Interdisciplinary Therapy for patients with dementia

Cera, Maysa Luchesi; Abreu, Daniela Cristina Carvalho de; Tamanini, Rosângela de Abreu Venancio; Arnaut, Amanda Carla; Mandrá, Patrícia Pupin; Santana, Carla da Silva

doi:10.1590/S1980-57642014DN83000013

Abstracts

Patients with dementia require rehabilitation involving several health professionals, where interdisciplinary care can further enhance the routine of patients and their families.

OBJECTIVE:

To compare the functional performance of elderly with dementia before and after an interdisciplinary intervention program provided by a healthcare service of medium complexity.

METHODS:

Three cases with clinically-confirmed dementia enrolled on an interdisciplinary rehabilitation program were reported. The following instruments were applied: Mini Mental-State Exam, Clinical Dementia Rating, Geriatric Depression Scale, Lawton & Brody Index, and the Functional Independence Measure for adults (FIM). The therapeutic strategies were individualized and designed based on patient performance on the FIM, according to the criteria of the Classification of Functionality, Disability and Health, implemented at the house of therapy of the Center for Integrated Rehabilitation together with provision of guidance.

RESULTS:

A reduction in functional dependence was observed after intervention, evidenced by less supervision needed to carry out Activities of Daily Living. Conclusion: The three patients benefited from the interdisciplinary intervention.

dementia; patient care team; interdisciplinary communication; therapy

Pacientes com demência necessitam de reabilitação com vários profissionais da saúde e a atenção interdisciplinar pode favorecer ainda mais a rotina do paciente e sua família.

OBJETIVO:

Comparar o desempenho funcional de idosos com demência antes e após um programa de estimulação interdisciplinar de um serviço de atenção à saúde de média complexidade.

MÉTODOS:

Relato de três casos com diagnóstico médico de demência usuários de um programa de reabilitação interdisciplinar. Foram aplicados os instrumentos: Mini Exame do Estado Mental, Clinical Dementia Rating,Geriatric Depression Scale, Índice de Lawton & Brody e Medida de Independência Funcional para adultos (MIF). As estratégias terapêuticas foram individualizadas, delineadas a partir do desempenho na MIF, com base, nos domínios da Classificação Internacional de Funcionalidade, Incapacidade e Saúde, exercidas em uma casa terapêutica e associadas a orientações.

RESULTADOS:

Após a intervenção, houve redução da dependência funcional, que evidencia diminuição da supervisão necessária para a realização das Atividades de Vida Diária.

CONCLUSÃO:

Os três pacientes se beneficiaram da intervenção interdisciplinar.

demência; equipe de assistência ao paciente; comunicação interdisciplinar; terapia

