control or intervention conditions . Intervention dyads received 6-curriculum guided sessions with an intervention specialist . Data came from in-person baseline interviews with caregivers conducted prior to r and omization and follow-up interviews conducted approximately 14.56 weekspost-baseline . RESULTS Intervention caregivers , compared to controls , had decreased care-related strain as indicated by lower emotional health strain , dyadic relationship strain , role captivity , and higher caregiving mastery . Additionally , intervention caregivers had improved well-being as indicated by fewer symptoms of depression and anxiety . IMPLICATION S ANSWERS was efficacious in improving key strain and psychosocial outcomes for caregivers . Features essential to the success of ANSWERS included a strength-based approach for selecting , developing , and implementing care goals , as well as teaching caregivers educational and cognitive rehabilitation skills for addressing care needs OBJECTIVE To test whether the Tailored Activity Program ( TAP ) reduces dementia-related neuropsychiatric behaviors , promotes activity engagement , and enhances caregiver well-being . DESIGN Prospect i ve , two-group ( treatment , wait-list control ) , r and omized , controlled pilot study with 4 months as main trial endpoint . At 4 months , controls received the TAP intervention and were reassessed 4 months later . SETTING Patients ' homes . PARTICIPANTS Sixty dementia patients and family caregivers . INTERVENTION The eight-session occupational therapy intervention involved neuropsychological and functional testing , selection , and customization of activities to match capabilities identified in testing , and instruction to caregivers in use of activities . MEASUREMENTS Behavioral occurrences , activity engagement , and quality of life in dementia patients ; objective and subjective burden and skill enhancement in caregivers . RESULTS At 4 months , compared with controls , intervention caregivers reported reduced frequency of problem behaviors , and specifically for shadowing and repetitive question ing , and greater activity engagement including the ability to keep busy . Fewer intervention caregivers reported agitation or argumentation . Caregiver benefits included fewer hours doing things and being on duty , greater mastery , self-efficacy , and skill enhancement . Wait-list control participants following intervention showed similar benefits for reductions in behavioral frequency and caregiver hours doing things for the patient and mastery .  Caregivers with depressed symptoms derived treatment benefits similar to nondepressed caregivers . CONCLUSIONS Tailoring activities to the capabilities of dementia patients and training families in activity use result ed in clinical ly relevant benefits for patients and caregivers . Treatment minimized trigger behaviors for nursing home placement and reduced objective caregiver burden . Noteworthy is that depressed caregivers effectively engaged in and benefited from the intervention OBJECTIVES Dementia is a rapidly growing public health problem in low and middle income countries . There is an urgent need , in the absence of formal services , to develop interventions design ed to improve the lives of people with dementia , and their families . This study tests the effectiveness of the 10/66 caregiver intervention among people with dementia , and their carers . DESIGN A single blind parallel group r and omized controlled trial ( IS RCT N41039907 ) . SETTING Moscow . PARTICIPANTS Sixty family caregivers of people aged 65 and over with dementia were r and omized to receive the intervention and medical care as usual ( n = 30 ) or medical care as usual only ( n = 30 ) . Caregiver and person with dementia outcomes were assessed at baseline and after 6 months . INTERVENTION The caregiver education and training intervention was delivered over five , weekly , half-hour sessions and was made up of three modules : ( i ) assessment ( one session ) ; ( ii ) basic education about dementia ( two sessions ) ; and ( iii ) training regarding specific problem behaviors ( two sessions ) . MEASUREMENTS Dementia was diagnosed using DSM-IV criteria . Caregiver : Zarit Carer Burden Interview ; carer psychological distress ( SRQ 20 ) ; and carer Quality of Life ( WHOQOL-BREF ) . Person with dementia : Behavioural and Psychological symptoms ( NPI-Q ) ; quality of life ( DEMQOL ) . RESULTS Caregivers in the intervention group reported large and statistically significant net improvements at 6-month follow-up in burden compared to controls . No group differences were found on caregiver psychological distress and patient and caregiver quality of life . CONCLUSIONS The low-level intervention seems to be as , if not more , effective than similar interventions applied in high income countries Objective : To determine the effectiveness of a counseling and support intervention for spouse caregivers in delaying time to nursing home placement of patients with Alzheimer disease ( AD ) , and identify the mechanisms through which the intervention accomplished this goal . Methods : We conducted a r and omized controlled trial of an enhanced counseling and support intervention compared to usual care . Participants were a referred volunteer sample of 406 spouse caregivers of community-dwelling patients who had enrolled in the study over a 9.5-year period . The intervention consisted of six sessions of individual and family counseling , support group participation , and continuous availability of ad hoc telephone counseling . Structured question naires were administered at baseline and at regular follow-up intervals , every 4 months for the first year and every 6 months thereafter . Cox proportional hazard models were used to test the effects of the intervention on the time to nursing home placement for the patients after controlling for multiple time-invariant and time-dependent predictors of placement . Results : Patients whose spouses received the intervention experienced a 28.3 % reduction in the rate of nursing home placement compared with usual care controls ( hazard ratio = 0.717 after covariate adjustment , p = 0.025 ) . The difference in model-predicted median time to placement was 557 days . Improvements in caregivers ’ satisfaction with social support , response to patient behavior problems , and symptoms of depression collectively accounted for 61.2 % of the intervention ’s beneficial impact on placement . Conclusion : Greater access to effective programs of counseling and support could yield considerable benefits for caregivers , patients with Alzheimer disease , and society Providing care to a family member with dementia is conceptualized as a chronic stressor with adverse psychological and physical effects . The purpose of this pilot study was to evaluate mood and immune outcomes of caregivers exposed to a community-based psychoeducational nursing intervention based on the progressively lowered stress threshold ( PLST ) model . The PLST intervention is design ed to strengthen the psychological re sources of dementia caregivers by teaching methods of preventing and /or managing behavioral problems exhibited by the person with dementia . Mood and immune outcomes were compared between caregivers r and omly assigned to receive either the PLST or a comparison intervention . Results of this pilot study suggest that caregivers who received the PLST intervention showed significantly stronger T-cell proliferative responses to both PHA and ConA , indicating an improvement in T-cell immune function immediately after the in-home intervention ( T2 ) and again after 6 months of telephone support for application of the PLST model ( T3 ) . Findings do not support the hypothesis that the PLST intervention had a significant effect on total mood disturbance or natural killer cell cytotoxicity over the course of the study PURPOSE The current article provides an in-depth description of a dyadic intervention for individuals with dementia and their family caregivers . Using a strength-based approach , caregiving dyads received skills training across 5 key areas : ( a ) education regarding dementia and memory loss , ( b ) effective communication , ( c ) managing memory loss , ( d ) staying active , and ( e ) recognizing emotions and behaviors . Results of the acceptability and feasibility of the intervention protocol s are also presented . DESIGN AND METHODS Caregiving dyads were r and omly assigned to participate in the intervention . Participants in the treatment condition were asked to complete a series of evaluation questions after each intervention session and an overall evaluation of the program . Data were also collected from the intervention specialists who implemented the protocol s. RESULTS Overall , the evaluation data indicated that the content and process of the intervention were viewed as highly acceptable and feasible by both participants and intervention specialists . IMPLICATION S This article highlights the merit of using a strength-based approach for working with caregiving dyads with dementia and how a single intervention protocol can be used to address the goals of both care partners . Furthermore , the intervention program was found to be highly acceptable and feasible , which is an important aspect of developing dyadic protocol BACKGROUND / OBJECTIVES Available services and intervention programs for dementia caregivers are often underutilized because of issues such as cost , logistics , lack of knowledge about available services , or insufficient support from others . Information technologies offer the potential of removing these barriers and facilitating the ability of caregivers to access needed support . This project evaluated the feasibility and efficacy of technology-based psychosocial intervention among minority family caregivers of dementia patients . DESIGN A feasibility and efficacy trial . SETTING Participants ' homes in the Greater Miami Community . PARTICIPANTS One hundred ten ( 56 Hispanic American and 54 African American ) caregivers of patients with dementia . INTERVENTION A technology-based multi-component psychosocial intervention was delivered in-home and via videophone technology over 5 months . The intervention was modeled after the REACH II intervention and targeted known areas of caregiver risk . MEASUREMENT St and ardized measures of depression , caregiver burden , social support , and the caregivers ' perception of the caregiver 's experience were administered at baseline and 5 months post-r and omization . RESULTS Overall , caregivers who received the intervention reported a decrease in burden , an increase in perceived social support and positive perceptions of the caregiving experience . No effect was observed for depression . Most participants indicated that the intervention improved their caregiving skills and found the technology to be easy to use . CONCLUSIONS A technology-based format was feasible for delivering a multi-component intervention to minority family dementia caregivers . The intervention improved caregiver outcomes for both Hispanic and African American caregivers . The results suggest that technology may help eliminate disparities in access to caregiver intervention programs Objective To assess whether the START ( STrAtegies for RelatTives ) intervention added to treatment as usual is cost effective compared with usual treatment alone . Design Cost effectiveness analysis nested within a pragmatic r and omised controlled trial . Setting Three mental health and one neurological outpatient dementia service in London and Essex , UK . Participants Family carers of people with dementia . Intervention Eight session , manual based , coping intervention delivered by supervised psychology graduates to  family carers of people with dementia added to usual treatment , compared with usual treatment alone . Primary outcome measures Costs measured from a health and social care perspective were analysed alongside the Hospital Anxiety and Depression Scale total score ( HADS-T ) of affective symptoms and quality adjusted life years ( QALYs ) in cost effectiveness analyses over eight months from baseline . Results Of the 260 participants recruited to the study , 173 were r and omised to the START intervention , and 87 to usual treatment alone .  