Download PDF
Psychiatr Prax 2011; 38(5): 221-231
DOI: 10.1055/s-0030-1266016
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Alltagsbewältigung bei Demenz: Medikamentöse und nicht medikamentöse Interventionen zeigen kleine Effekte auf heterogenen Skalen

Eine Synopse vier systematischer ReviewsDaily Functioning in Dementia: Pharmacological and Non-Pharmacological Interventions Demonstrate Small Effects on Heterogeneous ScalesA Synopsis of Four Health Technology AssessmentsSebastian  Voigt-Radloff1 , Michael  Hüll1
  • 1Zentrum für Geriatrie und Gerontologie, Universitätsklinikum Freiburg
Further Information

Publication History

Publication Date:
21 March 2011 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Anliegen Die Wirkung medikamentöser und nicht medikamentöser Interventionen auf Alltagsaktivitäten demenzerkrankter Patienten sowie die methodische Heterogenität in der Erfassung werden dargelegt. Methode Die Synopse von 4 Übersichtsarbeiten wurde um eine Itemübersicht der eingesetzten Messinstrumente ergänzt. Ergebnisse Die Analyse zeigte keine Effekte für psychosoziale Interventionen, nur kleine für Galantamin, Rivastigmin und Memantin sowie Hinweise auf positive Effekte für Donepezil, ginkgohaltige Präparate und Angehörigenschulung. Schlussfolgerung Harmonisierung der Messinstrumente und weitere Forschung sind dringend erforderlich.

Abstract

Objective To assess the effects of pharmacological and non-pharmacological interventions on activities of daily living in dementia and the heterogeneity of the applied measurement instruments. Methods Four Health Technology Assessments (HTA) on dementia are summarized regarding to effects on activities of daily living. These HTA assessed RCTs on ACE-inhibitors, Memantin, Ginkgo and non-pharmacological interventions according to Cochrane standards. An overview over the domains of activities of daily living covered by the applied assessment instruments is provided. Results The analysis of 40 RCTs revealed indications of a beneficial effect of Donepezil, small positive effects of Galantamin, Rivastigmin and Memantin, positive effects of caregiver training in only one of five RCTs and no beneficial effects in seven RCTs on validation and reminiscence therapy, cognitive training procedures or activity-based interventions. Conclusion The studies demonstrated a very heterogeneous methodological quality with regard to assessment instruments, measurement time points and report of study design and results. Harmonisation in research methods is imperative and further elaborated RCTs must be conducted.

