Dementia Early Stage Cognitive Aids New Trial (DESCANT) of memory aids and guidance for people with dementia : randomised controlled trial

Clarkson, Paul and Pitts, Rosa and Islam, Saiful and Peconi, Julie and Russell, Ian and Fegan, Greg and Beresford, Rebecca and Entwistle, Charlotte and Gillan, Vincent and Orrell, Martin and Challis, David and Chester, Helen and Hughes, Jane and Kapur, Narinder and Roe, Brenda and Malik, Baber and Robinson, Catherine A (2022) Dementia Early Stage Cognitive Aids New Trial (DESCANT) of memory aids and guidance for people with dementia : randomised controlled trial. Journal of Neurology, Neurosurgery and Psychiatry, 93 (9). pp. 1001-1009. ISSN 0022-3050

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Abstract

BACKGROUND Common memory aids for people with dementia at home are recommended. However, rigorous evaluation is lacking, particularly what guidance or support is valued. OBJECTIVE To investigate effects of memory aids and guidance by Dementia Support Practitioners (DSPs) for people in early stage dementia through a pragmatic, randomised controlled trial. METHODS Of 469 people with mild to moderate dementia and their informal carers, 468 were randomised to a DSP with memory aids or to usual care plus existing dementia guide. Allocation was stratified by: Trust/Health Board; time since first attendance at memory service; gender; age; and living with primary carer or not. Primary outcome was Bristol Activities of Daily Living Scale (BADLS) score at 3 and 6 months (primary end-point). Secondary outcomes for people with dementia: quality of life (CASP-19; DEMQOL); cognition and functioning (Clinical Dementia Rating Scale; SMMSE); capability (ICECAP-O); social networks (LSNS-R); and instrumental daily living activities (R-IDDD). Secondary outcomes for carers: psychological health (GHQ-12); sense of competence (SSCQ). RESULTS DSPs were successfully trained, compliance was good and welcomed by participants. Mean 6 months BADLS score increased to 14.6 (SD 10.4) in intervention and 12.6 (SD 8.1) in comparator, indicative of greater dependence in the activities of daily living. Adjusted between group difference was 0.38 (95% confidence interval -0.89 to 1.65, P=0.56). Though this suggests greater dependency in the intervention group the difference was not significant. No differences were found in secondary outcomes. CONCLUSIONS This intervention did not maintain independence in the activities of daily living with no improvement in other outcomes for people with dementia or carers.