Mean HADS-T scores were lower in the intervention group than the usual treatment group over the 8 month evaluation period ( mean difference −1.79 ( 95 % CI −3.32 to −0.33 ) ) , indicating better outcomes associated with the START intervention . There was a small improvement in health related quality of life as measured by QALYs ( 0.03 ( −0.01 to 0.08 ) ) . Costs were no different between the intervention and usual treatment groups ( £ 252 ( −28 to 565 ) higher for START group ) . The cost effectiveness calculations suggested that START had a greater than 99 % chance of being cost effective compared with usual treatment alone at a willingness to pay threshold of £ 30 000 per QALY gained , and a high probability of cost effectiveness on the HADS-T measure . Conclusions The manual based coping intervention START , when added to treatment as usual , was cost effective compared with treatment as usual alone by reference to both outcome measures ( affective symptoms for family carers , and carer based QALYs ) . Trial Registration ISCTRN To determine if teaching caregivers behavior management techniques ( BMTs ) reduces long-term psychotropic use in Alzheimer 's disease ( AD ) patients , we examined 12-month follow-up data from a 4-month r and omized study com paring placebo , BMTs , trazodone , and haloperidol for the treatment of  agitated behaviors in persons with AD . After 4 months , treatment was allowed with any agent . Between 42.8 % and 51 % of AD patients received additional psy chotropics between 4 and 12 months . The relative risk of being prescribed any psychotropic drug after the 4-month trial was at or about 1.0 for subjects in each drug arm or placebo arm versus BMTs . We concluded that teaching  caregivers BMTs did not diminish long-term prescription of psychotropic drugs . ( J Geriatr Psychiatry Neurol 2002 ; 15:95 - 98 ) BACKGROUND Over recent years multi-sensory stimulation ( MSS ) has become an increasingly popular approach to care and is used in several centres throughout Europe . This popularity could be explained by the limited alternatives available to staff and a widely held belief that MSS is a friendly and highly humane approach . A r and omized controlled trial was therefore essential to evaluate the effectiveness and extent of the benefits of MSS . AIM To assess whether MSS is more effective in changing the behaviour , mood and cognition of older adults with dementia than a control of activity ( playing card games , looking at photographs , doing quizzes , etc . ) . METHODS A total of 136 patients from three countries [ United Kingdom ( UK ) , the Netherl and s and Sweden ] were r and omized to MSS or activity groups . Patients participated in eight 30-minute sessions over 4 weeks . Ratings of behaviour and mood were taken before , during and after sessions to investigate immediate effects . Pre- , mid- , post-trial and follow-up assessment s were taken to investigate any generalization of effects to cognition and behaviour and mood at home/on the ward or at the day hospital . RESULTS There were limited short-term improvements for both the MSS and activity groups immediately after sessions , and limited short-term improvements between the groups during sessions . There were no significant differences between the groups when assessing change in behaviour , mood or cognition at home/on the ward or at the day hospital . In the UK , however , behaviour at the day hospital for both groups remained stable during the trial but deteriorated once the sessions had stopped , and active/disturbed behaviour at home improved but likewise deteriorated once sessions had stopped . CONCLUSIONS Overall , MSS was found to be no more effective than an activity in changing the behaviour , mood or cognition of patients with dementia in the short- or long-term We studied changes in apathy among 77 community-dwelling older persons with mild memory loss in a r and omized clinical trial comparing two nonpharmacological interventions over four weeks . The study used a pre-post design with r and omization by site to avoid contamination and diffusion of effect . Interventions were offered twice weekly after baseline evaluations were completed . The treatment group received classroom style mentally stimulating activities ( MSAs ) while the control group received a structured early-stage social support ( SS ) group . The results showed that the MSA group had significantly lower levels of apathy ( P < .001 ) and significantly lower symptoms of depression ( P < .001 ) . While both groups improved on quality of life , the MSA group was significantly better ( P = .02 ) than the SS group . Executive function was not significantly different for the two groups at four weeks , but general cognition improved for the MSA group and declined slightly for the SS group which produced a significant posttest difference ( P < .001 ) . Recruitment and retention of SS group members was difficult in this project , especially in senior center locations , while this was not the case for the MSA group . The examination of the data at this four-week time point shows promising results that the MSA intervention may provide a much needed method of reducing apathy and depressive symptoms , while motivating participation and increasing quality of life Objective To assess whether a manual based coping strategy compared with treatment as usual reduces depression and anxiety symptoms in carers of family members with dementia . Design R and omised , parallel group , superiority trial . Setting Three mental health community services and one neurological outpatient dementia service in London and Essex , UK . Participants 260 carers of family members with dementia . Intervention A manual based coping intervention comprising eight sessions and delivered by supervised psychology graduates to carers of family members with dementia . The programme consisted of psychoeducation about dementia , carers ’ stress , and where to get emotional support ; underst and ing behaviours of the family member being cared for , and behavioural management techniques ; changing unhelpful thoughts ; promoting acceptance ; assertive communication ; relaxation ; planning for the future ; increasing pleasant activities ; and maintaining skills learnt . Carers practised these techniques at home , using the manual and relaxation CDs . Main outcome measures Affective symptoms ( hospital anxiety and depression total score ) at four and eight months . Secondary outcomes were depression and anxiety caseness on the hospital anxiety and depression scale ; quality of life of both the carer ( health status question naire , mental health ) and the recipient of care ( quality of life-Alzheimer ’s disease ) ; and potentially abusive behaviour by the carer towards the recipient of care ( modified conflict tactics scale ) . Results 260 carers were recruited ; 173 were r and omised to the intervention and 87 to treatment as usual .  Mean total scores on the hospital anxiety and depression scale were lower in the intervention group than in the treatment as usual group over the eight month evaluation period : adjusted difference in means −1.80 points ( 95 % confidence interval −3.29 to −0.31 ; P=0.02 ) and absolute difference in means −2.0 points . Carers in the intervention group were less likely to have case level depression ( odds ratio 0.24 , 95 % confidence interval 0.07 to 0.76 ) and there was a non-significant trend towards reduced case level anxiety ( 0.30 , 0.08 to 1.05 ) . Carers ’ quality of life was higher in the intervention group ( difference in means 4.09 , 95 % confidence interval 0.34 to 7.83 ) but not for the recipient of care ( difference in means 0.59 , −0.72 to 1.89 ) . Carers in the intervention group reported less abusive behaviour towards the recipient of care compared with those in the treatment as usual group ( odds ratio 0.47 , 95 % confidence interval 0.18 to 1.23 ) , although this was not significant . Conclusions A manual based coping strategy was effective in reducing affective symptoms and case level depression in carers of family members with dementia . The carers ’ quality of life also improved . Trial registration Current Controlled Trials ISCTRN70017938 Context Providing care for patients with dementia can pose enormous burdens that may be eased with assistance and support . Needs may differ by race or ethnicity . Contributions The investigators r and omly assigned Hispanic , black , and white dementia caregivers to receive written educational material s or an intensive intervention to improve caregiver quality of life .  The specific interventions were determined by caregivers , were delivered via trained personnel and telephone support groups , and targeted several dimensions of need . The study found that quality of life improved for Hispanic and white caregivers and for black spousal caregivers in the intervention group but not in the control group . The intervention had no detectable effect on the number of care recipients who were institutionalized . Caution s The study used only a single 6-month follow-up assessment , combined heterogeneous cultures and ethnicities into 3 groups , and excluded some ethnicities . Implication s An intensive intervention targeting several dimensions of caregiver need improved caregiver quality of life without an apparent effect on care recipient institutionalization . The effect did not differ by caregiver race or ethnicity . The Editors Caring for a family member with dementia is extremely stressful , contributes to psychiatric and physical illness , and increases the risk for death ( 1 , 2 ) . The accumulating evidence on the personal , social , and health effects of dementia caregiving has generated a broad range of intervention studies , including r and omized trials aim ed at decreasing the burden and stress of caregiving . Several studies have demonstrated statistically significant effects in reducing caregiver burden , lowering caregiver depression , and delaying institutionalization of care recipients ( 1 , 3 , 4 ) through either targeted interventions that treat a specific caregiver problem , such as depression , or broad-based multicomponent interventions that include counseling , case management , and telephone support . Persistent limitations of caregiver intervention research are the paucity of well-controlled r and omized trials , the limited range of outcomes examined , small sample sizes and insufficient power , geographic limitations , inadequate racial or ethnic variation , and a scarcity of comprehensive multicomponent interventions ( 4 ) . Indeed , none of the 41 r and omized clinical trials published in the last 5 years met Consoli date d St and ards of Reporting Trials ( CONSORT ) recommendations for reporting r and omized trials ( 5 ) , and many have serious method ologic problems that call into question the reported findings ( 4 ) . To address these limitations , the National Institute on Aging and the National Institute of Nursing Research funded a multisite research program design ed to develop and test an effective caregiver intervention : the Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH ) study . We performed the study in 2 phases . In the first phase ( REACH I ) , we tested several different interventions at 6 U.S. sites to identify the most promising approaches to decreasing  caregiver burden and depression ( 6 ) . Results from the study showed that active treatments were superior to control conditions in reducing caregiver burden and that active engagement in skills training statistically significantly reduced  caregiver depression ( 7 , 8) . The existing literature and findings from REACH I helped guide the design of the REACH II intervention ( 7 , 8) . We based the REACH II study on the premise that caregivers can have problems in several areas at varying levels of intensity , and thus , interventions must be responsive to variations in needs among caregivers . The findings from REACH I also suggest that interventions that use active techniques , such as role-playing and interactive practice , are more effective at improving outcomes , such as depression symptoms , compared with more passive methods , such as providing information ( 7 ) . We based the REACH II intervention on these assumptions and design ed the intervention to maximize outcomes by systematic ally targeting several problem areas , tailored the intervention to respond to the needs of each individual , and actively engaged the caregiver in the intervention process . We hypothesized that participants assigned to the intervention would do better than those in the control group on several indicators of caregiver quality of life , including depression , burden , self-care , and social support and care recipient problem behaviors , and that these differences would be largest among Hispanic or Latino persons because they have lower access to support services ( 8) . In additional analyses , we assessed the effects of treatment on rates of caregiver clinical depression and care recipient institutional placement , as well as the benefits derived from study participation . Methods Caregivers Eligibility criteria for caregivers included the following : Hispanic or Latino , white or Caucasian , or black or African-American race or ethnicity ; age 21 years or older ; living with or sharing cooking facilities with the care recipient ; providing care for a relative with diagnosed Alzheimer disease or related disorders for at least 4 hours per day for at least the past 6 months ; and reported distress associated with caregiving ( reported at least 2 of the following 6 items at baseline assessment : felt overwhelmed , felt like they often needed to cry , were angry or frustrated , felt they were cut off from family or friends , reported  moderate to high levels of general stress , or felt their health had declined ) . We excluded caregivers who were involved in