TY  - JOUR
A1  - Treusch, Yvonne
A1  - Majic, Tomislav
A1  - Page, Julie
A1  - Gutzmann, Hans
A1  - Heinz, Andreas
A1  - Rapp, Michael Armin
T1  - Apathy in nursing home residents with dementia: Results from a cluster-randomized controlled trial
JF  - European psychiatry : the journal of the Association of European Psychiatrists
N2  - Purpose: Here we evaluate an interdisciplinary occupational and sport therapy intervention for dementia patients suffering from apathy.
 Subjects and methods: A prospective, controlled, rater-blinded, clinical trial with two follow-ups was conducted as part of a larger cluster-randomized trial in 18 nursing homes in Berlin. n = 117 dementia patients with apathy, defined as a score of 40 or more on the apathy evaluation scale (AES) or presence of apathy on the Neuropsychiatric Inventory (NPI), were randomly assigned to intervention or control group. The intervention included 10 months of brief activities, provided once a week. The primary outcome measure was the total score on the AES scale measured directly after the intervention period and again after 12 months.
 Results: We found significant group differences with respect to apathy during the 10 month intervention period (F-2,F-82 = 7.79, P < 0.01), which reflected an increase in apathy in the control group, but not in the intervention group. Within one year after the intervention was ceased, the treatment group worsened and no longer differed significantly from the control group (P = 0.55).
 Conclusions: Our intervention was effective for the therapy of apathy in dementia, when applied, but not one year after cessation of therapy. (C) 2014 Elsevier Masson SAS. All rights reserved.
KW  - Dementia
KW  - Apathy
KW  - Non-pharmacological intervention
KW  - Occupational therapy
KW  - Sport therapy
Y1  - 2015
U6  - https://doi.org/10.1016/j.eurpsy.2014.02.004
SN  - 0924-9338
SN  - 1778-3585
VL  - 30
IS  - 2
PB  - Elsevier
CY  - Paris
ER  - 
TY  - JOUR
A1  - Rapp, Michael Armin
A1  - Mell, Thomas
A1  - Majic, Tomislav
A1  - Treusch, Yvonne
A1  - Nordheim, Johanna
A1  - Niemann-Mirmehdi, Mechthild
A1  - Gutzmann, Hans
A1  - Heinz, Andreas
T1  - Agitation in Nursing Home Residents With Dementia (VIDEANT Trial) -  Effects of a Cluster-Randomized, Controlled, Guideline Implementation Trial
JF  - Journal of the American Medical Directors Association
N2  - Objective: To test the effect of a complex guideline-based intervention on agitation and psychotropic prescriptions.
 Design, Setting, Participants: Cluster randomized controlled trial (VIDEANT) with blinded assessment of outcome in 18 nursing homes in Berlin, Germany, comprising 304 dementia patients.
 Intervention: Training, support, and activity therapy intervention, delivered at the level of each nursing home, focusing on the management of agitation in dementia. Control group nursing homes received treatment as usual.
 Measurements: Levels of agitated and disruptive behavior (Cohen-Mansfield agitation inventory [CMAI]) as the primary outcome. Number of neuroleptics, antidepressants, and cholinesterase inhibitors (ChEIs) prescribed in defined daily dosages (DDDs).
 Results: Of 326 patients screened, 304 (93.3%) were eligible and cluster-randomized to 9 intervention (n = 163) and 9 control (n = 141) nursing homes. Data were collected from 287 (94.4%) patients at 10 months. At 10 months, compared with controls, nursing home residents with dementia in the intervention group exhibited significantly less agitation as measured with the CMAI (adjusted mean difference, 6.24; 95% CI 2.03-14.14; P = .009; Cohen's d = 0.43), received fewer neuroleptics (P < .05), more ChEIs (P < .05), and more antidepressants (P < .05).
 Conclusion: Complex guideline-based interventions are effective in reducing agitated and disruptive behavior in nursing home residents with dementia. At the same time, increased prescription of ChEIs and antidepressants together with decreased neuroleptic prescription suggests an effect toward guideline-based pharmacotherapy.
KW  - Dementia
KW  - agitation
KW  - nursing home
KW  - guideline
KW  - trial
Y1  - 2013
U6  - https://doi.org/10.1016/j.jamda.2013.05.017
SN  - 1525-8610
VL  - 14
IS  - 9
SP  - 690
EP  - 695
PB  - Elsevier
CY  - New York
ER  -