Although subthalamic stimulation is a recognised treatment for motor complications in Parkinson&#... more Although subthalamic stimulation is a recognised treatment for motor complications in Parkinson's disease, reports on behavioural outcomes are controversial, which represents a major challenge when counselling candidates for subthalamic stimulation. We aimed to assess changes in behaviour in patients with Parkinson's disease receiving combined treatment with subthalamic stimulation and medical therapy over a 2-year follow-up period as compared with the behavioural evolution under medical therapy alone. We did a parallel, open-label study (EARLYSTIM) at 17 surgical centres in France (n=8) and Germany (n=9). We recruited patients with Parkinson's disease who were disabled by early motor complications. Participants were randomly allocated (1:1) to either medical therapy alone or bilateral subthalamic stimulation plus medical therapy. The primary outcome was mean change in quality of life from baseline to 2 years. A secondary analysis was also done to assess behavioural outc...
Introduction : Les therapies de type cognitivo-comportemental (TCC) en groupe sont devenues, ces ... more Introduction : Les therapies de type cognitivo-comportemental (TCC) en groupe sont devenues, ces dernieres annees, la prise en charge de reference en terme d'efficacite, rapport cout/benefice et faisabilite aupres des aidants de patients atteints de la maladie d'Alzheimer. Elles sont principalement basees sur la psycho-education et les techniques de resolution de problemes. Cependant, leur effet reste modere cliniquement. Losada et son equipe (2004, 2006) ont montre que les programmes incluant aussi des sessions d'exploration et de modification des pensees dysfonctionnelles des aidants par rapport aux soins ameliorent les effets des TCC, en reduisant de maniere plus efficace les niveaux de symptomatologie depressive. Methodologie : Le but de cette etude etait d'evaluer l'efficacite de deux types de prises en charge combinees conjoints-malades, comparees a un suivi neurologique classique et d'etudier leur impact sur les conjoints et les malades : 1) Prise en charge en groupe PRISMA (therapie cognitivo-comportementale pour les conjoints, centree sur les pensees dysfonctionnelles par rapport aux soins, et stimulation cognitive pour les malades 2) Prise en charge en group ETNA (therapie par psycho-education des conjoints et stimulation cognitive pour les malades) comparees a 3) un suivi neurologique du malade, sans prise en charge des proches. Un objectif secondaire consistait a explorer les differences en fonction du type de relation : conjoint ou enfant et le malade. L'etude a porte sur 50 patients, 50 conjoints et 10 enfants. L'evaluation des conjoints et des malades a ete effectuee a l'inclusion ainsi qu'a M6 et a M12. Resultats : Les resultats de notre etude montrent qu'une prise en charge de type cognitivo-comportemental des conjoints, centree sur les pensees dysfonctionnelles par rapport aux soins, associee a une therapie par stimulation cognitive pour les patients, a le plus d'effets positifs sur l'etat psychologique tant bien des conjoints que sur celui des malades. Le benefice le plus important pour les conjoints concerne la diminution significative de la depression. La symptomatologie depressive et anxieuse des patients est egalement amelioree. Par ailleurs, on constate plus de fardeau et de stress percu chez les conjoints, compares aux enfants. II en est de meme en ce qui concerne les pensees dysfonctionnelles par rapport aux soins procures, significativement plus importantes chez les conjoints. Conclusion : Cette etude montre I'interet d'une prise en charge combinee conjoint/malade (avec une therapie cognitivo-comportementale, centree sur les pensees dysfonctionnelles chez les conjoints, associee a une therapie par stimulation cognitive), peu couteuse (car seulement a une intervention en groupe toutes les six semaines) pour ameliorer l'etat psychologique de ces derniers.
Over the last decade, several programs have been developed for caregivers of Alzheimer disease pa... more Over the last decade, several programs have been developed for caregivers of Alzheimer disease patients. In France however, studies exploring their effects are still scarce. We conducted a study to compare two different interventions: a structured multidisciplinary program versus a classical intervention designed for Alzheimer disease patients and their spouses. Sixteen couples (Alzheimer's disease patient and spouse) residing in our administrative district participated in this monocentric study. For at least two years, these couples participated in a multidisciplinary program (n=8 couples) or received usual care (n=8 couples). The multidisciplinary program involved biannual consultations with a neurologist, a neuropsychologist and a psychologist, in addition to an annual meeting, stratified on the patient's MMSE score, for spouses). Usual care involved biannual consultations with the neurologist. The multidisciplinary program included a psychological intervention based on c...