another caregiver intervention study , who had participated in REACH I , or who had an illness that would prevent 6 months of study participation . Other requirements were logistic , including having a telephone , planning to remain in the geographic area for at least 6 months , and competency in either English or Spanish ( see Appendix Table 1 for a detailed list of exclusions ) . Appendix Table 1 . Reasons for In eligibility Care Recipients To be eligible for the study , caregivers had to confirm that their relative had diagnosed Alzheimer disease or related disorders . In addition , we screened care recipients for a history of severe mental illness , head injury , Parkinson disease , or stroke , and we administered the  MiniMental State Examination ( MMSE )  ( 9 ) . We excluded patients who were bedbound with MMSE scores of 0 because we felt that our intervention had little to offer caregivers who were caring for such patients . Moreover , being bedbound is a risk factor for institutional placement or death , and we sought to exclude caregivers who were likely to transition out of the caregiving role within the 6-month study . For patients who scored more than 23 on the MMSE or had other conditions , such as head injury , we required a physician 's diagnosis of Alzheimer disease or related disorders . Procedures We recruited caregiver and care recipient dyads at 5 sites : Birmingham , Alabama ; Memphis , Tennessee ; Miami , Florida ; Palo Alto , California ; and Philadelphia , Pennsylvania . Enrollment began in June 2002 , and follow-up ended in August 2004 . Recruitment occurred in memory disorder clinics , primary care clinics , social service agencies , physician offices , churches , and community centers and by using professionally design ed brochures , public service announcements on radio stations , newspaper articles , television , targeted newsletters , and community presentations . We translated all intervention material s and assessment instruments into Spanish for the Hispanic or Latino participants by using established techniques for forward- and -back translation and allowing for regional variation in language expression . We used bilingual and bicultural staff at the 3 sites that recruited Hispanic or Latino participants : Palo Alto , Philadelphia , and Miami . At all sites , assessors and interventionists received cultural sensitivity training and were certified before entering the field . Certified assessors were blinded to group assignment of study participants . The institutional review boards of all 5 site institutions and the coordinating center in Pittsburgh , Pennsylvania , approved the study . We obtained written informed consent from all caregivers and from care recipients whenever possible . Caregivers provided consent on behalf of care recipients who could not do so on their own . After telephone screening ( n= 995 ) and baseline assessment ( n= 670 ) , we r and omly assigned participants ( n= 642 ) to the intervention or control group ( Figure ) . We stratified r and omization by using a block size of 2 or 4 within strata defined by the 5 intervention sites , 3 racial or ethnic groups ( Hispanic or Latino , white or Caucasian , and black or African American ) , and 2 caregivercare recipient relationships ( spouse or nonspouse ) . We performed r and omization at the coordinating center by using a computer-generated algorithm and a st and ard protocol for transmitting r and omization information between the coordinating center and the study sites . We administered 1 of 3 follow-up batteries , on the basis of care recipient status at follow-up ( full follow-up , bereavement battery , or placement battery ) , to study participants 6 months after r and omization when the intervention was completed . To maximize the number of individuals who could be included in the outcome analyses , we ensured that the 3 batteries were as similar as possible . We did not ask caregivers about caregiver burden and care recipient functional status if their care recipients had died ; thus , we could not include these caregivers in the primary outcome analysis ( 10 ) . Figure . Study flow diagram . * See Appendix Table 1 for reasons for in eligibility . See Appendix Table 2 ( for reasons for unavailable end points and types of 6-month follow-up . Appendix Table 2 . Reasons for Unavailable End Points and Types of 6-Month Follow-up Trial Groups Intervention The intervention involved a range of strategies : provision of OBJECTIVES To test the efficacy of a psychoeducative group program for informal caregivers of persons with dementia . METHODS The study was a multicenter r and omized controlled trial . R and omization was stratified according to sex and kinship . Participants r and omized to the control group were referred to the traditional support groups . Participants in the study group had fifteen 2-hr weekly sessions focusing on stress appraisal and coping .  Eligible participants ( primary caregivers of community-dwelling persons with dementia ) were blindly assessed before the r and omization and after 16 weeks on the following measures : frequency and reactions to behavioral problems ( primary outcome ) , burden , psychological distress , anxiety , perceived social support , and personal efficacy . RESULTS A total of 158 participants were r and omized to the study ( n = 79 ) and control ( n = 79 ) groups in 12 successive waves . Results show that study participants presented a 14 % decrease in their reactions to the behavioral problems of the care-receivers as opposed to a 5 % decrease in the control group ( p = .04 ) . The frequency of behavior problems also decreased ( p = .06 ) , as did the cross-product frequency/reaction ( p = .02 ) . There was no significant effect on the secondary outcome variables . DISCUSSION This is one of the first studies showing a significant effect of this type of support group program on the caregivers of participants with dementia Behavioral problems are among the most challenging aspects of caring for a person with Alzheimer 's disease . A sample of 406 spouses-caregivers of patients with Alzheimer 's disease was r and omized to an active multicomponent counseling and support intervention condition or to a usual care condition . Caregivers reported on the frequency of troublesome patient behaviors and their reactions to them at baseline and at regular follow-up interviews . R and om-effects regression models over the first 4 years after r and omization revealed that , although the intervention did not affect the frequency of patient behavioral problems , it did significantly reduce caregivers ' reaction ratings . Because caregiver appraisal s have been found to mediate the impact of caregiving stress on depression and to predict nursing home placement rates , they deserve greater attention as an important target of intervention services Background Almost all of the 820,000 people in the UK with dementia will experience Behavioural and Psychological Symptoms of Dementia ( BPSD ) . However , research has traditionally focused on treating cognitive symptoms , thus neglecting core clinical symptoms that often have a more profound impact on living with dementia . Recent evidence ( Kales et al , 2007 ; Ballard et al , 2009 ) indicates that the popular approach to managing BPSD - prescription of anti-psychotic medication - can increase mortality and the risk of stroke in people with dementia as well as impair quality of life and accelerate cognitive decline . Consequently , there is a need to evaluate the impact that non-pharmacological interventions have on BPSD ; we believe physical exercise is a particularly promising approach . Methods / Design We will carry out a pragmatic , r and omised , single-blind controlled trial to evaluate the effectiveness of exercise ( planned walking )  on the behavioural and psychological symptoms of individuals with dementia . We aim to recruit 146 people with dementia and their carers to be r and omized into two groups ; one will be trained in a structured , tailored walking programme , while the other will continue with treatment as usual . The primary outcome ( BPSD ) will be assessed with the Neuropsychiatric Inventory ( NPI ) along with relevant secondary outcomes at baseline , 6 and 12 weeks . Discussion Design ing this study has been challenging both ethically and method ologically . In particular to design an intervention that is simple , measurable , safe , non-invasive and enjoyable has been testing and has required a lot of thought . Throughout the design , we have attempted to balance method ological rigour with study feasibility . We will discuss the challenges that were faced and overcome in this paper . Trial Registration IS RCT PURPOSE We determine the main outcome effects of a 12-month computer-mediated automated interactive voice response ( IVR ) intervention design ed to assist family caregivers managing persons with disruptive behaviors related to Alzheimer 's disease ( AD ) . DESIGN AND METHODS We conducted a r and omized controlled study of 100 caregivers , 51 in the usual care control group and 49 in the technology intervention group , who received yearlong access to an IVR-mediated system .  The system provided caregiver stress monitoring and counseling information , personal voice-mail linkage to AD experts , a voice-mail telephone support group , and a distraction call for care recipients . We conducted analyses by using a repeated measures approach for longitudinal data and an intention-to-treat analytic approach . Outcomes included the caregiver 's appraisal of the bothersome nature of caregiving , anxiety , depression , and mastery at baseline , 6 , 12 , and 18 months . RESULTS There was a significant intervention effect as hypothesized for participants with lower mastery at baseline on all three outcomes : bother ( p = .04 ) , anxiety ( p = .01 ) , and depression ( p = .007 ) . Additionally , wives exhibited a significant intervention effect in the reduction of the bothersome nature of caregiving ( p = .02 ) . IMPLICATION S Wives who exhibited low mastery and high anxiety benefited the most from the automated telecare intervention . Findings suggest that , to optimize outcome effects , similar interventions should be tailored to match the users ' characteristics and preferences OBJECTIVE To evaluate the effectiveness of a combination of cholinesterase inhibitor therapy for patients with Alzheimer disease ( AD ) and psychosocial intervention  , for their spouse caregivers compared with drug treatment alone in three countries simultaneously . DESIGN R and omized controlled trial . Structured question naires were administered at baseline and at regular follow-up intervals for 24 months by independent raters blind to group assignment . SETTING Outpatient research clinics in New York City , U.S. , Manchester , U.K. and Sydney , Australia . PARTICIPANTS Volunteer sample of 158 spouse caregivers of community dwelling patients with AD . INTERVENTIONS Five sessions of individual and family counseling within 3 months of enrollment and continuous availability of ad hoc telephone counseling were provided for half the caregivers . Donepezil was prescribed for all patients . MAIN OUTCOME MEASURE Depressive symptoms of spouse caregivers measured at intake and follow-up assessment s for 24 months using Beck Depression Inventory ( revised ) . RESULTS Depression scores of caregivers who received counseling decreased over time , whereas the depression scores for caregivers who did not receive counseling increased . The benefit of the psychosocial intervention was significant after controlling for site , gender and country was not accounted for by antidepressant use and increased over 2 years even though the individual and family counseling sessions occurred in the first 3 months . CONCLUSION Effective counseling and support interventions can reduce symptoms of depression in caregivers when patients are taking donepezil . Harmonized multinational psychosocial interventions are feasible . Combined drug and supportive care approaches to the management of people with AD should be a priority OBJECTIVES To test the effects of an intervention that helps families manage  distressing behaviors in family members with dementia . DESIGN Two-group r and omized trial . SETTING In home . PARTICIPANTS Two hundred seventy-two caregivers and people with dementia . INTERVENTION Up to 11 home and telephone contacts over 16 weeks by health professionals who identified potential triggers of patient behaviors , including communication and environmental factors and patient undiagnosed medical conditions ( by obtaining blood and urine sample s ) and trained caregivers in strategies to modify triggers and reduce their upset . Between 16 and 24 weeks , three telephone contacts reinforced strategy use . MEASUREMENTS Primary outcomes were frequency of targeted problem behavior and caregiver upset with and confidence managing it at 16 weeks . Secondary outcomes were caregiver well-being and management skills at 16 and 24 weeks and caregiver perceived benefits . Prevalence of medical conditions for