Dementia is a disorder that affects a person’s ability to perform daily activities, and results in a broad range of psychological and health problems in both patients and their caregivers. Although the standard primary care setting is poorly equipped to effectively manage the complexities of progressive dementia, most older adults with dementia receive their care from primary care physicians.

In a study in the May 10, 2006 issue of the Journal of the American Medical Association , researchers tested the effects of a collaborative care program for Alzheimer’s disease (the most common form of dementia) in a primary care setting. They found that the program was associated with improvements in behavioral and psychological symptoms in dementia patients and decreased stress in their caregivers.

About the Study

In this study, 74 primary care physicians were randomly assigned to administer collaborative care or usual care to 153 patients with Alzheimer’s dementia (AD) and their caregivers.

The one-year collaborative care program was led by a nurse practitioner and primary care physician, who educated participants on communication, caregiver coping, legal and financial issues, and exercise guidelines. The nurse practitioner regularly evaluated study participants for problems with personal care, repetitive behavior, mobility, sleep, depression, agitation, delusions, hallucinations, and caregiver’s health. When identified, these problems were treated with protocols that stressed management without medications as the first approach.

Usual care involved providing the patients and caregivers with information about local resources, counseling, and any treatment deemed appropriate by the primary care physician.

Researchers interviewed participants before the study began, and at 6, 12, and 18 months to assess behavioral and psychological symptoms and quality of care.

Patients receiving collaborative care had fewer behavioral and psychological symptoms at 12 and 18 months. Caregivers also experienced significant improvements in stress related to the patients’ behavior at 12 months, but not at 18 months. Collaborative care was not associated with significant changes in the patients’ cognition, activities of daily living, or rates of nursing home placement. At 12 months, 83% of caregivers in the collaborative care group rated the patient’s care as good or excellent, compared with 56% of those in the usual care group.

This study is limited because the sample size fell short of the researchers’ goal of 225 participants. This may have limited the study’s power to detect smaller improvements associated with collaborative care.

How Does This Affect You?

These findings suggest that a collaborative care model in a primary care setting can significantly improve behavioral and psychological symptoms associated with dementia. Importantly, it appears to also relieve caregiver stress.

But will primary care practices soon adopt a collaborative care model for treating dementia? Probably not. More research is needed to determine the most efficient and practical way to implement this type of costly program in real-world primary care practices.

In the meantime, it is important for patients with dementia and their caregivers to realize that such a complex condition as AD cannot be effectively managed by a single primary care physician, no matter how skilled, dedicated, and conscientious he or she may be. Fortunately, there are numerous recourses (see below) available in most communities to help patients and families cope with the demanding behavioral, psychological, and medical implications of AD.