Effectiveness of a specific care plan in patients with Alzheimer’s disease: cluster randomised trial (PLASA study)
Identifieur interne : 000968 ( Main/Exploration ); précédent : 000967; suivant : 000969Effectiveness of a specific care plan in patients with Alzheimer’s disease: cluster randomised trial (PLASA study)
Auteurs : Fati Nourhashemi [France] ; Sandrine Andrieu [France] ; Sophie Gillette-Guyonnet [France] ; Bruno Giraudeau [France] ; Christelle Cantet [France] ; Nicola Coley [France] ; Bruno Vellas [France]Source :
- BMJ [ 0959-8138 ] ; 2010.
Abstract
Objective To test the effectiveness of a comprehensive specific care plan in decreasing the rate of functional decline in patients with mild to moderate Alzheimer’s disease compared with usual care in memory clinics. Design Cluster randomised trial. Setting 50 memory clinics in France. Participants Patients with Alzheimer’s disease (mini-mental state examination score 12-26). 1131 patients were included: 574 from 26 clinics in the intervention group, and 557 from 24 clinics in the usual care (control) group. Memory clinics were the unit of randomisation. Intervention The intervention included a comprehensive standardised twice yearly consultation for patients and their caregivers, with standardised guidelines for the management of problems identified during the assessment. Main outcome measures The primary outcome measure was change on the Alzheimer’s Disease Cooperative Study-activities of daily living scale assessed at 12 and 24 months. Secondary outcome measures were the rate of admission to institutional care and mortality. Results At two years the assessment was completed by 58.4% (n=335) of patients in the intervention group and 61.6% (n=343) in the control group. The rate of functional decline at two years did not differ between the groups. The annual rate of change on the Alzheimer’s Disease Cooperative Study-activities of daily living was estimated at −5.73 (95% confidence interval −6.89 to −4.57) in the intervention group and −5.96 (−7.05 to −4.86) in the control group (P=0.78). Conclusion A comprehensive specific care plan in memory clinics had no additional positive effect on functional decline in patients with mild to moderate Alzheimer’s disease. Future research should aim to determine the effects of more direct involvement of general practitioners. Trial registration ClinicalTrials.gov NCT00480220.
Url:
- https://api.istex.fr/document/FF52288570DE05AA74E2A5E7C8196C19258AD889/fulltext/pdf
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881198
DOI: 10.1136/bmj.c2466
Affiliations:
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type="city">Toulouse</settlement></placeName></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>University of Toulouse III</wicri:regionArea></affiliation></author><author><name sortKey="Vellas, Bruno" sort="Vellas, Bruno" uniqKey="Vellas B" first="Bruno" last="Vellas">Bruno Vellas</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Gérontopôle, CMRR, Toulouse</wicri:regionArea><placeName><settlement type="city">Toulouse</settlement></placeName></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Inserm U558, Toulouse</wicri:regionArea><placeName><settlement type="city">Toulouse</settlement></placeName></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>University of Toulouse III</wicri:regionArea></affiliation></author></analytic><monogr></monogr><series><title level="j">BMJ</title><title level="j" type="abbrev">BMJ</title><idno type="ISSN">0959-8138</idno><idno type="eISSN">1468-5833</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2010">2010</date><biblScope unit="volume">340</biblScope></imprint><idno type="ISSN">0959-8138</idno></series><idno type="istex">FF52288570DE05AA74E2A5E7C8196C19258AD889</idno><idno type="DOI">10.1136/bmj.c2466</idno><idno type="href">bmj-340-bmj-c2466.pdf</idno><idno type="ArticleID">nouf740902</idno><idno type="PMID">20522656</idno><idno type="local">bmj;340/jun03_1/c2466</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0959-8138</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Objective To test the effectiveness of a comprehensive specific care plan in decreasing the rate of functional decline in patients with mild to moderate Alzheimer’s disease compared with usual care in memory clinics. Design Cluster randomised trial. Setting 50 memory clinics in France. Participants Patients with Alzheimer’s disease (mini-mental state examination score 12-26). 