| BackgroundAlzheimer’s disease is the most common form of dementia.Apathy is one of the most common behavioural and psychological symptoms in AD patients.Apathy is associated with a number of adverse outcomes,including faster cognitive decline,faster functional decline,lower quality of life,and higher mortality rate.The Apathy Evaluation Scale(AES)developed by Marin is a classic and commonly used assessment scale.This study established the reliability and validity of the Apathy Evaluation Scale-Informant version(AES-I),and investigated the prevalence and influencing factors of apathy in the nursing home patients with AD.An intervention program of horticultural therapy(HT)was designed through the Delphi method,and the intervention effect of the program on apathy was verified.Objectives1.To determine the validity,reliability and optimal critical value of the Chinese version of the AES-I;2.To investigate the incidence of apathy among AD patients in nursing homes;3.To design a horticultural therapy intervention program for AD patients with apathy;4.To examine the effectiveness of the HT intervention program.Methods1 Questionnaire surveyStratified random sampling was used to select nursing homes and cluster sampling was used to select patients.In the first stage,127 valid data were used to analyze the reliability and validity of the Chinese version of the AES-I.In the second stage,290 valid data were used to analyze the apathy of AD patients in nursing homes in Guangzhou.2 Delphi methodTwo rounds of expert consultation were conducted with 15 specialists to develop a horticultural therapy intervention programme.3 Experimental methodA Matched-Pairs Design was used in this study.Thirty-two AD patients with apathy were recruited for a 10-week,weekly horticultural therapy intervention study.Results1 Validity and reliability of the AES-IThe Cronbach’s α was 0.977 and the split-half reliability was 0.967.Three common factors were extracted by the exploratory factor analysis.The optimal critical value for AES-I was 43 scores.2 Results of the inventory survey261 patients presented with apathy,the prevalence rate of apathy was 90%.Based on a logistic regression model,LAQ scores and MMSE scores were predictors of apathy(Nagelkerke R2=0.433,P<0.001).3 Results of the Delphi expert consultationThe positive coefficient of two rounds of expert consultation was 88.89%and 93.8%respectively.The Kendall’s W was 0.113 and 0.302(P<0.001).The authority coefficient is 0.807 and 0.795 respectively,so the expert reliability is strong in this study.A 10-session intervention program for horticultural therapy was developed through expert consultation.4 Results of the experimentThere were significant interaction effect and time effect in AES-I score and MMSE score(P<0.05).The AES-I score was sign ificantly lower in the experimental than in the control group after intervention(P=0.001).In the pairwise analysis,the AES-I score(P=0.013)was significantly lower after intervention than at baseline in the experimental group.The AES-I score(P=0.013)was significantly lower and the MMSE score(P=0.001)significantly higher at follow-up than after intervention in the experimental group.Conclusions1.Chinese version of AES-I is reliable and valid,and is suitable for measuring apathy among Alzheimer’s in nursing homes.The optimal critical value for AES-I was 43 scores.2.AD patients in nursing homes had a higher incidence of apathy.LAQ scores and MMSE scores were protective factors of apathy.3.A HT intervention program has been developed to address the apathy of AD patients.The program is scientific and operability.4.HT can help reduce apathy and improve cognitive function in AD patients. |
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