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ALZHEIMER'S ASSOCIATION
INTERNATIONAL CONFERENCE
AAIC 2026
London, UK & Online · July 12–15, 2026
Poster aaic2026.7b30e32
Who Benefits Most?
A responder analysis of the NOMAD home-based psychosocial intervention in North Macedonia
NOMAD STUDY · North Macedonia Interprofessional Dementia Care
Andrea Ivanovska¹·² Marija Taneska¹ Svetlana Iloski¹ Antoni Novotni¹·³ Julia Fischer⁴ Vildan Dogan⁴ Milos Milutinovic³ Ljubisha Novotni³ Shpresa Hasani¹ Timo Grimmer⁴ Alexander Kurz⁴ Vesna Dimitrova⁵ Mia Micevska¹ Ivan Chorbev⁵ Boban Joksimoski⁵ Gabriela Novotni¹·⁶
¹ Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia ² University of Ljubljana, Ljubljana, Slovenia ³ University Clinic of Psychiatry, Skopje, North Macedonia
⁴ Center for Cognitive Disorders, Technical University of Munich, Munich, Germany ⁵ Faculty of Computer Science & Engineering, Ss. Cyril and Methodius University, Skopje, North Macedonia ⁶ University Clinic of Neurology, Skopje, North Macedonia
KEY TAKEAWAY - NOMAD helps most where patient dependency and caregiver depression are highest — but high caregiver burden blocks improvement. Psychosocial support alone isn't enough; it must be backed by respite, support, and policy change.
PROTECTIVE · OR > 1
OR 1.29
Functional impairment (B-ADL)
95% CI 1.02–1.70 · p = 0.043
Each 1-pt rise in baseline dependency → 1.29× higher odds of clinical success.
PROTECTIVE · OR > 1
OR 1.45
Baseline depression (PHQ-9)
95% CI 1.19–1.89 · p = 0.001
Caregivers with more depressive symptoms at baseline had the most to gain.
BARRIER · OR < 1
OR 0.80
Caregiver burden (ZBI)
95% CI 0.68–0.91 · p = 0.003
Higher baseline burden significantly lowered the odds of success — a ceiling effect.
Introduction
LMICs bear 60% of the global dementia burden, projected to reach 71% by 2050, yet face a service gap exceeding 75%.
In North Macedonia, dementia care falls almost entirely on family. The system offers medication but no daycare or respite services.
NOMAD was the first RCT in the region to test a home-based, non-pharmacological intervention. This responder analysis asks who benefits — and whether systemic gaps block success.
Methods
Design. Responder analysis of the NOMAD cluster-RCT intervention group (N = 58).
Success. A reduction ≥ 0.5 SD of baseline on the Zarit Burden Interview (ZBI) or the PHQ-9, baseline → followup.
Analysis. Logistic regression on baseline predictors: functional impairment (B-ADL), neuropsychiatric symptoms (NPI), and caregiver demographics.
Results
Mean burden scores did not differ between groups — but the intervention showed targeted efficacy.
Functional impairment positively predicted burden reduction (OR 1.29), supporting dyads in advanced dependency.
A suppressor effect emerged: higher baseline depression predicted improvement (OR 1.45), while higher baseline burden reduced success (OR 0.80).
Relationship type (spouse vs. child) was not a significant predictor.
Conclusions
NOMAD helped caregivers with high depressive symptoms and those managing advanced dementia — but weak systemic support can pose a barrier to success.
High caregiver burden was a significant negative predictor of improvement: where burden is high, psychosocial support alone is not enough to improve wellbeing.
Known drivers of burden in LMICs — access to respite, education and support, and stigma — must be addressed, or caregivers stay too exhausted to fully benefit.
Policy change and stronger dementia-care infrastructure in North Macedonia are needed to maximise the impact of multicomponent interventions.
Baseline predictors of clinical success
No effect (OR = 1)
0.50 0.75 1.00 1.25 1.50 1.75 2.00
Odds Ratio for clinical success (95% CI)
← reduces odds increases odds →
Functional impairment
B-ADL
OR 1.29 [1.02–1.70]
Baseline depression
PHQ-9
OR 1.45 [1.19–1.89]
Caregiver burden
ZBI
OR 0.80 [0.68–0.91]
Contact & Study
Andrea Ivanovska, MSc
Institute for Alzheimer's Disease and Neuroscience (IAN) · Skopje, North Macedonia
andreaivanovska00@gmail.com
NOMAD: a cluster-RCT delivering 4 home visits by interprofessional mobile teams (psychoeducation + care planning) to dementia caregivers.
alzheimer's
association
International Conference® 2026
This work was supported by a Conference Fellowship from the Alzheimer's Association International Conference (AAIC) 2026.
Institute for Alzheimer's disease and Neuroscience (IAN)
IAN - Skopje