Date Published: August 29, 2017
Publisher: BioMed Central
Author(s): Tim Fleiner, Hannah Dauth, Marleen Gersie, Wiebren Zijlstra, Peter Haussermann.
The primary objective of this trial is to investigate the effects of a short-term exercise program on neuropsychiatric signs and symptoms in acute hospital dementia care.
Within a hospital-based randomized controlled trial, the intervention group conducted a 2-week exercise program with four 20-min exercise sessions on 3 days per week. The control group conducted a social stimulation program. Effects on neuropsychiatric signs and symptoms were measured via the Alzheimer’s Disease Cooperative Study-Clinical Global Impression of Change, the Neuropsychiatric Inventory, and the Cohen-Mansfield Agitation Inventory. The antipsychotic and sedative dosage was quantified by olanzapine and diazepam equivalents.
Eighty-five patients were randomized via minimization to an intervention group (IG) and a control group (CG). Seventy patients (82%) (mean age 80 years, 33 females, mean Mini Mental State Examination score 18.3 points) completed the trial. As compared to the CG (n = 35), the IG (n = 35) showed significantly reduced neuropsychiatric signs and symptoms. Especially, agitated behavior and lability improved. There were no between-group differences concerning antipsychotic and benzodiazepine medication.
This exercise program is easily applicable in hospital dementia care and significantly reduces neuropsychiatric signs and symptoms in patients suffering from predominantly moderate stages of dementia.
German Clinical Trial Register DRKS00006740. Registered 28 October 2014.
Neuropsychiatric signs and symptoms in dementia cover a broad range of symptoms with depression, agitation, and apathy being most common. They affect almost every patient in the course of the disease . These behavioral and psychological symptoms in dementia seriously impact caregiver burden and often lead to admission to geriatric or geriatric psychiatry hospital wards or to specialized dementia care units in nursing homes.
The primary objective of this hospital-based RCT was to investigate the effects of a short-term exercise program on exacerbated neuropsychiatric signs and symptoms. The analysis of the psychopathometric rating scales revealed a significant reduction of overall neuropsychiatric signs and symptoms for the IG as compared to the CG after a 2-week intervention period. We found clinically relevant effect sizes (r ≥ 0.5) with appropriate test power (1 – β ≥ 0.80) in four of the five ADCS-CGIC dimensions (Fig. 2). These results are further affirmed by the total NPI score, the NPI dimension ‘behavioral symptoms’, and the CMAI subscore ‘verbally agitated behavior’, which all show clinically relevant behavioral improvements in the IG, but not in the CG  (Table 2 and Fig. 3). The observed effects on neuropsychiatric signs and symptoms could not be explained by different use of benzodiazepine or neuroleptic medication in either of the groups (Table 3). Concerning neuroleptic medication, we found no significant differences between the IG and the CG before, during, or after the intervention period. Nearly all patients received antipsychotic medication. One-third of the patients in both groups were on benzodiazepine medication at baseline, and only eight patients in the IG and three patients in the CG were on benzodiazepine medication at follow-up measurement (Table 3). In the IG, there was a nonsignificant increase of benzodiazepine dosage. In the CG, there was a slight but significant decrease from 1.80 to 1.64 mg/day, which we do not consider to be clinically relevant. We saw a drop in the number of patients in the CG who received sedative medication between baseline and follow-up measurement from 11 to 4. Given comparable dosages of antipsychotic and sedative medication as well as a similar level of social stimulation, this structured short-term exercise program significantly improved neuropsychiatric signs and symptoms in the IG.
The exercise-carrousel program is easily applicable in hospital dementia care and significantly reduces neuropsychiatric signs and symptoms in patients suffering from predominantly moderate stages of dementia.