intervention patients were also examined . RESULTS At 16 weeks , 67.5 % of intervention caregivers reported improvement in targeted problem behavior , compared with 45.8 % of caregivers in a no-treatment control group ( P=.002 ) , and reduced upset with ( P=.03 ) and enhanced confidence managing ( P=.01 ) the behavior . Additionally , intervention caregivers reported less upset with all problem behaviors ( P=.001 ) , less negative communication ( P=.02 ) , less burden ( P=.05 ) , and better well-being ( P=.001 ) than controls . Fewer intervention caregivers had depressive symptoms ( 53.0 % ) than control group caregivers ( 67.8 % , P=.02 ) . Similar caregiver outcomes occurred at 24 weeks . Intervention caregivers perceived more study benefits ( P<.05 ) , including ability to keep family members home , than controls . Blood and urine sample s of intervention patients with dementia showed that 40 ( 34.1 % ) had undiagnosed illnesses requiring physician follow-up . CONCLUSION Targeting behaviors up setting to caregivers and modifying potential triggers improves symptomatology in people with dementia and caregiver well-being and skills PURPOSE We developed manual-guided , replicable interventions based on common needs and cultural preferences of White and African American family caregivers ( CGs ) of individuals with dementia , and we evaluated these interventions after a 6-month follow-up . DESIGN AND METHODS We r and omly assigned White ( n = 70 ) and African American ( n = 48 ) CGs of individuals with dementia to either a skills training condition or a minimal support control condition . RESULTS The degree of treatment implementation was method ically assessed , and findings demonstrated that both interventions were delivered according to protocol and were well received by CGs . CGs in both groups reported decreasing levels of problem behaviors and appraisal s of behavioral bother , and increased satisfaction with leisure activities over time . On a measure of appraisal of distress related to behavior problems , White CGs showed more improvement in the minimal support control condition , and African American CGs showed the greatest improvements in the skills training condition . Spouse and nonspouse CGs also showed differential responses to intervention . IMPLICATION S Brief manual-guided interventions can be effective with White and African American CGs , and greater attention should be paid to possible differential responses to interventions by race and relationship to care recipient OBJECTIVE The long-term effect of counseling and support on symptoms of depression was examined in spouse-caregivers of patients with Alzheimer 's disease . METHOD The participants were 406 spouse-caregivers of Alzheimer 's disease patients who lived at home at baseline . The caregivers were r and omly assigned to either a group receiving enhanced counseling and support treatment or a group receiving usual care ( control group ) . Caregivers in the enhanced treatment group were provided with six sessions of individual and family counseling , agreed to join support groups 4 months after enrollment , and received ongoing ad hoc counseling . The Geriatric Depression Scale was administered at baseline and at regular follow-up intervals for as long as the caregiver participated in the study . RESULTS After baseline differences were controlled for , caregivers in the enhanced treatment group had significantly fewer depressive symptoms after the intervention than did the control subjects . These effects were sustained for 3.1 years after baseline , similar across gender and patient severity level , and sustained after nursing home placement or death of the patient . CONCLUSIONS Counseling and support lead to sustained benefits in reducing depressive symptoms in spouse-caregivers of Alzheimer 's disease patients and should be widely available to provide effective , evidence -based intervention for family caregivers Family caregivers of individuals with dementia are at heightened risk for emotional and mental health problems . Many caregivers do not seek assistance or become isolated in their caregiving role . Multi-component interventions have demonstrated efficacy for reducing emotional distress and burden , although these approaches are potentially costly and are not widely accessible . In response to these issues , we developed the Family Intervention : Telephone Tracking - Caregiver ( FITT-C ) , which is an entirely telephone-based psychosocial intervention . The purpose of this paper is to describe the study design , methodology , and baseline data for the trial . This study uses a r and omized controlled trial design to examine the efficacy of the FITT-C to reduce depressive symptoms and burden in distressed dementia caregivers . All participants ( n=250 ) received a packet of educational material s and were r and omly assigned to receive 6 months of the FITT-C intervention or non-directive telephone support . The FITT-C intervention was design ed to reduce distress in caregivers and is based on the McMaster Model of Family Functioning , transition theory , and Lazarus and Folkman 's Stress and Coping Models . The primary dependent variables were depressive symptoms ( Centers for Epidemiological Studies - Depression ) and burden ( Zarit Burden Interview , Revised Memory and Behavior Problems Checklist - Reaction ) . Secondary outcome measures included family functioning , self-efficacy , and health-related quality of life . Results of the study will provide important data about the efficacy of a telephone-based approach to reduce distress in dementia caregivers Background Eighty percent of persons with Alzheimer ’s disease and related disorders are cared for by family members who often lack adequate support and training for this all-consuming job . Objective To evaluate the efficacy of a longitudinal , multisite , community-based intervention design ed to teach home caregivers to manage behavioral problems in persons with Alzheimer ’s disease . Methods Usable data were analyzed from 237 caregiver/care recipient dyads ( n = 132 Experimental;n = 105 Comparison ) . The experimental group received a psychoeducational nursing intervention that was conceptually grounded in the Progressively Lowered Stress Threshold model ( Hall & Buckwalter , 1987 ) . The comparison group received routine information and referrals for case management , community-based services , and support groups . Although a variety of psychosocial outcomes were compared between caregivers in the two groups , this article focuses on frequency and response to behavioral problems and functional decline . Results The Progressively Lowered Stress Threshold intervention had a statistically significant effect on spousal response to memory/behavioral problems ( p < .01 ) for all caregivers and on response to activities of daily living problems ( p < .01 ) for spousal caregivers . In addition , nonspouses in the experimental group reported a reduction in the frequency of memory/behavioral problems ( p < .01 ) . No intervention effect on reports of activities of daily living frequencies was found for either spouses or nonspouses . Conclusions This Progressively Lowered Stress Threshold-based intervention had a positive impact on both the frequency of and response to problem behaviors among spousal caregivers OBJECTIVES To test the effects of walking , light exposure , and a combination intervention ( walking , light , and sleep education ) on the sleep of persons with Alzheimer 's disease ( AD ) . DESIGN R and omized , controlled trial with blinded assessors . SETTING Independent community living . PARTICIPANTS One hundred thirty-two people with AD and their in-home caregivers . INTERVENTIONS Participants were r and omly assigned to one of three active treatments ( walking , light , combination treatment ) or contact control and received three or six in-home visits . MEASUREMENTS Primary outcomes were participant total wake time based on wrist actigraphy and caregiver ratings of participant sleep quality on the Sleep Disorders Inventory ( SDI ) . Secondary sleep outcomes included additional actigraphic measurements of sleep percentage , number of awakenings , and total sleep time . RESULTS Participants in walking ( P=.05 ) , light ( P=.04 ) , and combination treatment ( P=.01 ) had significantly greater improvements in total wake time at posttest ( effect size 0.51 - 0.63 ) than controls but no significant improvement on the SDI . Moderate effect size improvements in actigraphic sleep percentage were also observed in active treatment participants . There were no significant differences between the active treatment groups and no group differences for any sleep outcomes at 6 months . Participants with better adherence ( 4 d/wk ) to walking and light exposure recommendations had significantly less total wake time ( P=.006 ) and better sleep efficiency ( P=.005 ) at posttest than those with poorer adherence . CONCLUSION Walking , light exposure , and their combination are potentially effective treatments for improving sleep in community-dwelling persons with AD , but consistent adherence to treatment recommendations is required PURPOSE We investigated whether community consultants could be trained to teach family caregivers a systematic behavioral approach for reducing mood and behavior problems in persons with Alzheimer 's disease . DESIGN AND METHODS This study consisted of a r and omized controlled trial ; we r and omly assigned 95 family caregivers and care recipients with Alzheimer 's disease to STAR-caregivers ( STAR-C ) or control groups . Masked interviewers conducted assessment s at baseline , after treatment , and after 6 months . Consultants were master's-level health care professionals who were currently practicing in community setting s serving older adults . We assessed the extent to which consultants were able to learn and adhere to the treatment protocol , and the relationship between adherence and measures of caregiver mood , burden , and care recipient mood and behavior . RESULTS Community consultants were able to learn and adhere to the behavioral treatment protocol . Caregivers receiving STAR-C training showed significant improvements in depression , burden , and reactivity to behavior problems in the care recipient . There were also significant reductions in the frequency and severity of care recipient behavior problems , and improved quality of life . Results were maintained at 6-month follow-up . IMPLICATION S Community-based consultants successfully implemented a behavioral intervention with family caregivers of persons with Alzheimer 's disease . Consequently , STAR-C seems to be a practicable and reasonable evidence d-based approach to caregiver training in actual clinical setting BACKGROUND Anxiety is common and problematic in dementia , yet there is a lack of effective treatments . AIMS To develop a cognitive-behavioural therapy ( CBT ) manual for anxiety in dementia and determine its feasibility through a r and omised controlled trial . METHOD A ten-session CBT manual was developed . Participants with dementia and anxiety ( and their carers ) were r and omly allocated to CBT plus treatment as usual ( TAU ) ( n = 25 ) or TAU ( n = 25 ) . Outcome and cost measures were administered at baseline , 15 weeks and 6 months . RESULTS At 15 weeks , there was an adjusted difference in anxiety ( using the Rating Anxiety in Dementia scale ) of ( -3.10 , 95 % CI -6.55 to 0.34 ) for CBT compared with TAU , which just fell short of statistical significance . There were significant improvements in depression at 15 weeks after adjustment ( -5.37 , 95 % CI -9.50 to -1.25 ) . Improvements remained significant at 6 months . CBT was cost neutral . CONCLUSIONS CBT was feasible ( in terms of recruitment , acceptability and attrition ) and effective . A fully powered RCT is now required OBJECTIVE The objective of this study is to evaluate the effectiveness of a simple  dyadic ( person with dementia and their main carer ) exercise regimen as a therapy for the behavioural and psychological symptoms of dementia . METHOD A two arm , pragmatic , r and omised , controlled , single-blind , parallel-group trial of a dyadic exercise regimen ( individually tailored walking regimen design ed to become progressively intensive and last between 20 - 30 min , at least five times per week).Community-dwelling individuals with ICD-10 confirmed dementia with the following : clinical ly significant behavioural and psychological symptoms , a carer willing and able to co-participate in the exercise regimen , and no physical conditions or symptoms that would preclude exercise participation were invited by mental health or primary care services into the study . RESULTS One hundred and thirty-one dyads were recruited to this study . There was no significant difference in Behavioural and Psychological Symptoms as measured by the Neuropsychiatric Inventory at week 12 between the group receiving the dyadic exercise regimen and those that did not ( adjusted difference in means ( intervention minus control ) = -1.53 , p = 0.6 , 95 % CI [ -7.37 , 4.32 ] ) . There was a significant between-group difference in caregiver 's burden as measured by the Zarit Caregiver Burden Inventory at week 12 ( OR = 0.18 , p = 0.01 , CI [ 0.05 , 0.69 ] ) favouring the exercise group . CONCLUSIONS This study found that regular simple exercise does not appear to improve the behavioural and psychological symptoms of dementia , but did seem to attenuate caregiver burden . Further study to improve exercise uptake are needed Background : There is a lack of appropriately design ed trials investigating the efficacy of psychosocial interventions for patients with mild dementia and their family caregivers . This paper reports the rationale and design of the Danish Alzheimer Disease Intervention Study and baseline characteristics of the cohort . Methods : The study was a 1-year multicentre r and omized controlled rater-blinded trial with r and omization to follow-up and a multifaceted semitailored intervention programme or to follow-up only ( with extension of follow-up to 3 years ) . The intervention included a counselling programme , teaching courses , written information and logbooks . The outcomes included clinical efficacy parameters , patient satisfaction and health economic consequences . Results : A total of 330 patients and their 330 caregivers were included during a period of 18 months . The majority ( 65.2 % ) of the caregivers were spouses . At inclusion the mean age of the patients and caregivers was 76.2 and 66.0 years , respectively . Conclusion : The study will explore the added value of a multifaceted intervention programme and contribute to the design of future interventions for patients with mild dementia and their caregivers Prior research ( Gallagher-Thompson , D. , Gray , H. , Tang , P. , Pu , C.