- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03300180
Caregiver Outcomes of Alzheimer's Disease Screening (COADS)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
We are proposing the first randomized controlled trial (RCT) to evaluate the benefits and harms of AD screening on family members of older adults. The proposed trial will randomize 1,800 dyads (older adult and family member) into three groups. Older adults in the first group will be screened for AD at baseline coupled with disclosure of the screening results to the dyad and to the patient's primary care provider (Screening Only Group). Older adults in the second group will be screened for AD at baseline coupled with disclosure of the screening results and, if they screen positive, referred to the Aging Brain Care (ABC) Program for diagnostic evaluation and care, if AD is diagnosed (Screening Plus Group). Older adults in the third group will not be screened at baseline and will observed through surveillance of the patients' EHR for any screening or incident AD diagnoses that occurs as part of routine care. At the last follow-up assessment (24 months) we will we will screen the older adults and conduct an interview with the family caregiver to detect possible cognitive impairment (Control Group).
Specific Aim 1: Evaluate the impact of AD screening on family members' quality of life.
Hypothesis 1: In comparison to the control group, family members randomized to the screening only or the screening plus groups will express higher levels of health-related quality of life at 24 months as measured by the Short Form Health Survey (SF-36).
Specific Aim 2: Evaluate the impact of AD screening on family members' mood and anxiety.
Hypothesis 2: In comparison to the control group, family members randomized to the screening only or the screening plus groups will express lower rates of depressive and anxiety symptoms at 24 months as measured by the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7).
Specific Aim 3: Assess the impact of AD screening on family members' caregiving preparedness and caregiving self-efficacy.
Hypothesis 3: In comparison to the control group, family members randomized to the screening only or the screening plus group, will be more prepared for caregiving and have higher self-efficacy at 24 months as measured by the Preparedness for Caregiving Scale and the Revised Scale for Caregiving Self-Efficacy.
Specific Aim 4: Compare the effectiveness of two strategies for diagnostic evaluation and management after AD screening.
Hypothesis 4: In comparison to the screening only group, family members randomized to the screening plus group will express higher levels of health-related quality of life, caregiver preparedness and caregiving self-efficacy and lower levels of depressive and anxiety symptoms at 24 months, as measured by the SF-36, Preparedness for Caregiving Scale, the Revised Scale for Caregiving Self-Efficacy, PHQ-9, and GAD-7, respectively.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Indiana
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Indianapolis, Indiana, United States, 46202
- Eskenazi Hospital
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Indianapolis, Indiana, United States, 46202
- IU Health-Primary Care Clinics
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Patients
- 65 years or older
- At least one visit to primary care practice within past 24 months
- Ability to provide informed consent
- Ability to communicate in English
Family Members
- 21 years or older
- Identified by the patient as the person most likely to provide them care if needed.*
- Lives with the patient or lives within a 50 mile radius.
- Ability to provide informed consent.
- Ability to communicate in English
Exclusion Criteria:
Patients
- Has a diagnosis of AD as determined by ICD-10 code.
- Evidence of a prescription for a cholinesterase inhibitors or memantine.
- Has serious mental illness such as bipolar or schizophrenia as determined by ICD-10 code
- Permanent resident of a nursing facility
- Already seen by the Healthy Aging Brain Care Program
Family Member
- Is a non-family member who is not a legal Healthcare Power of Attorney
- Has serious mental illness such as bipolar or schizophrenia as determined by ICD-10 code
- Has a diagnosis of AD as determined by ICD-10 code.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Screening
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Control
The patients in this group will receive no AD screening
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Active Comparator: Screening Only
The patients in this group will receive screening for AD.
Patients and family members will receive a letter about how the patient performed on the screening.
If they screen positive (e.g.
≤5 on the MIS-T or ≤2 on the Mini-Cog), the patient and family member will receive an infographic and some information about local clinical resources for them to peruse regarding follow-up care.
The patient's PCP is also be notified of the screening results via EHR message.
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The patients in this group will receive screening for AD coupled with letters sent to the dyads and the primary care PCP informing them of the results of the screening
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Experimental: Collaborative Dementia Care Program
The patients in this group will receive screening for AD, Patients and family members will receive a letter about how the patient performed on the screening.
If they screen positive (e.g.
≤5 on the MIS-T or ≤2 on the Mini-Cog), the patient and family member will receive an infographic.
Also, the family member will receive two follow-up phone calls.
One from the COADS Study Coordinator and one from a care coordinator at the Aging Brain Care Program (ABC).
This phone call will include an opportunity for the family to ask questions and a conversation about the program and diagnostic evaluation and management.
Dyads have the option to refuse the follow-up visit.
The patient's PCP is also be notified of the screening results via EHR message,
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Much of the intervention, facilitated by care coordinator, is targeted to co-manage or support the practice behavior of primary care clinicians, enhance self-management skills of both the care-recipient and the informal caregiver, and maximize the coping behavior of the patient and the informal caregiver.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Short Form Health Survey (SF-36)
Time Frame: 24 month
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Multi-level mixed effects models will be used to examine differences in SF-36 scores for both patients and family members using dyadic analytic approaches.
For this aim, we will compare family members in the two screening groups (Screening Only and Screening Plus) to those in the no screening (Control) group.
Repeated SF-36 scores from both patients and family members will be included as the outcome variables with participant type (patient or family member), group (Screening Only and Screening Plus versus Control), time, and interaction between groups and time as independent variables.
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24 month
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Depressive symptoms
Time Frame: 24 month
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The investigators will use the Patient Health Questionnaire-9 (PHQ-9) to determine the impact of AD screening on caregivers and patients mood.
The PHQ-9 is a nine-item depression scale with a total score from 0 to 27.
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24 month
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Anxiety symptoms
Time Frame: 24 month
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The investigators will use the Generalized Anxiety Disorder Scale (GAD-7) to determine the impact of AD screening on caregivers and patients anxiety.
The GAD-7 is a seven-item anxiety scale with a total score from 0 to 21.
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24 month
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Caregiving preparedness
Time Frame: 24 month
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The investigators will use the Preparedness for Caregiving Scale to measure the impact of ADRC screening on family member preparedness.
The Preparedness for Caregiving Scale consists of eight items that asks family members how well prepared they believe they are for multiple domains of caregiving.
Responses are rated on a 5-point scale with scores ranging from 0 (not at all prepared) to 4 (very well prepared).
The scale is scored by calculating the mean of all items answered with a score range of 0 to 4. The higher the score the more prepared the caregiver feels for caregiving; the lower the score, the less prepared the caregiver feels.
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24 month
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Caregiving self efficacy
Time Frame: 24 month
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The investigators will use the Revised Scale for Caregiving Self Efficacy to measure the impact of AD screening on caregiver self-efficacy.
Respondents rate their degree of self-efficacy on a scale from 0 (absolutely incapable) to 100 (fully capable).
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24 month
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Nicole Fowler, PHD, Indiana University
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 1705649205
- 5R01AG056325-05 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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