Schlüsselwörter

Demenz - Aktivitäten des täglichen Lebens - randomisierte Interventionsstudien

Keywords

dementia - activities of daily living - randomised clinical trials

Literatur

  • 1 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders 4th Ed (DSM-IV).. Washington DC: American Psychiatric Association; 1994
    Search in Google Scholar
  • 2 European Medicines Agency .Guideline on Medicinal Products for the Treatment of Alzheimer‘s Disease and other Dementias. Doc. Ref. CPMP / EWP / 553 / 95 Rev. 1. http://www.emea.europa.eu/pdfs/human/ewp/055395en.pdf [letzter Zugriff: Dez 2010]
  • 3 Riedel-Heller S G, Luppa M, König H H. Institutionalisierung psychisch kranker alter Menschen.  Psychiat Prax. 2010;  37 53-55
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Stelling K, Kuhn K, Riedel-Heller S G. et al . Leichte kognitive Beeinträchtigung und Demenzentwicklung.  Psychiat Prax. 2009;  36 119-124
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Georges J, Jansen S, Jackson J. et al . Alzheimer’s disease in real life – the dementia carer’s survey.  Int J Geriatr Psychiatry. 2008;  23 546-551
    CrossrefPubMedSearch in Google Scholar
  • 6 Wahl H W. Zum Konstrukt der Alltagskompetenz.  Z Gerontol Geriatr. 1998;  31 243-249
    CrossrefPubMedSearch in Google Scholar
  • 7 Valenzuela M J, Breakspear M, Sachdev P. Complex mental activity and the aging brain: molecular, cellular and cortical network mechanisms.  Brain Res Rev. 2007;  56 198-213
    CrossrefPubMedSearch in Google Scholar
  • 8 Van Praag H. Exercise and the brain: something to chew on.  Trends Neurosci. 2009;  32 283-290
    CrossrefPubMedSearch in Google Scholar
  • 9 Wilks S E, Croom B. Perceived stress and resilience in Alzheimer’s disease caregivers: testing moderation and mediation models of social support.  Aging Ment Health. 2008;  12 357-365
    CrossrefPubMedSearch in Google Scholar
  • 10 Gaugler J E, Kane R L, Newcomer R. Resilience and transitions from dementia caregiving.  J Gerontol B Psychol Sci Soc Sci. 2007;  62 38-44
    CrossrefPubMedSearch in Google Scholar
  • 11 Liberati A, Altman D G, Tetzlaff J. et al . The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration.  PLoS Med. 2009;  6 e1000100 Doi DOI: 10.1371/journal.pmed.1000100
    CrossrefPubMedSearch in Google Scholar
  • 12 IQWiG .Cholinesterasehemmer bei Alzheimer Demenz. Abschlussbericht A05–19A. Köln: Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG); Februar 2007 http://www.iqwig.de [letzter Zugriff Dez 2010]
    Search in Google Scholar
  • 13 Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen .Ginkgohaltige Präparate bei Alzheimer Demenz. Abschlussbericht A05–19B.. Köln: IQWiG; 2008. http://www.iqwig.de [letzter Zugriff Dez 2010]
    Search in Google Scholar
  • 14 IQWIG .Memantin bei Alzheimer Demenz, Abschlussbericht A05–19C.. Köln: Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG); Juli 2009. http://www.iqwig.de [letzter Zugriff Dez 2010]
    Search in Google Scholar
  • 15 IQWIG .Nichtmedikamentöse Behandlung der Alzheimer Demenz, Abschlussbericht A05–19D.. Köln: Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG); Januar 2009. http://www.iqwig.de [letzter Zugriff Dez 2010]
    Search in Google Scholar
  • 16 Gauthier S, Feldman H, Hecker J. et al, Donepezil MSAD Study Investigators’ Group . Functional, cognitive and behavioral effects of donepezil in patients with moderate Alzheimer’s disease.  Curr Med Res Opin. 2002;  18 347-354
    CrossrefPubMedSearch in Google Scholar
  • 17 Tariot P N, Cummings J L, Katz I R. et al . A randomized, double-blind, placebo-controlled study of the efficacy and safety of donepezil in patients with Alzheimer’s disease in the nursing home setting.  J Am Geriatr Soc. 2001;  49 1590-1599
    CrossrefPubMedSearch in Google Scholar
  • 18 Winblad B, Engedal K, Soininen H. et al . A 1-year, randomized, placebo-controlled study of donepezil in patients with mild to moderate AD.  Neurology. 2001;  57 489-495
    PubMedSearch in Google Scholar
  • 19 Homma A, Takeda M, Imai Y. et al . Clinical efficacy and safety of donepezil on cognitive and global function in patients with Alzheimer’s disease. A 24-week, multicenter, double-blind, placebo-controlled study in Japan. E2020 Study Group.  Dement Geriatr Cogn Disord. 2000;  11 299-313
    CrossrefPubMedSearch in Google Scholar
  • 20 Burns A, Rossor M, Hecker J. et al . The effects of donepezil in Alzheimer’s disease – results from a multinational trial.  Dement Geriatr Cogn Disord. 1999;  10 237-244
    CrossrefPubMedSearch in Google Scholar
  • 21 Moher D, Hopewell S, Schulz K F Consolidated Standards of Reporting Trials Group et al. CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials.  J Clin Epidemiol. 2010;  63 e1-37
    CrossrefPubMedSearch in Google Scholar
  • 22 Sikkes S A, de Lange-de Klerk E S, Pijnenburg Y A. et al . A systematic review of Instrumental Activities of Daily Living scales in dementia: room for improvement.  J Neurol Neurosurg Psychiatry. 2009;  80 7-12
    CrossrefPubMedSearch in Google Scholar
  • 23 Wilson R S, Mendes De Leon C F, Barnes L L. et al . Participation in cognitively stimulating activities and risk of incident Alzheimer disease.  JAMA. 2002;  287 742-748
    CrossrefPubMedSearch in Google Scholar
  • 24 Akbaraly T N, Portet F, Fustinoni S. et al . Leisure activities and the risk of dementia in the elderly: results from the Three-City Study.  Neurology. 2009;  73 854-861
    CrossrefPubMedSearch in Google Scholar
