Affiliations: [a] INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France
| [b]
University Bordeaux, Bordeaux, France
| [c] Service de Neurologie, Department of Clinical Neurosciences, CHU Pellegrin, Bordeaux, France
| [d] INSERM, Clinical Investigation Center – Clinical Epidemiology 1401, Bordeaux, France
Correspondence:
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Correspondence to: Clément Pimouguet, Institut de Santé Publique, d’Epidémiologie et de Développement, Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux Cedex, France. Tel.: +33 05 57 57 56 44; Fax: +33 05 56 24 00 81; E-mail: [email protected].
Abstract: Background: There is a growing interest in developing non-pharmacological approaches in dementia. Clinical efficacy of occupational therapy (OT) under routine care conditions has not been investigated yet. Objective: To analyze the short-term effects of OT in patients with dementia; and to identify factors related to greater benefit. Methods: Patients referred to OT were evaluated before starting a 3-month intervention and at 3 and 6 months later. Measures included: Mini-Mental State Examination (MMSE), Disability Assessment in Dementia (DAD), Neuropsychiatric Inventory (NPI) Questionnaire, patients’ quality of life (EQ 5D-VAS), caregivers’ burden (Zarit scale), and amount of informal care. Linear mixed models were used to analyze trajectories of outcomes. Logistic regressions with stepwise descending selection were used to study factors associated with benefits. Results: 421 dementia patients benefited from OT (mean MMSE = 17.3). Patients remained cognitively stable over time. Functional performances also remained stable at 3 months and significantly decreased at 6 months (crude reduction of 2.8 points, p < 0.01). Behavioral troubles were significantly reduced over the intervention period and remained stable after (p < 0.01). Patients’ quality of life increased over the 3-month intervention (p = 0.16) and significantly decreased thereafter. Caregivers’ burden and informal care significantly decreased over the 3-month intervention and remained stable thereafter. Patients who benefited from OT with regard to function were less educated and had higher cognitive level. Conclusion: OT may be an effective intervention to maintain cognition and functionality and to reduce psychiatric symptoms in dementia patients. Mild stages of dementia could gain more benefits from OT with regard to functional decline.