-Y. , Tse , C. , Hsu , S. , et al. ( 2007 ) . Impact of in-home intervention versus telephone support in reducing  depression and stress of Chinese caregivers : Results of a pilot study . American Journal of Geriatric Psychiatry , 15 , 425–434 . ) found that an in-home behavioral management program , derived conceptually from cognitive behavioral theories ( CBT ) , was effective in reducing caregiver related stress and depressive symptoms in Chinese American dementia caregivers ( CGs ) . Results were promising , but a more cost-effective intervention is needed to serve this growing population . Past work also found that a psychoeducational videotaped training program based on CBT was effective in reducing stress due to caregiving in Caucasian and African American dementia family CGs ( Steffen , 2000 , Anger management for dementia caregivers : A preliminary study using video and telephone interventions . Behavior Therapy , 31 , 281–299 . ) . To date no research has been conducted using a technological medium to deliver a similar kind of intervention to Chinese American caregivers . The present study evaluated the effectiveness of a similar but culturally “ tailored ” program in which 70 CGs were r and omly assigned to a 12-week CBT skill training program delivered on a DVD , or to a general educational DVD program on dementia . Both were available in M and arin Chinese or English as preferred . Pre post change analyses indicated that CGs did not differ on change in level of negative depressive symptoms , but positive affect was higher , and patient behaviors were appraised as less stressful and bothersome , for CGs in the CBT skill training program . They were also more satisfied with the program overall and reported that they believed they were able to give care more effectively . Results encourage further development of theoretically based interventions , delivered using modern technology , for this ever increasing group of CGs OBJECTIVES We reported the findings of a r and omized controlled trial ( RCT ) to examine the effects of an individualized functional enhancement program ( FEP ) on functional skills and mood symptoms in mild and moderate dementia . SUBJECTS & METHODS 74 Chinese older persons with dementia were recruited into a skills training program by occupational therapists ( OT ) . Thirty seven subjects were trained with an individualized selection of daily activities ( FEP Intervention , I ) ; 37 were trained with general occupational therapy ( Control , C ) . The FEP comprised of twice weekly group sessions of skills training and problem solving using cognitive behavioral approach . RESULTS At 1 month after completion of program , both I and C subjects showed an improvement in process skills of the assessment of motor and process skills (AMPS)(paired t-tests , p < 0.05 ) . At 4 months post-program , the I group showed a further reduction of cornell scale for depression in dementia ( CSDD ) scores ( paired t-test , p = 0.02 ) ; Apathy improved at 1 month post-training ( p = 0.04 ) , but deteriorated at 4 months ( p = 0.01 ) . Group differences in changes of mood and functional scores were not significant ( ANVOCA , p > 0.05 ) . CONCLUSIONS The findings suggested a potential benefit for individualized occupational therapy . It should be tailor made with individual needs and continued for sustained effectiveness PURPOSE The majority of persons with Alzheimer 's disease ( AD ) are cared for at home by a family member such as a spouse or daughter . Caregiving places enormous dem and s on these caregivers , and the negative consequences associated with caregiving are well documented . This paper reports results from the Miami site of the REACH ( Re sources for Enhancing Alzheimer 's Caregiver Health ) program that examined the efficacy of a family therapy and technology-based intervention in reducing depressive symptoms ( according to the Center for Epidemiological Studies Depression scale ) among family caregivers of AD patients at 6 months and 18 months follow-up . DESIGN AND METHODS There were 225 White American and Cuban American caregivers that were r and omized into a structural ecosystems therapy , structural ecosystems therapy + computer-telephone integrated system , or minimal support control condition .  RESULTS Caregivers in the combined family therapy and technology intervention experienced a significant reduction in depressive symptoms at 6 months . The 18-month follow-up data indicated that the intervention was particularly beneficial for Cuban American husb and and daughter caregivers . IMPLICATION S The results indicate that information technology has a promising role in alleviating distress and depression among groups of AD caregivers . The data also demonstrate that interventions have differential impacts according to ethnic group and the caregiver-patient relationship OBJECTIVE The objective of this study was to determine the effects of counseling and support on the physical health of caregivers of spouses of people with Alzheimer disease . METHODS A r and omized controlled trial , conducted between 1987 and 2006 at an outpatient research clinic in the New York City metropolitan area compared outcomes of psychosocial intervention to usual care . Structured question naires were administered at baseline and regular follow-ups . A referred volunteer sample of 406 spouse caregivers of community dwelling patients with Alzheimer disease enrolled over a 9.5-year period .  Enhanced counseling and support consisted of six sessions of individual and family counseling , support group participation , and continuous availability of ad-hoc telephone counseling . Indicators of physical health included self-rated health ( SRH ) of caregivers and the number of reported illnesses . RESULTS Controlling for baseline SRH ( mean : 7.24 ) , intervention group caregivers had significantly better SRH than control group caregivers based upon model predicted mean scores four months after baseline ( 6.87 versus 7.21 ) , and this significant difference was maintained for two years ( 6.70 versus 7.01 ) . The effect of the intervention on SRH remained significant after controlling for the effects of patient death , nursing home placement , caregiver depressive symptoms and social support satisfaction . Similar benefits of intervention were found for number of illnesses .  CONCLUSION Counseling and support preserved SRH in vulnerable caregivers . Enhancing caregivers ' social support , fostering more benign appraisal s of stressors , and reducing depressive symptoms may yield indirect health benefits . Psychosocial intervention studies with biological measures of physical health outcomes are warranted BACKGROUND Few studies evaluate whether short-term intervention effects are maintained over time for families caring for persons with dementia . This article examines whether treatment effects found at 6 months following active treatment were sustained at 12 months for 127 family caregivers who participated in an occupational therapy intervention tested as part of the National Institutes of Health Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH ) initiative . METHODS A r and omized two-group design was implemented with three assessment points : baseline , 6 months , and 12 months . Caregivers were r and omly assigned to a usual care control group or intervention that consisted of six occupational therapy sessions to help families modify the environment to support daily function of the person with dementia and reduce caregiver burden . Following 6-month active treatment , a maintenance phase consisted of one home and three brief telephone sessions to reinforce strategy use and obtain closure . Non-inferiority statistical analysis was used to evaluate whether intervention caregivers maintained treatment benefits from 6 to 12 months in comparison to controls . RESULTS For the sample of 127 at 6 months , caregivers in intervention reported improved skills ( p = .028 ) , less need for help providing assistance ( p = .043 ) , and fewer behavioral occurrences ( p = .019 ) compared to caregivers in control . At 12 months , caregiver affect improved ( p = .033 ) , and there was a trend for maintenance of skills and reduced behavioral occurrences , but not for other outcome measures . CONCLUSION An in-home skills training program helps sustain caregiver affect for those enrolled for more than 1 year . More frequent professional contact and ongoing skills training may be necessary to maintain other clinical ly important outcomes such as reduced upset with behaviors OBJECTIVES This study tested the effectiveness of a dementia care management program for Chinese families of relatives with dementia on  caregivers ' and  patients  ' health outcomes over a 12-month follow-up period . METHODS The dementia care management program is an educational and supportive group for caregivers that lasts six months . A controlled trial was conducted with 88 primary caregivers of persons with dementia in two dementia care centers in Hong Kong . Family members were assigned r and omly to either the dementia care program or st and ard care . The two groups were compared for patients ' symptoms and institutionalization rates and caregivers ' quality of life , burden , and social support upon recruitment and six and 12 months after group assignment . RESULTS Over the 12-month follow-up period , patients with family members in the dementia care program showed significantly greater improvements in symptoms and institutionalization rates and their caregivers reported significantly greater improvements in quality of life and burden compared with the control group . CONCLUSIONS The findings provide evidence that the dementia care management program can improve the psychosocial functioning of Chinese persons with dementia and their caregivers OBJECTIVE To evaluate the effectiveness of the Systematic Care Program for Dementia ( SCPD ) on patient institutionalization and to determine the predictors of institutionalization . DESIGN Single-blind , multicenter , cluster-r and omized , controlled trial . SETTING Six community mental health services ( CMHSs ) across the Netherl and s. PARTICIPANTS A total of 295 patient-caregiver dyads referred to a CMHS with suspected patient dementia . INTERVENTION Training of health professionals in the SCPD and its subsequent use . The SCPD consists of a systematic assessment of caregiver problems and alerts health professionals in flexible , connecting , proactive interventions to them . The intensity of the SCPD depends on the judgment of the health professional , based on individual caregiver needs . PRIMARY OUTCOME Institutionalization in long-term care facilities at 12 months of follow-up . RESULTS No main intervention effect on institutionalization was found . However , a better sense of competence in the control group reduced the chance of institutionalization but not in the intervention group . The caregiver 's sense of competence and depressive symptoms and the patient 's behavioral problems and severity of dementia were the strongest predictors of institutionalization . The intensity of the program was low , even for dyads exposed to the SCPD . CONCLUSIONS Although no main effect was found , the results suggest that the SCPD might prevent a deterioration of the sense of competence in the intervention