Background: Sleep disturbance is common and distressing for people with dementia, with no known safe, effective treatments. We previously developed and delivered DREAMS-START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives), a multimodal non-pharmacological intervention, and demonstrated feasibility and acceptability. This randomised controlled trial (RCT) aimed to establish whether DREAMS-START is clinically-effective in reducing sleep disturbances in people with dementia at home after 8 months compared to usual care.
Methods: We conducted a two-arm, multi-centre, parallel arms, superiority RCT with masked outcome assessment, recruiting dyads of people with dementia and sleep disturbance, and their family caregivers, in English community settings. Those meeting inclusion criteria were randomised (1:1) to DREAMS-START or usual treatment. DREAMS-START is a six-session, manualised intervention delivered by supervised, non-clinical graduates. Strategies were tailored and included routine, comfort, increasing light exposure, relaxation, and activity. Outcomes were collected at baseline, 4 months, and 8 months. The primary outcome was the Sleep Disorders Inventory (SDI) score at 8 months and analyses were intention to treat. Secondary outcomes for people with dementia included quality of life, daytime sleepiness, and neuropsychiatric symptoms and for family caregivers - quality of life, sleep disturbance, mood, and burden.
Results: Between February 2021 and March 2023, 377 participant dyads were randomised, 189 were allocated to usual treatment and 188 to intervention. Mean age of participants with dementia was 79.4 years (SD 9.0). 206 (54.6%) were women. Mean SDI score at 8 months was lower in the intervention arm versus usual treatment (15.16 [SD 12.77], n = 159, vs 20.34 [16.67], n = 163]; adjusted difference in means -4.70 (95% CI -7.65 to -1.74; p = 0.002). At 8 months carer sleep (difference in means 0.57 [95% CI 0.10 to 1.05]) and carer anxiety (difference in means -0.86 [95% CI -1.71 to -0.01]), were significantly lower in the intervention group than usual treatment.
Conclusion: To our knowledge, this is the first and largest fully powered RCT of a multicomponent non-pharmacological intervention that improves sleep in people living at home with dementia and their caregivers, with sustained effectiveness beyond delivery. DREAMS-START has potential to be delivered at scale in health services.
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http://dx.doi.org/10.1002/alz.094661 | DOI Listing |
BMC Geriatr
January 2025
International Observatory on End of Life Care, Lancaster University, Lancaster, UK.
Background: Namaste Care is an intervention designed to improve the quality of life for people with advanced dementia by providing individualised stimulation and personalised activities in a group setting. Current evidence indicates there may be benefits from this intervention, but there is a need to explore the practical realities of its implementation, including potential barriers, enablers, and how it is delivered within the context of nursing care homes.
Objective: To systematically assess the factors involved in implementing Namaste Care for people with advanced dementia in nursing care homes.
Aust Occup Ther J
February 2025
Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
Introduction: Driving safety may be compromised in people with dementia or mild cognitive impairment (MCI). Occupational therapists assess and screen for driving safety in older people with cognitive impairment. However, little is known about their perspectives relating to these assessments.
View Article and Find Full Text PDFJ Nutr Health Aging
January 2025
The Center of Gerontology and Geriatrics and National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, China. Electronic address:
Objectives: Motor cognitive risk (MCR) syndrome, defined as the cooccurrence of subjective cognitive complaints and a slow gait speed, is a form of pre-dementia condition. Balance has previously been associated with cognitive function. However, to date, no study has examined the relationship between balance and MCR in a large cohort of older adults.
View Article and Find Full Text PDFNoise Health
January 2025
Institute of Hygiene and Medical Ecology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Exposure to sound energy may be a risk factor or a therapeutic intervention for Alzheimer's disease (AD). On one hand, noise has a harmful effect on people with AD by contributing to hearing loss, sleep disturbance, oxidative stress, inflammation, and excitotoxicity. But on the other hand, clinical trials and nursing home interventions with soundscape augmentation involving natural sounds have shown promising results in alleviating psychophysiological symptoms in people with AD.
View Article and Find Full Text PDFNeurology
January 2025
Leonard Davis School of Gerontology, University of Southern California, Los Angeles.
Background And Objectives: Cerebrovascular reactivity (CVR) represents the ability of cerebral blood vessels to regulate blood flow in response to vasoactive stimuli and is related to cognition in cerebrovascular and neurodegenerative conditions. However, few studies have examined CVR in the medial temporal lobe, known to be affected early in Alzheimer disease and to influence memory function. We aimed to examine whether medial temporal CVR is associated with memory function in older adults with and without mild cognitive impairment (MCI).
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!