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References

¹
Ferri CP, Prince M, Brayne C, et al. Global prevalence of dementia: a Delphi consensus study. Lancet Neurol 2005;366:2112-2117.
²
Brunnström H, Gustafson L, Passant U, et al. Prevalence of dementia subtypes: a 30-year retrospective survey of neuropathological reports. Arch Gerontol Geriatr 2009;49:146-149.
³
Herrup K, Carrillo MC, Schenk D, et al. Beyond amyloid: getting real about nonamyloid targets in Alzheimer's disease. Alzheimers Dement 2013;9:452-458.
⁴
Birks J, Havey RJ. Donepezil for dementia due to Alzheimer's disease. Cochrane Database Syst Rev 2006;1.CD001190.
⁵
Birks J, Evans G, Iakovidov V, et al. Rivastigmine for Alzheimer's disease. Cochrane Database Syst Rev 2009;2.CD001191.
⁶
Loy C, Schneider L. Galantamine for Alzheimer's disease and mild cognitive impairment. Cochrane Database Syst Rev 2009; CD001747.
⁷
McShane R, Sastre AA, Minakaran N. Memantine for dementia. Cochrane Database Syst Rev 2006;19(2)CD003154.
⁸
Lang PO, Vogt-Ferrier N, Hasso Y, et al. Interdisciplinary geriatric and psychiatric care reduces potentially inappropriate prescribing in the hospital: interventional study in 150 acutely II elderly patients with mental and somatic comorbid. J Am Med Dir Assoc 2012;13:406. e1-406.e7.
⁹
Trojanowski JQ, Arnold SE, Karlawish JH, et al., A model for improving the treatment and care of Alzheimer's disease patients through interdisciplinary research. Alzheimer Dement 2012;8:564-573.
¹⁰
Eleni T, Dimitris, E. Implications of a longitudinal cognitive intervention program in mild Alzheimer's disease. Arch Psychiatr Nurs . In Press. doi: 10.1016/j.apnu.2013.12.004.
» https://doi.org/10.1016/j.apnu.2013.12.004
¹¹
Andrade LP, Gobbi LT, Coelho FG, et al. Benefits of multimodal exercise intervention for postural control and frontal cognitive functions in individuals with Alzheimer's disease: a controlled trial. Am Geriatri Soc 2013;61:1919-1926.
¹²
Pedroso RV, Coelho FG, Santos-Galduróz RF, et al. Balance, executive functions and falls in elderly with Alzheimer's disease (AD): a longitudinal study. Arch Gerontol Geriatr 2012;54:348-351.
¹³
Frota NAF, Nitrini R, Damasceno BP, et al. Critérios para o diagnóstico de doença de Alzheimer. Dement Neuropsychol 2011;5:5-10.
¹⁴
Folstein MF, Folstein ME, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
¹⁵
Brucki SMD, Nitrini R, Caramelli P, et al. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.
¹⁶
Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414.
¹⁷
Montaño MBM, Ramos LR. Validade da Versão em português da Clinical Dementia Rating. Rev Saude Publica 2005;39:912-917.
¹⁸
Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1983;17:37-49.
¹⁹
Lawton MP, Brody EM. Assessment of older people: selfmaintaining and instrumental activities of daily living. Gerontologist 1969;9:179-186.
²⁰
Riberto M, Miyazaki MH, Jucá SSH, et al. Validação da versão brasileira da Medida de Independência Funcional. Acta Fisiatr 2004;11:72-76.
²¹
CIF: Classificação Internacional de Funcionalidade, Incapacidade e Saúde / [Centro Colaborador da Organização Mundial da Saúde para a Família de Classificações Internacionais, org.; coordenação da tradução Cassia Maria Buchalla]. São Paulo: Editora da Universidade de São Paulo; 2003. p. 328p.
²²
Bourgeois MS, Camp C, Rose M, et al. A comparison of training strategies to enhance use of external aids by persons with dementia. J Commun Disord 2003;36:361-378.
²³
Ortiz KZ, Lira JO. Plano terapêutico fonoaudiológico para Demência: Intervenção em Aspectos Cognitivos. In: Pró-Fono (Eds), Planos Terapêuticos Fonoaudiológicos. Barueri/SP: Pró-Fono, 2012: 273-278.
²⁴
Machado F, Nunes PV, Viola LF, et al., Quality of life and Alzheimer's disease: the influence of partipation in a rehabilitation Center. Dementia Neuropsychologia 2009;3:241.
²⁵
Abrisqueta-Gomez J, Canali F, Vieira VLD et al. A longitudinal study of a neuropsychological rehabilitation program in Alzheimer's disease. Arq Neuropsiquiatr 2004;62:778-783.
²⁶
Viola LF, Nunes PV, Yassuda MS, et al. Effects of a multidisiplinar cognitive rehabilitation program for patients with mild Alzheimer's disease. Clinics 2011;66:1395-1400.
²⁷
Crooks EA, Geldmacher DS. Interdisciplinary approaches to Alzheimer's disease management. Clin Geriatr Med 2004;20:121-139.

Publication Dates

Publication in this collection
Sept 2014

History

Received
13 May 2014
Accepted
17 July 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

[1] ¹
Ferri CP, Prince M, Brayne C, et al. Global prevalence of dementia: a Delphi consensus study. Lancet Neurol 2005;366:2112-2117.

[2] ²
Brunnström H, Gustafson L, Passant U, et al. Prevalence of dementia subtypes: a 30-year retrospective survey of neuropathological reports. Arch Gerontol Geriatr 2009;49:146-149.

[3] ³
Herrup K, Carrillo MC, Schenk D, et al. Beyond amyloid: getting real about nonamyloid targets in Alzheimer's disease. Alzheimers Dement 2013;9:452-458.

[4] ⁴
Birks J, Havey RJ. Donepezil for dementia due to Alzheimer's disease. Cochrane Database Syst Rev 2006;1.CD001190.

[5] ⁵
Birks J, Evans G, Iakovidov V, et al. Rivastigmine for Alzheimer's disease. Cochrane Database Syst Rev 2009;2.CD001191.