  • 25 Wilson R S, Barnes L L, Aggarwal N T. et al . Cognitive activity and the cognitive morbidity of Alzheimer disease.  Neurology. 2010;  75 990-996
    CrossrefPubMedSearch in Google Scholar
  • 26 Scarmeas N, Luchsinger J A, Brickman A M. et al . Physical Activity and Alzheimer Disease Course.  Am J Geriatr Psychiatry. 2010 Jul 14 ;  [Epub ahead of print]
    Search in Google Scholar
  • 27 Weih M, Abu-Omar K, Esselmann H. et al . Körperliche Aktivität und Prävention der Alzheimerdemenz. Übersicht über die aktuelle Evidenz und Überlegungen zur Machbarkeit einer Interventionsstudie.  Fortschr Neurol Psychiatr. 2009;  77 146-151
    Thieme ConnectPubMedSearch in Google Scholar
  • 28 Rockwood K, Graham J E, Fay S. ACADIE Investigators . Goal setting and attainment in Alzheimer’s disease patients treated with donepezil.  J Neurol Neurosurg Psychiatry. 2002;  73 500-507
    CrossrefPubMedSearch in Google Scholar
  • 29 Rockwood K, Fay S, Song X Video-Imaging Synthesis of Treating Alzheimer’s Disease (VISTA) Investigators et al. Attainment of treatment goals by people with Alzheimer’s disease receiving galantamine: a randomized controlled trial.  CMAJ. 2006;  174 1099-1105
    CrossrefPubMedSearch in Google Scholar
  • 30 Clare L, Linden D E, Woods R T. et al . Goal-oriented cognitive rehabilitation for people with early-stage Alzheimer disease: a single-blind randomized controlled trial of clinical efficacy.  Am J Geriatr Psychiatry. 2010;  18 928-939
    CrossrefPubMedSearch in Google Scholar
  • 31 Mittelman M S, Brodaty H, Wallen A S. et al . A three-country randomized controlled trial of a psychosocial intervention for caregivers combined with pharmacological treatment for patients with Alzheimer disease: effects on caregiver depression.  Am J Geriatr Psychiatry. 2008;  16 893-904
    CrossrefPubMedSearch in Google Scholar
  • 32 Galasko D, Bennett D, Sano M. et al . An inventory to assess activities of daily living for clinical trials in Alzheimer’s disease. The Alzheimer’s Disease Cooperative Study.  Alzheimer Dis Assoc Disord. 1997;  11 (S 02) S33-39
    CrossrefPubMedSearch in Google Scholar
  • 33 Reisberg B, Finkel S, Overall J. et al . The Alzheimer’s disease activities of daily living international scale (ADL-IS).  Int Psychogeriatr. 2001;  13 163-181
    CrossrefPubMedSearch in Google Scholar
  • 34 Hindmarch I, Lehfeld H, de Jongh P. et al . The Bayer Activities of Daily Living Scale (B-ADL).  Dement Geriatr Cogn Disord. 1998;  9 (S 02) 20-26
    PubMedSearch in Google Scholar
  • 35 Mahoney F I, Barthel D W. Functional Evaluation: The Barthel Index.  Md State Med J. 1965;  14 61-65
    PubMedSearch in Google Scholar
  • 36 Homma A, Takeda M, Imai Y. et al . Clinical efficacy and safety of donepezil on cognitive and global function in patients with Alzheimer’s disease. A 24-week, multicenter, double-blind, placebo-controlled study in Japan. E2020 Study Group.  Dement Geriatr Cogn Disord. 2000;  11 299-313
    CrossrefPubMedSearch in Google Scholar
  • 37 Feldman H, Sauter A, Donald A. et al . The disability assessment for dementia scale: a 12-month study of functional ability in mild to moderate severity Alzheimer disease.  Alzheimer Dis Assoc Disord. 2001;  15 89-95
    CrossrefPubMedSearch in Google Scholar
  • 38 Dodds T A, Martin D P, Stolov W C. et al . A validation of the functional independence measurement and its performance among rehabilitation inpatients.  Arch Phys Med Rehabil. 1993;  74 531-536
    CrossrefPubMedSearch in Google Scholar
  • 39 Bråne G, Gottfries C G, Winblad B. The Gottfries-Bråne-Steen scale: validity, reliability and application in anti-dementia drug trials.  Dement Geriatr Cogn Disord. 2001;  12 1-14
    CrossrefPubMedSearch in Google Scholar
  • 40 Schwartz E. Development and Validation of the Geriatric Evaluation by Relative’s Rating Instrument (GERRI).  Psychological Reports. 1983;  53 479-488
    CrossrefPubMedSearch in Google Scholar
  • 41 Teunisse S, Derix M M. The interview for deterioration in daily living activities in dementia: agreement between primary and secondary caregivers.  Int Psychogeriatr. 1997;  9 (S 01) 155-162
    PubMedSearch in Google Scholar
  • 42 Katz S, Downs T D, Cash H R. et al . Progress in development of the index of ADL.  Gerontologist. 1970;  10 20-30
    CrossrefPubMedSearch in Google Scholar
  • 43 Lawton M P, Brody E M. Assessment of older people: Self-maintaining and Instrumental Activities of Daily Living.  Gerontologist. 1969;  9 179-186
    CrossrefPubMedSearch in Google Scholar
  • 44 Lawton M P. Scales to measure competence in everyday activities.  Psychopharmacol Bull. 1988;  24 609-614
    PubMedSearch in Google Scholar
  • 45 Pruchno R A, Kleban M H, Resch N L. Psychometric Assessment of the Multidimensional Observation Scale for Elderly Subjects (MOSES).  J Gerontol Psych Sci. 1988;  43 164-169
    PubMedSearch in Google Scholar
  • 46 Weyer G. Internationale Skalen für Psychiatrie.. Göttingen: Belz Test; 2005
    Search in Google Scholar
  • 47 DeJong R, Osterlund O W, Roy G W. Measurement of quality-of-life changes in patients with Alzheimer’s disease.  Clin Ther. 1989;  11 545-554
    PubMedSearch in Google Scholar
  • 48 Cullum C M, Saine K, Chan L D. et al . Performance-based instrument to assess functional capacity in dementia: The Texas Functional Living Scale.  Neuropsychiatry Neuropsychol Behav Neurol. 2001;  14 103-108
    PubMedSearch in Google Scholar

Sebastian Voigt-Radloff

Zentrum für Geriatrie und Gerontologie, Universitätsklinikum Freiburg

Lehener Straße 88

79106 Freiburg

Email: sebastian.voigt@uniklinik-freiburg.de