Over the last decade, several programs have been developed for caregivers of Alzheimer disease pa... more Over the last decade, several programs have been developed for caregivers of Alzheimer disease patients. In France however, studies exploring their effects are still scarce. We conducted a study to compare two different interventions: a structured multidisciplinary program versus a classical intervention designed for Alzheimer disease patients and their spouses. Sixteen couples (Alzheimer's disease patient and spouse) residing in our administrative district participated in this monocentric study. For at least two years, these couples participated in a multidisciplinary program (n=8 couples) or received usual care (n=8 couples). The multidisciplinary program involved biannual consultations with a neurologist, a neuropsychologist and a psychologist, in addition to an annual meeting, stratified on the patient's MMSE score, for spouses). Usual care involved biannual consultations with the neurologist. The multidisciplinary program included a psychological intervention based on cognitive behavioral theories and centered on psycho-education, problem solving, adaptation strategies and on prevention of depression and anxiety. The spouses and the patients evaluated the 2-year follow-up during clinical interviews, completed by questionnaires. Sociodemographic data were noted for the patients and their spouses. Levels of depression and anxiety (Mini International Neuropsychiatric Inventory, Montgomery and Asberg Depression Scale, State-Trait Anxiety Inventory), perceived stress (Perceived Stress Scale) and care burden (Zarit Burden Inventory) were evaluated in spouses. Levels of cognitive impairment (Mini Mental State Examination), autonomy (Instrumental Activities of Daily Living), psychological state (Montgomery and Asberg Depression Scale, Covi Anxiety Scale), and behavioral symptoms frequency (Neuropsychiatric Inventory) were assessed in patients. The main significant result showed that the spouses' state of anxiety was lower among participants in the multidisciplinary program, compared with the classical neurological intervention. It also was found that the spouses and the patients who participated in this multidisciplinary program were less depressed. This study shows that a multidisciplinary structured intervention, with only two annual consultations and one annual meeting for spouses, can contribute to decrease significantly the spouses' state of anxiety. Further studies including a larger number of subjects should be conducted to confirm these findings.
Although subthalamic stimulation is a recognised treatment for motor complications in Parkinson&#... more Although subthalamic stimulation is a recognised treatment for motor complications in Parkinson's disease, reports on behavioural outcomes are controversial, which represents a major challenge when counselling candidates for subthalamic stimulation. We aimed to assess changes in behaviour in patients with Parkinson's disease receiving combined treatment with subthalamic stimulation and medical therapy over a 2-year follow-up period as compared with the behavioural evolution under medical therapy alone. We did a parallel, open-label study (EARLYSTIM) at 17 surgical centres in France (n=8) and Germany (n=9). We recruited patients with Parkinson's disease who were disabled by early motor complications. Participants were randomly allocated (1:1) to either medical therapy alone or bilateral subthalamic stimulation plus medical therapy. The primary outcome was mean change in quality of life from baseline to 2 years. A secondary analysis was also done to assess behavioural outc...