1131 patients were included: 574 from 26 clinics in the intervention group, and 557 from 24 clinics in the usual care (control) group. Memory clinics were the unit of randomisation. Intervention The intervention included a comprehensive standardised twice yearly consultation for patients and their caregivers, with standardised guidelines for the management of problems identified during the assessment. Main outcome measures The primary outcome measure was change on the Alzheimer’s Disease Cooperative Study-activities of daily living scale assessed at 12 and 24 months. Secondary outcome measures were the rate of admission to institutional care and mortality. Results At two years the assessment was completed by 58.4% (n=335) of patients in the intervention group and 61.6% (n=343) in the control group. The rate of functional decline at two years did not differ between the groups. The annual rate of change on the Alzheimer’s Disease Cooperative Study-activities of daily living was estimated at −5.73 (95% confidence interval −6.89 to −4.57) in the intervention group and −5.96 (−7.05 to −4.86) in the control group (P=0.78). Conclusion A comprehensive specific care plan in memory clinics had no additional positive effect on functional decline in patients with mild to moderate Alzheimer’s disease. Future research should aim to determine the effects of more direct involvement of general practitioners. Trial registration ClinicalTrials.gov NCT00480220.</div></front></TEI><affiliations><list><country><li>France</li></country><settlement><li>Toulouse</li><li>Tours</li></settlement></list><tree><country name="France"><noRegion><name sortKey="Nourhashemi, Fati" sort="Nourhashemi, Fati" uniqKey="Nourhashemi F" first="Fati" last="Nourhashemi">Fati Nourhashemi</name></noRegion><name sortKey="Andrieu, Sandrine" sort="Andrieu, Sandrine" uniqKey="Andrieu S" first="Sandrine" last="Andrieu">Sandrine Andrieu</name><name sortKey="Andrieu, Sandrine" sort="Andrieu, Sandrine" uniqKey="Andrieu S" first="Sandrine" last="Andrieu">Sandrine Andrieu</name><name sortKey="Andrieu, Sandrine" sort="Andrieu, Sandrine" uniqKey="Andrieu S" first="Sandrine" last="Andrieu">Sandrine Andrieu</name><name sortKey="Andrieu, Sandrine" sort="Andrieu, Sandrine" uniqKey="Andrieu S" first="Sandrine" last="Andrieu">Sandrine Andrieu</name><name sortKey="Cantet, Christelle" sort="Cantet, Christelle" uniqKey="Cantet C" first="Christelle" last="Cantet">Christelle Cantet</name><name sortKey="Cantet, Christelle" sort="Cantet, Christelle" uniqKey="Cantet C" first="Christelle" last="Cantet">Christelle Cantet</name><name sortKey="Coley, Nicola" sort="Coley, Nicola" uniqKey="Coley N" first="Nicola" last="Coley">Nicola Coley</name><name sortKey="Coley, Nicola" sort="Coley, Nicola" uniqKey="Coley N" first="Nicola" last="Coley">Nicola Coley</name><name sortKey="Gillette Guyonnet, Sophie" sort="Gillette Guyonnet, Sophie" uniqKey="Gillette Guyonnet S" first="Sophie" last="Gillette-Guyonnet">Sophie Gillette-Guyonnet</name><name sortKey="Gillette Guyonnet, Sophie" sort="Gillette Guyonnet, Sophie" uniqKey="Gillette Guyonnet S" first="Sophie" last="Gillette-Guyonnet">Sophie Gillette-Guyonnet</name><name sortKey="Gillette Guyonnet, Sophie" sort="Gillette Guyonnet, Sophie" uniqKey="Gillette Guyonnet S" first="Sophie" last="Gillette-Guyonnet">Sophie Gillette-Guyonnet</name><name sortKey="Giraudeau, Bruno" sort="Giraudeau, Bruno" uniqKey="Giraudeau B" first="Bruno" last="Giraudeau">Bruno Giraudeau</name><name sortKey="Giraudeau, Bruno" sort="Giraudeau, Bruno" uniqKey="Giraudeau B" first="Bruno" last="Giraudeau">Bruno Giraudeau</name><name sortKey="Giraudeau, Bruno" sort="Giraudeau, Bruno" uniqKey="Giraudeau B" first="Bruno" last="Giraudeau">Bruno Giraudeau</name><name sortKey="Nourhashemi, Fati" sort="Nourhashemi, Fati" uniqKey="Nourhashemi F" first="Fati" last="Nourhashemi">Fati Nourhashemi</name><name sortKey="Nourhashemi, Fati" sort="Nourhashemi, Fati" uniqKey="Nourhashemi F" first="Fati" last="Nourhashemi">Fati Nourhashemi</name><name sortKey="Nourhashemi, Fati" sort="Nourhashemi, Fati" uniqKey="Nourhashemi F" first="Fati" last="Nourhashemi">Fati Nourhashemi</name><name sortKey="Vellas, Bruno" sort="Vellas, Bruno" uniqKey="Vellas B" first="Bruno" last="Vellas">Bruno Vellas</name><name sortKey="Vellas, Bruno" sort="Vellas, Bruno" uniqKey="Vellas B" first="Bruno" last="Vellas">Bruno Vellas</name><name sortKey="Vellas, Bruno" sort="Vellas, Bruno" uniqKey="Vellas B" first="Bruno" last="Vellas">Bruno Vellas</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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