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Apathy and its response to antipsychotic review and non-pharmacological interventions in people with dementia living in nursing homes : WHELD, A factorial cluster randomised controlled trial

Rajkumar, Anto P.; Ballard, Clive; Fossey, Jane; Corbett, Anne; Woods, Bob; Orrell, Martin; Prakash, Rohan; Moniz-Cook, Esme; Testad, Ingelin

Authors

Anto P. Rajkumar

Clive Ballard

Jane Fossey

Anne Corbett

Bob Woods

Martin Orrell

Rohan Prakash

Professor Esme Moniz-Cook E.D.Moniz-Cook@hull.ac.uk
Professor of Clinical Psychology of Ageing and Dementia Care Research/ Dementia Research Work Group Lead

Ingelin Testad



Abstract

Objectives: Apathy is common, impactful, and difficult to manage in people with dementia. We evaluated the efficacy of non-pharmacological interventions, exercise and social interaction, in combination with antipsychotic review, to reduce apathy in people with dementia living in nursing homes in a cluster randomised controlled trial (RCT). Methods: Well-being and health for people with dementia (WHELD) programme included a 2X2X2 factorial cluster RCT involving people with dementia living in 16 nursing homes in UK. All homes received training in person-centred care, and were randomised to receive antipsychotic review, social interaction, and exercise, either alone or in combinations. Apathy was one of the secondary outcomes of the WHELD trial, and it was measured by the Neuropsychiatric Inventory-nursing home version at baseline and nine months (N=273). We employed multilevel mixed effects linear regression models to assess the impact of the interventions on apathy. Results: Prevalence of apathy was 44.0% (n=120; 95% CI 38.1-49.9%) at baseline. Severity of apathy had significant positive correlations with dementia severity, neuropsychiatric symptoms, depressive symptoms, agitation, and the needs of the people with dementia (p<0.001). Antipsychotic review reduced antipsychotic use, but it significantly increased apathy (β=5.37; SE=0.91; p<0.001). However, antipsychotic review in combination with either social interaction (β=-5.84; SE=1.15; p<0.001) or exercise (β=-7.54; SE=0.93; p<0.001) significantly reduced apathy. Conclusions: Antipsychotic review can play a significant role in improving apathy in people with dementia living in nursing homes, when combined with psychosocial interventions such as social interaction and exercise. Guidance must be adapted to reflect this subtlety in care.

Publication Date 2016-08
Journal Journal of the American Medical Directors Association
Print ISSN 1525-8610
Electronic ISSN 1538-9375
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 17
Issue 8
Pages 741-747
Institution Citation Rajkumar, A. P., Ballard, C., Fossey, J., Corbett, A., Woods, B., Orrell, M., …Testad, I. (2016). Apathy and its response to antipsychotic review and non-pharmacological interventions in people with dementia living in nursing homes : WHELD, A factorial cluster randomised controlled trial. Journal of the American Medical Directors Association, 17(8), 741-747. https://doi.org/10.1016/j.jamda.2016.04.006
DOI https://doi.org/10.1016/j.jamda.2016.04.006
Keywords Apathy; Dementia; Randomized controlled trial
Publisher URL http://www.jamda.com/article/S1525-8610(16)30091-3/abstract
Copyright Statement © 2017. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Additional Information Authors' accepted manuscript of article published in: Journal of the American Medical Directors Association, 2016, v.17, issue 8.

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Copyright Statement
© 2017. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/







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