group . The intensity of a program is crucial and should be prescribed on the basis of evidence rather than left to the discretion of health professionals . Future controlled trials in daily clinical practice should use a process analysis to control for compliance The purpose of this study was to determine if telephone support groups for dementia caregivers have an effect on bother with patient behaviours , burden , depression , and general well-being . The r and omized controlled trial compared telephone support groups ( 15 groups of 5 or 6 caregivers ) with control groups ( print material s ) . Groups met 14 times over 1 year . The 1-hour sessions included content on education , coping skills , and support . Data were collected at baseline and at 6 and 12 months . The sample comprised 154 caregivers , 77 per arm , providing care to veterans with dementia or a veteran caregiver . Bother was found to differ significantly at baseline . There were no significant treatment effect differences between study arms . Participants anecdotally reported improvement . It was concluded that telephone support groups are an efficient way to interact with caregivers . Further research should test different models of care . Interventions that are targeted to specific needs or occur frequently may provide better support for caregivers of individuals with a worsening condition OBJECTIVES To investigate short-term effects of Multi-Sensory Stimulation ( MSS ) on behaviour , mood and cognition of older adults with dementia , the generalization of effects to day hospital and home environments and the endurance of any effects over time . DESIGN A r and omized controlled trial comparing MSS with a credible control of one-to-one activities . METHODS Fifty patients with diagnoses of moderate to severe dementia were r and omized to either MSS or Activity groups . Patients participated in eight 30-minute sessions over a 4-week period . Ratings of behaviour and mood were taken before , during and after sessions to investigate immediate effects . Pre , mid , post-trial , and follow-up assessment s were taken to investigate any generalization of effects on cognition , behaviour at the day hospital and behaviour and mood at home and endurance of effects once sessions had ceased . RESULTS Immediately after MSS and Activity sessions patients talked more spontaneously , related better to others , did more from their own initiative , were less bored/inactive , and were more happy , active or alert . Both groups were more attentive to their environment than before , with a significantly greater improvement from the MSS group . At the day hospital , patients in the Activity group improved on their ' speech skills ' ( amount of speech ; initiation of speech ) , whereas the MSS group remained unchanged during the trial . The MSS group showed a significant improvement in mood and behaviour at home compared to the Activity group whose behaviour deteriorated . No longer-term benefits were shown ; indeed , behaviour declined sharply during the month follow-up period . CONCLUSIONS Both MSS and Activity sessions appear to be effective and appropriate therapies for people with dementia Objectives To examine the long-term efficacy at the 36-month follow-up of an early psychosocial counselling and support programme lasting 8–12 months for community-dwelling patients with mild Alzheimer 's disease and their caregivers . Design Multicentre , r and omised , controlled , rater-blinded trial . Setting Primary care and memory clinics in five Danish districts . Participants 330 home-dwelling patients with mild Alzheimer 's disease and their primary caregivers ( dyads ) . Interventions Dyads were r and omised to receive intervention during the first year after diagnosis . Both intervention and control groups had follow-up visits at 3 , 6 , 12 and 36 months . Main outcome measures Primary outcomes for the patients assessed at 36-month follow-up were changes from baseline in global cognitive function ( Mini-Mental State Examination ) , depressive symptoms ( Cornell Depression Scale ) and proxy-rated EuroQoL quality of life on visual analogue scale . The primary outcomes for the caregivers were changes from baseline in depressive symptoms ( Geriatric Depression Scale ) and self-rated EuroQoL quality of life on a visual analogue scale . The secondary outcome measures for the patient were proxy-rated Quality of Life Scale for Alzheimer 's disease ( QoL-AD ) , Neuropsychiatric Inventory- Question naire , Alzheimer 's disease Cooperative Study Activities of Daily Living Scale , all-cause mortality and nursing home placement . Results At a 36-month follow-up , 2 years after the completion of the Danish Alzheimer Intervention Study ( DAISY ) , the unadjusted positive effects previously detected at the 12-month follow-up in one patient primary outcome ( Cornell depression score ) and one patient secondary outcome ( proxy-rated QoL-AD ) disappeared ( Cornell depression score , p=0.93 ; proxy-rated QoL-AD , p=0.81 ) . No long-term effect of DAISY intervention on any other primary and secondary outcomes was found at the 36-month follow-up . Conclusions For patients with very mild Alzheimer 's disease and their caregivers , an intensive , multi-component , semitailored psychosocial intervention programme with counselling , education and support during the first year after diagnosis did not show any positive long-term effect on primary and secondary outcomes . Trial registration The study was registered in the Clinical Trial Data base ( http://www.controlled-trials.com/IS RCT N74848736 ) The objective of this study was to examine the preliminary efficacy of Family Intervention : Telephone Tracking — Dementia ( FITT-D ) , a multi-component intervention that is delivered in 23 telephone contacts over 12 months . Thirty-three dementia caregivers were r and omly assigned to receive either FITT-D ( n = 16 ) or st and ard care ( n = 17 ) using urn r and omization to balance the groups on dementia severity , caregiver gender and relationship type ( spouse versus other ) . Inclusion criteria included formal dementia diagnosis , caregiving for at least six months , residing with the care recipient , and providing at least four hours of direct supervision per day . Master's-level therapists contacted caregivers by telephone over 12 months . Each contact followed a st and ardized treatment manual , involving assessment and individualized application of interventions to address mood , family functioning , social support and health . Outcomes included Zarit Burden Interview , Revised Memory and Behavior Problem Checklist , and the Geriatric Depression Scale at baseline and 12 months ( end of treatment ) . Caregivers receiving  FITT-D exhibited significantly lower burden scores and less severe reactions to memory and behavior problems than caregivers in the st and ard care condition . Findings provide preliminary evidence for the efficacy of FITT-D , a potentially highly accessible , low-cost intervention for dementia caregivers OBJECTIVE There is a need , in the absence of formal services , to design interventions aim ed at improving the lives of people with dementia and their families . This study tested the effectiveness of the 10/66 caregiver intervention among people with dementia and their caregivers in Lima , Peru . METHOD DESIGN / PARTICIPANTS a r and omized controlled trial was performed involving 58 caregivers of people with dementia that received the intervention in the beginning of the trial ( n = 29 ) or six months later ( n = 29 ) . The intervention consisted of three modules : 1 ) assessment ( one session ) ; 2 ) basic education about dementia ( two sessions ) ; and 3 ) training regarding specific problem behaviors ( two sessions ) . MAIN OUTCOME MEASURES Caregivers and patients with dementia were assessed at baseline and after six months . For caregivers , the measures included strain ( Zarit Burden Interview ) , psychological distress ( SRQ-20 ) , and quality of life ( WHOQOL-BREF ) . Dementia patients completed scales assessing behavioral and psychological symptoms ( NPI-Q ) and quality of life ( DEMQOL ) . RESULTS Caregivers in the intervention group reported significantly decreased strain measures six months after the intervention compared to controls . No group differences were found in respect to the caregivers ' psychological distress and to quality of life in both caregivers and patients . CONCLUSION The 10/66 intervention seems to be as effective as similar interventions used in more developed countries CONTEXT Exercise training for patients with Alzheimer disease combined with teaching caregivers how to manage behavioral problems may help decrease the frailty and behavioral impairment that are often prevalent in patients with Alzheimer disease . OBJECTIVE To determine whether a home-based exercise program combined with caregiver training in behavioral management techniques would reduce functional dependence and delay institutionalization among patients with Alzheimer disease . DESIGN , SETTING , AND PATIENTS R and omized controlled trial of 153 community-dwelling patients meeting National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer Disease and Related Disorders Association criteria for Alzheimer disease , conducted between June 1994 and April 1999 . INTERVENTIONS Patient-caregiver dyads were r and omly assigned to the combined exercise and caregiver training program , Reducing Disability in Alzheimer Disease ( RDAD ) , or to routine medical care ( RMC ) . The RDAD program was conducted in the patients ' home over 3 months . MAIN OUTCOME MEASURES Physical health and function ( 36-item Short-Form Health Survey 's [ SF-36 ] physical functioning and physical role functioning subscales and Sickness Impact Profile 's Mobility subscale ) , and affective status ( Hamilton Depression Rating Scale and Cornell Depression Scale for Depression in Dementia ) . RESULTS At 3 months , in comparison with the routine care patients , more patients in the RDAD group exercised at least 60 min/wk ( odds ratio [ OR ] , 2.82 ; 95 % confidence interval [ CI ] , 1.25 - 6.39 ; P = .01 ) and had fewer days of restricted activity ( OR , 3.10 ; 95 % CI , 1.08 - 8.95 ; P<.001 ) . Patients in the RDAD group also had improved scores for physical role functioning compared with worse scores for patients in the RMC group ( mean difference , 19.29 ; 95 % CI , 8.75 - 29.83 ; P<.001 ) . Patients in the RDAD group had improved Cornell Depression Scale for Depression in Dementia scores while the patients in the RMC group had worse scores ( mean difference , -1.03 ; 95 % CI , -0.17 to -1.91 ; P = .02 ) . At 2 years , the RDAD patients continued to have better physical role functioning scores than the RMC patients ( mean difference , 10.89 ; 95 % CI , 3.62 - 18.16 ; P = .003 ) and showed a trend ( 19 % vs 50 % ) for less institutionalization due to behavioral disturbance . For patients with higher depression scores at baseline , those in the RDAD group improved significantly more at 3 months on the Hamilton Depression Rating Scale ( mean difference , 2.21 ; 95 % CI , 0.22 - 4.20 ; P = .04 ) and maintained that improvement at 24 months ( mean difference , 2.14 ; 95 % CI , 0.14 - 4.17 ; P = .04 ) . CONCLUSION Exercise training combined with teaching caregivers behavioral management techniques  improved physical health and depression in patients with Alzheimer disease OBJECTIVE To evaluate a case management ( CM ) model for people with mild dementia , whereby re sources within the family and in the community were mobilized and optimally used . METHOD Community dwelling psychiatric and geriatrics out patients with mild dementia were r and omized to receive CM by a trained occupational therapist for 4 months ( CM group , N = 59 ) or usual care only ( control group , N = 43 ) . Primary outcome indicators included the Zarit Burden Scale ( ZBI ) , General Health Question naire ( GHQ ) , and Personal Well-Being Index for Adult ( PWI-A ) of the family caregivers . Secondary outcome indicators included the Mini-Mental State Examination ( MMSE ) , Neuropsychiatric Inventory ( NPI ) , Cornell Scale for Depression in Dementia ( CSDD ) , and Personal Well-Being Index for Intellectually Disabled ( PWI-ID ) of the demented subjects as measured at fourth and twelfth months . RESULT CSDDis reduced in the CM group at fourth month , but not at twelfth month . The changes in outcome variables of persons with dementia did not differ between the groups ( Mann-Whitney U-test , p > 0.05 ) . At follow-up , CM group used more day care and domestic helpers than control group ( chi ( 2 ) , p > 0.05 ) . CONCLUSION Case management for Chinese persons with mild dementia out patients did not show significant effects in reducing caregiver burden , but encouraged family caregivers to seek external support OBJECTIVES Family caregiving is an integral part of the care system for persons with dementing disorders , such as Alzheimer 's disease . This study tested role-training intervention as a way to help family caregivers appreciate and assume a more clinical belief set about