Acta Scientific Neurology (ASNE) (ISSN: 2582-1121)

Research Article Volume 4 Issue 2

Non-pharmacological Interventions for the Apathy in Patients with Dementia. A Cross-over Randomized Controlled Trial

Dimitriou Tatiana-Danai1*, Papatriantafyllou John2, Konsta Anastasia3, Kazis Dimitrios4, Athanasiadis Loukas3, Ioannidis Panagiotis5, Koutsouraki Efrosini5, Tegos Thomas5 and Tsolaki Magda6

1PhD Neuroscientist, Department of Neurology, Aristotle University of Thessaloniki, Greece
2Psychiatrist, Age Center IASIS, Neurology Department, University of Athens, ‘Attikon’ Hospital, Greece
3Associate Professor, Department of Psychiatry, “Papageorgiou” General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece
4Associate Professor, Neurology Department, Aristotle University of Thessaloníki, Greece
5Associate Professor, Department of Neurology, Aristotle University of Thessaloniki, Makedonia, Greece
6Neuropsychiatrist, Professor, Department of Neurology, Aristotle University of Thessaloniki, Makedonia, Greece

*Corresponding Author: Dimitriou Tatiana-Danai, Department of Neurology, Aristotle University of Thessaloniki, Greece..

Received: October 20, 2020; Published: November 30, 2020

×

Abstract

Background: Apathy is associated with greater caregiver burden and affects the cognitive abilities of the patient. Having a high prevalence of more than 71% in patients with dementia (PwD), it is a very common symptom in Alzheimer’s Disease (AD). In many cases it remains under-diagnosed or is misdiagnosed with depression.

Methods: This study is a cross-over randomized controlled trial with 60 participants conducted in Greece. The participants were randomly assigned in 6 different groups of 10 participants each. The interventions that were evaluated are: a) Body Exercise (BE), b) Reminiscence therapy (RT) and c) Music therapy (MT). The interventions lasted for 5 days and there was two days off, as a wash-out period. There was no drop-out rate. The measurements which were used at baseline were: MMSE, ACE-R, GDS, FRSDD and NPI questionnaires.

Results: The most effective combination was in order: RT- BE- MT. RT when applied in the first week reduced apathy statistically significant (p = 0.007). BE when applied in the second week reduced the symptoms further (p = 0.013) and MT when applied in the third week reduced apathy even more (p = 0.027). We had about the same results with the caregivers’ burden following the same order of interventions: RT (p = 0.006)- BE (p = 0.016)- MT (p = 0.030).

Conclusion: A combination of a cognitive intervention (RT) in the first week, followed by BE the second week and a sensory intervention (MT) the third week, can reduce apathy in PwD and their caregivers’ burden, as well.

Keywords: Apathy; BPSD; Dementia; Cross-over Trial; Non-pharmacological Interventions; RCT; Reminiscence Therapy; Body Exercise; Music Therapy

