The largest pragmatic randomized trial of dementia care programs conducted in the United States found that two comprehensive care models, one delivered through health systems and one through community organizations, did not reduce caregiver burden or improve outcomes for people living with dementia compared with usual care. The finding comes from a prespecified analysis published online September 2, 2025, in JAMA Internal Medicine (print issue October 1, 2025; 185(10):1227-1236).
The Dementia Care Study, known as D-CARE, enrolled 2,176 dyads of people living with dementia and their family caregivers at four clinical trial sites and ran as an 18-month, three-arm, assessor-blinded trial from June 2019 through August 2023. One group received health system dementia care, coordinated by a nurse practitioner or physician assistant; a second received community-based dementia care, delivered by telephone by a social worker, nurse, or licensed therapist; a third received usual care, which included referral to the Alzheimer's Association helpline. The trial's original primary results, published in JAMA on January 29, 2025 (333(11):950-961), had already found no significant differences among the three groups in patients' behavioral symptoms or in caregiver strain, though caregiver self-efficacy, meaning confidence in managing dementia-related challenges, improved more in both intervention groups than in usual care.
The newer analysis extended that finding. Across all three groups, there were no differences in the cognition, functional status, or quality of life of people living with dementia, nor in caregivers' overall burden or in their sense of the positive aspects of caregiving. The one measure that consistently favored the two structured programs was caregiver satisfaction with the care itself: caregivers in the health-system group rated satisfaction 2.6 points higher than usual care on an 11-to-55-point scale (98.3% CI, 1.0-4.2), and those in the community-based group rated it 3.3 points higher (98.3% CI, 1.7-4.9); both differences appeared by three months and held through 18 months.
"Caregiving for individuals with dementia can be stressful and can have a negative impact on well-being," said Jeff Williamson, one of the study's investigators, in a statement accompanying the January 2025 results. The distinction the trial draws, between caregivers feeling more supported and satisfied on one hand, and the practical strain of caregiving being measurably lighter on the other, is one the study's authors say matters for how health systems, insurers, and policymakers judge these programs going forward.