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

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
• 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
• 4 Stelling K, Kuhn K, Riedel-Heller S G. et al . Leichte kognitive Beeinträchtigung und Demenzentwicklung.  Psychiat Prax. 2009;  36 119-124
• 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
• 6 Wahl H W. Zum Konstrukt der Alltagskompetenz.  Z Gerontol Geriatr. 1998;  31 243-249
• 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
• 8 Van Praag H. Exercise and the brain: something to chew on.  Trends Neurosci. 2009;  32 283-290
• 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
• 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
• 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
• 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]
• 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]
• 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]
• 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]
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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]
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 35 Mahoney F I, Barthel D W. Functional Evaluation: The Barthel Index.  Md State Med J. 1965;  14 61-65
• 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
• 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
• 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
• 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
• 40 Schwartz E. Development and Validation of the Geriatric Evaluation by Relative’s Rating Instrument (GERRI).  Psychological Reports. 1983;  53 479-488
• 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
• 42 Katz S, Downs T D, Cash H R. et al . Progress in development of the index of ADL.  Gerontologist. 1970;  10 20-30
• 43 Lawton M P, Brody E M. Assessment of older people: Self-maintaining and Instrumental Activities of Daily Living.  Gerontologist. 1969;  9 179-186
• 44 Lawton M P. Scales to measure competence in everyday activities.  Psychopharmacol Bull. 1988;  24 609-614
• 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
• 46 Weyer G. Internationale Skalen für Psychiatrie.. Göttingen: Belz Test; 2005
• 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
• 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