Authors (including presenting author) :
Lo HTS (1), Choi WK (1), Lau HW (1)
Affiliation :
(1) Occupational Therapy Deparment, Prince of Wales Hospital
Introduction :
Dementia is a progressive neurocognitive disease, apart from cognitive impairment and self-care abilities decline, sometimes also accompanied by psychiatric and behavioral symptoms. Caregiver of people with dementia usually encounters different challenges in caring as the disease progresses. With the aging population all around the world, the impact of dementia is hard to overlook. According to the World Alzheimer Report 2018 edition, 50 million people worldwide were diagnosed as dementia. In Hong Kong, there are no differences from the world trend.More than ten thousand people diagnosed as dementia at their sixties and in view of the growing population of elderly, a projection of dementia patient in 2039 is three-fold.
An NIH Consensus Conference concluded that there are no treatments demonstrated to alter the pathophysiology of Alzheimer’s disease and related dementia. In other words, no cure is established for this devastating disease. Over the years, different pharmacological interventions had been evaluated. Although some were found to have positive effects on cognition and ADL performance, the clinical impact of these medications remains modest and controversial. Side effects of these drugs also limit its efficacy. As a result, a wide array of non-pharmacological interventions had been developed. A number of them had proven to be beneficial for treating dementia symptoms, whereas multimodal intervention was found better efficacy than unimodal intervention for mild cognitive impairment patients. However, only a handful of studies were identified to address the effect of multimodal non-pharmacological interventions on later stage of dementia.
Objectives :
Occupational Therapy (OT) plays an important role in dementia care. Therapists focus their interventions on the relationship between the one’s cognitive level, ADL performance, and environmental context to optimize their function, thus enhance their well-being. Quality of life (QoL) in dementia has become a major concern in recent decades because of the social consequences of the disease progression and the medical efforts aimed to improve the quality of survival. A meta-analysis questioned the clinical effect of OT interventions on QoL despite the positive effects on physical functioning.
In this pilot study, an OT multimodal intervention - Living And Stimulation Training (LAST) is evaluated about its effect on QoL primarily for moderate dementia patients. Besides, to provide more information for future larger scale study if possible.
Methodology :
All OT progress reports of the people with dementia who recruited into LAST were screened by principal investigator. For participants who attended more than 75% were selected for data analysis. LAST was an 8-week therapeutic program, consisted of 8 sessions with mainly cognitive stimulation, augmented with others modalities including art therapy, doll therapy, reminiscence therapy, and multi-sensory stimulation. Outcome measures were done before and after the group intervention. QoL-AD measured the QoL of patients from the caregivers’ perspective. MoCA-5min and CDAD measured cognitive level and functional performance respectively. Wilcoxon Signed Ranks test were used to analyze pre- and post-intervention differences.
Result & Outcome :
21 dementia patients were eligible for data analysis. Caregiver-rated QoL (p< 0.05) and MoCA-5min (p< 0.05) were found statistical significant differences after 8-week therapeutic program. No significant differences were found for CDAD total scores and subscores. The results of this retrospective study indicated that the locally developed multimodal OT intervention - LAST has the potential to improve quality of life and cognitive function of people with moderate dementia. Its effect on functional performance is yet to be proven. Future randomized controlled study on the effect of LAST could provide further evidence in formulating a holistic and comprehensive dementia care in Hong Kong.
