Effects of a psychoeducational intervention focusing on cognitive training in caregivers of older adults with Alzheimer's disease

Caparrol, Ana Julia de Souza; Martins, Gabriela; Barbosa, Gustavo Carrijo; Gratão, Aline Cristina Martins

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Original Article • Cad. Bras. Ter. Ocup. 29 • 2021 • https://doi.org/10.1590/2526-8910.ctoAO2181 copy

Effects of a psychoeducational intervention focusing on cognitive training in caregivers of older adults with Alzheimer's disease¹ 1 This study is the result of a randomized, controlled and blind clinical trial (UTN: U1111-1206-5773), whose steps followed Resolutions 466/12 and 510/16 of the National Health Council. The participation of volunteers was subject to agreement with the Informed Consent Form. The project was approved by the Ethics Committee for Research in Human Beings (Opinion number 2.069.671/2017), CAEE 65119517.1.0000.5504.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Cognitive interventions can be important support strategies for caregivers of older adults with Alzheimer's disease (AD) since they improve their physical and mental health.

Objective

To evaluate and analyze the effects of psychoeducational intervention with a focus on cognitive stimulation on cognition, anxiety, stress, and overload in caregivers of elderly people with Alzheimer's disease.

Method

This is a randomized, controlled, blinded clinical trial, performed with 37 informal caregivers divided into Home Intervention Group (HIG) and Control Group (CG). Participants were assessed before and after the intervention using Addenbrooke's Cognitive Examination-Revised, Perceived Stress Scale, Depression Inventory and Beck Anxiety, and Zarit Overload Scale.

Results

There was improvement in the HIG, significant for symptoms of stress (p= 0.0027), cognition (p= 0.003; p= 0.008), attention/orientation (p= 0.004), memory (p= 0.017), and verbal fluency (p= 0.023). Regarding the CG, despite the improvement in the parameters, this was not significant.

Conclusion

Intervention in caregivers at home is an important tool for improving cognition and stress in caregivers of older adults with AD, but it does not seem to be as effective for symptoms of overload, which highlights the need for specific strategies in this domain.

Keywords:
Caregivers; Alzheimer Disease; Aged; Cognition; Occupational Therapy

SCHEDULE OF COGNITIVE STIMULATION ACTIVITIES
Activities	Week
Circle the vowels with "Blue pen"	1
Cross out the letters "R" and "S"
Reproduce recipes
Find elements of the figures
SUDOKU	2
Memorize words
Elaboration of a story from the figure
TETRA
Face to face	3
Text interpretation
Figure Categorization
SUM 15
TETRA	4
Sum of the Yellow Triangle
Reproduce Recipe
Colored toothpicks
Training with change	5
7 Mistakes Game
Memorization of figure elements
Form words (to elaborate from the letters on the given sheet)
WRITE FROM BACKWARDS	6
Associative memory game
Sum of the Orange Triangle
Mind Academy Game – Face to Face	7
Cross out the letters "R" and "S"
Form words (to elaborate from the letters on the given sheet)
Reading and Interpreting	8
Figure Categorization
SUM 15
Connect the dots	9
Find the design
Story elaboration
Mind Academy Game – What's Different?	10
SUM 15	10
SUDOKU	11
TETRA	11
Sum of Triangle	12
Tower of Hanoi
Training with change - supermarket list

Variables	HIG (n=17)	CG (n=21)	HIG vs. CG
Age	52.5 (±15,3)	55.1 (±18.2)	T=-0.458; p=0.650²
20-39 years old	11.8%	20.0%
40-59 years old	64.7%	35.0%
≥60 years old	23.5%	45.0%
Gender			p=0.350¹
Male	11.8%	5.0%
Female	88.2%	95.0%
Education level	8.8 (±4,2)	9.35 (±3.7)	T=-0.359; p=0.722²
Illiterate	5.9%	-
1-4 years	17.6%	20.0%
5-8 years	23.5%	30.0%
≥9 years	47.1%	45.0%
Missings	5.9%	5.0%
Marital Status			NA
Single	29.4%	35.0%
Married	52.9%	55.0%
Widower	11.8%	5.0%
Separate	5.9%	5.0%
Individual income			NA
<1 Minimum Wage	11.8%	5.0%
1 Minimum Wage	64.7%	70.0%
2 Minimum Wages	17.6%	10.0%
3 Minimum Wages	5.9%	15.0%
Family income			NA
<1 Minimum Wage	5.9%	-
1 Minimum Wage	41.2%	45.0%
2 Minimum Wages	35.3%	30.0%
3 Minimum Wages	17.6%	25.0%
Kinship			NA
Husband/wife	17.6%	10.0%
Son/Daughter	52.9%	60.0%
Grandson/Granddaughter	11.8%	15.0%
Others	17.6%	15.0%
Living with the elderly person
Yes	64.7%	65.0%	p=0.269¹
No	35.3%	35.0%

