Supportive care and cognitive rehabilitation at home in the management of early neurocognitive disorders in general practice ; Soins d’accompagnement et de réhabilitation cognitive à domicile dans la prise en charge des troubles neurocognitifs précoces en médecine générale

Background: the implementation of cognitive rehabilitation sessions (CRS) in the management of individuals with neurodegenerative diseases has increased following the 2008-2012 Alzheimer Plan in France. The care providers rely on primary caregivers to optimize management and ensure a better quality of life at home. Objective: to identify the barriers to the implementation of CRS at home from the perspective of the primary caregiver. Method: this is a multicentric, quantitative, descriptive, observational, cross-sectional study. We distributed questionnaires from May to November 2023 to the primary caregivers of patients being followed for mild to moderate cognitive disorders and who had received a prescription for CRS. Comparisons of variables were made using the Kruskal-Wallis test. Results: we collected 150 questionnaires. Our population had an average age of 81 years, predominantly female (55%), and mainly followed in memory clinics (61%) for Alzheimer's disease (58%). The primary caregiver was mainly a spouse (74%), with 40% being female. The patients mostly received home nursing care (SSIAD) (47%) and physiotherapy (34%), with 54% of the patients receiving the personalized autonomy allowance (APA). 69% of CRS prescriptions were made by a geriatrician, and 19% by a general practitioner. The time to prescription of CRS differed according to the place of follow-up (15 months day hospital vs. 26 months general practitioner vs. 20 months memory clinic (p = 0.03)). The average time between prescription and implementation of CRS was 3 months. Regarding the opinions of the primary caregivers: 98% of the primary caregivers considered them beneficial but insufficient in quantity (67%); 22% did not accept the presence of a team at home, and 21% found the home unsuitable for sessions. Discussion: The sessions should be started as early as possible in the management of cognitive disorders to prevent the progression of the pathology. Our study showed that patients managed in a day hospital had a quicker prescription of ...