Discussion
depression, AD, anxiety
The present study was a randomized controlled trial (RCT) that investigated the effect of the internet-based and in-person interventions on cognitive function, mood, and ADL of 42 patients with probable AD according to the NINCDS-ADRDA criteria. This study suggests that the multimodal intervention, in conjunction with pharmacological treatment, was more effective in improving cognitive function, mood, and ADL than pharmacological treatment alone which is compatible with previous studies (Previous studies have shown that non-pharmacological interventions, including cognitive training, affect cognition in older adults (First, cognitive intervention was more effective in improving the K-MMSE, S-IADL, GdepS, and BAI scores in the case group than in the control group with only pharmacological treatment. In terms of cognition, because of the practice effect of repeated tests, we double-checked the subjective change in the cognitive function to be identified to caregivers using the KDSQ-C. The KDSQ-C score of the intervention group significantly improved compared to that of the control group. Considering that existing pharmacological treatment has only a limited effect on ADL, it is noteworthy that it added evidence of the effect of cognitive intervention on ADL (Second, when the effect of the internet-based intervention was compared with that of the in-person intervention among the same patients, the effects on cognition and depression were not significantly different between the two interventions. However, the internet-based intervention may be as effective as in-person intervention for improving anxiety and ADL. Regarding depression, the internet-based intervention might be as effective as in-person interventions, which is consistent with a previous study that found that group intervention relieves loneliness and depression among older people during the COVID-19 pandemic (This RCT demonstrated that non-pharmacological multimodal interventions (internet-based and in-person interventions) improve cognitive function, ADL, and mood in patients with AD compared to the control group (pharmacological treatment only). In addition, the effect of the internet-based intervention on cognition and depression was not significantly different from that of the in-person intervention. Therefore, the internet-based intervention may be effective enough to be applied to patients with mild to moderate AD. However, our study has some limitations. First, it’s difficult to say that this study perfectly controlled the effects of the medication. There was no significant difference in the proportion of drug use between the two groups and we maintained the type and dosage of medication from the original drug treatment during the research period, although we could not completely stop medication and purely observe the effects of the intervention due to ethical considerations. Second, the washout period was not allocated between the two intervention periods, considering that each intervention period was only 4 weeks long, and the intervention may not be residual in the body, unlike pharmacologic treatment. Third, we did not use an amyloid biomarker to diagnose AD; therefore, diagnostic uncertainty remains unclear. Fourth, the sample size was relatively small, and the study period was not long. Particularly, due to the limited sample size in both intervention A and B group, it’s still uncertain whether the internet-based interventions is effective as the in-person interventions.In conclusion, this study demonstrated that the intervention (in-person and internet-based) group showed improved cognition, ADL, and mood more than the control group in patients with mild to moderate AD. In terms of anxiety and ADL, the effect of the in-person interventions might be more effective than the-internet based interventions. Furthermore, this study suggested that both types of non-pharmacological interventions (in-person and internet-based interventions) may be viable supplementary treatments to be administered along with an approved pharmacological therapy.