RESUMO
OBJECTIVES: We reported the findings of a randomized controlled trial (RCT) to examine the effects of an individualized functional enhancement program (FEP) on functional skills and mood symptoms in mild and moderate dementia. SUBJECTS & METHODS: 74 Chinese older persons with dementia were recruited into a skills training program by occupational therapists (OT). Thirty seven subjects were trained with an individualized selection of daily activities (FEP Intervention, I); 37 were trained with general occupational therapy (Control, C). The FEP comprised of twice weekly group sessions of skills training and problem solving using cognitive behavioral approach. RESULTS: At 1 month after completion of program, both I and C subjects showed an improvement in process skills of the assessment of motor and process skills (AMPS)(paired t-tests, p < 0.05). At 4 months post-program, the I group showed a further reduction of cornell scale for depression in dementia (CSDD) scores (paired t-test, p = 0.02); Apathy improved at 1 month post-training (p = 0.04), but deteriorated at 4 months (p = 0.01). Group differences in changes of mood and functional scores were not significant (ANVOCA, p > 0.05). CONCLUSIONS: The findings suggested a potential benefit for individualized occupational therapy. It should be tailor made with individual needs and continued for sustained effectiveness.
Assuntos
Terapia Cognitivo-Comportamental , Demência/psicologia , Demência/reabilitação , Transtornos do Humor/diagnóstico , Atividades Cotidianas/psicologia , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Apatia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/reabilitação , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/reabilitação , Avaliação da Deficiência , Feminino , Humanos , Masculino , Transtornos do Humor/reabilitação , Destreza Motora/fisiologia , Testes Neuropsicológicos , Avaliação de Programas e Projetos de Saúde , Desempenho PsicomotorRESUMO
OBJECTIVES: This study aims at assessing mental competence in Chinese patients with mild and very mild dementia with a semistructured assessment method and the impact of repeated presentations of information on patients' mental competence. DESIGN: Subjects with mild and very mild dementia were compared with cognitively intact subjects. SETTING: Chinese subjects were recruited from local social centers and residential hostels for the elderly in Hong Kong. PARTICIPANTS: Sixty-six Chinese community-dwelling older adults (aged from 65 to 87 years) were recruited. MEASUREMENTS: Clinical diagnosis was made by experienced geriatric psychiatrists. Subjects were assessed with the Mini-Mental State Examination and the Clinical Dementia Rating (CDR). Mental capacity to consent to treatment was assessed by using the Chinese version of the MacArthur Competence Assessment Tool-Treatment (MacCAT-T) and independent clinician ratings based on the definition in the Mental Capacity Act 2005 of the United Kingdom. RESULTS: Thirty-three (50%) participants were diagnosed with very mild or mild dementia (CDR = 0.5 or 1). In this group, 15 (45.5%) subjects were rated as mentally incompetent in clinician ratings. In the assessment of interrater reliability, the intraclass correlation coefficient of MacCAT-T summary scores among three raters ranged from 0.64 to 0.83. The MacCAT-T summary scores correlated significantly with clinician ratings, years of education, Mini-Mental State Examination score, and CDR. In contrast to the nonimpaired group, repeated presentation of information did not significantly improve capacity in the demented group. CONCLUSION: Results from this study suggest that even patients with very mild dementia in this population can show substantial deficits in decision-making capacity, and that improved capacity is not likely to result from repeated disclosure of information.