[6] ⁶
Loy C, Schneider L. Galantamine for Alzheimer's disease and mild cognitive impairment. Cochrane Database Syst Rev 2009; CD001747.

[7] ⁷
McShane R, Sastre AA, Minakaran N. Memantine for dementia. Cochrane Database Syst Rev 2006;19(2)CD003154.

[8] ⁸
Lang PO, Vogt-Ferrier N, Hasso Y, et al. Interdisciplinary geriatric and psychiatric care reduces potentially inappropriate prescribing in the hospital: interventional study in 150 acutely II elderly patients with mental and somatic comorbid. J Am Med Dir Assoc 2012;13:406. e1-406.e7.

[9] ⁹
Trojanowski JQ, Arnold SE, Karlawish JH, et al., A model for improving the treatment and care of Alzheimer's disease patients through interdisciplinary research. Alzheimer Dement 2012;8:564-573.

[10] ¹⁰
Eleni T, Dimitris, E. Implications of a longitudinal cognitive intervention program in mild Alzheimer's disease. Arch Psychiatr Nurs . In Press. doi: 10.1016/j.apnu.2013.12.004.
» https://doi.org/10.1016/j.apnu.2013.12.004

[11] ¹¹
Andrade LP, Gobbi LT, Coelho FG, et al. Benefits of multimodal exercise intervention for postural control and frontal cognitive functions in individuals with Alzheimer's disease: a controlled trial. Am Geriatri Soc 2013;61:1919-1926.

[12] ¹²
Pedroso RV, Coelho FG, Santos-Galduróz RF, et al. Balance, executive functions and falls in elderly with Alzheimer's disease (AD): a longitudinal study. Arch Gerontol Geriatr 2012;54:348-351.

[13] ¹³
Frota NAF, Nitrini R, Damasceno BP, et al. Critérios para o diagnóstico de doença de Alzheimer. Dement Neuropsychol 2011;5:5-10.

[14] ¹⁴
Folstein MF, Folstein ME, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.

[15] ¹⁵
Brucki SMD, Nitrini R, Caramelli P, et al. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.

[16] ¹⁶
Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414.

[17] ¹⁷
Montaño MBM, Ramos LR. Validade da Versão em português da Clinical Dementia Rating. Rev Saude Publica 2005;39:912-917.

[18] ¹⁸
Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1983;17:37-49.

[19] ¹⁹
Lawton MP, Brody EM. Assessment of older people: selfmaintaining and instrumental activities of daily living. Gerontologist 1969;9:179-186.

[20] ²⁰
Riberto M, Miyazaki MH, Jucá SSH, et al. Validação da versão brasileira da Medida de Independência Funcional. Acta Fisiatr 2004;11:72-76.

[21] ²¹
CIF: Classificação Internacional de Funcionalidade, Incapacidade e Saúde / [Centro Colaborador da Organização Mundial da Saúde para a Família de Classificações Internacionais, org.; coordenação da tradução Cassia Maria Buchalla]. São Paulo: Editora da Universidade de São Paulo; 2003. p. 328p.

[22] ²²
Bourgeois MS, Camp C, Rose M, et al. A comparison of training strategies to enhance use of external aids by persons with dementia. J Commun Disord 2003;36:361-378.

[23] ²³
Ortiz KZ, Lira JO. Plano terapêutico fonoaudiológico para Demência: Intervenção em Aspectos Cognitivos. In: Pró-Fono (Eds), Planos Terapêuticos Fonoaudiológicos. Barueri/SP: Pró-Fono, 2012: 273-278.

[24] ²⁴
Machado F, Nunes PV, Viola LF, et al., Quality of life and Alzheimer's disease: the influence of partipation in a rehabilitation Center. Dementia Neuropsychologia 2009;3:241.

[25] ²⁵
Abrisqueta-Gomez J, Canali F, Vieira VLD et al. A longitudinal study of a neuropsychological rehabilitation program in Alzheimer's disease. Arq Neuropsiquiatr 2004;62:778-783.

[26] ²⁶
Viola LF, Nunes PV, Yassuda MS, et al. Effects of a multidisiplinar cognitive rehabilitation program for patients with mild Alzheimer's disease. Clinics 2011;66:1395-1400.

[27] ²⁷
Crooks EA, Geldmacher DS. Interdisciplinary approaches to Alzheimer's disease management. Clin Geriatr Med 2004;20:121-139.

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