Introduction : Les therapies de type cognitivo-comportemental (TCC) en groupe sont devenues, ces ... more Introduction : Les therapies de type cognitivo-comportemental (TCC) en groupe sont devenues, ces dernieres annees, la prise en charge de reference en terme d'efficacite, rapport cout/benefice et faisabilite aupres des aidants de patients atteints de la maladie d'Alzheimer. Elles sont principalement basees sur la psycho-education et les techniques de resolution de problemes. Cependant, leur effet reste modere cliniquement. Losada et son equipe (2004, 2006) ont montre que les programmes incluant aussi des sessions d'exploration et de modification des pensees dysfonctionnelles des aidants par rapport aux soins ameliorent les effets des TCC, en reduisant de maniere plus efficace les niveaux de symptomatologie depressive. Methodologie : Le but de cette etude etait d'evaluer l'efficacite de deux types de prises en charge combinees conjoints-malades, comparees a un suivi neurologique classique et d'etudier leur impact sur les conjoints et les malades : 1) Prise en charge en groupe PRISMA (therapie cognitivo-comportementale pour les conjoints, centree sur les pensees dysfonctionnelles par rapport aux soins, et stimulation cognitive pour les malades 2) Prise en charge en group ETNA (therapie par psycho-education des conjoints et stimulation cognitive pour les malades) comparees a 3) un suivi neurologique du malade, sans prise en charge des proches. Un objectif secondaire consistait a explorer les differences en fonction du type de relation : conjoint ou enfant et le malade. L'etude a porte sur 50 patients, 50 conjoints et 10 enfants. L'evaluation des conjoints et des malades a ete effectuee a l'inclusion ainsi qu'a M6 et a M12. Resultats : Les resultats de notre etude montrent qu'une prise en charge de type cognitivo-comportemental des conjoints, centree sur les pensees dysfonctionnelles par rapport aux soins, associee a une therapie par stimulation cognitive pour les patients, a le plus d'effets positifs sur l'etat psychologique tant bien des conjoints que sur celui des malades. Le benefice le plus important pour les conjoints concerne la diminution significative de la depression. La symptomatologie depressive et anxieuse des patients est egalement amelioree. Par ailleurs, on constate plus de fardeau et de stress percu chez les conjoints, compares aux enfants. II en est de meme en ce qui concerne les pensees dysfonctionnelles par rapport aux soins procures, significativement plus importantes chez les conjoints. Conclusion : Cette etude montre I'interet d'une prise en charge combinee conjoint/malade (avec une therapie cognitivo-comportementale, centree sur les pensees dysfonctionnelles chez les conjoints, associee a une therapie par stimulation cognitive), peu couteuse (car seulement a une intervention en groupe toutes les six semaines) pour ameliorer l'etat psychologique de ces derniers.
Over the last decade, several programs have been developed for caregivers of Alzheimer disease pa... more Over the last decade, several programs have been developed for caregivers of Alzheimer disease patients. In France however, studies exploring their effects are still scarce. We conducted a study to compare two different interventions: a structured multidisciplinary program versus a classical intervention designed for Alzheimer disease patients and their spouses. Sixteen couples (Alzheimer's disease patient and spouse) residing in our administrative district participated in this monocentric study. For at least two years, these couples participated in a multidisciplinary program (n=8 couples) or received usual care (n=8 couples). The multidisciplinary program involved biannual consultations with a neurologist, a neuropsychologist and a psychologist, in addition to an annual meeting, stratified on the patient's MMSE score, for spouses). Usual care involved biannual consultations with the neurologist. The multidisciplinary program included a psychological intervention based on c...
Over the last decade, several programs have been developed for caregivers of Alzheimer disease pa... more Over the last decade, several programs have been developed for caregivers of Alzheimer disease patients. In France however, studies exploring their effects are still scarce. We conducted a study to compare two different interventions: a structured multidisciplinary program versus a classical intervention designed for Alzheimer disease patients and their spouses. Sixteen couples (Alzheimer's disease patient and spouse) residing in our administrative district participated in this monocentric study. For at least two years, these couples participated in a multidisciplinary program (n=8 couples) or received usual care (n=8 couples). The multidisciplinary program involved biannual consultations with a neurologist, a neuropsychologist and a psychologist, in addition to an annual meeting, stratified on the patient's MMSE score, for spouses). Usual care involved biannual consultations with the neurologist. The multidisciplinary program included a psychological intervention based on cognitive behavioral theories and centered on psycho-education, problem solving, adaptation strategies and on prevention of depression and anxiety. The spouses and the patients evaluated the 2-year follow-up during clinical interviews, completed by questionnaires. Sociodemographic data were noted for the patients and their spouses. Levels of depression and anxiety (Mini International Neuropsychiatric Inventory, Montgomery and Asberg Depression Scale, State-Trait Anxiety Inventory), perceived stress (Perceived Stress Scale) and care burden (Zarit Burden Inventory) were evaluated in spouses. Levels of cognitive impairment (Mini Mental State Examination), autonomy (Instrumental Activities of Daily Living), psychological state (Montgomery and Asberg Depression Scale, Covi Anxiety Scale), and behavioral symptoms frequency (Neuropsychiatric Inventory) were assessed in patients. The main significant result showed that the spouses' state of anxiety was lower among participants in the multidisciplinary program, compared with the classical neurological intervention. It also was found that the spouses and the patients who participated in this multidisciplinary program were less depressed. This study shows that a multidisciplinary structured intervention, with only two annual consultations and one annual meeting for spouses, can contribute to decrease significantly the spouses' state of anxiety. Further studies including a larger number of subjects should be conducted to confirm these findings.
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