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Name of Intervention: Reducing Disability in Alzheimer’s Disease (RDAD)

Principal Investigator (s): Linda Teri, Ph.D.

Institutional Affiliation: University of Washington

Description of Intervention:

1. Summary of Intervention

The RDAD intervention was a caregiver education program that combined exercise training with teaching caregivers how to manage dementia-related behavior problems in persons with Alzheimer’s disease. The exercise component included 30 minutes of aerobic and endurance activities and strength, balance, and flexibility training for the person with Alzheimer’s disease. The behavioral management component included training for family caregivers about dementia, and how to identify and modify behavioral symptoms, modulate caregiver responses to the symptoms, and identify pleasant activities for the care recipient. Subjects were seen at home in twelve 1-hour sessions over an 11-week period and three follow-up sessions over the following three months. The program was delivered by home health professionals.

After 3 months, persons with dementia in the RDAD group were exercising more, had better physical function, and less depression than those in usual care control. At 2-year follow-up, people in the RDAD group still had better physical functioning and were less likely to have been placed in a nursing home because of behavioral disturbances than those in the control group.

Key search terms: Exercise, Alzheimer’s disease, dementia, caregivers, behavior management, depression, evidence-based treatments

2. Intervention Materials

A treatment manual was followed. Caregivers completed weekly exercise logs and received forms to assist in problem-solving dementia-related behavioral disturbances, and a copy of the Pleasant Events Schedule for Alzheimer’s disease (PES-AD; Logsdon & Teri, 1995). A copy of the treatment manual, including study handouts, is available from:

Linda Teri, Ph.D., School of Nursing, University of Washington, 9709 3^rd Ave NE, Suite 507, Seattle WA 98115-2053, lteri@u.washington.edu.

3. Implementing the Intervention

The published intervention was conducted by MS-level home health professionals. No current training program to implement the intervention is in place.

Estimated costs of implementing the intervention:

1. Delivery costs: The RDAD intervention is 12 sessions over 11 weeks; each session is one hour in length. It could be done in-home or in-facility. It is designed to be delivered by professionals (not lay leaders) with experience guiding and supervising exercise activities in older adults.

2. Costs of materials: Reproduction costs include the treatment manual with session-by-session outlines, descriptions of the exercise program, and all therapist and caregiver handouts (125 pages). Strengthening exercises in the intervention were conducted using ankle weights, which are readily available for under $20/set.

Caveats/ limitations on the implementation of this intervention:

a. Persons with dementia need to be living with a family caregiver or in a residential facility with caregiver staff that could guide and supervise the RDAD intervention.

b. The relative impact of the exercise and behavior management components is unknown, since only a combination RDAD program was evaluated.

4. For more information

Teri L, McCurry SM, Buchner D, Logsdon RG, et al. (1998) Exercise and Activity Level in Alzheimer’s Disease: a Potential Treatment Focus. Journal of Rehabilitation Research and Development, 35, 411-419.

Teri L, Gibbons LE, McCurry SM, Logsdon RG, et al. (2003) Exercise Plus Behavioral Management in Patients With Alzheimer’s Disease: A Randomized Trail. Journal of the American Medical Association, 290(15), 2015-2022.

Logsdon, R.G., McCurry, S.M., Teri, L. (2005) A home health care approach to exercise for persons with Alzheimer's disease. Care Management Journals, 6(2), 90-97.

Larson, E.B., Wang, L., Bowen, J.D., McCormick, W.C., Teri, L., Crane, P., Kukull, W. (2006) Exercise associated with reduced risk of incident dementia among people aged 65 years and older. Annals of Internal Medicine, 144(2), 73-81.