Outcomes of a multimodal cognitive and physical rehabilitation program for persons with mild dementia and their caregivers: a goal-oriented approach

Abstract

Background

Nonpharmacological interventions such as exercise and cognitive rehabilitation programs have shown promise in reducing the impact of dementia on the individual and the caregiver. In this study, we examine the effect of a multimodal cognitive and physical rehabilitation program for persons with mild dementia and their caregivers using conventional measures of cognition, behavior, quality of life (QoL), and caregiver burden together with goal attainment scaling (GAS), an individualized outcome measure.

Methods

Goals were set at baseline, and GAS score was calculated at the end of the program. Participants were also assessed with the Chinese Mini-Mental State Examination, functional and behavioral scales (Barthel Index), Instrumental Activities of Daily Living, Neuropsychiatric Inventory Questionnaire, QoL, and caregiver burden using EuroQol-five dimension questionnaire and Zarit Burden Interview (ZBI). Differences in median scores postintervention were obtained. Further analysis of caregiver burden was undertaken utilizing the multidimensional classification of burden on the ZBI.

Results

Thirty-four (61.8%) patients were assessed to have met their goals (GAS score≥50). Mean (standard deviation) GAS score was 48.6 (6.5). Cognition goals were set in only 20.6%, followed by goals to improve engagement and socialization; reduce caregiver stress; and improve physical function, behavior, and mood. Median scores in the cognitive, functional, and QoL measures did not differ significantly pre- and postintervention. The intervention had a positive impact on role strain, a unique dimension of caregiver burden.

Conclusion

This study provides evidence that a multimodal approach combining physical exercise and cognitive rehabilitation improves goal attainment and caregiver burden in individuals and caregivers of persons with mild dementia.

Keywords:

• dementia
• rehabilitation
• goal attainment scaling

Acknowledgments

We would like to thank all the participants and caregivers of the MINDVital program. We also gratefully acknowledge all the members of the MINDVital team, including dementia care nurse clinicians Philomena Anthony and Han Huey Charn, Agnes Teo and her team of physiotherapists, Pamela Chew and June Lim, Sabrina Ow and her team of occupational therapists, and Sharon Wee for her editorial assistance.

Disclosure

Dr Tay was supported by the Tan Tock Seng Hospital Pitch-for-Fund grant in 2012 for a pilot study evaluating the impact of MINDVital on physical performance in early Alzheimer’s disease. The authors report no other conflicts of interest in this work.