Journal de la maladie d'Alzheimer et du parkinsonisme

Abstrait

Effectiveness of a Specific Care Plan in Alzheimers Disease in the Oldest Old

Sandrine Sourdet, Sophie Guyonnet, Maria E. Soto, Sandrine Andrieu, Christelle Cantet, Bruno Vellas and Fati Nourhashemi

Objective: To investigate the effectiveness of a multicomponent specific care and assistance plan, in reducing the rate of functional decline in oldest-old patients (age > 85 years) with Alzheimer’s disease (AD), compared with usual care. Patients and methods: This is a post-hoc analysis of a cluster randomized trial (the PLASA study), assessing the impact of a specific care plan in AD patients in 50 memory clinics in France. Two hundred community-dwelling mild to moderate AD patients aged 85 or more, were analyzed: 97 patients were enrolled in the intervention group and 103 in the control group (usual care). Patients and their caregivers in the intervention group had a twice-yearly follow-up, with a comprehensive standardized and global assessment. If any complication was identified during the assessment, standardized management protocols were proposed to guide the intervention of the physician, along with an information and training of the caregiver. The primary outcome was measured by change on the Alzheimer’s disease Cooperative Study-Activities of Daily Living (ADCS-ADL) scale at 24 months, and analyzed on an intentionto treat-basis, using a mixed model. Results: Of the 200 participants randomized and analyzed, 89 completed the study: 36 (37.11 %) in the intervention group and 53 (51.46 %) in the control group. The participants’ mean age were respectively 88.1 years (SD 3.1) and 87.8 (SD 2.3) in the intervention and control group. Intervention showed no effectiveness in reducing the rate of functional decline at two years. Indeed, the decline in the ADCS-ADL score was -12.8 (SE=4.0) in the intervention group, and -9.0 (SE=3.0) in the control group (p=0.46). Conclusion: A comprehensive specific health care plan did not reduce functional decline rate in oldest-old patients with mild to moderate AD, followed-up in memory clinics. More research is needed to identify actions that will lessen functional decline in this high-risk population.