×

References

  1. Lopez O L., et al. “Epidemiology of aging and associated cognitive disorders: Prevalence and incidence of Alzheimer’s disease and other dementias”. Handbook of Clinical Neurology 167 (2019): 139-148.
  2. Theleritis C G., et al. “Unmet Needs in Pharmacological Treatment of Apathy in Alzheimer's Disease: A Systematic Review”. Frontiers in Pharmacology 10 (2019): 1108.
  3. Massimo L., et al. “State of the Science: Apathy As a Model for Investigating Behavioral and Psychological Symptoms in Dementia”. JAGS 66 (2018): S4-S12.
  4. Harrison F., et al. “Apathy in Dementia: Systematic Review of Recent Evidence on Pharmacological Treatments”. Current Psychiatry Report 18 (2016): 103.
  5. Sherman C., et al. “Prevalence, neurobiology, and treatments for apathy in prodromal dementia”. International psychogeriatrics2 (2018): 177-184.
  6. Le Heron C., et al. “The anatomy of apathy: A neurocognitive framework for amotivated behaviour”. Neuropsychologia 118 (2018): 54-67.
  7. Lanctôt KL., et al. “Apathy associated with neurocognitive disorders: recent progress and future directions”. Alzheimers Dementia: the journal of the Alzheimer's Association1 (2016): 84-100.
  8. Ruthirakuhan MT., et al. “Pharmacological interventions for apathy in Alzheimer’s disease (Review)”. Cochrane Systematic Review (2018): CD012197.
  9. Lanctot KL., et al. “Neuropsychiatric signs and symptoms of Alzheimer's disease: New treatment paradigms”. Alzheimers Dementia (NY) 3.3 (2017): 440-449.
  10. Veronese N., et al. “Role of physical activity in ameliorating neuropsychiatric symptoms in Alzheimer disease: A narrative review”. International Journal of Geriatric Psychiatry9 (2019): 1316-1325.
  11. Kouloutbani, K., et al. Psychiatrike = Psychiatriki 30.2 (2019): 142-155.
  12. Woods B., et al. “Reminiscence therapy for dementia”. Cochrane Data Systematic Review (2018): CD001120.
  13. Van der Steen JT., et al. “Music-based therapeutic interventions for people with dementia”. Cochrane Data Systematic Review 7 (2018): CD003477.
  14. Folstein MF., et al. “The mini-mental state examination”. Archives of General Psychiatry (1983): 812-822.
  15. Fountoulakis KN., et al. “Mini Mental State Examination (MMSE): A validation study in Greece”. American Journal of Alzheimer’s Disease and Other Dementias6 (2000): 342-345.
  16. Mathuranath P.S., et al. “A brief cognitive test battery to differentiate Alzheimer's disease and frontotemporal dementia”. Neurology11 (2000): 1613-1620.
  17. Konstantinopoulou E., et al. “Adaptation of Addenbrooke's Cognitive Examination-Revised for the Greek population”. European Journal of Neurology3 (2011): 442-447.
  18. Yesavage JA., et al. “Development and validation of a geriatric depression screening scale: A preliminary report”. Journal of Psychiatry Research 17 (1983): 37-49.
  19. Fountoulakis KN., et al. “The validation of the short form of the Geriatric Depression Scale (GDS) in Greece”. Aging (Milano) 6 (1999): 367-372.
  20. Hutton JT., et al. “Functional rating scale for the symptoms of dementia”. In J. J. Gallo, W, Reichel and L, Andersen (Eds.) Handbook of geriatric assessment. Rockville, MD: Aspen Publishers 77-80 (1998).
  21. Tsolaki M. “Neuropsychological Evaluation of the Elderly”. Melissa, Thessaloniki (1997).
  22. Cummings JL., et al. “The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia”. Neurology 44 (1994): 2308-2314.
  23. Politis AM., et al. “Validity and reliability of the newly translated Hellenic Neuropsychiatric Inventory (H-NPI) applied to Greek outpatients with Alzheimer's disease: a study of disturbing behaviors among referrals to a memory clinic”. Geriatriatric Psychiatry3 (2004): 203-208.
  24. Cummings J. “The Neuropsychiatric Inventory: Development and Applications”. Journal of Geriatric Psychiatry Neurology2 (2020): 73-84.
  25. Amieva H., et al. “Group and individual cognitive therapies in Alzheimer's disease: the ETNA3 randomized trial”. International Psychogeriatrics5 (2016): 707-717.
  26. Hsieh CJ., et al. “Reminiscence group therapy on depression and apathy in nursing home residents with mild to moderate dementia”. Journal of Experimental Clinical Medicine2 (2010): 72-78.
  27. Abraha I., et al. “Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series”. BMJ Open3 (2017): e012759.
  28. Hokkanen L., et al. “Dance/movement therapeutic methods in management of dementia”. Journal of the American Geriatrics Society 51 (2003): 576-577.
×

Citation

Citation: Dimitriou Tatiana-Danai., et al. "Non-pharmacological Interventions for the Apathy in Patients with Dementia. A Cross-over Randomized Controlled Trial". Acta Scientific Neurology 4.2 (2021): 62-69.




Metrics

Acceptance rate32%
Acceptance to publication20-30 days
Impact Factor0.844

Indexed In




News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is June 30, 2021.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of “Best Article of the Issue”.
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.
  • Contact US