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Brief psychosocial therapy for the treatment of agitation in Alzheimer disease (the CALM-AD trial)

Brief psychosocial therapy for the treatment of agitation in Alzheimer disease (the CALM-AD trial)
Brief psychosocial therapy for the treatment of agitation in Alzheimer disease (the CALM-AD trial)
Background: good practice guidelines state that a psychological intervention should usually precede pharmacotherapy, but there are no data evaluating the feasibility of psychological interventions used in this way.

Methods: at the first stage of a randomized blinded placebo-controlled trial, 318 patients with Alzheimer disease (AD) with clinically significant agitated behavior were treated in an open design with a psychological intervention (brief psychosocial therapy [BPST]) for 4 weeks, preceding randomization to pharmacotherapy. The therapy involved social interaction, personalized music, or removal of environmental triggers.

Results: overall, 318 patients with AD completed BPST with an improvement of 5.6 points on the total Cohen-Mansfield Agitation Inventory (CMAI; mean [SD], 63.3 [16.0] to 57.7 [18.4], t = 4.8, df = 317, p < 0.0001). Therapy worksheets were completed in six of the eight centers, with the key elements of the intervention delivered according to the manual for >95% of patients. More detailed evaluation of outcome was completed for the 198 patients with AD from these centers, who experienced a mean improvement of 6.6 points on the total CMAI (mean [SD], 62.2 [14.3] to 55.6 [15.8], t = 6.5, df = 197, p < 0.0001). Overall, 43% of participants achieved a 30% improvement in their level of agitation.

Conclusion: the specific attributable benefits of BPST cannot be determined from an open trial. However, the BPST therapy was feasible and was successfully delivered according to an operationalized manual. The encouraging outcome indicates the need for a randomized controlled trial of BPST.
726-33
Ballard, Clive
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Brown, Richard
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Fossey, Jane
387ebf5d-3dc3-4bbf-acba-5db27d275265
Douglas, Simon
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Bradley, Paul
a8542d07-8d99-4839-ab06-b04a404f740d
Hancock, Judith
a3be20be-21e7-48a1-a916-7e327be251bf
James, Ian A
449d56a6-79f3-4b66-914d-d2c5cb0043a7
Juszczak, Edmund
9267758e-8ab8-44c7-ab14-48ef82fa6b6e
Bentham, Peter
3c600094-9382-46a2-9ade-ac945e1a637d
Burns, Alistair
3b42ceb2-cc8b-4159-807b-fe1bc095f723
Lindesay, James
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Jacoby, Robin
c67a2b99-e910-4a33-ad26-624bf3a16284
O'Brien, John
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Bullock, Roger
60e07513-ab0c-4b75-b6b1-633af699ead0
Johnson, Tony
e609b445-afbf-4cd1-b4e3-4432d711553b
Holmes, Clive
ada5abf3-8459-4cf7-be40-3f4e9391cc96
Howard, Robert
d77c3b3a-24ae-4d2b-bd73-1dfd87544357
Ballard, Clive
e244c4e5-5dd4-4c66-9efb-6bf2006bdb7e
Brown, Richard
906b3b6e-a64a-4fab-8dae-6f5459bc3770
Fossey, Jane
387ebf5d-3dc3-4bbf-acba-5db27d275265
Douglas, Simon
f4173866-822e-4ed8-8298-7c79c3ab9d99
Bradley, Paul
a8542d07-8d99-4839-ab06-b04a404f740d
Hancock, Judith
a3be20be-21e7-48a1-a916-7e327be251bf
James, Ian A
449d56a6-79f3-4b66-914d-d2c5cb0043a7
Juszczak, Edmund
9267758e-8ab8-44c7-ab14-48ef82fa6b6e
Bentham, Peter
3c600094-9382-46a2-9ade-ac945e1a637d
Burns, Alistair
3b42ceb2-cc8b-4159-807b-fe1bc095f723
Lindesay, James
4b6a8efb-00c8-43df-81f8-076829e6ea35
Jacoby, Robin
c67a2b99-e910-4a33-ad26-624bf3a16284
O'Brien, John
0906821d-4431-47e6-8155-27de5d7f9612
Bullock, Roger
60e07513-ab0c-4b75-b6b1-633af699ead0
Johnson, Tony
e609b445-afbf-4cd1-b4e3-4432d711553b
Holmes, Clive
ada5abf3-8459-4cf7-be40-3f4e9391cc96
Howard, Robert
d77c3b3a-24ae-4d2b-bd73-1dfd87544357

Ballard, Clive, Brown, Richard, Fossey, Jane, Douglas, Simon, Bradley, Paul, Hancock, Judith, James, Ian A, Juszczak, Edmund, Bentham, Peter, Burns, Alistair, Lindesay, James, Jacoby, Robin, O'Brien, John, Bullock, Roger, Johnson, Tony, Holmes, Clive and Howard, Robert (2009) Brief psychosocial therapy for the treatment of agitation in Alzheimer disease (the CALM-AD trial). American Journal of Geriatric Psychiatry, 17 (9), 726-33. (doi:10.1097/JGP.0b013e3181b0f8c0). (PMID:19700946)

Record type: Article

Abstract

Background: good practice guidelines state that a psychological intervention should usually precede pharmacotherapy, but there are no data evaluating the feasibility of psychological interventions used in this way.

Methods: at the first stage of a randomized blinded placebo-controlled trial, 318 patients with Alzheimer disease (AD) with clinically significant agitated behavior were treated in an open design with a psychological intervention (brief psychosocial therapy [BPST]) for 4 weeks, preceding randomization to pharmacotherapy. The therapy involved social interaction, personalized music, or removal of environmental triggers.

Results: overall, 318 patients with AD completed BPST with an improvement of 5.6 points on the total Cohen-Mansfield Agitation Inventory (CMAI; mean [SD], 63.3 [16.0] to 57.7 [18.4], t = 4.8, df = 317, p < 0.0001). Therapy worksheets were completed in six of the eight centers, with the key elements of the intervention delivered according to the manual for >95% of patients. More detailed evaluation of outcome was completed for the 198 patients with AD from these centers, who experienced a mean improvement of 6.6 points on the total CMAI (mean [SD], 62.2 [14.3] to 55.6 [15.8], t = 6.5, df = 197, p < 0.0001). Overall, 43% of participants achieved a 30% improvement in their level of agitation.

Conclusion: the specific attributable benefits of BPST cannot be determined from an open trial. However, the BPST therapy was feasible and was successfully delivered according to an operationalized manual. The encouraging outcome indicates the need for a randomized controlled trial of BPST.

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Published date: September 2009

Identifiers

Local EPrints ID: 152271
URI: https://eprints.soton.ac.uk/id/eprint/152271
PURE UUID: 71592d79-881a-4b84-9f72-c1905dd9e758
ORCID for Clive Holmes: ORCID iD orcid.org/0000-0003-1999-6912

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Date deposited: 14 May 2010 09:03
Last modified: 05 Nov 2019 01:56

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Contributors

Author: Clive Ballard
Author: Richard Brown
Author: Jane Fossey
Author: Simon Douglas
Author: Paul Bradley
Author: Judith Hancock
Author: Ian A James
Author: Edmund Juszczak
Author: Peter Bentham
Author: Alistair Burns
Author: James Lindesay
Author: Robin Jacoby
Author: John O'Brien
Author: Roger Bullock
Author: Tony Johnson
Author: Clive Holmes ORCID iD
Author: Robert Howard

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