Effectiveness of Circulo de Cuidado-a cognitive behavioral group intervention for Latino Alzheimer's families: A randomized controlled trial

By 2050, Alzheimer's disease (AD) rates among U.S. Latinos are projected to increase 6-fold, from 200,000 to 1.3 million. Yet, there is evidence that many Latino elders are not receiving services to reduce their risk or manage their dementia. We sought to address this gap through the development and testing of Circulo de Cuidado, a Spanish-language, culturally-sensitive approach which uses a cognitive behavioral framework to teach caregivers how to manage neuropsychiatric symptoms. Using a randomized controlled design, caregivers were assigned to 1 of 2 study arms: cognitive behavioral (CBT) experimental condition or psycho-educational (PE) control condition. The 2 conditions' structures were identical; 5-weekly, 90-minute group sessions followed by booster telephone calls at 3-, 6-, 9- and 12-weeks. However, the objectives and content differed; the CBT group taught the principles and skills of behavioral change through individualized exercises while the PE group provided information on topics such as disease stages and community resources. Participants were interviewed at baseline, post-intervention and 3-month follow-up on targeted outcomes. Repeated measures ANOVA was used; predictor variables were condition (experimental, control) and time (baseline, post-test, 3-month follow-up). We considered the condition x time interaction effects to be most important because we hypothesized significantly different changes over time in outcomes for participants in the two arms of the study. Results revealed statistically significant differences for condition by time interactions for AD relative's neuropsychiatric impairment (p<.05), caregiver neuropsychiatric symptom distress (p<.001), caregiver self-efficacy (p<.001), and depression (p<.01). No significant interactive effect was found, however, for caregiver anxiety (p>.05).