Variables	HIG (n=17)	CG (n=21)	HIG vs. GC
Care time	5.7 years (±4.5)	7.1 years (±4,5)	T=-0.905; p=0.372²
Days of the week	6.0 (±1.2)	5.3 (±1,1)	T=-1.808; p=0.079²
Hours per day	15.3 (±8.7)	16.5 (±8,1)	T=-0.413; p=0.682²
Alzheimer's information
Yes	88.2%	95.0%	p=0.584¹
No	11.8%	5.0%
Care information
Yes	94.1%	95.0%	p=0.715¹
No	5.9%	5.0%
Care activities
Body hygiene	82.4%	55.0%	p=0.094¹
Oral hygiene	70.6%	55.0%	p=0.498¹
Eliminations	70.6%	25.0%	p=0.009 ¹
Food	88.2%	75.0%	p=0.416¹
Medication	76.5%	95.0%	p=0.036 ¹
Sleep/rest	76.5%	60.0%	p=0.319¹
Physiotherapy	11.8%	20.0%	p=0.667¹
Medical appointment	70.6%	75.0%	p=0.526¹
Activities
Church	17.6%	40.0%	p=0.169¹
Community groups	5.9%	10.0%	p=0.562¹
Clubs	11.8%	10.0%	p=0.633¹
Social assistance	-	5.0%	NA
Others	11.8%	-	NA
Morbidities
Dyslipidemias	-	-	NA
Arterial hypertension	29.4%	35.0%	p=0.498¹
Diabetes	17.6%	35.0%	p=0.209¹
Cardiac disease	5.9%	5.0%	p=0.715¹
Osteoporosis	11.8%	-	NA
Arthrosis	23.5%	5.0%	p=0.123¹
Spine	5.9%	20.0%	p=0.225¹
Other diseases	41.2%	45.0%	p=0.540¹
Total morbidities	1.3 (±0.9)	1.3 (±0.8)	T=0.186; p=0.854²

Variables	HIG (n=17)		Pre vs. post¹	CG (n=20)			Pre vs. post¹	HIG vs. CG²	HIG vs CG²
Variables	Pre	Post	Pre vs. post¹	Pre	Post		Pre vs. post¹	Pre	Post
ACE-R	82.2 (±10.9)	89.9 (±7.0)	T=-3.4; p=.003	80.8 (±13.4)		81.5 (±11.7)	T=-0.5; p=.613	T=0.4; p=.631	T=2.6; p=.012
Attention/Guidance	16.0 (±1.2)	17.0 (±1.1)	T=-3.3; p=.004	15.5 (±2.6)		15.1 (±2.6)	T=0.8; p=.394	T=0.8; p=.413	T=3.0; p=.005
Memory	19.2 (±5.5)	22.1 (±2.9)	T=-2.6; p=.017	18.6 (±5.8)		19.9 (±4.4)	T=-2.0; p=.060	T=0.3; p=.717	T=1.7; p=.081
Verbal fluency	9.2 (±3.1)	11.4 (±2.0)	T=-2.5; p=.023	10.0 (±3.3)		10.8 (±2.8)	T=-3.0; p=.007	T=-0.7; p=.454	T=0.8; p=.427
Language	24.6 (±1.6)	24.7 (±1.3)	T=-0.5; p=.608	22.9 (±2.8)		22.4 (±3.4)	T=0.6; p=.504	T=2.2; p=.029	T=2.7; p=.011
Visual-spatial	13.5 (±2.9)	14.4 (±2.0)	T=-1.4; p=.172	13.6 (±2.7)		13.1 (±3.4)	T=0.9; p=.358	T=0.1; p=.948	T=1.3; p=.172
MMSE	24.4 (±2.3)	26.0 (±1.4)	T=-3.0; p=.008	25.1 (±3.3)		25.6 (±2.6)	T=-0.8; p=.387	T=-0.4; p=.483	T=0.5; p=.577
Depression	11.1 (±9.3)	7.0 (±6.0)	T=2.0; p=.059	9.9 (±6.0)		9.4 (±5.3)	T=0.5; p=.620	T=0.4; p=.646	T=-1.3; p=.202
Stress	32.7 (±6.0)	29.0 (±5.6)	T=2.4; p=.027	33.7 (±6.2)		30.8 (±4.5)	T=2.3; p=.031	T=-0.4; p=.648	T=-1.0; p=.306
Anxiety	11.4 (±9.5)	6.8 (±7.3)	T=3.0; p=.008	10.2 (±6.1)		8.6 (±4.5)	T=2.1; p=.049	T=0.4; p=.643	T=-0.8; p=.377
Overload	25.5 (±13.1)	22.4 (±12.2)	T=1.2; p=.247	28.9 (±15.5)		28.4 (±14.9)	T=0.2; p=.792	T=-0.7; p=.479	T=-1.1; p=.194

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E-mail: cadto@ufscar.br

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[1] Author´s Contributions

Ana Julia de Souza Caparrol was responsible for the conception and design of the project, data collection and analysis, and writing of the article. Gabriela Martins was responsible for writing the article, collecting and interpreting data. Gustavo Carrijo Barbosa was responsible for the critical review and writing of the article. Aline Cristina Martins Gratão was responsible for the critical review of the article and approval of the final version to be published. All authors approved the final version of the article.