caregiving and thereby ameliorate the adverse outcomes associated with caregiving . DESIGN Training effectiveness was tested in a trial in which family care receiver dyads were r and omly assigned to training beginning immediately or were placed in a wait-list control group and assigned to receive training in 5 to 6 months , following completion of data collection . SETTING A community-based 14-hour training program provided in seven weekly 2-hour sessions . The training program curriculum was built on a stress and coping theory base . Recruitment and r and omization were ongoing . Programs were begun every 2 months over a two and one half-year period for a total of 16 programs . PARTICIPANTS Community health and social service agencies referred primary caregivers and at least one other family member of community-dwelling persons with dementia to participate . MEASUREMENTS Data reported in this paper were gathered from each participating family at entry to the study and 5 months later . St and ard measures of beliefs about caregiving , burden , depression , and reaction to care receiver behavior were administered to caregivers . A st and ard measure of mental status was administered to the person with dementia and st and ardized instruments were used to gather information from caregivers concerning care receivers ' behavior and abilities to perform activities of daily living ( ADLs ) . RESULTS Data were analyzed from 94 caregiver/care receiver dyads with complete sets of data . Treatment and control caregivers and care receivers were similar at baseline , and care receivers in both groups declined similarly over the 5-month period . Significant within-group improvements occurred with treatment group caregivers on measures of beliefs about caregiving ( P = .044 ) and reaction to behavior ( P = .001 ) . When outcomes were compared , treatment group caregivers were significantly different ( in the expected direction ) from those in the control group on measures of the stress mediator , beliefs ( P = .025 ) , and key outcomes , response to behavior ( P = .019 ) , depression ( P = .040 ) , and burden ( P = .051 ) . There was a significant positive association between the strengthened mediator , the caregivers ' having less-emotionally enmeshed beliefs about caregiving roles and responsibilities , and the outcome , namely improvements in burden ( P = .019 ) and depression ( P = .007 ) . CONCLUSION A caregiver training intervention focused on the work of caregiving and targeted at knowledge , skills , and beliefs benefits caregivers in important outcome dimensions . The results suggest the benefits of providing information , linkage , and role coaching to dementia family caregivers OBJECTIVES To evaluate whether a comprehensive sleep education program ( Nighttime Insomnia Treatment and Education for Alzheimer 's Disease ( NITE-AD ) ) could improve sleep in dementia patients living at home with their family caregivers . DESIGN A r and omized , controlled trial . PARTICIPANTS Thirty-six community-dwelling patients with Alzheimer 's disease ( AD ) and their family caregivers . INTERVENTION All participants received written material s describing age- and dementia-related changes in sleep and st and ard principles of good sleep hygiene . Caregivers in active treatment ( n=17 ) received specific recommendations about setting up and implementing a sleep hygiene program for the dementia patient and training in behavior management skills . Patients in active treatment were also instructed to walk daily and increase daytime light exposure with the use of a light box . Control subjects ( n=19 ) received general dementia education and caregiver support . MEASUREMENTS Primary sleep outcomes were derived for patients and caregivers from 1 week of sleep-wake activity measured at baseline , posttest ( 2 months ) , and 6-month follow-up using an Actillume wrist-movement recorder . Secondary patient outcomes included the Epworth Sleepiness Scale , the Cornell Depression Scale , and the Revised Memory and Behavior Problem Checklist . Caregiver self-reports included the Pittsburgh Sleep Quality Index and the Center for Epidemiological Study of Depression Scale . RESULTS Patients participating in NITE-AD showed significantly greater ( P<.05 ) posttest reductions in number of nighttime awakenings , total time awake at night , and depression , and increases in weekly exercise days than control subjects . At 6-month follow-up , treatment gains were maintained , and additional significant improvements in duration of night awakenings emerged . When cognitive level was controlled , NITE-AD patients had lower longitudinal ratings of daytime sleepiness than controls . There was a trend for control subjects to spend more time in bed at 6 months than NITE-AD patients . CONCLUSION This study provides the first evidence that patients with AD who are experiencing sleep problems can benefit from behavioral techniques ( specifically , sleep hygiene education , daily walking , and increased light exposure ) that are known to improve sleep in nondemented , institutionalized older adults PURPOSE The Tailored Activity Program ( TAP ) is a home-based occupational therapy intervention shown to reduce behavioral symptoms and caregiver burden in a r and omized trial . This article describes TAP , its assessment s , acceptability , and replication potential . DESIGN AND METHODS TAP involves 8 sessions for a period of 4 months . Interventionists identify preserved capabilities , previous roles , habits , and interests of individuals with dementia ; develop activities customized to individual profiles ; and train families in activity use . Interventionists documented time spent and ease conducting assessment s , and observed receptivity of TAP .  For each implemented prescribed activity , caregivers reported the amount of time their relative spent in activity and perceived benefits . RESULTS The TAP assessment , a combination of neuropsychological tests , st and ardized performance-based observations , and clinical interviewing , yielded information on capabilities from which to identify and tailor activities . Assessment s were easy to administer , taking an average of two 1-hr sessions . Of 170 prescribed activities , 81.5 % were used , for an average of 4 times for 23 min by families between treatment sessions for a period of months . Caregivers reported high confidence in using activities , being less upset with behavioral symptoms ( 86 % ) , and enhanced skills ( 93 % ) and personal control ( 95 % ) . Interventionists observed enhanced engagement ( 100 % ) and pleasure ( 98 % ) in individuals with dementia during sessions . IMPLICATION S TAP offers families knowledge of their relative 's capabilities and easy-to-use activities . The program was well received by caregivers . Prescribed activities appeared to be pleasurable and engaging to individuals with dementia . TAP merits further evaluation to establish efficacy with larger more diverse population s and consideration as a nonpharmacological approach to manage behavioral symptoms OBJECTIVES To examine the cost-effectiveness of a r and omized , clinical trial of a home-based intervention for caregivers of people with dementia . DESIGN This cost-effectiveness analysis examined Re sources for Enhancing Alzheimer 's Caregivers Health ( REACH II ) , a multisite , r and omized , clinical trial , from June 2002 through December 2004 , funded by the National Institute on Aging and the National Institute of Nursing Research , of a behavioral intervention to decrease caregivers ' stress and improve management of care recipient behavioral problems . SETTING Community-dwelling dementia caregiving dyads from the Memphis REACH II site . PARTICIPANTS Of Memphis ' r and om sample of 55 intervention and 57 control black and white dyads , 46 in each arm completed without death or discontinuation . Family caregivers were aged 21 and older , lived with the care recipient , and had provided 4 or more hours of care per day for 6 months or longer . Care recipients were cognitively and functionally impaired . INTERVENTION(S ) Twelve individual sessions ( 9 home sessions and 3 telephone sessions ) supplemented by five telephone support-group sessions . Control caregivers received two " check in " phone calls . MEASUREMENTS Incremental cost-effectiveness ratio ( ICER ) , the additional cost to bring about one additional unit of benefit ( hours per day of providing care ) . RESULTS At 6 months , there was a significant difference between intervention caregivers and control caregivers in hours providing care ( P=.01 ) . The ICER showed that intervention caregivers had 1 extra hour per day not spent in caregiving , at a cost of $ 5 per day . CONCLUSION The intervention provided that most scarce of caregiver commodities -- time . The emotional and physical costs of dementia caregiving are enormous , and this intervention was able to alleviate some of that cost This study evaluated a one year long course education and counseling program with 93 family caregivers of elders afflicted with Alzheimer 's disease . The elders had received treatment for agitation in an inpatient setting and were subsequently discharged to the caregivers ' home . Caregivers were r and omly assigned to an experimental group ( n = 68 ) and a control group ( n = 25 ) .  Baseline assessment s ( Time 0 ) were conducted while the elder was an inpatient . Postdischarge interventions and assessment s were conducted at 2 weeks , 6 weeks , 12 weeks , and 6 and 12 months ( Times 1 - 5 respectively ) . There were no significant treatment effects for care recipient agitation , caregiver stress , depression , and physical health , and no significant differences between groups in rates of institutionalization for afflicted elders . Longitudinal data , however , revealed several important trends . Afflicted elders ' agitation rose steadily for control group subjects at Times 3 through 5 but declined for experimental group subjects . Caregiver depression increased for control group subjects at Time 5 , but declined for experimental group subjects . Caregiver physical health declined for control group subjects at Times 4 and 5 but was maintained for experimental group subjects . A significantly higher number of afflicted elders were still at home among experimental group subjects at the end of the one year study . The difficulties in demonstrating efficacy of interventions with family caregivers of Alzheimer 's disease are discussed . Finally , the issue of data collection being perceived as support by control group subjects is evaluated AIM Art therapy has been reported to have effects on mental symptoms in patients with dementia , and its usefulness is expected . We performed a controlled trial to evaluate the usefulness of art therapy compared with calculation training in patients with mild Alzheimer 's disease . METHODS Thirty-nine patients with Alzheimer 's disease showing slightly decreased cognitive function allowing treatment on an outpatient basis were r and omly allocated to art therapy and control ( learning therapy using calculation ) groups , and intervention was performed once weekly for 12weeks . RESULTS Comparison of the results of evaluation between before and after therapy in each group showed significant improvement in the Apathy Scale in the art therapy group ( P=0.014 ) and in the Mini-Mental State Examination score ( P=0.015 ) in the calculation drill group , but no significant differences in the other items between the two groups . Patients showing a 10 % or greater improvement were compared between the two groups . Significant improvement in the quality of life ( QOL ) was observed in the art therapy compared with the calculation training group ( P=0.038 , odds ratio , 5.54 ) . anova concerning improvement after each method revealed no significant difference in any item . CONCLUSION These results suggested improvement in at least the vitality and the QOL of patients with mild Alzheimer 's disease after art therapy compared with calculation , but no marked comprehensive differences between the two methods . In non-pharmacological therapy for dementia , studies attaching importance to the motivation and satisfaction of patients and their family members rather than the superiority of methods may be necessary in the future Behavioral symptoms of Alzheimer 's disease , particularly agitation , appear to be a major contributing factor to the emotional distress exhibited by family caregivers .  