Comprehensive evaluations every six months do not result in improvements over usual care
FRIDAY, June 4 (HealthDay News) -- A comprehensive specific care plan carried out with biannual clinic consultations and management of problems with standardized guidelines does not decrease the rate of functional decline in individuals with mild to moderate Alzheimer's disease, according to research published June 3 in BMJ.
Fati Nourhashemi, M.D., of the Toulouse University Hospital in France, and colleagues conducted a cluster-randomized trial of 1,131 patients with Alzheimer's disease from 50 memory clinics in France. Clinics were randomized to provide either a comprehensive assessment every six months and specific guideline-based treatment to participating patients, or to provide usual care. The main outcome measured was change on the Alzheimer's Disease Cooperative Study-activities of daily living scale assessed after 12 and 24 months.
At two-year follow-up, the researchers observed no difference in the rate of functional decline between the intervention group and the usual-care group. On the Alzheimer's Disease Cooperative Study-activities of daily living scale, the researchers estimated the annual rate of change to be −5.73 in the intervention group and −5.96 in the control group (P = 0.78). The authors conclude that the intervention did not provide benefit in activities of daily living and may have little public health value.
"The lack of a significant effect of the care plan in Nourhashemi and colleagues' trial should not deter clinicians from providing care that is consistent with this care plan and with evidence-based guidelines. The study highlights that specialists need to build a contract with patients and their families to provide the best quality of care; review care more often; and collaborate with other care providers, including primary care practitioners, social workers, and nurse specialists," writes the author of an accompanying editorial.