Psychosocial interventions have been shown to reduce caregiver emotional distress , but few studies have examined the efficacy of these interventions with caregivers exposed to high levels of dementia-related behavioral symptoms . The purpose of this study is to test the efficacy of a caregiver skill building intervention in reducing emotional distress to agitated behaviors of care recipients . This study analyzed data from a subgroup of caregivers who participated in a larger r and omized clinical trial ( N = 295 ) . Data from 143 caregivers of family members with baseline agitated behaviors indicate that the skill building intervention was more effective than an information and support oriented comparison condition in reducing emotional distress over an 18-month period . These findings indicate that dementia caregivers exposed to agitated behaviors can benefit from psychosocial interventions , particularly those aim ed at building behavioral management skills Background : Treatment of agitation is a crucial problem in the care of patients with AD . Although antipsychotic and antidepressant medications and behavior management techniques ( BMT ) have each been used to treat agitation , clinical trials of these treatments have been characterized by small sample sizes and uncontrolled treatment design s. Objective : To compare haloperidol , trazodone , and BMT with placebo in the treatment of agitation in AD out patients . Methods : A total of 149 patients with AD and their caregivers participated in a r and omized , placebo-controlled , multicenter trial . Blind assessment was conducted at baseline and after 16 weeks of treatment . The three active treatments were haloperidol , trazodone , and BMT . The Alzheimer ’s Disease Cooperative Study Clinical Global Impression of Change was the primary outcome measure . Secondary outcomes included patient agitation , cognition , and function , and caregiver burden . Results : Thirty-four percent of subjects improved relative to baseline . No significant differences on outcome were obtained between haloperidol ( mean dose , 1.8 mg/d ) , trazodone ( mean dose , 200 mg/d ) , BMT , or placebo . Significantly fewer adverse events of bradykinesia and parkinsonian gait were evident in the BMT arm . No other significant difference in adverse events was seen . Symptoms did not respond differentially to the different treatments . Conclusions : Comparable modest reductions in agitation occurred in patients receiving haloperidol , trazodone , BMT , and placebo .  More effective pharmacologic , nonpharmacologic , and combination treatments are needed This study enrolled 184 middle-aged and older women ( 95 Non-Hispanic White and 89 Hispanic/Latino ) who provided in-home h and s-on care to an elderly relative with Alzheimer ’s disease or another form of dementia . Within ethnic group they were r and omly assigned to either a CBT-based small group intervention program called “ Coping with Caregiving ” ( CWC ) that taught a variety of cognitive and behavioral skills to reduce stress and depression , or to a minimal telephone based control condition ( TSC ) . Intervention lasted about 4 months ; one post-treatment assessment was completed 6 months after baseline by interviewers blind to the intervention condition . Interviews and interventions were conducted in English or Spanish by trained staff . Results indicated that those in the CWC ( regardless of ethnicity ) showed greater improvement from pre to post intervention than those in the TSC on measures of depressive symptoms , overall life stress , and caregiving-specific stress . In order to investigate if these changes may have been related to one proposed mechanism of change in CBT ( skill utilization ) , a new measure was constructed . Change in frequency of use and perceived helpfulness of adaptive coping skills were assessed in all caregivers . Results indicated that caregivers in CWC reported greater frequency of use , and greater perceived helpfulness , of these skills at post intervention compared to caregivers in the TSC . Improvement measured by dependent measures was correlated with an increase in these indices for those in the CWC . Tests for mediation suggest that effective skill utilization may mediate the effect of treatment on outcome . Implication s of these findings are discussed and recommendations provided for future research PURPOSE This study developed and tested two 24-month primary care interventions to alleviate the psychological distress suffered by the caregivers of those with Alzheimer 's disease . The interventions , using targeted educational material s , were patient behavior management only , and patient behavior management plus caregiver stress-coping management . We hypothesized that the addition of the stress-coping component would improve caregiver outcomes . DESIGN AND METHODS A r and omized clinical trial of 167 caregiver-care recipient dyads was run , of whom 76 completed the study without bereavement or placement . RESULTS During 24 months , caregivers who received the patient behavior management component only , compared with those who also received the stress-coping component , had significantly worse outcomes for general well-being and a trend toward increased risk of depression ( i.e. , a score of > 16 on the Center for Epidemiological Studies Depression scale ) . There was a study wide improvement for bother associated with care recipient behaviors ( according to the Revised Memory and Behavior Problems Checklist ) . IMPLICATION S Our data suggest that brief primary care interventions may be effective in reducing caregiver distress and burden in the long-term management of the dementia patient . They further suggest that interventions that focus only on care recipient behavior , without addressing caregiving issues , may not be as adequate for reducing caregiver distress Individuals with cognitive impairment , their family members , and their care providers have all identified " quality of life " as a central goal in the treatment of dementia . In this article , we identify factors that influence quality of life for individuals with cognitive impairment , review evidence -based psychosocial interventions that improve quality of life for community-residing individuals with dementia , and describe innovative ongoing r and omized clinical trials design ed to improve or maintain quality of life for individuals with mild to moderate memory problems This 3-year r and omized clinical trial tested the effectiveness of an interdisciplinary psychoeducational family group intervention in decreasing the caregivers ' perceptions of the frequency and severity of behavioral problems in persons with dementia and their reactions to those problems , and in decreasing caregiver burden and depression . The intervention consisted of seven weekly , 2-hour multimedia training sessions that included education , family support , and skills training for 94 primary caregivers and their families . Repeated measures ANOVA was used to test for significant differences between the intervention and waiting list control groups over a 5-month period . The intervention was successful in reducing caregivers ' negative reactions to disruptive behaviors and in reducing caregiver burden over time Objective : To test the effect of a short-term psychosocial intervention programme for family carers of patients with dementia and identify characteristics of carers and patients that responded positively . Methods : The study was a multi-centre r and omized controlled trial . Carers of 180 patients suffering from dementia recruited at 7 memory clinics at geriatric or psychiatric departments participated in the study . Carers of the intervention group were educated about dementia and in 6 group meetings taught how to use structured problem-solving . The control group received treatment as usual . The effect on patients was measured with the Neuropsychiatric Inventory and on carers with the Relatives ’ Stress Scale ( RSS ) . Results : The intention-to-treat efficacy analysis included 171 carer/patient dyads . The intervention did not have any effect on the primary outcome variables . The burden measured by the RSS increased in both groups ; however , more carers of the control group converted from a low-burden group to a medium- or high-burden group after 4.5 months . In a subgroup analysis we found a statistically significant difference in the Neuropsychiatric Inventory score in favour of the intervention group among female patients . Conclusion : The predominately negative result of this study emphasizes the need of individually tailored interventions for carers and the use of narrow inclusion criteria when performing group-based interventions , such as the extent of burden as well as gender and kinship We investigated the usefulness of a computer-mediated interactive voice response ( IVR ) system integrated with voicemail to help family caregivers manage disruptive behaviours in people with Alzheimer 's disease . The r and omization procedure result ed in 49 caregivers being assigned to the intervention group and 51 to the control group . Using their ordinary telephone , the caregivers were linked to the four components of the IVR system : monitoring and counselling , an in-home support group , ' ask the expert ' , and a respite conversation . During an 18-month study , total system usage amounted to 55 min per user ( SD 78 , range 1 - 318 ) . Half the participants used the system for at least 22 min , and 25 % for at least 70 min . Participants made between one and 45 calls over the study period , averaging 11 calls ( SD 12 ) . Approximately half of the intervention group used the system regularly for two or more months . These ' adopters ' were significantly older , more highly educated and reported a greater sense of management of the situation than ' non-adopters ' . Adopters were much more likely than non-adopters to have been rated as highly proficient by the trainer following the technology training session . The IVR approach appealed to a subset of users . However , the overall preference was for human interaction Theories supporting the existence of a use-dependent neuroplasticity in the older brain were used to guide this pilot study . A repeated- measures r and omized design was used to test the effectiveness of a multimodal ( Taiji exercises , cognitive-behavioral therapies , support group ) intervention on cognitive functioning , physical functioning , and behavioral outcomes in persons with dementia . The treatment group ( n = 24 persons with dementia ) participated in a 40-week intervention , with outcomes assessed at 20 and 40 weeks to assess optimal treatment length . Control group subjects ( n = 19 persons with dementia ) received attention-control educational programs . At 20 weeks , differences between groups were found for mental ability and self-esteem , with gains in balance being evident . Also , stability in depression and physical health were evident at 20 and 40 weeks for treatment group subjects . Continued improvement in outcomes was not observed at 40 weeks . However , findings support further testing of the intervention along with potential for achieving positive outcomes in early-stage dementia Background Care for people with dementia and their informal caregivers is a challenging aim in healthcare . There is an urgent need for cost-effective support programs that prevent informal caregivers of people with dementia from becoming overburdened , which might result in a delay or decrease of patient institutionalization . For this reason , we have developed the Systematic Care Program for Dementia ( SCPD ) . The SCPD consists of an assessment of caregiver 's sense of competence and suggestions on how to deal with competence deficiencies . The efficiency of the SCPD will be evaluated in our study . Methods and design In our ongoing , cluster , r and omized , single-blind , controlled trial , the participants in six mental health services in four regions of the Netherl and s have been r and omized per service . Professionals of the ambulatory mental health services ( psychologists and social psychiatric nurses ) have been r and omly allocated to either the intervention group or the control group . The study population consists of community-dwelling people with dementia and their informal caregivers ( patient-caregiver dyads ) coming into the health service . The dyads have been clustered to the professionals . The primary outcome measure is the patient 's admission to a nursing home or home for the elderly at 12 months of follow-up . This measure is the most important variable for estimating cost differences between the intervention group and the control group . The secondary outcome measure is the quality of the patient 's and caregiver 's lives . Discussion A novelty in the SCPD is the pro-active and systematic approach . The focus on the caregiver 's sense of competence is relevant to economical healthcare , since this sense of competence is an important determinant of delay of institutionalization of people with dementia . The SCPD might be able to facilitate this with a relatively small cost investment for caregivers ' support , which could result in a major decrease in costs in the management of dementia . Implementation on a national level will be started if the SCPD proves to be efficient . Trial Registration
Background Two-thirds of people living with dementia live at home in the UK and many experience distressing behavioural and psychological symptoms .
This systematic review evaluates the effectiveness of non-pharmacological interventions for behavioural and psychological symptoms among community-dwelling people living with dementia .